Welcome to Motivational Interviewing

MOTIVATIONAL INTERVIEWING

Christopher Campbell and Deborah Webb

Definition

"Our best current definition is this: Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with nondirective counselling, it is more focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal."

The Spirit of Motivational Interviewing

"We believe it is vital to distinguish between the spirit of motivational interviewing and techniques that we have recommended to manifest that spirit. Clinicians and trainers who become too focused on matters of technique can lose sight of the spirit and style that are central to the approach. There are as many variations in techniques as there are clinical encounters. The spirit of the method, however, is more enduring and can be characterized in a few key points."

1. "Motivation to change is elicited from the client, and not imposed from without." Extrinsic forms of motivation such as confrontation and persuasion may have their place but the spirit of MI "relies upon identifying and mobilizing the client's intrinsic values and goals to stimulate behaviour change."
   
2. "It is the client's task, not the counsellor's, to articulate and resolve his or her ambivalence." Ambivalence is the conflict the client feels when he or she is presented with two courses of action which have perceived costs and benefits for each. "The counsellor's task is to facilitate expression of both sides of the ambivalence impasse, and guide the client toward an acceptable resolution that triggers change."
   
3. "Direct persuasion is not an effective method for resolving ambivalence." Persuasion about the urgency to change tends to increase client resistance and diminish the probability of change. (Miller, Benefield and Tonigan, 1993, Miller and Rollnick, 1991)
   
4. "The counselling style is generally a quiet and eliciting one." Confrontational styles of counseling and giving advice can push the client into a pattern of change for which he is not ready. Counselors used to this style may conceptualize MI as a slow, passive process. The proof of effectiveness is in the outcomes.
   
5. "The counsellor is directive in helping the client to examine and resolve ambivalence." Behavioral skills are usually not taught to the client. Once the client's ambivalence has been resolved, that is enough of a trigger for change and no further intervention is needed. Behavioral techniques are not incompatible with MI. "The specific strategies of motivational interviewing are designed to elicit, clarify, and resolve ambivalence in a client-centred and respectful counselling atmosphere."
   
6. "Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction." The therapist is very attentive to the client's motivational signs. Resistance and denial are signs that the counselor needs to change the interactional style of relating. The counselor is more ready for change than is the client.
   
7. "The therapeutic relationship is more like a partnership or companionship than expert/recipient roles. The therapist respects the client's autonomy and freedom of choice (and consequences) regarding his or her own behavior." MI is not so much a set of techniques used on people, but an interactional style of relating which can be used in or out of a counseling setting. It is client-centered, directive and respectful of people and is "shaped by a guiding philosophy and understanding of what triggers change". (Miller, 1994)
   

(Rollnick S., & Miller, W.R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334)

Its Beginnings

Motivational Interviewing did not begin in a formal setting per se. "Motivational interviewing began in a barber shop in Norway. Actually, the haircutter for the Hjellestad Clinic outside Bergen had vacated the room to make space for a visiting professor from the United States, and I found myself in a lovely corner office looking out into the dense forest above a fjord." (Addictive Behaviors, Vol. 21, No. 6, pp. 835-842, "Motivational Interviewing; Research, Practice and Puzzles.") One of the tasks Dr. William R. Miller was assigned was to supervise a group of bright, young psychologists who had been newly trained and hired to treat alcohol and other drug problems at the Hjellestadklinikken. He used role play enactment of therapeutic methods. As he demonstrated therapeutic methods the students asked him very challenging questions which encouraged him to formalize his methodology. The result was a concept paper entitled, "Motivational Interviewing with Problem Drinkers". An edited version became published in Behavioural Psychotherapy (Miller, 1983) Dr. Miller expected that would be all since he had no empirical data to back his theory. Dr. Miller was forced to study the processes and outcomes he had inadvertently begun.

"Professor Stephen Rollnick grew up in Cape Town, South Africa and completed a Masters training in research methods in Strathclyde
University in Glasgow (1978) and a professional training in clinical psychology in Cardiff (1983). Since then he has lived and worked in this city, as a clinical psychologist in the National Health Service and more recently, as member of the Department of General Practice. His early experience as a trainee nurse in a hospital addiction treatment setting led to an interest in constructive methods for helping people resolve difficult behaviour change problems. This has taken him through a close collaboration with Professor William R Miller on the subject of Motivational interviewing, a Doctoral thesis (1993) on counselling for excessive drinkers, to more recent work on consultations about lifestyle and medication use in healthcare practice." (Wikipedia)

Application to the Vocational Rehabilitation process

The Motivational Interviewing approach can be readily adapted for use in the Vocational Rehabilitation process. It is a person-centered, respectful, non-confrontational but directive style which can combine with other therapeutic techniques to assist people who may be entrenched in behaviors and fearful of change, especially when taking risks to become employed. The VR Counselor can use empathy to engage the client, use discrepancy to bring ambivalence to the surface, roll with resistance and use the open-ended questions, affirmations, reflective listening and summarization to help the client move toward the positive goal of changes necessary to become employed

Theoretical Foundations

Motivational Interviewing has its theoretical roots in the Person-Centered Theory of Carl Rogers. "Motivational interviewing builds on Carl Rogers' optimistic and humanistic theories about people's capabilities for exercising free choice and changing through a process of self-actualization"(cite www.addictioninfo.org/.../Motivational-Interviewing-as.../Page1.html on Jan 8, 2009).

My colleagues, Sophie and Janice found this information. The underlying philosophy is that humans intrinsically know what is best for them and, when given the right atmosphere, they will change.