top-rated free essay

Describe and Evaluate the Roles and Principles of One of the Treatment Interventions or Approaches: Motivational Interviewing

By beautiful105 Nov 01, 2010 1600 Words
Describe and evaluate the roles and principles of one of the treatment interventions or approaches: Motivational Interviewing.

The treatment approach, motivational interviewing, was first described by Miller (1983) in a paper he had not intended to publish but did so while in Norway supervising young psychologists. He found that the principles and concepts were interesting to clinicians and so decided to research them further, (Miller, 1996). Motivational interviewing developed as a result of observation of various alternative methods to therapist treatment, for example behavioural self-control training (Miller, 1978). He also began to discover that those therapists who showed more empathy showed greater behaviour change in their clients (Miller and Baca, 1983). This then led Miller to coin the term motivational interviewing, which Rollnick and Miller (1995) described as being “a directive, client-centered counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence” (Rollnick and Miller, 1995, p.325). Since writing extensively about motivational interviewing in 1991, Miller and Rollnick (1991, 2002) note that they have placed less emphasis on the techniques and more on the spirit of motivational interviewing. They believe this is necessary because, in their opinion, some people use techniques that are called motivational interviewing that do not compare to their understanding of what motivational interviewing actually is. Miller and Rollnick (2002) argue that motivational interviewing is about being with people and that it’s “underlying spirit lies in understanding and experiencing the human nature that gives rise to that way of being” (Miller and Rollnick, 2002, p. 34). Miller and Rollnick (2002) note three main components in the spirit of motivational interviewing: collaboration, evocation and autonomy. They describe collaboration as being where the counsellor does not make it feel as though he is in charge. Communication is equal between the counsellor and their client and the intervention is one of discovery and support rather than one of contention. Evocation is where the interviewer attempts to draw from ideas from the client and encourage them to produce their own goals and targets. Finally Miller and Rollnick (2002) describe autonomy as the role of motivational interviewing. That is that the client is free to attend or not, they take responsibility for change themselves, the aim is to increase motivation so that goals and values are manifested from within the client and so that change will therefore serve a purpose to the client. As well as describing the spirit of motivational interviewing, Miller and Rollnick (2002) also describe four general principles, used in practice: express empathy, develop discrepancy, roll with resistance and support self-efficacy. The First, express empathy, involves what is known as reflective listening and allows the counsellor to understand their client’s feelings and experiences without laying judgement or blame. Miller and Rollnick (2002) point out that the counsellor does not have to agree with the client but needs to accept their views and are free to voice their differing opinions, while avoiding an authoritarian approach. They argue that an important aspect is to be respectful of the client in order to promote behaviour change by improving their self-esteem. The counsellor needs to understand that it is likely that the client will be reluctant to change and they may even be faced with ‘problematic behaviour’ (Miller and Rollnick, 2002, p.37). The second principle, develop discrepancy, involves the counsellor finding a way to present the truth of the situation to the client. Miller and Rollnick (2002) point out that motivational interviewing does not aim to solely listen to the client so that they end up accepting who they are at the time, for example a drug addict, and not move on. They argue that a difference needs to be made between their current behaviour and their goals and values and that this can be done by helping them to weigh up the costs of the present behaviour and the benefits of change. Miller and Rollnick (2002) believe that discrepancy is to do with the importance of change and that an important aspect of this is the amount of behaviour change needed, a term they call ‘behavioural gap’. The two, however, should not be confused. A large behavioural gap, for one client, can decrease motivation, whereas another client may have a small behavioural gap, however, it is equally important that both gaps are jumped. Miller and Rollnick (2002) argue that change needs to come from within the client and that the counsellor should not pressurize them into change, as they become less motivated. In the end it is the client who needs to present the reasons to change. Miller and Rollnick’s (2002) third principle is roll with resistance. They argue that the worst situation would be for the counsellor to be pushing for a change while the client is resisting it. The client is unlikely to be persuaded, when in this situation, and they could even end up going in the opposite direction. Miller and Rollnick (2002) describe work by Haley (1963), for strategies of family therapy, who suggests, like in martial arts, that its better to go with the “attacker’s momentum”, (Miller and Rollnick, 2002, p. 39), as you can try and use it to your advantage. They, however, believe that this can be taken too far, although do take note of the suggestion of going with the client’s momentum, in terms of their resistance. They argue that the counsellor should not directly oppose resistance but it should be noted as being natural and understandable. The counsellor should offer new viewpoints and use the approach “Take what you want and leave the rest.” (Miller and Rollnick, 2002, p. 40). They are encouraged to turn problems and questions back to the client so they can think about it for themselves and generate their own answers and solutions. The fourth and final principle is support self-efficacy. Miller and Rollnick (2002) note that self-efficacy is the client’s belief that they have the ability to change. They also believe that it can predict the outcome of treatment and they claim that “hope and faith are important elements of change” (Miller and Rollnick, 2002, p. 41). The counsellor’s expectations that a client will change are important and can have an effect on outcome by acting as a self-fulfilling prophecy. An important goal is to increase the client’s confidence. Evidence from studies involving motivational interviewing has provided support for the technique. A study by Stotts, Schmitz, Rhoades and Grabowski (2001) tested cocaine-dependent patients on a detoxification program before entering a relapse prevention treatment study. Participant’s either received motivational interviewing and the detoxification program or detoxification only. There was no difference between the two groups in their initial abstinence and the rate at which the detoxification program was completed. The differences emerged at the start of the relapse prevention treatment when those patients who had received motivational interviewing were more likely to be abstinent from cocaine and were less likely to use cocaine during the treatment. Saunders, Wilkinson and Phillips (1995) also reported positive outcomes with a one-hour session of motivational interviewing enhancing abstinence and commitment to treatment and time before heroin was taken again. Another study involving short motivational interviewing sessions was that of Aubrey (1998). It was found that a session of between 30 and 60 minutes almost tripled attendance of outpatients and increased the number of days abstinent. Daley, Salloum, Zuckoff, Kirisci and Thase (1998) found that with more sessions of motivational interviewing attendance increased, as did the number of days abstinent. They found that it enlightened mood and that less days had been spent in hospital at the one-year follow-up. Not all studies, however, have had success with motivational interviewing. Donovan, Rosengren, Downey, Cox and Sloane (2001) found that motivational interviewing did not affect treatment entry, adherence or the outcome. Both Booth, Kwiatkowski, Iguchi, Pinto and John (1998) and Schneider, Casey and Kohn (2000) also found that motivational interviewing had no affect on entry to treatment programs. Another study that failed to produce a significant result was that by Miller, Yahne and Tonigan (2003). In this study they tested both in and outpatients at treatment agencies for drug problems. The patients were assigned to receive or not receive motivational interviewing. They found that motivational interviewing did not influence treatment outcome or treatment attendance. They do argue, however, that it is unlikely that motivational interviewing has no effect whatsoever as so many previous studies have found that it has an effect. They suggest that it may be that motivational interviewing only helps or shows a significant effect for those people who are not very motivated. Miller and Rollnick (2002) have described the role of motivational interviewing to improve a client’s motivation to change. This is to be done by improving self-efficacy and by listening to the client’s experiences. Increase in motivation to change needs to come from within and the client needs to manifest their own values and goals. The counsellor must not be authoritarian and an important goal is to improve the client’s confidence. Evidence suggests that motivational interviewing is a useful technique to use before a patient enters into a more substantial treatment program, but there is no evidence that it can be used in isolation or with those who are already motivated. Miller and Rollnick (2002) also suggest themselves that more research needs to be made and that motivational interviewing is not suitable for everybody, for example some need to be told what to do in order for them to do it.

Cite This Document

Related Documents

  • Motivational Interviewing

    ...Internet Assignment By Tesa Bunch Motivational Interviewing: Applications to Christian Therapy and Church Ministry In my research I found a great article titled “MI: applications to Christian therapy and church ministry” the article contains a great amount of good information about MI. The author John E. Martin explains how MI is import...

    Read More
  • Motivational Interviewing

    ... Motivational Interviewing Katey Andersen Bethany Degner Jessica Fulton Natalia Pitts Chelsy Stadler Motivational Interviewing 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 Psychiat...

    Read More
  • Motivational Interviewing

    ...dual diagnosis and motivational interviewing. Professional Counselor 12(1): 41-6. Reprinted with permission from Health Communications, publisher of Counselor (formerly Professional Counselor), www.counselormagazine.com. All rights reserved. "Removing Barriers: Dual Diagnosis Treatment and Motivational Interviewing" In the past, traditional ...

    Read More
  • Motivational Interviewing

    ...Introduction The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy. These fundamental concepts and approaches were later elaborated by Miller and Rollnick (1991) in a more detailed description of clin...

    Read More
  • Motivational Interviewing

    ...Motivational interviewing – Reflection Motivational interviewing (MI) is psychological intervention that was originally developed through helping people with alcohol problem (Miller, 1983). MI is strongly ingrained in client-centred therapy of C. Rogers (1951) in its emphasis on understanding client’s internal frame of reference and present...

    Read More
  • Motivational Interviewing

    ...Effectiveness of Motivational Interviewing as a Treatment for People with Co-Occurring Disorders HUS 436 Counseling for Co-Occurring Assignment: Research Paper The topic of this research paper is the effectiveness of Motivational Interviewing (MI) with people dealing with co-occurring disorders. To begin, I would like to introduce th...

    Read More
  • motivational interviewing

    ... Module Title: Promoting Health Module Coordinator: Mary Murphy Word Count: 1750 Actual Word Count: 1894 Introduction Motivational interviewing may be defined as “a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen perso...

    Read More
  • Describe and Evaluate Two Approaches to the Treatment of Self-Defeating Behaviour.

    ...Describe and evaluate two approaches to the treatment of self-defeating behaviour. “Pain is inevitable… Suffering is optional.” Buddhist Scripture Introduction Self-defeating behaviour (maladaptive behaviour) is the idea that people knowingly respond to stimuli that will cause them to fail or bring them trouble. It is defined as “a...

    Read More

Discover the Best Free Essays on StudyMode

Conquer writer's block once and for all.

High Quality Essays

Our library contains thousands of carefully selected free research papers and essays.

Popular Topics

No matter the topic you're researching, chances are we have it covered.