Motivational Interviewing

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).

Motivational interviewing is a practice wherein conveying acceptance of your client, you become an aid in the process of change. Motivational interviewing fosters Carl Rogers ' optimistic and humanistic theories; around ones competences for employing free choice and shifting through a course of self-actualization. The therapeutic relationship for both Motivational Interviewers and Rogerians’ is a democratic partnership. The concept of Motivational Interviewing (MI) progressed from the experience of treating problem drinkers. Motivational Interviewing was first described by William R. Miller, Ph.D., in 1983.

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.

(Rollinick et al. 2010). This technique isn’t considered to be a form of psychotherapy but rather a formalized therapeutic relationship that engages the assessment and intervention steps of the nursing process (Moller & Potter 2016b). Motivational interviewing is focused on activating the client’s capability to make a beneficial change regarding one’s health (Easton, Swan & Sinha 2000).

Combined Motivational Interviewing and Cognitive-Behavioral Therapy with Older Adult Drug and Alcohol Abusers is an article written by Lyle Cooper concerning the abuse or misuse of illicit drugs, prescription medications, and alcohol in older populations. Due to lack of knowledge or resources, elderly individuals are falling victim to substance use problems and the numbers are projected to rise. Therefore, an assistance program called HeLP was created to provide evidence-based treatment to the specific cohort of 50 and up age range. Motivational interviewing is used to eliminate internal uncertainties clients may have concerning their treatment; hence, opening themselves up to behavioral changes. Clients who decide to move on to the next stage and if HeLP workers deem it necessary, cognitive-behavioral therapy is implemented to promote changes in thoughts, behaviors, and prevention of future relapse.

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.

The third and final stage of recovery is known as late recovery, and involves a client finding growth and meaning in life. In this stage, relapse may be less frequent as a sense of purpose is found. As this stage is found only by enduring great challenges, a client may not be as tempted by relapse and the act of back tracking in their recovery may seem tiresome and unworthy of their time. However, though a deep awareness of the consequences of substance abuse is profound, relapse is still possible if an addict forgets that he or she has a disease that is incurable and succumbs to the enticement of “just this one time can’t hurt” or has the thought that “I have been clean for so long. I am cured.” Bill W. stated in his book Alcoholics Anonymous that “This is the baffling feature of alcoholism as we know it-this utter inability to leave it alone, no matter how great the necessity or the wish” (pg. 34). Complete abstinence is the only choice for those with the disease of addiction, and so many recovering addicts forget this simple realization in the late recovery stage.

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

Addiction is a “chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” The initial decision to take drugs is voluntary for most individuals, but frequent drug use can lead to brain alterations that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain alterations can be persistent, which is why drug addiction is considered a "relapsing" disease. People in recovery from drug use disorders are at increased threat for returning to drug use even after years of not taking the drug. It's common for an individual to relapse, but relapse doesn't mean that treatment doesn’t work. As with other chronic health conditions, treatment should be constant and should be adjusted based on how the patient answers. Treatment plans need to be reviewed often and modified to fit the patient’s changing desires.