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Substance Abuse and Brain Injuries
Motivational Interviewing
Background
General
Principles
Three
Phases
PDF
Version of Motivational Interviewing
The roots of Motivational Interviewing are found in Motivational Psychology. The underlying principle is that people will make the most long-lasting behavior change when their motivation is internal rather than external.*
Working with people to change alcohol and other drug use habits, psychologist W.R. Miller found that persons were more likely to make lasting changes when they reached the decision themselves rather than through force or coercion.
The role of the therapist, according to Miller, is to release the potential for change that exists within each person. The therapist does this by approaching clients as an ally, to free them from ambivalence that has trapped them in a cycle of alcohol and other drug dependency. Though the person with a brain injury may not have expressed goals for abstinence, he or she will have goals in other life areas that are inconsistent with continued use of alcohol and other drugs. Motivational Interviewing helps clients establish plans and actions toward goals.
Therapists using Motivational Interviewing use a variety of strategies, but the process is more than techniques: Miller describes it as a way of "being with clients, which is probably quite different from how others may have treated them in the past."
In Motivational Interviewing, these general principles guide the therapist's actions: express empathy, develop discrepancy, avoid arguing, roll with resistance, and support self-efficacy.
Express Empathy - Expressing empathy is the key to building rapport with clients. This is accomplished through reflective listening and acceptance.
Develop Discrepancy - The interview is used to develop discrepancies between the person's life goals and the effects of continued substance use on these goals.
Avoid Arguing - Motivational Interviewing uses a positive approach and does not use negative confrontation. People are not seen as cooperative or uncooperative, or "in denial" of their problem. The goal is not for a person to complete a First Step before meaningful progress can be made. Direct confrontation and arguing are avoided in this approach.
Roll with Resistance - Resistance is seen as ambivalence about the change being addressed, and it is an indication that the counseling should return to a previous step. A typical way to meet resistance is, "You seem to be ambivalent about this, let's come back to this later," or "Maybe there are other options you can consider."
Support Self-Efficacy - By encouraging clients to consider and choose personal options, they develop belief in their own power to make change.
These principles are guidelines for therapists as they work with clients in the change process. Miller suggests that change occurs in three phases, and that therapists adapt their strategies to match the client's progress.
This brief discussion does not describe Motivational Interviewing in depth, but only outlines general concepts.
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