Motivational Interviewing

Motivational Interviewing Katey Andersen Bethany Degner Jessica Fulton Natalia Pitts Chelsy Stadler Motivational interviewing is a counseling approach developed by Professor William R. Miller, Ph. D and Professor Stephen Rollnick, Ph. D Miller is a professor of Psychology and Psychiatry at the University of New Mexico and received his Ph. D in clinical psychology from the University of Oregon in 1976.Stephan Rollnick completed his Masters in research in Strathclyde University in Glasgow and his professional clinical psychology training in Cardiff, Wales. Motivational interviewing was first thought of y Miller in 1983 in his article Behavioural Psychotherapy and was elaborated on in 1991 with Rollnick. It is a goal-orientated approach (Hall, Gibbie, &Lubman, 2012). There are some specific strategies that have been used to work with individuals. SAMHSA believes that by employing these, MI is a successful method for clients with co-occurring disorders.Motivational interviewing includes: assessing the client's view of the issue and seeing if they understand their condition, finding out if the client wishes to pursue a treatment plan and, if so, having them attend sessions, and astly, helping the client see that there are possibilities for them to change (SAMHSA). MI also assists clients in exploring their motivations for changing. It is important to remember that this approach isn't about counselors telling clients what to do, but clients realizing their potential for change (Hall et al. 2012). Motivational interviewing is helpful for clients that are going through different stages of treatment, but it is thought that it is the most helpful in early treatment. This might be because clients have difficulties realizing the depth of their problems (SAMHSA). Motivational interviewing is a good method to connect with clients because it is a joint and collaborative decision process. The choice for change is up to the client (Hall et al. , 2012).The counselor often uses t echniques to engage the client such as open-ended questions, affirmation, and retlective statements S important to note that only the individual can commit to a change even if goal plans are made between the client and counselor (SAMHSA). When practicing motivational interviewing, the counselor helps the client realize discrepancies in their behavior ersus their goals but otherwise lets the counselor do a lot of the listening to gain information from the client (SAMHSA).They are directive with the client so, together; they can examine goals and resolve ambivalence, therefore; motivational interviewing is solution based (Sobell, 2008). Counselors use multiple techniques to help clients reach their goals for change. The first is eliciting/evoking change talk, which is usually associated with stressful outcomes (Sobell, 2008). It can be used to address discrepancies that the counselor notices. Different questions the counselor can ask include: â€Å"What would you like to ee different about your current situation† or â€Å"What will happen if you don't change† (Sobell, 2008).Counselors could also invite the client to look forward in time to see how their life would be if they do or do not change (Sobell, 2008). Other tactics that are used are reflective listening (SAMSHA) and normalizing (Sobell, 2008). Reflective listening is a tactic of responding to the client in the form of a hypothesis as well as building rapport between the client and the counselor (Sobell, 2008). A specific example is, â€Å"It seems to me that you want to start eating better ecause you have concerns about your health but it is hard to eliminate Junk food from your house. Clients will either agree or disagree with the hypothesis given back to them (Sobell, 2008). Normalizing is letting the client know that they are not alone in their situation and that others find change difficult (Sobell, 2008). Lastly, our research found the Columbo Approach to be intriguing. It is also a means of showing the client discrepancies and sometimes can sound a bit unsympathetic (Sobell, 2008). It got its name from the 1970's TV series Columbo and when counselors evoke discrepancies, it is usually done without bringing about a efensive behavior from the client.The client is also more likely to elaborate on their story (Sobell, 2008). An example would be, â€Å"So, help me to understand, on the one hand you say you want to live to see your 12-year old daughter grow up and go to college, and yet you won't take your medicine your doctor prescribed for your diabetes. How will that help you live to see your daughter grow up,† (Sobell, 2008). Researching motivational interviewing was a good experience for our group. We liked how it was a client-based process because the client has to want to change;Katey especially liked that Motivational Interviewing holds the client accountable. If the client is not following through with their goals and the planning (and counselors hav e tried to suggest those discrepancies), motivational interviewing is not right for the client. We also liked that this form of counseling is adaptable for different types of problems that a client could be experiencing such as substance abuse, health coaching, dual diagnosis, or gambling problems. There doesn't seem to be limits to the help a client can receive with this process if they are willing.These different ypes of problems and addictions are difficult to change if the client doesn't own up to them; which is critical with Motivational Interviewing. One thing that was more of a challenge for us (it could be seen as a good thing or a bad thing) was a lot of our sources had the same information. This means that it was good information and solid work, but it also made it harder to tind tresner sources until we knew about the Riverland search engines. Once we knew how to log into that, there were an abundance of opportunities for more sources that were otherwise unknown about bef ore. Motivational Interviewing Motivational Interviewing Katey Andersen Bethany Degner Jessica Fulton Natalia Pitts Chelsy Stadler Motivational interviewing is a counseling approach developed by Professor William R. Miller, Ph. D and Professor Stephen Rollnick, Ph. D Miller is a professor of Psychology and Psychiatry at the University of New Mexico and received his Ph. D in clinical psychology from the University of Oregon in 1976.Stephan Rollnick completed his Masters in research in Strathclyde University in Glasgow and his professional clinical psychology training in Cardiff, Wales. Motivational interviewing was first thought of y Miller in 1983 in his article Behavioural Psychotherapy and was elaborated on in 1991 with Rollnick. It is a goal-orientated approach (Hall, Gibbie, &Lubman, 2012). There are some specific strategies that have been used to work with individuals. SAMHSA believes that by employing these, MI is a successful method for clients with co-occurring disorders.Motivational interviewing includes: assessing the client's view of the issue and seeing if they understand their condition, finding out if the client wishes to pursue a treatment plan and, if so, having them attend sessions, and astly, helping the client see that there are possibilities for them to change (SAMHSA). MI also assists clients in exploring their motivations for changing. It is important to remember that this approach isn't about counselors telling clients what to do, but clients realizing their potential for change (Hall et al. 2012). Motivational interviewing is helpful for clients that are going through different stages of treatment, but it is thought that it is the most helpful in early treatment. This might be because clients have difficulties realizing the depth of their problems (SAMHSA). Motivational interviewing is a good method to connect with clients because it is a joint and collaborative decision process. The choice for change is up to the client (Hall et al. , 2012).The counselor often uses t echniques to engage the client such as open-ended questions, affirmation, and retlective statements S important to note that only the individual can commit to a change even if goal plans are made between the client and counselor (SAMHSA). When practicing motivational interviewing, the counselor helps the client realize discrepancies in their behavior ersus their goals but otherwise lets the counselor do a lot of the listening to gain information from the client (SAMHSA).They are directive with the client so, together; they can examine goals and resolve ambivalence, therefore; motivational interviewing is solution based (Sobell, 2008). Counselors use multiple techniques to help clients reach their goals for change. The first is eliciting/evoking change talk, which is usually associated with stressful outcomes (Sobell, 2008). It can be used to address discrepancies that the counselor notices. Different questions the counselor can ask include: â€Å"What would you like to ee different about your current situation† or â€Å"What will happen if you don't change† (Sobell, 2008).Counselors could also invite the client to look forward in time to see how their life would be if they do or do not change (Sobell, 2008). Other tactics that are used are reflective listening (SAMSHA) and normalizing (Sobell, 2008). Reflective listening is a tactic of responding to the client in the form of a hypothesis as well as building rapport between the client and the counselor (Sobell, 2008). A specific example is, â€Å"It seems to me that you want to start eating better ecause you have concerns about your health but it is hard to eliminate Junk food from your house. Clients will either agree or disagree with the hypothesis given back to them (Sobell, 2008). Normalizing is letting the client know that they are not alone in their situation and that others find change difficult (Sobell, 2008). Lastly, our research found the Columbo Approach to be intriguing. It is also a means of showing the client discrepancies and sometimes can sound a bit unsympathetic (Sobell, 2008). It got its name from the 1970's TV series Columbo and when counselors evoke discrepancies, it is usually done without bringing about a efensive behavior from the client.The client is also more likely to elaborate on their story (Sobell, 2008). An example would be, â€Å"So, help me to understand, on the one hand you say you want to live to see your 12-year old daughter grow up and go to college, and yet you won't take your medicine your doctor prescribed for your diabetes. How will that help you live to see your daughter grow up,† (Sobell, 2008). Researching motivational interviewing was a good experience for our group. We liked how it was a client-based process because the client has to want to change;Katey especially liked that Motivational Interviewing holds the client accountable. If the client is not following through with their goals and the planning (and counselors hav e tried to suggest those discrepancies), motivational interviewing is not right for the client. We also liked that this form of counseling is adaptable for different types of problems that a client could be experiencing such as substance abuse, health coaching, dual diagnosis, or gambling problems. There doesn't seem to be limits to the help a client can receive with this process if they are willing.These different ypes of problems and addictions are difficult to change if the client doesn't own up to them; which is critical with Motivational Interviewing. One thing that was more of a challenge for us (it could be seen as a good thing or a bad thing) was a lot of our sources had the same information. This means that it was good information and solid work, but it also made it harder to tind tresner sources until we knew about the Riverland search engines. Once we knew how to log into that, there were an abundance of opportunities for more sources that were otherwise unknown about bef ore. Motivational Interviewing It is one of the most carefully defined and rigorous treatment for substance abuse (Miller, 1991). It was developed my William Miller, Stephen Rollnick, and other colleagues over the past 2 decades. It uses a concise psychotherapeutic intervention for helping people change an addictive behavior such as a substance abuse. It is intended to assist and enhance a person’s intrinsic motivation to change addictive behavior in a highly empathetically supportive but strategically directed conversation about the person’s use of substance and related life events.Variety of techniques are used that will increase intrinsic motivation for change. Some useful techniques used are micro skills (open – ended questioning, affirmations, reflections, and Summary or OARS) and strategies (creating discrepancies between a person’s current behavior and his or her goals, his values, the way he perceived himself, establishing and exploring ambivalence and handling resistance skillf ully.(Miller, 1990)Initially, Miller and his colleagues developed Motivational Interviewing to treat people who have alcohol substance abuse; they used principles of motivational psychology and clinical research. If clients have options for alternative approaches they are seem to have an improved treatment and a better outcome. This kind of therapy helped people become realistic, have a set of clear goals which are achievable and possible that will help him or her change for the better.What is motivation? It is the probability that a person will be ready to change, namely, enter into, continue, and adhere to a specific change strategy. Each one of us can be motivated, and those who are lifeless are only considered unmotivated. But, not only motivation will work alone on this kind of therapy, confrontation is also needed, it is a part of all psychotherapies. The question is not solely based if people should be confronted or not, but how to confront effectively and efficiently that ev entually will lead to a successful therapy.Change could not be achieved right away. It takes a lot of time, hard work, and perseverance both for the therapist and the client. Change is hard, but it is essential. Uncertainty or ambivalence is accompanied by change. Every client undergoes this kind of stage where he feels uncertain. This is just a normal part or process of change. Successfully addressing ambivalence is considered to be a crucial skill for a Motivational Interviewing. (Miller, 1990)There are four basic assumptions of Motivational Interviewing according to Miller (1990), they are as follows:Optimistic and humanistic perspectiveMotivation is considered to be a condition, not a traitApproaching change where ambivalence is constant, it is a normal, acceptable, and understandable aspect.Motivation is an interpersonal phenomenonPrimarily, clients do not seek therapy because they are motivated. It is the sole responsibility of the therapist to initiate change, and help his or her client to be motivated. It shouldn’t come within from the client, rather it is a process imposed by therapy and slowly accepting by the client.According to Miller (1990) there are 4 key principles of Motivational Interviewing, such as: Empathy should be expressed, develop discrepancy, roll with resistance, and support self – efficacy. This should be applied into 2 phases, while building motivation for change to the client and be able to strengthen his commitment to change. Aside from this, there are 3 critical components of motivation: readiness, willingness and ability.The client should be ready for change. It is a step by step process, slowly the person begins to adapt new things to his system that leads to changes, and he is ready for change. Thus, readiness is relatively linked to priorities; you prioritize things which are important for you to change. Willingness, one should be willing to commit himself to change, not influenced by any factor rather he is ope n freely to change. The ability of motivation is of great importance both for the client and the therapist. It should be coming mostly from the therapist, to initiate change and be motivated.Rational Emotive Behavior TherapyIt was developed by Dr. Albert Ellis; it is a cognitive-behavioral approach to treatment. Therapy was done by identifying some ideas that are problematic and erroneous that is linked with emotional and behavioral problems that are correlated with irrational thoughts, assumptions and beliefs, thus irrational thoughts are then replaced with more rational, reality-based perspectives. In a therapy session, therapist teaches his clients to stay away from negative thoughts, feelings and behaviors for a more positive outlook in life. In this way, the client can achieve self acceptance and life satisfaction because he was able to gain and maintain realistic perception in life. (Dryden, 1990)Certain beliefs or thoughts that are considered to be irrational are confronted a nd other options or alternative are made that make more sense especially when it is examined logically and factually. Rather than focusing on historical or abstract theories, the focal point of the therapy is on the present and at the same time using scientific thinking. People who come for REBT are taught and encouraged to accept personal responsibility for their own thoughts, feelings and behavior, and empowered to change beliefs and reactions that are maladaptive, distorted, interfere with their goals and functioning, and thwart their enjoyment of life. With practice, the new ideas become part of the person, integrated into their way of being. (Dryden, 1990)It is a system of psychotherapy that was designed to help people live longer, decrease their emotional disturbances and self defeating behaviors, and actualize themselves so that they live a more fulfilling, productive, and happier lives ( Ellis & Bernard, 1985)ABC Model of REBTIrrational beliefs are defined as rigid, inconsis tent, illogical and detrimental to the persons’ pursuit of basic goals and purposes. The ultimate goal of REBT is to replace these irrational thoughts with rational thoughts, because it will help the client to live longer and happier through therapeutic process. Development includes (1) setting up for themselves certain happiness – producing values, purposes, goals, or ideals (2) using efficient, flexible, scientific, logico – empirical easy to achieve such values and goals to avoid contradictory or self – defeating results (Ellis & Bernard, 1985)ABC Model ApproachThe initial component of the ABC Model is the â€Å"A† or activating event. A’s are considered to be events that we attend to and that trigger our beliefs or thoughts. However, this doesn’t cause any emotional reactions. It is our beliefs that cause our emotional reponse.activating events could be external or internal to the person, whether the person is directly or indirect ly exposed to such event. Events can also refer to the past, present or future events ( Dryden, 1999)B stands for Beliefs in the ABC Model. Beliefs are fully and explicitly evaluative and are at the core of a person’s emotions and significant behaviors (Dryden, 1999). People take the activating events in their lives and formulate beliefs that could essentially affect their reactions or consequences. These beliefs can be rational or irrational and are usually based on their preferences. Preferences refer to the basic needs, wants, wishes, and desires of the person. When beliefs become unrealistic, illogical and impossible it can considered dysfunctional.C variable refers to the consequences of our beliefs in the context of a particular situation. When the individual preferences are not met, the person experience healthy negative emotions (Dryden, 1999). Examples of this are remorse, sadness, and sorrow. These negative emotions are regarded as to be healthy because they force p eople to change. People doesn’t like the way they feel because of these negative emotions, and in turn they seek for changes in their belief system.There are also unhealthy negative emotions; anxiety, depression, guilt and hurt. These feelings can become severe that they damage normal functioning. Thus, a therapeutic intervention is needed. REBT was designed to help those individuals change the experienced unhealthy negative emotions as a result of the beliefs they hold.Both therapies are beneficial for the people who are on a substance abuse. One significant difference is that motivational interviewing takes more time and is more in depth because of the actual process the person undergoes. The client should be ready for change, and the therapist gradually imposing change to the person. On the other hand, REBT is more concise and focus; it is directly targeted on the individual’s main problem.References:Dryden, W. (Ed.). (1990). The Essential Albert Ellis: Seminal Writ ing on Psychotherapy. New York: Springer Publishing Company, Inc.Dryden, W. (1999) Rational Emotive Behavior Therapy: A Training Manual. New York: Springer Publishing Company, IncEllis, A., & Bernard, M.E. (Eds.). (1985) Clinical Applications of Rational – Emotive Therapy. New York: Plenum Press.Miller, W.R., & Rollnick, S. (1991, 2002) Motiovational Interviewing: Preparing People for Change ( New York, Guilford Press)Miller, W.R. (1999). Enhancing Motivation for Change in Substance Abuse Treatment TIP Series 35. Rockville, MD: U.S. DHSS Publication No. (SMA)02-3693. Motivational Interviewing It is one of the most carefully defined and rigorous treatment for substance abuse (Miller, 1991). It was developed my William Miller, Stephen Rollnick, and other colleagues over the past 2 decades. It uses a concise psychotherapeutic intervention for helping people change an addictive behavior such as a substance abuse. It is intended to assist and enhance a person’s intrinsic motivation to change addictive behavior in a highly empathetically supportive but strategically directed conversation about the person’s use of substance and related life events.Variety of techniques are used that will increase intrinsic motivation for change. Some useful techniques used are micro skills (open – ended questioning, affirmations, reflections, and Summary or OARS) and strategies (creating discrepancies between a person’s current behavior and his or her goals, his values, the way he perceived himself, establishing and exploring ambivalence and handling resistance skillf ully.(Miller, 1990)Initially, Miller and his colleagues developed Motivational Interviewing to treat people who have alcohol substance abuse; they used principles of motivational psychology and clinical research. If clients have options for alternative approaches they are seem to have an improved treatment and a better outcome. This kind of therapy helped people become realistic, have a set of clear goals which are achievable and possible that will help him or her change for the better.What is motivation? It is the probability that a person will be ready to change, namely, enter into, continue, and adhere to a specific change strategy. Each one of us can be motivated, and those who are lifeless are only considered unmotivated. But, not only motivation will work alone on this kind of therapy, confrontation is also needed, it is a part of all psychotherapies. The question is not solely based if people should be confronted or not, but how to confront effectively and efficiently that ev entually will lead to a successful therapy.Change could not be achieved right away. It takes a lot of time, hard work, and perseverance both for the therapist and the client. Change is hard, but it is essential. Uncertainty or ambivalence is accompanied by change. Every client undergoes this kind of stage where he feels uncertain. This is just a normal part or process of change. Successfully addressing ambivalence is considered to be a crucial skill for a Motivational Interviewing. (Miller, 1990)There are four basic assumptions of Motivational Interviewing according to Miller (1990), they are as follows:Optimistic and humanistic perspectiveMotivation is considered to be a condition, not a traitApproaching change where ambivalence is constant, it is a normal, acceptable, and understandable aspect.Motivation is an interpersonal phenomenonPrimarily, clients do not seek therapy because they are motivated. It is the sole responsibility of the therapist to initiate change, and help his or her client to be motivated. It shouldn’t come within from the client, rather it is a process imposed by therapy and slowly accepting by the client.According to Miller (1990) there are 4 key principles of Motivational Interviewing, such as: Empathy should be expressed, develop discrepancy, roll with resistance, and support self – efficacy. This should be applied into 2 phases, while building motivation for change to the client and be able to strengthen his commitment to change. Aside from this, there are 3 critical components of motivation: readiness, willingness and ability.The client should be ready for change. It is a step by step process, slowly the person begins to adapt new things to his system that leads to changes, and he is ready for change. Thus, readiness is relatively linked to priorities; you prioritize things which are important for you to change. Willingness, one should be willing to commit himself to change, not influenced by any factor rather he is ope n freely to change. The ability of motivation is of great importance both for the client and the therapist. It should be coming mostly from the therapist, to initiate change and be motivated.Rational Emotive Behavior TherapyIt was developed by Dr. Albert Ellis; it is a cognitive-behavioral approach to treatment. Therapy was done by identifying some ideas that are problematic and erroneous that is linked with emotional and behavioral problems that are correlated with irrational thoughts, assumptions and beliefs, thus irrational thoughts are then replaced with more rational, reality-based perspectives. In a therapy session, therapist teaches his clients to stay away from negative thoughts, feelings and behaviors for a more positive outlook in life. In this way, the client can achieve self acceptance and life satisfaction because he was able to gain and maintain realistic perception in life. (Dryden, 1990)Certain beliefs or thoughts that are considered to be irrational are confronted a nd other options or alternative are made that make more sense especially when it is examined logically and factually. Rather than focusing on historical or abstract theories, the focal point of the therapy is on the present and at the same time using scientific thinking. People who come for REBT are taught and encouraged to accept personal responsibility for their own thoughts, feelings and behavior, and empowered to change beliefs and reactions that are maladaptive, distorted, interfere with their goals and functioning, and thwart their enjoyment of life. With practice, the new ideas become part of the person, integrated into their way of being. (Dryden, 1990)It is a system of psychotherapy that was designed to help people live longer, decrease their emotional disturbances and self defeating behaviors, and actualize themselves so that they live a more fulfilling, productive, and happier lives ( Ellis & Bernard, 1985)ABC Model of REBTIrrational beliefs are defined as rigid, inconsis tent, illogical and detrimental to the persons’ pursuit of basic goals and purposes. The ultimate goal of REBT is to replace these irrational thoughts with rational thoughts, because it will help the client to live longer and happier through therapeutic process. Development includes (1) setting up for themselves certain happiness – producing values, purposes, goals, or ideals (2) using efficient, flexible, scientific, logico – empirical easy to achieve such values and goals to avoid contradictory or self – defeating results (Ellis & Bernard, 1985)ABC Model ApproachThe initial component of the ABC Model is the â€Å"A† or activating event. A’s are considered to be events that we attend to and that trigger our beliefs or thoughts. However, this doesn’t cause any emotional reactions. It is our beliefs that cause our emotional reponse.activating events could be external or internal to the person, whether the person is directly or indirect ly exposed to such event. Events can also refer to the past, present or future events ( Dryden, 1999)B stands for Beliefs in the ABC Model. Beliefs are fully and explicitly evaluative and are at the core of a person’s emotions and significant behaviors (Dryden, 1999). People take the activating events in their lives and formulate beliefs that could essentially affect their reactions or consequences. These beliefs can be rational or irrational and are usually based on their preferences. Preferences refer to the basic needs, wants, wishes, and desires of the person. When beliefs become unrealistic, illogical and impossible it can considered dysfunctional.C variable refers to the consequences of our beliefs in the context of a particular situation. When the individual preferences are not met, the person experience healthy negative emotions (Dryden, 1999). Examples of this are remorse, sadness, and sorrow. These negative emotions are regarded as to be healthy because they force p eople to change. People doesn’t like the way they feel because of these negative emotions, and in turn they seek for changes in their belief system.There are also unhealthy negative emotions; anxiety, depression, guilt and hurt. These feelings can become severe that they damage normal functioning. Thus, a therapeutic intervention is needed. REBT was designed to help those individuals change the experienced unhealthy negative emotions as a result of the beliefs they hold.Both therapies are beneficial for the people who are on a substance abuse. One significant difference is that motivational interviewing takes more time and is more in depth because of the actual process the person undergoes. The client should be ready for change, and the therapist gradually imposing change to the person. On the other hand, REBT is more concise and focus; it is directly targeted on the individual’s main problem.References:Dryden, W. (Ed.). (1990). The Essential Albert Ellis: Seminal Writ ing on Psychotherapy. New York: Springer Publishing Company, Inc.Dryden, W. (1999) Rational Emotive Behavior Therapy: A Training Manual. New York: Springer Publishing Company, IncEllis, A., & Bernard, M.E. (Eds.). (1985) Clinical Applications of Rational – Emotive Therapy. New York: Plenum Press.Miller, W.R., & Rollnick, S. (1991, 2002) Motiovational Interviewing: Preparing People for Change ( New York, Guilford Press)Miller, W.R. (1999). Enhancing Motivation for Change in Substance Abuse Treatment TIP Series 35. Rockville, MD: U.S. DHSS Publication No. (SMA)02-3693.