In Behavioral Health, Motivational Interviewing, Substance Use Disorder, Treatment

Motivational Interviewing: The One Tool Every Behavioral Health Provider Needs

Motivational Interviewing: The One Tool Every Behavioral Health Provider Needs

“Motivational Interviewing is a clinical approach that helps people with mental health and substance use disorders and other chronic conditions such as diabetes, cardiovascular conditions, and asthma make positive behavioral changes to support better health. The approach upholds four principles— expressing empathy and avoiding arguing, developing discrepancy, rolling with resistance, and supporting self-efficacy (client’s belief s/he can successfully make a change).” — SAMHSA-HRSA Center for Integrated Health Solutions

For those not as familiar with this treatment modality as they might like to be, Motivational Interviewing (MI) is a clinical approach that was developed by William R. Miller and Stephen Rollnick in 1983 from experiences in treating people with alcohol use disorder. MI is a method that is useful for helping people become internally motivated to change behaviors when insecurity and ambivalence interfere.   While developed originally for those with alcohol use disorder (AUD) and substance use disorders (SUDs), MI has been widely adapted and is used by behavioral health and healthcare providers for a variety of behavioral health disorders and health issues. Miller discovered quite by accident during two studies (Miller & Munoz, 2005; Miller & Baca, 1983) that the clinical style of treatment providers impacted behavioral outcomes and that that counselor empathy led to successful outcomes (Miller, 1983; Miller and BACA, 1983). During subsequent interactions with Stephen Rollnick and other colleagues during a sabbatical in Australia, Miller was questioned about his thinking and processing during a role-play demonstration. The conceptual model and clinical guidelines for MI were derived from the notes he took during that process (Miller & Rose, 2009). Miller and Rollnick co-authored the original MI book, Motivational interviewing: Preparing people to change addictive behavior (1991).

While MI is not invariably effective for everyone or across populations, it pairs well with the Stages of Change model developed by Prochaska and DiClemente (1982, 1983).

Graphic depiction of the Stages of Change Model. This model describes five stages that people go through on their way to change: precontemplation, contemplation, preparation, action, and maintenance.

MI is also effective in reducing denial, and helps clients conflicted about having problems with substance misuse to tip the scale more toward being motivated to do something about it than to avoid doing anything about it (Miller, 1983). The two main components of MI are “a relational component focused on empathy and the interpersonal spirit of MI, and a technical component involving the differential evocation and reinforcement of client change talk” (Miller & Rose, 2009). The focus of MI is on establishing therapeutic conditions that encourages positive change, such as “accurate empathy.”  With a spirit that promotes collaboration between client and counselor, brings forth the client’s own motivation, and honors client autonomy, and specifically training clinicians in MI, clinical practice has met with research for the past 30 years to evolve MI in its current form. Over 200 clinical trials of MI have been published and reviews and meta-analyses support efficacy for a variety of problem behaviors in addition to problem drinking, gambling, smoking, and associated mental disorders, such as management of diabetes, dietary changes, hypertension, chronic mental disorders, and cardiovascular rehabilitation, to name a few. Multiple studies support MI as a method that promotes “change talk” and decreases resistance in clients, which is highly predictive of behavior change (Miller & Rose, 2009)

The four principles of MI are:

  • Less emphasis on labeling: Counselors do not have to insist that labels such as “alcoholic” are accepted by the client and can focus on issues that arise due to consumption and on what the client wants to do about them.
  • Individual responsibility: The client is treated as an adult taking responsibility for deciding if there is a problem and what to do about it. This fosters a respectful client/counselor partnership without moral judgments or a power differential.
  • Internal Attribution: The responsibility for both the condition and the credit for changes made are the clients. Since the clients do not have to admit “helplessness” they can accept responsibility for their own use and are more likely to decide not to use.
  • Cognitive Dissonance: One of the goals of MI is to help the client to experience dissonance or a discrepancy between the client’s behaviors and beliefs by deciding to change the behaviors.
Graphic depiction of Motivational Interviewing facts 30 years after the original concept was initiated. Motivational interviewing (MI) is the only standardized, evidence-based approach for facilitating behavior change. The MI framework includes four steps: 1.) Engaging the patient; 2.) Focusing on an area of behavior change; 3.) Evoking motivation and commitment for the change; and, 4.) Planning the steps toward change. There are over 200 clinical trials and 1200 published studies on MI. MI is now taught in over 43 different languages.

MI is a psychotherapeutic method that is based on empirical evidence, is reasonably brief, specific, complements other treatment methods, and can be used for a diverse assortment of problem behaviors. Moreover, MI is a set of specific skills and can be learned by professionals and staff for use in a variety of behavioral health and in healthcare settings (Miller & Rose, 2009).

Many tools and links to additional information and resources are available in the CASAT OnDemand Resources & Downloads section. Also available in the Learning Labs section is an entire Motivational Interviewing Learning Lab with research articles, websites, training opportunities, and tools to download for those wanting to take a “deep dive” into MI. In the Catalyst Blog, are two additional posts about MI: So You Want to be a Motivational Interviewing (MI) Trainer? for those wanting to learn to train others in MI – an excellent way to learn! Another blog post How Can a Professional Become a Mint Trainer? tells you exactly what you need to do to become a “MINTie” courtesy of our guest blogger, Jennifer Hettema, Associate Professor in the Department of Family and Community Medicine (DFCM) at the University of New Mexico.

Last, but not least, on August 9, 2019 in Reno and November 9, 2019 in Las Vegas, CASAT Training is offering a Motivational Interviewing (M.I.) in-person one-day training refresher for supervisors. The workshop is designed to introduce supervisors to integrating the spirit and skills of M.I. in the context of supervising interns. This workshop will help supervisors to:

  • Practice building and maintaining a strong and collaborative working alliance with supervisees while integrating the spirit and skills of M.I. into working with interns,
  • Basic proficiency standards for research based micro-skills, and
  • An introduction to coding so that interns may be given data-based/coded feedback.

This workshop is designed to teach supervisors to use M.I. skills for providing feedback to interns, such as delivering advice in ways that reduce defensiveness, supporting intern autonomy when setting a requirement, and giving interns opportunities to understand and integrate feedback and balance levels of skills used in practice.

 

References

Miller WR. Motivational interviewing with problem drinkers. Behavioural Psychotherapy 1983;11:147–172.

Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), 527-537. doi:10.1037/a0016830

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276-288. doi:10.1037/h0088437

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395. doi:10.1037/0022-006X.51.3.390

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