Ambika Agnihotri
Motivational
interviewing in a client-centred counselling technique used by therapists, for
patients who need to overcome ambivalence. It aims to help patients with
behavioural change. Since its conception by Bill Miller, it has been studied
and opted by numerous psychologists and therapists. The novel style of
counselling and the flexibility offered, made this technique popular and has
since been used along with various other therapeutic approaches. Through this
post, I aim to throw some light upon this technique and briefly explain the
process it entails.
Bill
Miller, in 1983, was treating patients with drinking problems. He began
thinking about the efficiency of behaviour change. Through this experience, he
formed the fundamentals of motivational interviewing. In 1991, Miller and
Rollnick elaborated on these fundamentals to give this counselling style some
shape and structure (Rollnick & Miller, 1995). It grew into a focused,
directive and client-centred style for bringing about the required behavioural
change, by helping clients gain knowledge about the conflict and eventually resolve
ambivalence.
Ambivalence
manifests as a conflict between two desired and/or undesired courses of action.
There could be numerous reasons for its occurrence; addiction, peer pressure, coercion,
etc. While talking about the process of motivational interviewing, it would be
better to start by describing the core features or characteristics and then
moving on to the process. First and foremost, it is important to note that it is
based on an interpersonal style of counselling and isn’t bound by formal counselling
settings wherein therapy is ‘applied to’ the patient (Rollnick & Miller,
1995). Finding a balance between directive and client-centred aspects of
counselling is extremely important. This technique lies totally opposite to styles
like confrontation, aggressive argumentation and directive persuasion.
The
next most important component of motivational interviewing is the
therapist-client relationship. It has a huge impact on how the results of
counselling turn out. The ideal relationship is like a partnership or a
collaboration, where the therapist acts like a facilitator. This may sound easy
but is, in fact, difficult to achieve because of what Treasure calls the
‘righting reflex’ (2004). It is the tendency that therapists have, to try and solve
the problem for the client. However, in motivational interviewing, the ideal
approach is to allow the patient to recognize and understand his/her
ambivalence, and subsequently work towards resolving it; it is seen as the
patient’s task (Rollnick & Miller, 1995). If the relationship lacks warmth
and empathy, and in the presence of direct persuasion from the therapist’s
side, the client will be unable to recognise and accept the conflict. Moreover,
it might even increase client resistance, which will in turn decrease the
probability of realization of the goal. Thus, the therapist adopts a
subordinate position to emphasise the patient’s autonomy and the right to
choose the level of indulgence (Treasure, 2004).
Moving
on to the techniques that are adopted in motivational interviewing, the aim is two-fold:
(1) to increase the importance of change in the client’s mind, (2) to increase
the client’s confidence regarding realisation of the goal, i.e. ‘change can
actually happen’. For the former, the process of developing discrepancy is of
utmost importance. Differentiation has to be created between the patient’s values
and their current behaviour, that may be contradictory to them. This may be
followed by negotiation through which the client thinks about the costs and benefits
involved in the process of change. The therapist might help reach the decision
of change through selective reinforcement. For improving the client’s
confidence, developing his/her self-efficacy is important. The therapist’s role
here is to support the client’s autonomy, allow self-reflection, offer positive
feedback and encourage small steps (Treasure, 2004).
The client’s readiness to change is seen as a
product of the interpersonal interaction, rather than his/her own trait (Rollnick
& Miller, 1995). Thus, the therapist, through active listening, pays
attention to the client’s motivational signs. The level of denial or resistance
and the rate of self-elicited motivational statements by the client are seen as
predictors of change, drawing from the therapist’s behaviour and efficiency.
These serve as a feedback to the client-therapist relationship. It has been
pointed out that the motivational style of counselling is a balanced
combination of three kinds of interactions; following, directing and guiding (Rollnick,
Miller, Butler & Aloia, 2008).
Motivational
interviewing is the counselling technique that helps the client realise his/her
intrinsic need for change. It has proven to be highly effective and has many
applications within psychiatry (Treasure, 2004). There have been studies
indicating that motivational interviewing proves to be superior than other
skill-based interventions, as it was better able to increase readiness to
change (Rollnick & Miller, 1995). It has the potential and flexibility of
being incorporated into everyday clinical practice (Rollnick, Miller, Butler
& Aloia, 2008). It can be adapted to a wide range of clients. An overall
treatment regime might include motivational interviewing, followed by other
techniques like cognitive-behavioural therapy. It proves to be important and impactful
with patients as they shift from being apprehensive about change to being open
to it. Thereafter, they can be taken through other required therapies.
References
Comments
Post a Comment