Tuesday, May 09, 2006

Motivational Interviewing

Motivational Interviewing (MI) is a model of reframing and working with what is often referred to as client resistance. I'll be giving a workshop on Motivational Interviewing this Friday, so I thought I would summarize some of my thoughts here in preparation. And also provide some links to resources on MI.

I was first introduced to MI while working in the substance abuse field. It was, infact, developed in this field. This makes quite a bit of sense, given the ambivalence that individuals in early recovery or "pre-recovery" often experience.

The whole model revolves around this idea of ambivalence, a concept that could be summed up in a statement like, "I feel strongly both ways." Ambivalence is not a lack of motivation, but rather two competing motivations in different directions. For example, the substance abuser who is sick and tired of the consequences brought on by drug use, yet at the same time cannot fathom life without the drug. This sort of "fence-sitting" ambivalence typically makes behavioral change difficult.

In the counseling setting, such ambivalence is, unfortunately, seen by many clinicians as resistance or a lack of motivation. According to the MI model, what often occurs in the counseling relationship is that the ambivalence of the client gets played out in the therapeutic relationship.

An example might clarify:

Joe comes to counseling to quit smoking. He feels "strongly both ways", wanting to quit but not wanting to quit. The counselor, wanting to help enhance Joe's motivation, might ask Joe if he's thought about the health consequences of smoking. Joe says he has, but then proceeds to point out the relaxation and enjoyment he gets from it. Because the ambivalence inside Joe is complex, whenever one side of the argument (for or against smoking) is brought up, he may feel inclined to rebutt the other side of the argument just to balance things out.

This may often lead to a pattern in which the counselor is arguing for change, while the client is arguing for the status quo, or a lack of change. MI offers techniques to help the client become the one arguing for change. In some ways, MI does not look a whole lot different from classic Rogerian therapy. However, it may be seen as Rogers with more of a goal in mind. It is, perhaps more directional and behavioral in nature.

I'll leave it at that for now, so this post doesn't get too long. Next post, I'll describe some of the basic techniques. In the meantime, check out the Motivational Interviewing Website for tons of useful info, articles, etc.


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