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Paper Topic:

Motivational Interviewing

Motivational Interviewing

Discuss the Spirit , Key Principles and Definition of MI

Motivational Interviewing (MI ) is a method for developing and building upon an individual 's motivation for change . MI is generally considered to be client centered , though the therapist has an active role in treatment . The therapist helps the client explore and resolve issues around ambivalence and resistance to move towards the desired change The main principles of MI are to express empathy , develop discrepancy and roll with resistance and support self-efficacy . The goal is to build motivation that results in

positive change and then assures a strong commitment to the change . The long term goal is to maintain the positive change . MI was developed by William R . Miller and Stephen Rollnick and was originally used for working with substance abusers , specifically alcoholics . The use of the approach has since broadened and is now used as a general therapeutic approach with a wide range of client populations

MI looks at the subject of change from a positive , strength based viewpoint . When developing the approach , Miller and Rollnick asked the question , Why do people change ' They wondered How is it that people adapted to new things and change behaviors to become more productive and healthy and happy ' Rather than assuming that people with problem behaviors are unable to change , they took a more positive approach to therapeutic techniques . While we know that many people appear stuck in self destructive relationships and lifestyles that is not the norm . This model looked at positive examples or role models essentially , it is built on what makes people succeed in change , rather than what leaves them stuck

What motivational interviews research has found is that most people change without intervention rather than with professional help . Most people make the change without counselors or professionals prodding them along . Brief interventions can hasten change and in fact , sometime a brief intervention is the mode . Essentially a push in the right direction . While we may think that more professional help /sessions might lead to greater change and success , it may well be that the first couple of sessions did the trick and provided the motivation to change . MI points to research evidence that shows that change occurs early in treatment , and while longer term therapy can be helpful and indicated , it is not always needed . The motivation that occurs early in treatment may well be what carries the person to move forward in the change process

MI points to the research that shows that people who have faith and believe in their ability to change from the start , are more likely to have success in changing . This is known as self-efficacy . The same principle is true for counselors also , meaning that counselors , who expect positive results , get positive results . There is some truth to the self-fulfilling prophecy idea . MI also talks about counselor characteristics and the relationship to a clients dropping out of therapy or continuing . Carl Rogers identified these characteristics as accurate empathy , non possessive warmth and genuineness

MI is evidenced based , which means there is research to support the effectiveness of the approach . MI is aimed at helping people to make the changes in their life that will lead to a happy and healthier lifestyle Used initially with clients with substance abuse problems , the MI approach has since broadened to include those with other issues as well MI is based on a growing body of knowledge about what helps people change and how to unstick those who are having difficulty making desired changes in their life . MI understands the concept of ambivalence . MI has strategies that professionals can use to build motivation and help clients grow stronger in their commitment to improvement . MI acknowledges and understands common pitfalls and resistance and help clients to address these issues

Identify and describe the essential theoretical /clinical concepts of the approach

The basic concepts of MI are that a person 's intrinsic motivation can be increased . Using the correct kills and tools , a therapist can help a client work towards change by developing their motivation . Miller and Rollnick refer to the "spirit of motivational interviewing " as a necessary underpinning for this approach . They explain the spirit ' as the connection that occurs when the therapist collaborates with the clients , the process evokes changes and the client maintains autonomy The client and therapist are in the process together and the therapist evokes what is commonly referred to as change talk ' which guides the clients towards developing motivation . Change talk is purposefully positive and forward thinking . The open ended questions provoke change talk by asking the clients questions such as what makes this the right time to change ' or what about this time make you feel ready to change ' etc . The questions ask the client to see the possibilities and to respond with solution oriented ideas and discussion

Therapist who can work within the spirit of the approach , are able to actively participate with the client , as a guid and helper . The client however , remains in charge , autonomus and controls the powere to change The relationship that the therapist establishes requires skill and restraint on the part of the therapist . He or she must trust that the client has the ability to change and believe that the motivation for change can be developed within the therapeutic relationship

Identify and discuss the types of interventions or techniques that are part of this approach (be sure to include a discussion of OARS MI uses proven techniques to increase motivation and enhance the person 's ability to make positive changes . In MI , these skills are known by the acronym OARS . OARS stands for open-ended questions , affirmations reflections and summary . These strategies are used by the therapist to help a person recognize the difference between heir behavior and their goals . The therapist can also help the clients identify discrepancies between behavior and perception or behavior and personal goal . Through these use of these strategies in therapy , the client begins to explore their own ambivalence about change and work towards developing motivation for change

MI helps the client ,move from awareness to commitment to action . The clients , through open ended questioning begins to indentify and clarify the problem . An awareness of the problems and an establishment of the goal is the first step to change . Once the awareness has been established , the therapist beings the change talk and leads the client to commitment to change . The time line and goals become more specific thought hey must be established by the client . Client autonomy is critical to the long term change and commitments . Once commitment is established , the client move to action . At this point , the change takes place and the goal fromt his point in maintaining the positive change

Explain how these concepts and interventions work

MI is based on research which indicates that the confrontational style of therapy results in client more resistance rahtern than positive outcomes . The research shows that clients are more successful at changing behavior when they work with empathetic counselors who can help explore issues , provide feedback and illicit motivations for change towards positive outcomes . Clients are more likely to change if they feel understood and have some help or guidance in terms of looking at behaviors and goals openly and honesty without feeling judged Motivation is the key component to MI as higher motivation indicates that a person is more inclined to change and succeed in treatment . MI does not it is done so in a way that clearly leaves the client in control and does not appear to be threatening , punishing or judgmental . Rather than confrontation as tradionally understood , the use of confrontation is MI is a genteler version . The confrontation is more about teaching and providing information thanchallenging the client

MI focuses on ambivalence , and overcoming ambivalence is a key component to building motivation . MI assumes that people are ambivalent from time to time . The therapist is not surprised or concerned by ambivalence . MI is humanistic and positive making the assumption that motivation can be encouraged and learned . Ambivalence is handled through techniques such as reframing , goal setting , timelines and decision making skills . The therapist 's use of open ended questions can help guide the client to an understanding of the problem . For example , the therapist may ask the client to expand on a statement about what is concerning him or her . The therapist can ask for examples of how the problem affects them and why the feel the need to change . Therapy is optimistic and goal oriented focusing on how to change and encouraging motivation and stamina

Discuss the strengths and weaknesses of this approach in general and specifically in treating substance use /abuse

MI began has a treatment approach for use by trained therapist working with substance abusers . The approach is now used with a much broader client base . One of the populations therapist are using MI with are those with co occurring mental illness . While there is potential for this application , therapist much be careful and trained to particularly work with this population . Open ended questions might be problematic if used whith clients who have disorganized thinking or any psychotice symptoms . There is the potential to adapt the model to work with the population . This would require a more active and directive role on the part of the therapist

Explain why this approach appeals to you professionally

I think that this approach is respectful of the client . While the therapist acts as a guide and encourages exploration and change , the therapist is not overbearing or forcing the issues . This approach makes sense , as it encourages the therapist to do more than just listen the therapist is an active engaged part of the process . The therapist is not annoyed by resistance and does not rush to close the case or terminate therapy because of resistance or lack of motivations . In fact , the therapist expects these things . The strategies of open ended questions and reflective listening lead to a recognition of the clients strengths and efforts

MI is an honest and upfront approach to therapy . The therapist really gets to know and understand the client , the problem and the need to change . The therapist is free to give the client some reference and examples of others with similar problems , so that the client can gain some insight into the severity . The client learns from the therapist but is not forced in any direction . The therapist can identify risk factors discuss his experience and provide feedback , meant to be helpful to the client . As an active participant , the therapist appears more invested involved and caring

References

Martini , Stephen and Hopfer , Christian , An Introduction to Motivational Interviewing Blending Clinical Practice and Research NIDA Clinical Trials Netwoek ,http /www .mac1988 .com /blendingcolorado /ppts /Martino .pdf

Steve Martino , Ph .D , Kathleen Carroll , Ph .D , Demetrios Kostas , M .S .W Jennifer Perkins , B .A , Bruce Rounsaville , M .D , Dual Diagnosis Motivational Interviewing : A modification of Motivational Interviewing for substance-abusing patients with psychotic diss . Volumn 23 Issue 4 December 2002

Miller , William R and Rollnick , Stephen . Motivational Interviewing Second Edition : Preparing People for Change (Hardcover ...

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