Motivational Interviewing

Motivational Interviewing

Motivational Interviewing is a good secular alternative to AA and the Twelve Steps theory of addiction treatment.  I like Motivational Interviewing and use many of the principles in counseling people about addiction.  For more information on this approach, see the book titled Motivational Interviewing by Miller and Rollnick or click on the Motivational Interviewing link to the right under the heading, Blogroll.  The material for this article comes from these two sources.

Motivational Interviewing is a directive, client-centered approach to helping people change.It is directive in that the therapist tries to help people resolve their ambivalent feelings regarding their addictions.  It is client-centered in that it is non-confrontational and does not force people to make changes.  The key strategy is to elicit, clarify, and resolve ambivalence in a respectful counseling atmosphere.

What is ambivalence?  Ambivalence is the simultaneous and contradictory desire to do something and not do something.It is being attracted and repulsed at the same time.  Most addicts experience ambivalence relative to their addictions; that is, they have strong feelings about engaging in their addictions and strong feelings about wanting to stop.  The subject of ambivalence reminds me of Paul’s words in Romans 7:

So I find this law at work: When I want to do good, evil is right there with me.For in my inner being I delight in God’s law; but I see another law at work in the members of my body, waging war against the law of my mind and making me a prisoner of the law of sin at work within my members. (Romans 7:21-23)

The essence of Motivational Interviewing is to help people explore and resolve their ambivalence regarding their addictions.  It is believed that most people will make the correct decision once they work through a cognitive appraisal of the costs and benefits of their behaviors.  The following are some rules that must be observed in the Motivational Interviewing process:

1. Motivation to change is elicited from people and not imposed from without.  Studies have shown that confrontational approaches do not work and tend to make people less likely to change.

2. It is not the counselor’s task to articulate and resolve people’s ambivalence.  The best results occur when people decide for themselves whether they should restrain or indulge in their addictions.  Many people, however, have never worked through the benefits and costs of their behaviors.  It is also helpful when people are given the opportunity to express their ambivalence, as in the following example, “If I stop smoking I will feel better, but if I do, I might put on extra weight, which will make me feel bad.”  The idea is to help people express and understand both sides of their ambivalence.

3. Direct persuasion is not an effective method for resolving ambivalence.  I tend to be impatient with people and would rather just tell them what they need to do.  The reason this is not very effective is because people are more likely to make permanent change when they have a greater understanding of their behaviors.  Miller and colleagues have found that direct persuasion and confrontation tends to increase resistance and diminish the likelihood of change.

4. The counseling style is generally a quiet and eliciting one.  Direct persuasion and confrontation are the opposite of Motivational Interviewing.  Aggressive confrontation pushes people to make changes for which they are not ready.  Motivational Interviewing helps people discover that it is in their own best interest to change based on a cognitive appraisal of the pros and cons of addiction.

5. The counselor is directive in helping people examine and resolve ambivalence.  The goal of Motivational Interviewing is not just to talk or help people develop coping skills. The goal is to help people explore and resolve their ambivalent feelings about their addictions. Most addicts need to develop their coping skills, but this is not the focus of Motivational Interviewing.  It is assumed that ambivalence is the most important obstacle to change.  Skill training can follow change.

6. Readiness to change in people comes from interpersonal interaction.Resistance is viewed as a signal that people are not ready to change.  It is not called denial and people are not confronted about their denial.

7. The therapeutic relationship is more like a partnership than an expert/recipient relationship.  This means that we should respect people’s freedom of choice regarding their own behaviors.  I often point out to people that they are free to experience all of the negative consequences of their addictions if that is their choice.  It is also important for people to know that you will not reject them even if they choose to behave in irresponsible ways.

I know many of the above points will not make sense to you if you believe in a more aggressive and confrontational style.  It certainly goes against my style of preaching because preaching is all about convincing and persuading people to change based on biblical teaching.  Although Motivational Interviewing seems slower and more frustrating than just confronting people with the error of their ways, there is evidence that this helping style is much more effective than confrontational approaches.  A reason I believe this is the case is because it allows people to make changes based on what they believe is in their own best interest rather than to please someone else.  I have noticed similar results in trying to get people to conform their lives to biblical teaching.There is a place for confrontation in some aspects of biblical religion, but pressuring people to obey God seldom works.

J B Myers

jbmyers1@gmail.com

Books:

Faith and Addiction

Elders and Deacons

Life Choices

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