Motivational Interviewing Therapy For Substance Abuse

Addressing what's behind one's actions.

What is Motivational Interviewing?

M Motivational Interviewing is a treatment tool that is usually employed for individuals who do not have clear reasoning regarding recovery. Developed by William Miller and Stephen Rollnick in 1991, Motivational Interviewing has become an effective way of treating people who are either unmotivated to pursue recovery, or are in denial about his/her substance use. Motivational Interviewing places great value on being sensitive to the client’s state, and gently influencing his/her reasoning to recognize addiction as a serious problem.

``Motivational interviewing is a way of being with a client, not just a set of techniques for doing counseling.`` William Miller and Stephen Rollnick.

Concepts and Principles Behind Motivational Interviewing

M Motivation Interviewing has a heavy orientation in the belief that the causes behind one’s repeated patterns are a direct result of motivation. Miller and Rollnick came to several conclusions as to the nature and role of change and motivation.

  • Motivation is a key to change: This concept places an immense amount of importance on motivation. According to Rollnick and Miller, motivation is directly tied to the prospect of personal change.
  • Motivation is multidimensional: This concept notes that motivation is a complex system that is composed of a balance of separate urges, pressures from external and internal sources, and goals that are wished to be met.
  • Motivation is dynamic and fluctuating: This concept operates under the assumption that motivation is not a fixed factor. Instead, motivation can fluctuate in focus, intensity and conflict or cooperate with other ideas depending on time and other influences.
  • Motivation is influenced by social interactions: With the knowledge of the fluidity of motivation, this concept seeks act on the malleability of motivation and adjust it through external forces, such as social support or emotional states.
  • Motivation can be modified: This concept operates under the assumption that well focused influence can affect one’s motivation
  • Motivation is influenced by the clinician’s style: Since the clinician tends to hold greater sway over the client’s mental and emotional state, much of the source for change will be attributed to the clinician.
  • The clinician’s task is to elicit and enhance motivation: With this responsibility, clinicians are assigned with the duty of assisting the client in changing his/her lifestyle.

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William Miller

William Miller has been renowned in the field of psychology and psychiatry for many years. After acquiring his Ph.D. in Clinical Psychology from the University of Oregon, he took a faculty position at the University of New Mexico in 1976. While he taught a wide range of subjects in psychology, his primary focus was in the areas of motivation and change. After extensive research, collaboration with experts like Stephen Rollnick, and proven clinical studies, Miller contributed to the formation of what we know today as Motivational Interviewing.

 

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Stephen Rollnick

Stephen Rollnick acquired certification for research in psychology from several institutions. He completed his Masters training in research from Strathclyde University in 1978, as well as his professional training from Cardiff in 1983. He also acquired adequate experience from serving as a clinical psychologist in the National Health Service, followed by time with the Department of General Practice. Upon witnessing the effects of addiction in his field, Rollnick worked closely with William Miller and developed several concepts and principles that Motivational Interviewing was founded upon.

“These four person-centered conditions convey what we mean by “acceptance.” One honors each person’s absolute worth and potential as a human being, recognizes and supports the person’s irrevocable autonomy to choose his or her own way, seeks through accurate empathy to understand the other’s perspective, and affirms the person’s strengths and efforts.” - William Miller

Therapeutic Techniques Behind Motivational Interviewing

Expressing empathy through the use of reflective listening: This technique consists of the therapist demonstrating sensitivity to the client’s needs and current state. This sensitivity is exhibited by non-judgmental conduct as well as paraphrasing the client’s statements and concerns to ensure and establish that the counselor is listening.

Develop discrepancy between clients’ goals or values and their current behavior: This technique consists of the therapist having the client evaluate his/her patterns, as well as his/her ultimate goals in treatment. The client is then asked to evaluate the benefits and detriments of each goal, displayed behavior, patterns and habits and other factors that stem from core motivation. Ultimately, the client should be able to recognize conflictions between certain displayed behaviors and pattern, and the goals he/she wants to achieve.

Avoid argument and direct confrontation: This technique operates under the recognition that a direct opposition of one’s displayed patterns may create barriers (such as denial, argument, anger and other defense mechanisms). A therapist can be more effective in addressing a problem when power-struggles and arguments are avoided.

Adjust to client resistance rather than opposing it directly: This technique is crucial to the recovery process, as the therapist will demonstrate sensitivity to the client’s disposition, and gently suggest alternative viewpoints, or ask more questions to generate more discrepancy, ultimately resulting in a client that will be more willing to pursue recovery and cease harmful patterns.

These techniques and concepts are applied throughout the treatment process. They may be altered in intention depending on the phase of treatment the client is in, as well as the client’s level of willingness to change.

Motivational Interviewing Strengths

Strengths in Treatment

  • Motivation Interviewing can be used with clients who are in denial about their use, or willing to pursue recovery.
  • Motivational Interviewing has been proven by numerous clinical studies to be effective.
  • Motivational Interviewing can be applied in a group setting in addition to one-on-one counseling.

Conflicts with Motivational Interviewing

Conflicts in Treatment

  • While Motivational Interviewing is effective in addressing the motivation aspect, another therapy (such as Cognitive Behavioral Therapy) would need to be applied in conjunction in order to provide an educational aspect to treat addiction.
  • Motivational Interviewing may encounter some barrier when treating clients with delusions or psychosis, as their reasoning abilities may be compromised.

References:

Neukrug, E. (2011). Counseling theory and practice. Australia: Brooks/Cole, Cengage Learning.

Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.). Available from: http://www.ncbi.nlm.nih.gov/books/NBK64972/