What Is Motivational Interviewing?
Motivational interviewing (MI) is a form of client-centered therapy that uses a non-confrontational approach to enhance a client’s motivation for behavior change. Motivational Interviewing encourages the client to play a direct role in his or her recovery by using a spirit of collaboration, evocation, and autonomy.
“Essentially, motivational interviewing activates the capability for beneficial change that everyone possesses,” (National Library of Medicine).
- Collaboration – Therapist creates an atmosphere that’s conducive to change, rather than being forceful, and built on a partnership. Collaboration helps the patient become the expert.
- Evocation – Therapist evokes the patient’s resources and motivation to change from within. Evocation helps the patient realize that they have what it takes to stop using drugs.
- Autonomy – Patient has the right and capacity for self-direction — the therapist respects and affirms this. Autonomy helps the patient realize that they don’t have to change unless they want to.
Motivational interviewing was developed by Miller and Rollnick in 1983 as a method to help problem drinkers quit drinking. MI is now an established form of evidence-based treatment for substance use disorder. Motivational interviewing has been used to help people overcome many forms of addiction.
A substance use disorder (SUD) is a primary and progressive illness in which an individual’s use of alcohol and/or other drugs causes significant clinical, and functional distress or impairment.
Motivational interviewing incorporates one to three individual sessions, although more than one is suggested for the best results. Motivational interviewing is goal-directed, and therapists use specific strategies, skills, and approaches based on the patient’s individual needs, or attitudes during sessions. Each MI session can last anywhere from 30 to 50 minutes.
Ambivalence And Motivational Interviewing
Motivational interviewing is designed to help clients overcome any ambivalence about their substance abuse. Ambivalence is the state of having contradictory, or mixed feelings about a problem. An individual may want to stop using drugs, but at the same they don’t want to stop, even if they’re somewhat aware of the problems drug use cause in their life.
Motivational interviewing is based on the following assumptions:
- Ambivalence about substance use, and change is normal and constitutes an important motivational obstacle in recovery.
- Ambivalence can be resolved by working with a client’s inherent motivations and values.
- The alliance between therapist and client is a collaborative partnership to which each brings an important expertise.
- An empathic, supportive, yet directive, counseling style provides conditions under which change can occur. Direct argument and aggressive confrontation may tend to increase client defensiveness and reduce the likelihood of behavioral change.
Even those who want to stop using drugs may be unable to do so without help. Oftentimes friends and family members try to force a person to quit using drugs by using ultimatums, warnings, and threats. Trying to force a person to quit using drugs often contributes to resentment, and defensive attitudes.
Instead of telling a client that they must stop using drugs, a motivational counselor helps clients see the problem for themselves, and then helps them to list and work towards obtainable goals. Motivational interviewing helps an individual play a direct role in their recovery.
Five Principles Of Motivational Interviewing
Motivational interviewing uses persuasion, rather than bullying, and support, rather than argument. A motivational interviewer works with a sense of purpose, and strategy to help clients see what drugs are doing to them. Motivational interviewers encourage a person that they have within them what it takes to stop using drugs.
The five principles of motivational interviewing are:
- Express empathy through reflective listening.
- Develop discrepancy between clients’ goals or values and their current behavior.
- Avoid argument and direct confrontation.
- Adjust to client resistance rather than opposing it directly.
- Support self-efficacy and optimism.
The principles of motivational interviewing help build rapport between a therapist and their client. A motivational interview is a collaborative conversation that’s meant to strengthen a person’s motivation, and commitment to recovery. The principles of motivational interviewing also help to keep counseling sessions, and recovery moving forward.
Motivational Interviewing Stages Of Change
Motivational interviewing helps to elicit change. It’s natural for a person to become defensive, or try to protect their drug of choice in the early stages of recovery. Many people suffering from addiction believe that their drug use isn’t that bad. Motivational interviewing helps an individual work through these negative feelings, and emotions.
Researchers have identified several common stages of change throughout the process of motivational interviewing. A motivational interviewer, and client work through stages of change, which include:
- Precontemplation – Patient has no intention to change behavior, either because they’re unaware or under-aware of the problems drugs are causing them.
- Contemplation – Patient becomes aware of problems, and begins to seriously consider making a change. Yet in the contemplation stage, no commitment has been made to take action.
- Preparation – Patient wants to change, and begins making small behavioral changes.
- Action – Patient realizes, in full, the severity of their drug problem, and decides to take action to change.
- Maintenance – Patient works towards preventing relapse, and consolidating change. For many patients, the maintenance stage includes taking an active role in their recovery by seeking further treatment, or support.
Motivational Interviewing And Cognitive Behavioral Therapy
Motivational interviewing is a form of brief intervention, and though it works towards eliciting change, it may be followed-up with other treatment methods. It’s common for motivational interviewing to be paired with cognitive behavioral therapy (CBT), which helps clients change the way they think, and behave.
Motivational interviewing sessions prepare an individual for recovery, but because addiction is a chronic disease, treatment needs to be ongoing. CBT is used as an individualized, and evidence-based treatment approach that helps patients identify self-defeating thoughts, and behaviors that may be the driving force behind their addiction.
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Benefits Of Motivational Interviewing
Motivational interviewing can help patients realize that they have what it takes to replace unhealthy behaviors and live a full life in recovery. When using motivational interviewing in brief encounters of 15 minutes, 64 percent of the studies showed some positive effect. Two of the most common obstacles of motivational interviewing are ambivalence, and fear of change.
What often begins as a way to cope with mental illness, boredom, grief, loneliness, or other reasons can quickly escalate into obsessive and compulsive drug use. Research shows that motivational interviewing helps people feel engaged in their treatment, while moving away from ambivalence, and towards positive change.
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