Motivational Interviewing Controversy

Psychologists William Miller, PhD. and Stephen Rollnick, PhD. developed the counseling approach known as Motivational Interviewing (MI). Motivational Interviewing evolved out of experience in the treatment of persons who were problem drinkers, and was first described by Miller in 1983. In 1991 Miller and Rollnick provided these techniques as a method that promotes and engages intrinsic motivation within the client in order to change behavior. MI is a client-centered counseling style that is goal -directed and brings about behavior change by helping clients to explore and resolve ambivalence. Traditional Rogerian client-centered therapy does not guide or direct or focus in the way that MI therapists do to influence individuals to consider making changes, instead of non-directively explore themselves.

The idea of motivational interviewing builds on Rogers' theories about people having freedom of choice and changing through the process of self-actualisation (Davidson, 1994). Miller and Rollnik (1991) describe it as a technique in which the heath practitioner becomes a helper in the change process while expressing acceptance of their client. A central goal of motivational interviewing, says Geldard & Geldard (2012), is to help resolve the ambivalence which prevents clients from realising their personal goals and to facilitate positive change. Motivational interviewing is mostly utilised to counsel those troubled by addiction (not just substance, but also behaviours).

Solution-Focused Interviewing, The Transtheoretical Model, and Motivational Interviewing are three approaches used by practitioners to assist and guide people in changing their behavior. Each approach has its own format and process and this paper will compare and contrast some similarities and differences between these three approaches. This will be done by looking at five client scenarios and comparing and contrasting them with the approaches. The five client scenarios are; the client who wants something and sees themselves as part of the solution, the client who says someone else needs to change, the client who seems uninterested or resistant to changing, the client who wants what is not good for them and finally the client who does not seem to want anything.

The discussion of the video below is in accordance with the Motivational Interviewing Reflection Tool (MIRT).

Solution-focused therapy is different from narrative and collaborative therapy because it focuses more on discovering solutions to problems by asking miracle and scaling questions (Goldenberg & Goldenberg, 2013). Solution-focused therapists utilize miracle and scaling questions to help clients change their thoughts and behavior. Miracle questions challenge clients to think about what their lives could be like if all their problems suddenly went away and were solved (Henderson & Thompson, 2016). Scaling questions challenge the client to magnify their view of the current circumstance (Goldenberg & Goldenberg, 2013). Solution-focused therapy is also different from narrative and collaborative therapy because the counselor leads the counseling session. Counselors lay out clear expectations for their clients to change, and expect them to actively participate in counseling so change occurs. The third difference between the three approaches is that solution-focused therapy is complaint-based, while narrative and collaborative therapy is not (Goldenberg & Goldenberg, 2013). Clients come to counseling with a complaint, and counselors typically work with those who ready and willing to change. Another difference is that solution-focused therapy consists of five steps, which are “co-constructing a problem and goal, identifying and amplifying exceptions, assigning tasks, evaluating effectiveness, and reevaluating problems and goals” (Goldenberg & Goldenberg, 2013, p. 382). Collaborative and narrative therapy do not follow these five

McCabe C. (2004) Nurse-patient communication: an exploration of patients’ experiences. Journal of Clinical Nursing. 13, 41-49.

An interview utilizing motivational interviewing techniques was conducted by a nurse practitioner student and a consenting patient. The patient is a 55-year-old, male, with occupation as a heating, ventilation, and air conditioner technician that the nurse practitioner student identified on physical examination to have mild hearing loss. Hearing protection is admittedly not worn consistently at the jobsite during the history taking portion of the exam. This paper will discuss the behavioral health problem of noncompliance with hearing protection, the evidence supporting motivational interviewing strategies to support behavior change, and a discussion of the techniques used during the interview.

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

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.

There are 4 aspects of motivational interviewing (MI) spirts that practitioners need to consider when working with clients, these aspects include partnership, acceptance, compassion, and evocation. Partnership has to do with the practitioner functioning as the partner for the client and working with the client’s own knowledge to help them. Acceptance has to do with communicating absolute worth, accurate empathy, affirmation, and autonomy support. Compassion is the aspect of sincerely caring about the suffering of your clients and promoting the welfare of clients, giving priority to their needs. Lastly, evocation involves drawing out the client’s personal motivation for changing (Clifford, Curtis, 2015) Out of all 4 aspects of MI spirts, the

‘Clients often are able to provide a theory or an idea of cause, blaming past experiences for behaviors of which they are ashamed. The therapist listens to their explanations however are concerned more with their willingness to accept responsibility for their future behavior and the achievement for their attainable goals’ (Milner & O Byrne, P162). Furthermore, by ‘Acknowledging the clients paradoxical strategies have the effect of empowering clients of their perfectly valid cautious, more fearful concerns about change and leaving them to operate out of their arguments as to why change should be attempted’ (Cade, B. p156).

Licensed professional counselors have a unique occupation in that not only do they interact with their clients on a highly personal level, but they also momentarily share their client’s burdens, worries, and concerns. This vicarious aspect of counseling creates the possibility for a counselor to continue sharing the client’s troubles long after the session has ended. According to Norcross and Guy (2007), “The person of the psychotherapist is inextricably intertwined with treatment success” (p. 2) meaning that if we desire more positive outcomes than negative ones we must figuratively become one with our clients. Due to this fact, “self-care is not simply a personal matter but also an ethical necessity, a moral imperative” (p. 6). If we fail to leave work at work at the day’s end, then other facets of our lives are in jeopardy of becoming tainted.

Motivational Interviewing (MI) refers to a client centred counselling approach, which is directed to enhance motivation in an individual for behaviour change Miller & Rollnick (as cited in Christopher & Dougher, 2009). MI as a method understands and accepts that the clients are at different levels of readiness to change their behavior. It consistently focuses on goals to prepare the client for transformation by providing motivation for commitment to change (Bricker & Tollison, 2011) in the domains of substance abuse, addiction and risky health problems. It proceeds to make the client aware of the causes, consequences and risks that could be a result of the behavior. Through this, the client foresees the possibilities of enhancement and becomes motivated to achieve it (Jenson, Cushing, Aylward, Craig, Sorell & Steel, 2011). MI is coherent with the

Another important skill I have learnt is reflective responding. It is a back and forth process between a client and counsellor; which simply aids to clarify meanings, summarise and to help the client to delve deeper into the issue (Egan, 2010). I illustrated this virtuosity during a conversation with Nathan were I respond with “Correct me if I am wrong but are you saying that there is no point to life if you do not have someone”? Responding reflectively allowed him to clarify my understanding of his original statement; and also confide in more depth about his worries. Equally important, Egan has confirmed (2010) that “effective helping is a mixture of support and challenge”, and one with out the other can seem harsh and counterproductive (p. 211). In saying this I felt there was a need to challenge; to test the reality of one