Motivational Interviewing: Literature Review
Extensive research has been executed on the subject of motivational interviewing (MI) since it was originally published as a key approach to eliciting behavioral change (Shulman, 2011). In his original designation, Miller & Rollnick (2013) described motivational interviewing as an approach that is based on the fundamental principles of experimental social psychology and the application of such principles such as cognitive dissonance, attribution, and self-efficacy. Motivational Interviewing can be defined as a client centered directive counseling style critical in eliciting behavior change by helping clients to explore and resolve ambivalence (Shulman, 2011). The approach, therefore, comes out as facilitative, focusing on exploring and resolving ambivalence hence centering on the motivational processes within the client to bring about change.
Key Approaches
Different authors agree on the key approaches that are often used in the motivational interviewing approach. Shulman (2011) identify identification, examination and resolution of ambivalence with regards to behavior change as the central approaches to MI. Ambivalence is described as a two way feeling about behavior change and is often regarded as a natural part within the change process. MI involves a conversation about change, is collaborative and evocative (Shulman, 2011). MI uses a collaborative approach to strengthen an individual’s own motivation hence is person centered and addresses the problem of ambivalence. It is noteworthy to state that the approach is collaborative and not confrontational hence it involves a partnership between the client and the therapist.
Dart (2011) highlight that the approach is grounded on the client’s experiences and point of view hence its effectiveness is dependent upon building a rapport and listening to the client reflectively in a bid to win the client’s trust. Additionally, evocation is a key approach as the therapist must be able to draw out the client’s own thoughts and ideas rather than influencing or imposing his or her opinions on the client. A lasting change is only possible if the client discovers their reasons and makes a decision to change. Reportedly, the approach must nonetheless rely on autonomy rather than authority comparative to other treatment models. Shulman (2011) stress that the true power of change is with the client hence it is up to the client to decide to change.
Principles
Key principles that define motivational interviewing are identified by a number of authors. A key principle of MI is that, motivation to change is not imposed to the client (Miller & Rollnick, 2013). This contrasts other motivational approaches which emphasize strategies such as persuasion, use of external contingencies and coercion. The second principle is that, it is the client’s task and not the counselor’s to articulate and resolve his or her ambivalence, (Miller & Rollnick, 2013). Basically, the counselor’s task remains to help in the expression of either sides of the ambivalence impasse, hence guiding the client towards accepting resolution and triggering change. Ideally, the principle of serenity with the counseling style being quiet and eliciting one is critical for success. Approaches such as aggressive confrontation, argumentation or direct persuasion are explicitly discouraged within the motivational interviewing approach (Miller & Rollnick, 2013). Additionally, the counselor is expected to express empathy by seeing things from the client’s viewpoint, support self efficacy, roll with resistance and develop discrepancy to help the client examine any discrepancies between circumstances, behavior and their current and future goals (Miller & Rollnick, 2013). Admittedly, when therapists demonstrate empathy, clients are most likely to open up and will show higher engagement leading to better outcomes.
Skills and Strategies
There are explicit strategies and skills that are apposite to the success of the motivational interviewing approach. The therapist should seek to understand the client’s frame of reference hence reflective listening is critical (Miller & Rollnick, 2013). Additionally, the therapist should express affirmation and acceptance, elicit selective reinforcement of the client’s self motivational statements such as concern, desire, ability and intention to change and problem recognition. The therapist also ought to be able to monitor the client’s degree of readiness to change and ensure that a form of resistance is not generated by coercing the client when not ready. Affirming the client’s freedom of self direction and choice is critical to the MI approach.
Related Approaches
A number of intervention methods have been derived from motivational interview. Key among them includes; the checkup method, Motivational Enhancement Therapy (MET) and Brief intervention. MET was developed as a treatment approach for alcohol abuse and dependence although it has become relevant and adaptable to the treatment of other related problems (Dart, 2011). The approach uses a set of designed quick concrete techniques to manifest the practice and spirit of motivational interviewing in contact settings; the encounters may be as brief as 5-10 minutes. The brief intervention approach is also inherently different from MI since it uses an authoritative expert who does most of the talking in a unidirectional information system (Bertholet, Faouzi, Gmel, Gaume, & Daeppen, 2010).
Summary
In summary, motivational interviewing style has been found effective based on the multiple tests especially with problem drinkers. The five therapeutic guidelines remains; expression of empathy, avoidance or argument, support of an individual’s ability to change, a change in a client’s behavior, and rolling with resistance (Dart, 2011). Bertholet et. al. (2010), however, note that, that there is a need for further unpackaging and testing of the key defining components of motivational interviewing. There is also need to extend the approaches to other problem areas and populations since a majority of studies have tended to focus on conflicts unique to alcohol and other drug problems. Recent research has attempted to apply motivational interview to other problem areas including pain management, diabetes, HIV risk reduction, eating disorders and compliance with medical advice. Nonetheless, there is a need for the development of specific adaptations for criminal offenders, couples, the youth, intravenous drug users, concerned family member smokers and abusive families.
Demonstration Script
The client in this case is an alcoholic with hepatic manifestation of alcohol over consumption hence is suffering from alcoholic hepatitis as a result of excessive alcohol intake. There is, therefore, a dire need for a lifestyle change to avert the development of liver cirrhosis, which is fatal. The client is nonetheless, ambivalent on whether or not to quit drinking since he has been clinically diagnosed as alcoholic dependent. The following is an exempt of motivational interviewing between the nurse and the client who is due to be discharged after undergoing detoxification and alcoholic hepatitis treatment within the medical institution. The technique used is the Open-Ended Questions which invites the client to identify the problem and gives him, self-direction towards a solution.
Nurse:
How are you doing today?
I am feeling better, just a little restless and mild headache.
Nurse:
Oh, that will subside. How do you feel about being discharged today?
Oh, I feel good, just a little anxious. At least the pain and tremors are gone.
Nurse:
The anxiety will die down, just give it time. What do you think about your alcohol use?
Nurse:
You liked drinking alcohol?
Nurse:
So you’ve tried very hard to quit?
Nurse:
You are very courageous to be honest and revealing about this. So you worry about your alcohol use?
Nurse:
Quitting is hard. But you were told that your disease cold recur or worsen if you continued drinking?
Nurse:
On a scale of 0 to 10, how important then do you think it would be important to quit?
Nurse:
What difficult goals have you achieved in the past?
Nurse:
Oh, really. So did you quit all at once or in stages?
Nurse:
That was quite brave of you, not many people successfully quit smoking. What do you think might work for you if you decide to quit drinking?
Nurse:
Of course, it is difficult to quit all alone. But you said you were considering joining the Alcoholic Anonymous. Perhaps they can be of help.
Nurse:
Yes that would be great. From what I have heard, it is a very interesting organization which has helped thousands of individuals.
Nurse:
I only know that they hold daily support meetings in which they help people maintain abstinence by going through a 12 step program of personal growth and self understanding.
Nurse:
It was nice talking to you too. Have a safe journey home.
References
Bertholet, N., Faouzi, M., Gmel, G., Gaume, J., & Daeppen, J. (2010). Change talk sequence during brief motivational intervention, towards or away from drinking. Addiction, 105, 2106-2112.
Dart, M. A. (2011). Motivational Interviewing in Nursing Practice: Empowering the Patient.
Sudbury, Mass: Jones and Bartlett Publishers.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping People Change. New
York, NY: Guilford Press.
Shulman, L. (2011). Dynamics and skills of group counseling. Belmont, Calif: Brooks/Cole Pub Co.
