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 concerns, and in discrepancies between behaviours and values. However MI differs in having specific goal to reduce ambivalence about change and to increase intrinsic motivation to change. The most current definition of MI states that:
“MI is a collaborative, person-centred form of guiding to elicit and strengthened motivation for change” (Miller & Rolnick, 2009, p.137)
MI is goal-oriented method of communication with particular attention to the language of change. It is intended to strengthen personal motivation for and commitment to a target behaviour change by eliciting and exploring an individual’s own arguments for change (Miller & Rolnick, 2009). Earlier literature describes MI as two phase’s process. During first phase, intrinsic motivation for change is enhanced whereas in phase two, commitment to change is strengthened (Miller & Rollnick, 2002). More recent trend tends to divide MI into four overlapping processes; i.e. engaging, guiding; evoking and planning.
Collaboration, evocation, and autonomy, is central to MI (also known as the MI ‘spirit’). To achieve this, MI uses specific principles i.e. express empathy, developing discrepancy, rolling with resistance and support self efficacy. Different methods are suggested to accomplish these principles (e.g. building good therapeutic relationship, engagement, OARS, active listening, summarising, DARN, PAPA). MI is refined form of guiding communication style, also sometimes called as listening with a purpose. Asking, listening and informing in right way are core communication skills needed for successful MI. The concept of MI argues that no person is completely unmotivated and every client is ambivalent to certain extent about their behavioural change. Clients are sensitive to the way they are spoken to and this will likely affect the outcome. Client – therapist relationship is therefore very important and the therapist engagement with the client is vital for positive outcome of the MI sessions. Motivation is vital element of change and is driven by confidence and importance and is expressed by change talk or resistance.
MI has now been used and tested with broad range of health behaviours e.g. drug misuse, gambling, eating disorders, anxiety disorders, chronic disease management, and health related behaviours (Arkowitz, Westra & Miller 2008). MI is often combined with other treatments, such as CBT (Westra & Dozois, 2006); in form of motivational enhancement therapy (MET; Miller, Zweben, DiClemente & Rychtarik 1992); and brief motivational interviewing (BMI, Fernandes, et. al., 2010). There are some similarities between and Transtheoretical model of change (e.g. readiness of change; Prochaska & Norcross, 2004), although they were developed independently. A systematic review that included 72 studies found that MI outperformed traditional advice giving in 80% of studies (Rubak, Sandbaek, Lauritzen & Christensen, 2005). Another systematic review shows that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care (Soderlund, Madson, Rubak & Nilsen, 2011). Another review included 37 articles found MI effective in promoting health behaviours, i.e. diet, exercise, diabetes, and oral health (Martins & McNeil, 2009). MI can be also delivered in different ways, the most frequent is face-to face, but also telephone MI was used. These finding show strong evidence for MI and its future importance.
This part will focus on my personal account of reflection on motivational interviewing. Reflective practice is important tool of...
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