Motivational interviewing (MI)
Motivational interviewing (MI) is an evidence-based counseling approach designed to help individuals navigate ambivalence toward change and enhance their motivation for self-improvement. Developed in the 1980s by William R. Miller and later expanded with coauthor Stephen Rollnick, MI was initially focused on aiding those with substance abuse issues. Research has shown MI to be effective not only in treating alcohol and drug problems, but also in promoting healthier lifestyle choices, such as improved eating habits and increased physical activity.
The approach emphasizes the importance of “change talk,” where therapists encourage clients to express their own motivations for change, thereby fostering a sense of autonomy and empowerment. This method contrasts with more directive therapeutic techniques, as it prioritizes the client's perspective and readiness to engage in the therapeutic process. While MI has demonstrated solid effectiveness in certain areas, its application in promoting cardiovascular exercise has shown mixed results, highlighting the necessity for practitioners to have proper training in MI principles. Overall, MI offers a nuanced framework for facilitating client-driven change across various health and psychological domains, making it a valuable tool for mental health professionals.
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Motivational interviewing (MI)
Motivational interviewing (MI) is an evidence-based counseling practice that helps clients and patients overcome ambivalence about change or even uncertainty about whether they want to truly engage in psychotherapy. It was originally developed to help those who struggle with substance abuse, and there is a strong body of research supporting its effectiveness in that realm. Researchers have also applied motivational interviewing to a variety of other domains—for example, promoting healthy eating habits or more frequent exercise, preparing clients to get more out of other therapies for alleviating depression and anxiety, and helping parents and teachers implement psychosocial and academic interventions to help children thrive at home and school.
Background
Motivational interviewing (MI) was developed by William R. Miller in the 1980s. In the early 1990s he and coauthor Stephen Rollnick wrote the first book on MI. In what appears to be the first peer-reviewed scientific article on MI in 1983, Miller explained that MI is a strategic blend of Carl Rogers’ nondirective approaches and therapy employing motivational principles derived from various social psychological models showing that motivation is malleable within the social context. Part of the impetus for developing MI was the fact that the developers were aware that many therapists and counselors were ineffective in treating alcohol abuse. For instance, therapists sometimes make controlling statements with clients (for example, “How could you possibly drink so much?”), and these types of statements in therapy predict more drinking over subsequent months. On the other hand, one good therapeutic interview that employs principles of MI, such as autonomy-supportive communication, warmth, and eliciting change talk from the client, can promote decreased alcohol abuse for months to come.
Although MI has accumulated the most research in the realm of treating alcohol and drug abuse, it has also been used with various other issues that can be improved through enhanced motivation. For instance, MI has been incorporated into efforts to increase healthy activities (like exercise and healthy eating habits). School psychological consultants have used MI to help teachers and parents activate their motivation to improve classroom and home environments.
As another example, cognitive-behavioral therapy (CBT) researchers have recognized that although CBT is generally effective for reducing depression and anxiety symptoms, quite a few clients are ambivalent about participating in therapy in the first place. CBT often involves rigorous examination of thought patterns and behaviors that contribute to negative feelings, as well as strategic development of healthier thoughts and behaviors. In other words, it is potentially highly rewarding, but requires a fair amount of motivation, thought, and effort on the part of the client. Researchers have found that MI sessions can improve clients’ readiness for CBT, thereby improving their emotional health outcomes more than if they have CBT sessions only.
Overview
One of the keys to MI is the therapist or counselor eliciting change talk from the client or patient. Change talk is the clients’ own words about what they want to do or will do to make their lives better. In their book, Motivational Interviewing: Helping People Change, Miller and Rollnick provide clear examples about how therapists can frame questions in ways that enhance the likelihood clients will engage in change-oriented talk. For instance, rather than saying to a problem drinker, “Why did you drink ten shots of tequila?” the therapist might say, “What would be a benefit of drinking in moderation?” or “What is a disadvantage of drinking so much?” This type of questioning helps the client marshal their own cognitive resources to understand the problem, while also preventing the unnecessary arousal of psychological defenses, such as denial and resisting therapy. Once the client can identify the benefits of healthier drinking habits and the disadvantages of baneful practices, they may then be more ready to articulate their own plans for improvement. In other words, the client may be ready to answer change oriented questions such as, “What could you do to start drinking less?” or “What could you do to promote your long-term wellbeing, next time you feel like drinking?”
Another key concept in MI is empowering clients to overcome ambivalence about positive change. For instance, a client who likes an addictive habit, but also realizes it is getting them into trouble, is likely to have mixed feelings about changing. If such a client is rushed into other therapeutic techniques for promoting change (for example, thought restructuring, goal setting, implementation intentions, or positive activity scheduling) before being ready, they may not adequately engage in the therapeutic process or may even quit coming to sessions. By understanding where the client is along a motivational continuum and helping the client gain related insight, the therapist can then tailor sessions accordingly, such that the client is optimally challenged.
MI to increase cardiovascular exercise and thereby prevent diseases is an exciting area of development. However, early research did not show the same level of effectiveness or consistency that was discovered with alcohol and drug problems. While some studies indicate that MI leads to significantly more physical activity, others have failed to find this effect. There is some evidence that part of the problem may be that MI has been diffused so quickly and widely that some practitioners think that they are applying MI without catching the essence of it. For instance, one qualitative study in Wales published in 2012 found that some fitness instructors who were taught MI over the course of a couple of days were misunderstanding MI or had a cursory view of it. It is important for professionals to be highly trained in MI before they conduct it. The issue of whether anyone other than highly trained mental health professionals can apply MI with authentic fidelity needs to be thoroughly investigated.
Bibliography
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