Motivational Interviewing In 1947 the President of the American Psychological Association, Carl Rogers, was one of the first to study patient centered therapy. Throughout decades of evidence base research Roger identified a paradigm shift in client outcomes through Motivational Interviewing (MI). (Miller & Moyers, 2017) Scientific research has shown that MI in clinical practice actually created positive change versus the traditional psychological approaches. The National Institute for Health Care Excellence found that traditional evidence based psychological approaches like providing professional advice on lifestyle choices were ineffective. (Day, Gould, & Hazelby, 2017, p. 60) MI is a relatively new form of evaluating a client’s outcome based on “accurate empathy”. Accurate empathy in clinical study can be measured, something that can be improved by training, and it can predict the client’s outcome. (Miller & Moyers, 2017, para. 1) Roger’s used therapeutic communication like ‘dialectical behavioral’ therapy and ‘emotion-focused’ therapy emphasizing accurate empathy. (Miller & Moyers, 2017) Motivational Interviewing was not created through a preexisting theory but from experience in a clinical practice. After the paradigm shift to patient centered therapy there was an essence of guiding the conversation so that it would be the client rather than the counselor voicing the reasons to change. This gentle approach for counseling promotes the autonomy and personal choice and a
MI therapists prize the client when they are with the client. As in Person-Centered therapy, the client is regarded as the expert of his life. Within the client lies the will to change if it can be adequately identified and then encouraged to come out. Once encouraged and heard, the will to change can then be involved in planning a change. Carl Rogers developed a therapy method that trusted the client. His person-centered approach began with the client receiving and benefiting from a special status conferred upon him by the therapist. This theoretical approach pivots around the idea that clients have the ability to
Motivational interviewing is a way of conducting and occupy the essential motivation within the client in order to change behavior. It is “an efficient and collaborative style of clinical interaction that can boost the effectiveness of the therapeutic alliance” (Jellinek, Henderson, Dilallo, & Weiss, 2009, p.108). Motivational
Rogers worked with many others in developing the idea that clients could heal themselves, if only the therapist provided ‘facilitative’ or core conditions of, ‘empathy, congruence and unconditional positive regard.’
The spirit of motivational interviewing (MI), which entails collaboration, evocation and autonomy, is the fundamental approach to elicit intrinsic motivations (1, 2). Throughout the video, the therapist appears to have applied the MI spirit in accordance with Miller and Rollnick (2). The therapist firstly created an encouraging atmosphere for change by monitoring and accommodating the client’s aspirations (collaboration). The therapist then evoked the client’s motivation through their perceptions, goals and values (evocation) and also informed about the right for self-direction leading to commitment to change (Autonomy). However, to sustain the MI spirit, a breakdown of the requirements will be discussed below.
Person-centred therapy came about through Roger’s theory on human personality. He argued that human experiences were valuable whether they were positive or negative so long as they maintained their self actualising tendency. Through one’s experiences and interactions with others Roger believed that a self-concept/regard was developed. Carl Rogers believed that a truly therapeutic relationship between client and counsellor depends on the existence, of three core conditions. The core conditions are important because they represent the key concepts and principles of person-centred therapy. These core conditions are referred to as congruence, unconditional positive regard and empathy. Congruence is when the therapist has the ability to be real and honest with the client. This also means that the therapist has to be aware of their own feelings by owning up to them and not hiding behind a professional role. For example, a therapist may say ‘I understand where you are coming from’’ to the client. However the therapist has expressed a confused facial expression while saying this. The clients can be become aware of this and may feel uncomfortable in expressing their feelings, which might impact their trust and openness towards the therapist. Therefore the major role of the therapist is to acknowledge their body language and what they say and if confusion happens the therapist needs to be able to
Afterwards, the essential concepts and methods were later particularized by Miller and Stephen Rollnick, Ph.D., in 1991. This involved a more comprehensive description of the clinical procedures of motivational interviewing. Motivational Interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence (Miller & Rollnick, 1991). Motivational Interviewing is goal directed and more focused when compared with nondirective therapies. The central purpose is to examine and resolve ambivalence, with an intentionally directive therapist to carry out this goal (Miller & Rollnick, 1991).
The main focus of this essay has to be on the three ‘core conditions’, as utilised by the counsellor to promote a positive movement in their client’s psychology. They are intended for maintaining a focus on the client’s personal growth, and detract from the therapist’s own outside world. The three core conditions are the professional apparatus or tool-kit of the therapist, and the use of each is a skill in itself but the combined forces of all three in an effective manner requires an abundance of skill or experience. These are, as have already been mentioned, congruence, unconditional positive regard and empathy. They are separate skills but are intrinsically linked to each other. If used correctly, they can guide the client to a state of self-realisation, which could lead to the development of a healing process.
This closely simulated a patient interaction with candid answers and the presence of other family members. It was most challenging to calculate the responsive statement to use while maintaining the direction of the interview. Motivational interviewing techniques employed in this interaction include the use of open ended questions to encourage change talk from the patient, affirmation of the patient’s honesty and accountability, reflective statements to show active listening and to illicit further change talk from the patient, and the use of summarization to communicate the patient’s identified growth (Miller & Rollnick, 2013). Transcending these techniques was the spirit of motivational interviewing that communicated acceptance to the patient, guiding versus directing communication, and the support of self-efficacy (Miller & Rollnick, 2013). This was done by first asking permission to discuss the topic and was then carried through the
The process of motivational interviewing is essentially about creating "intrinsic motivation to change" within the client (Moyers, 1998). The choice to change must originate with the client and the process for helping this occur begins with motivational interviewing. There are two phases within motivational interviewing, the first focuses on increasing the client’s motivation to change and the second phase is negotiating a plan and consolidating commitment. It is important to understand the traps that can be encountered within this process, such as the question/answer trap. In this trap the client is led by the counselor with little chance to have free speech to explain themselves because the counselor is just focused on the next question instead of focusing on where the client is leading them. This trap is very similar to the expert trap in the fact that the client is left to believe they cannot find answers for themselves; they instead must listen to the expert who is giving them the answers. This is most definitely not the way to motivate a client to make changes for themselves. Other traps include premature focus, denial, labeling, and blaming; all of which can prevent the client from opening up in the treatment process.
Motivational interviewing recognizes and accepts the fact that clients who need to make changes in their lives approach counseling at different levels of readiness to change their behavior. During counseling, some patient may have thought about it but not taken steps to change it while some especially those voluntarily seeking counseling, may be actively trying to change their behavior and may have been doing so unsuccessfully for years. In order
Changing is something that someone has to want to do, if there is no motivation things will stay the same. The first step to change is knowing and accepting the wrong that has been done and trying to figure out a way to change. There are numerous of practices that are used to help an offender bring their mistake to the light. These types of methods are called Evidence Based Practices and are used to help both the offender and probation officer learn to communicate on a different level. Evidence based practices are cognitive behavioral training, vocational education and training programs and treatment oriented intensive supervision program. They are used to reintegrate offender s back into the community successfully. The type of evidence based practice that I am going to talk about is motivational interviewing, the pro and cons and if it helps the offenders learn from their mistakes and if it is going to help in the future.
Motivational interviewing is a counseling approach that was studied and understood as an applicable theory of practice that would be beneficial in the environment where I currently work which is an alcohol treatment facility. Whereas, it is understood that clinical and applied aspects of Motivational Interviewing (MI) have shown effective as a relatively brief intervention (Levensky, Cavasos, & Brooks, 2008), especially those dealing with an alcohol dependency. According to Miller and Roderick, MI, has been defined mostly as a directive, client centered counseling approach for eliciting behavior change by helping clients to explore and resolve ambivalence. In addition, with its goal-orientated approach it can help break down resistance to change (Corey, 2013, pp. 191-194). This theoretical approach is the most favored for the environment in my profession of choice, in addition, integrating it with the practice of Cognitive Behavioral Therapy (CBT) which is already in use.
Therapeutic relationship is defined as the collaboration and attachment between the client and therapist that focuses on meeting the health care needs of the client (Bordin, 1979). In this relationship, the therapist without prejudice shows Empathy, insight, understanding and acceptance of the client. Duan and Hill (1996) defined Empathy as “feeling into” the experience of the client. Over the years, the research evidence keeps piling up, and indicating a high degree of Empathy in a Therapeutic relationship is possibly one of the most potent factors in bringing about positive outcome in the therapy
After reviewing the article written by Lisa Moore, I began to reflect upon how I would incorporate empathy in my interactions with a client during the assessment phase of therapy. Empathy in a nutshell is attempting to match your feelings or current state of mind with that of another individual. In our field, empathy is of the utmost importance. It allows the speech-language pathologist (SLP) to meet clients where they are, to enter their world, and truly understand what it feels like to be them. SLP’s must not only view the client from an external frame of reference, but they must attempt to extract the client’s thoughts, feelings, ideas, beliefs, and values before and whilst administering an assessment protocol. There are several ways in
The three counseling approaches that I saw these past few days were inspiring and educational. Some seemed to be useful in some ways and destructive in others. As a person interested in counseling, I have to assess these pros and cons and decide which approach I am most comfortable with. In each video, Gloria brought up different topics that affected her life. In the first approach, Carl Rogers’, the two talked about her guilt about her family.