Motivational Interviewing (MI) Overview

Introduction to Motivational Interviewing (MI)

• Definition: A humanistic, client-centered, psychosocial, directive counseling approach.
• Developers: William R. Miller and Stephen Rollnick in the early 1980s.
• Applications: Effective as a brief intervention for a variety of clinical problems, including:
  • Problem drinking
  • Substance abuse
  • Compulsive gambling
  • Eating disorders
  • Anxiety disorders
  • Depression
  • Suicidality
  • Chronic disease management
  • Health behavior change practices.

MI Philosophy and Spirit

• Humanistic Principles: Expands on person-centered therapy, yet is more structured and directive.
• Core Beliefs:
  • Clients are allies, not opponents.
  • Clients have capacity for self-responsibility and positive change.
  • Change is facilitated through empathy and reflective listening.
• Therapist Attitudes and Skills:
  • Use of open-ended questions.
  • Reflective listening.
  • Avoid confrontational stances.
  • Reframing resistance as healthy.
  • Guiding discussions on ambivalence and change.

Basic Principles of Motivational Interviewing (Miller & Rollnick, 2002)

1. Empathy and Understanding:
   • Experience the world from the client's perspective.
   • Reflective listening to create a safe environment for exploration of ambivalence.
2. Explore Discrepancies and Ambivalence:
   • Highlight discrepancies between clients' behaviors and values.
   • Elicit arguments for change versus maintaining the status quo.
3. Acceptance of Ambivalence:
   • Recognize reluctance as a normal part of the process.
   • Respect clients' concerns and fears about changing.
4. Support Self-Efficacy:
   • Empower clients to use their resources to enact change.
   • Focus on present and future conditions for achieving goals.
5. Commitment to Change:
   • Recognize when clients are ready to change and support their commitment to action.
   • Help develop a concrete plan for implementing changes.

The Stages of Change (Prochaska & Norcross, 2010)

• Precontemplation: No intention to change.
• Contemplation: Aware of problems but no commitment to action.
• Preparation: Intents to take action soon with minor behavioral changes.
• Action: Active steps are being taken to modify behavior.
• Maintenance: Work to consolidate gains and prevent relapse.
• Non-linear Progress: Clients can move back and forth between stages.

Therapist Roles Across Stages of Change

• Precontemplation Stage: Nurturing parent.
• Contemplation Stage: Socratic teacher.
• Preparation Stage: Experienced coach.
• Action/Maintenance Stage: Consultant.

Case Example: "Stan"

• Background:
  • Struggles with self-worth, seeking love and acceptance.
• Therapy Approach:
  • Encourage self-exploration of feelings, fears, and self-concept discrepancies.
  • Foster a trusting and supportive therapeutic relationship.
• Outcomes:
  • Increased self-verification and capacity to make decisions.
  • Greater sensitivity to internal messages and reduced dependence on external validation.
  • Develops faith in self and the ability to rely on own choices.

Conclusion

• MI is an evolution of person-centered therapy emphasizing structured interventions tailored to client readiness for change, fostering a strong therapeutic alliance to facilitate personal growth.