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Motivational Interviewing

Motivational Interviewing is described by the pioneers of MI, Miller and Rollnick (2002) as ‘a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence’. This description reminds one of Egan’s Skilled-Helper Model (2002) - however, the directive aspect of MI seeks to generate momentum by not being explicitly directive with the client; furthermore, the principles of MI, which will be described later, show how the emphasis in MI is on the motivation to change – a fluid state of mind which is ‘susceptible to influence’ (Ashton, 2005) – rather than on change per se.

There is substantial evidence to suggest that Motivational Interviewing may help people overcome ambivalence that can prevent them from making changes in their lives. (Miller, Hedrick, and Taylor, 1983.) Although they may be able to understand the potential benefits of change – smoking causes cancer and kills; one would assume it would be healthier not to smoke - they may be unwilling, unable or unready to change prior to MI interventions. Incidentally, there is better research record than practically any other treatment regarding modifications of Motivational Interviewing in substance abuse treatment settings.

The ‘spirit of MI - ‘a way of being with and for people’ - is integral to this approach and constitutes Carl Roger’s three core conditions; congruence, empathy and unconditional positive regard. It also involves operating from within the client’s own frame of reference – which in effect means ‘trying to see things with their eyes, think things with their minds, and feel things with their hearts’. (Barclay, 1959.)  This motivational spirit or approach can also be described as collaborative, respectful, non-confrontational, non-labelling, non-judgmental and affirming of the client’s autonomy. In other words, the client knows best. (Kirschenbaum and Henderson, 1989.)

According to Miller and Rollnick (2002. P 76) there are five skills that are fundamental to Motivational Interviewing: asking open-ended questions; affirming the client; reflective listening; summarising; and eliciting ‘change talk’. While the first four skills may be present in other counselling styles, eliciting ‘change talk’ helps the client to resolve ambivalence, which has been identified as the focus of MI – this is the ‘directive or ‘steering’ part of MI, incidentally, which is usually done by using reflective listening and selective reinforcement. Miller and Rollnick, have also identified four guiding principles which help to elicit ‘change talk’ and resolve ambivalence; these are:

Express Empathy
The counsellor expresses empathy by reflecting back to the client in a way that demonstrates that he understands and accepts the client’s feelings in a non-judgmental way, and without imposing the counsellor’s own material. It is worth remembering, incidentally, that showing sympathy or having had similar past experiences to the client does not constitute ‘accurate empathy’ – indeed, it can lead to ‘over-identification’ which can compromise a counsellor’s ability to provide the necessary critical conditions of change (Miller and Rollnick, 2002).

Develop Discrepancy
 A client may be encouraged to develop discrepancy between his personal values and the behavioural problem. This could be done in the addictions field, for example, by asking the client to reflect on what life was like before drugs, and to compare that life to how things are now. Or, he could be asked to project forward a few years and to imagine life without drink or drugs. Developing discrepancy, therefore, is a fundamental difference between MI and other counselling styles. (Miller and Rollnick, 2002.) 

Roll with resistance
If resistance occurs, the counsellor using MI will then attempt to roll with it - for disagreeing with a client will be counter-productive and will adversely affect the therapeutic alliance, which may in turn reinforce resistance. The counsellor chooses responses that are intended to diminish and defuse resistance, or he can reframe the resistance in a positive way, thus using the client’s energy to create forward momentum and elicit ‘change talk,’ much as a black-belt uses the opponent’s momentum to execute a fall in judo.

The ‘style’ of counselling is also very important because recent evidence indicates that ‘confrontation can foster denial’, and as Miller (1985) emphasises ‘clinicians who work with unmotivated patients must implement less confrontational and more motivation-generated treatment approaches’. However, those clients who are willing to accept direction ‘do better when this is what they get’. (Ashton, 2005.) In MI, therefore, the counsellor works in a collaborative manner with the client, with a primary emphasis on building the relationship.

Supporting self-efficacy
‘Perceived prognosis influences real outcomes.’ Miller and Rollnock (2002) describe supporting self-efficacy as ‘the effects of faith and hope in facilitating change’. It is about self-belief – the ‘I-can-do factor’ -; but it is also about other peoples’ beliefs – the counsellor, doctor or teacher – in the client’s capacity to change. In an experiment conduced in America a few years ago, six “spurters” (potential geniuses) were identified in a junior High School; their identity was known only to the scientists facilitating the experiment. At the end of the year, the teaching staff were astounded to discover that all the pupils in the class which included the “spurters” had progressed academically way beyond  expectations. The reason: the teachers treated everyone as though they were “spurtors”; as though they were geniuses!  They were further astounded to learn that there were no “spurters” at the school in the first place – and that their ‘faith and hope’ alone had caused the children’s amazing progress (Owen, 2004). That is what supporting self-efficacy is all about.

BIBLIOGRAPHY
ASHTON, M., (2005) Motivational hallo. Drug and Alcohol Findings. Part 3 (13) pp. 23-30.

BARCLAY, W., (1959). The Plain Man’s Book of Prayers. Glasgow: Collins/Fontana Books.

EGAN, G., (2002). The Skilled Helper A problem-management and opportunity-development approach to helping. 7th ed. California: Brooks/Cole Thomson Learning.

KIRSCHENBAUM, H., HENDERSON, V. L., (1989). The Carl Rogers Reader. New York: Houghton Mifflin.

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