Topic 7: Motivational Interviewing
Topic 7: Motivational Interviewing
The focus of this topic is on howmotivational interviewingcan be particularly useful for working with people who arereluctant or ambivalent about changing.
Change isnt always easy, as you may have experienced in your own life. While we can talk about making changes in a persons life the person has to be ready, willingandable to make that change, otherwise it won't happen. As a counsellor, to facilitate change we need to be sure that the client is also ready for change. While it would seem that a person wanting to change and saying they can change would be enough to instigate change; this is not necessarily so, and obstacles to achieving and maintaining change may need to be overcome.
Motivational interviewing (MI) is designed to help people develop insight into their ambivalence about change and utilises strategies to instigate the change through a person-centered yet directive manner. Motivational interviewing can be used in conjunction with the Stages of Change model, which is a way of understanding a persons insight and proximity to the change process. MI therapy and the Stages of Change model were developed about the same time and complement each other so well in practice that they are often inadvertently assumed to be the same.
Source:https://pixabay.com/illustrations/can-t-can-motivation-positivity-4512618/
It is expected that at the completion of this topic, you will be able to:
Understand the philosophy and 5 key strategies of motivational interviewing
Explain the differences and similarities between Motivational Interviewing and the Stages of Change model
Reflect on counselling skills relating to motivational interviewing
Background and Philosophy of Motivational Interviewing
Miller, the developer of Motivational Interviewing, noticed an interesting yet unexpected development during research on behavioural treatment of people presenting with alcohol abuse. Curiously, the control group, which had been provided with only encouragement and advice, and who had been excluded from behavioural interventions, improved far more than the intervention group (those treated with behavioural therapy). Despite replicating the research, the effect remained. As a result, In collaboration with another researcher, Rollnick, Miller developed the central principles of motivational interviewing. MI was developed to elicit and amplify then direct the client's own desire for change, and help them identify and overcome obstacles to that change (Prochaska & Norcross, 2003). Motivational interviewing is now widely used in a variety of therapeutic settings where behavioural change is the aim.
Readpp.182-184 of your Corey (2016)text to learn about the background and general philosophy to this therapy developed by Miller and Rollnick, initially intended to address alcoholism.
Then watch this short interview, where Miller discusses the evolution of Motivational Interviewing, the spirit of MI, and specific techniques.
Motivational Interviewing with William MillerLinks to an external site.Motivational Interviewing with William Miller Video Transcript.docxDownload Motivational Interviewing with William Miller Video Transcript.docxActivity One:
For your own reflection, consider the following questions and record your answers below.
Watch this extended video with William Miller(101:43 minutes)
In this longer but very useful video, Miller explains why he believes MI is a genuinely person-centred approach, how MI developed based on Rogerian principles, and Millers perception of gaps in behavioural therapies. As well as exploring the processes of MI in general, Miller explains that MI is a skill that develops through practice, and that people are experts on their own lives.
Motivational Interviewing William R. MillerLinks to an external site.Motivational Interviewing William R. Miller Transcript.docxDownload Motivational Interviewing William R. Miller Transcript.docxRead (in your reading list) Miller, W.R. & Rollnick, S. (2009). Ten things that motivational interviewing is not.Behavioural and Cognitive Psychotherapy, 37(2), pp. 129140.
This article also explains the difference between MI and the 'Stages of Change' model - you'll understand more about how the two came to be seen as one - even though they are different.
Motivational Interviewing Strategies and Their Evolution
Originally, five key principles of motivational interviewing were developed (Miller & Rollnick, 1991):
Express empathy: Through using reflective listening, communicate your understanding of your client's positionfrom their perspective.
Develop discrepancy: Help the client develop insight into their thinking and behaviours, from a perspective of curiosity.
Avoid argumentation: MI recognises that a client arguing against change can simply be acknowledged. This is a particularly pivotal aspect of MI; the therapist communicates that they understand and acknowledge the client's position; yet change is not coerced nor enforced, and no judgement is conferred about the client's position in relation to change.
Roll with resistance: As a natural progression of declining to push against a client's proferred resistance to change, the therapist simply accepts that that is the client's perspective, and moves on.
Support self-efficacy: MI understands that each person is an expert on their own lives, and also that they can develop the skills to access change if they want.
MI has evolved over the years from these five principles into a four-stage process (Miller & Rollnick, 2012): Engaging, focusing, evoking and planning.
Watch this lecture by Rollnick about the spirit and evolution of MI: In the first half of the video, Rollnick explains the development of MI and the reasons for the evolution into its current form and process. From 36:00 on Rollnick explains the evolved process of MI, and includes analysis of a conversation from an MI process perspective.
The Changing Face of MILinks to an external site.The Changing Face of MI Transcript.docxDownload The Changing Face of MI Transcript.docxNow, watch an MI session in action which utilises the evolved MI structure of engaging, focusing, evoking and planning. Helpfully, the video has been subtitled with the MI process in use.
Using Motivational Interviewing ApproachesLinks to an external site.Using Motivational Interviewing Approaches Transcript.docxDownload Using Motivational Interviewing Approaches Transcript.docx
Stages of Change Model
The Stages of Change Model is a key part of the Transtheoretical Model of Behaviour Change.
Prochaska and DiClemente developed a theory around a person's ability to effect change (Prochaska & Norcross, 2003). They proposed that when considering change, a person moves forward (and sometimes backwards) through several stages:
'Pre-contemplation', where the person does not have an intention to change, and may be completely unaware that they may have a problem to address
'Contemplation', where there is an awareness of a problem, but no commitment to change has been made
'Preparation', where there is intention to change
'Action', where change is taking place
'Maintenance', where change is consolidated. It is actually an active phase as the person seeks to avoid relapsing.
Relapsing is such a common part of progressing through the stages of change that it is often normalised as one of the stages rather than viewing it as failure.
Activity Two:
Listen to this podcast about the Stages of Change Model and include some notes in the activity box below. A transcript is also included.
https://radiopublic.com/the-social-work-podcast-8XMevq/s1!a7aa4Links to an external site.
Companion Activity
Discuss the podcast with your companion.
Looking back over your notes from Activity One, does it make you think about where some people you know of might be on the wheel of change?
Make some notes in the box below.
Reading
From your reading list: Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (2013). Applying the stages of change.Psychotherapy in Australia, 19(2), 10-15.
You will notice in this article the emphasis that change is not a linear process; people move backwards and forwards between the stages.
Stages of Change Model
Source:Prochaska&DiClemente(1983, 1993).
This table sets out what each stage of change 'looks' like, and some potential strategies.
Potential Strategies
Stage Strategies
Pre-contemplation The client is unaware there is a problem, unwilling to change, or perhaps toodiscouraged. There is no plan tochange within next sixmonths. The least effectivestrategy at this stage is persuasion - the most effective strategies are listening, empathy, and identifying barriers, using OARS techniques (Open-ended questions,Affirmations,Reflections, &Summaries). Focus on the advantages of changeifchange talk emerges.
Potential approaches for the 'pre-contemplation' stage of change:
Validate their expressed lack of readiness for change
Clarify that the decision around change is theirs
Explore potential concerns the client may have
Acknowledge that the client may feel pressured
Encourage self-exploration (not action)
Enquire: Was there a time when life was going well? What is the client's history of events and feelings?
Encourage re-framing of current state of change as the potential beginning of a change, rather than a decision to never change.
Contemplation The client is open to information, thinking about trying something in next sixmonths - a goodplace for providing information and, emotional support. Keep in mind that the client might express negative aspects to change.
Potential approaches for the 'contemplation' stageofchange:
Validate the client's lack of readiness
Clarify that decision for change is theirs
Encourage evaluation of pros and cons of behaviour change: Whats good about the problem behaviour? Whats negative?
Ask: What is likely to happen if you continue [problem behaviour]?
Ask: How would it be if you stop [problem behaviour]?
Ask: What would you like life to look like in the future?
Identify and promote new, positive outcome expectations.
Preparation The client is getting ready to try out new behaviours within 30day. Strategies at this stage can include goal setting and enlisting the support of others
Potential approaches for the 'preparation' stageofchange:
Prioritise behaviour change opportunities
Identify and assist in problem solving around obstacles
Help the client identify social support
Verify that the client has the underlying skills for behaviour change
Encourage small initial steps
Action Taking steps, needing will power, habituatingbehavioursneedstimulus control, reinforcing positive behaviours, continuing emotional support.
Potential approaches for the 'action' stageofchange:
Focus on restructuring cues for the unwanted behaviour and bolstering social support
Bolster self-efficacy for dealing with obstacles
Combat feelings of loss and reiterate long term benefits of this change
Maintenance Has engaged for at least sixmonthscontinueto give emotional support, relapse identification &prevention.
Potential approaches for the 'maintenance' stageofchange:
Plan for follow-up support
Reinforce internal rewards
Discuss coping with relapse
Relapse Fall back into old patterns of behaviour- the cycle starts again.
Potential approaches for the 'relapse' stageofchange:
Evaluate the triggers for this relapse
Reassess the client's motivation - Have they moved back to an earlier phase?
Assess for barriers to change and plan for stronger coping strategies.
Utilising the Stages of Change Model in Motivational Interviewing
Watch this presentation on how the Stages of Change Model can be utilised in Motivational Interviewing:
Motivational Interviewing and the Transtheoretical Model of ChangeLinks to an external site.Motivational Interviewing and the Transtheoretical Model of Change Transcript.docxDownload Motivational Interviewing and the Transtheoretical Model of Change Transcript.docx
Question Summary
You candownload a summaryof the questions together with your submitted answers above to assist with assessment preparation.
References
Miller, W. R. & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behaviour. New York: Guilford Press
Miller, W. R. & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press
Prochaska, J. O., & Norcross, J. C., (2003). Systems of psychotherapy: A transtheoretical analysis (5th ed.). Pacific Grove, CA: Brooks/Cole Pub.
ASSESSMENT 3: CASE STUDY, VIDEO RECORDING & SELF-CRITIQUE
INFORMATION SHEET
Due date: Check course profile
Weight: 50%
Format: Essay and video recording
Marked out of: 100
Word limit: Maximum of 2,500 words (Word count is from beginning of first paragraph to end of last paragraph, excluding reference list).
Aim
The aim of this assessment item is to develop your knowledge of how to use specific counselling approaches when working with an individual.
Task description
This assessment requires you to develop a 30-minute video recording of yourself demonstrating counselling skills and write a 2,500-word critical reflection.
To complete this task, you will be provided with a hypothetical case scenario (see below) to apply one of the following counselling approaches to:
Motivational Interviewing or
Solution focused brief therapy or
Cognitive behavioural therapy
Recording and submitting your counselling video
You will make a 30-minute video recording of your counselling session with the 'client' in the case study utilising one of the counselling approaches listed above, with another student in the role of client. You can record an in-person session using your device or a telehealth (online) session using Teams.
Read through the case study and decide what counselling approach you will use with the person. Think about what micro-skills and therapy techniques you can draw on when working with them.
Provide your fellow student in the role of client with the case study scenario.
Your session should be one continuous recording (i.e., not edited), however if you apply the 10-minute break as part of Solution Focused Brief Therapy pause the recording for the break, and overtly state in the recording when you return from the break.
Critical reflection (2,500 words)
On completion of the recorded session, you will then undertake a written self-critique, followed by a critical reflection on how you could have used the other two counselling approaches. Follow these steps to write your critical reflection:
Watch your video several times and take notes on your approach and the impact of your skills on the session. Document specific examples from the video and back up your analysis with evidence from the literature (as you did for Assessment 2). When watching your video think about:
Was rapport established with the client?
Which skills did you use in the session? Were the skills used effectively?
What was the impact of the counselling skills or approach used?
What helped or hindered the counselling process? How could you tell?
How did your use of skills or approach contribute to the counselling relationship?
What worked well or not so well in the session and why?
What could have been done differently? Suggestions for change or improvement.
When and how could you have used the other two approaches in the session?
Before writing your essay review the marking criteria below which contains more in-depth information about the breakdown for marks.
Tips for completion
Focus on the approach and skills used in the video, using examples to illustrate your points.
Make sure to discuss what you did well, but if you think you made mistakes in the session then discuss this also and propose suggestions for how things could have been improved.
In writing up your critique ensure you note the timing on your recording where you have demonstrated a particular skill or technique that you want noted by the markers (e.g., 2:30).
Use the literature to support your ideas in your essay, drawing on academic journal articles and books (not websites).
Make sure to include an introduction to your essay which introduces the reader to the topic, includes a thesis statement and explains what you will be covering.
You will also need a conclusion which summarises the key points in your essay and considers the thesis statement. Do not introduce any new information in your conclusion.
It can be easy to go off track when writing an essay. Before submitting your essay review the marking criteria again to ensure that you have covered all the areas.
Referencing
Use APA7 referencing style for in-text citations and for your reference list.
Submitting your assignment
Submit your video file through the dedicated video submission point.
Submit your paper through the dedicated submission point for assignment 3.
Extensions
Information about the circumstances in which extensions are considered and the supporting documentation needed is here: Assessment applications (griffith.edu.au)Marking Criteria for Assessment Item 3: Case Study, Video Recording and Self-Critique
Criteria Excellent Good Poor
Use of the chosen approach to working with the client
( /20 marks)
15 to 20 marks
Rapport was clearly established with the client and maintained.
Specific strategies from the approach were executed at a high level.
The goals of the session were achieved.
Appropriate open and closed questioning used throughout the session.
Demonstrates accurate and clear paraphrasing of what the client said.
Demonstrates accurate reflection of the clients key emotions.
Displays care and is non-judgemental towards the client throughout the whole session.
The conversation with the client flowed naturally.
Supported autonomy of the client in making decisions. 9 to 14.5 marks
Rapport was established with the client.
Specific strategies from the approach were successfully attempted.
The goals of the session were partly achieved.
Some appropriate open and closed questioning used in session.
Some accurate and clear paraphrasing of what the client has said.
Some accurate reflection of the clients key emotions throughout the session
Displays care and is non-judgemental towards the client for most of the session.
Mostly respected client autonomy. 0 to 8.5 marks
Rapport was not established with the client.
Specific strategies from the approach were attempted but not successfully.
The goals of the session were not achieved.
Limited appropriate open and closed questioning used in session.
Limited accurate paraphrasing of what the client has said.
Limited accurate reflection of the clients key emotions
Limited display of care and/or is judgemental towards the client in the session.
The counsellor appeared to be reading from a script.
The client appeared to be reading from a script.
The counsellor was directive with the client.
In-depth self-critique of the counselling session focusing on you in the role of the practitioner.
( /25 marks) 19 to 25 marks
The key features of the approach are clearly discussed.
Comprehensive self-evaluation of the skills and approach used by you (the practitioner) in the video.
Comprehensive consideration of the impact of the approach/skills on the individual/session.
Discussion of the limitations and benefits of the approach used.
High level changes or improvements suggested in order to better address the clients needs. 12 to 18.5 marks
The key features of the approach are described.
Self-evaluates the skills and approach used by you (the practitioner) in the video.
Consideration of the impact of the approach/skills on the individual/session
Brief listing of the limitations and benefits of the approach used
Several changes or improvements suggested in order to better address the clients needs. 0 to 11.5 marks
The key features of the approach are inadequately covered.
Limited or inadequate self-evaluation of the skills and approach used.
Limited or inadequate consideration of the impact of the approach/skills on the individual/session
No discussion of the limitations and benefits of the approach used.
Limited suggestions made to better address the clients needs.
Critical discussion about how you could have used the two other counselling approaches in this session.
( /15 marks) 11 to 15 marks
Comprehensive discussion of how/when the two other approaches could have been used in the session.
Specific skills/techniques are identified that could have been used and how they could make a difference. 7 to 10.5 marks
Describes how/when the two other approaches could have been used in the session.
Specific skills/techniques are identified that could have been used. 0 to 6.5 marks
Little or no reflection on how/when the two other approaches could have been used in the session.
No specific skills/techniques are identified that could have been used.
Inclusion of examples to support your self-evaluation of the session and critical discussion of the other two approaches. (Including time codes and/or quotes)
( /15 marks)
11 to 15 marks
Analysis includes highly relevant examples which support the points raised in the self-critique.
Analysis includes a broad range of highly relevant examples which support the points raised in the discussion on using other approaches.
All examples are used correctly to support the analysis/discussion.
It is always clear which part of the video is being discussed (time codes always used).
Highly relevant quotes provided to demonstrate points. 7 to 10.5 marks
Analysis includes some relevant examples from the videos to support the points raised in the self-critique.
Analysis includes some relevant examples from the videos to support the points raised in the discussion on using other approaches.
Most examples are used correctly to support the analysis/discussion.
It is unclear sometimes which part of the video is being discussed (time codes not always used).
Relevant quotes provided to demonstrate points. 0 to 6.5 marks
Little or no examples used to support the points raised in the self-critique.
Little or no examples used to support the points raised in the discussion on using other approaches.
Few or no examples are used to correctly support the discussion.
It is not clear which part of the video is being discussed (time codes not used).
Poor use of quotes to demonstrate points.
Effectively integrate evidence-based literature for the self-critique and critical discussion of the other two approaches
( /15 marks) 11 to 15 marks
A high level of evidence-based literature/theory used to justify the self-critique.
A high level of evidence-based literature/theory used in the discussion on using other approaches.
Literature is very well integrated to support all ideas/points made
Excellent selection of highly relevant peer-reviewed journal articles and books support the discussion. 7 to 10.5 marks
Appropriate but limited evidence-based literature/theory used to justify the self-critique.
Appropriate but limited evidence-based literature/theory used in the discussion on using other approaches.
Literature is adequately integrated to support the ideas presented.
Journal articles and books within course reading list used as evidence to support the discussion. 0 to 6.5 marks
Little or no theory/literature used to justify the self-critique.
Little or no theory/literature used in the discussion on using other approaches.
Little or no literature support provided for the ideas presented.
Inappropriate references or websites are the primary source of evidence to support the discussion.
Academic conventions including appropriate form, structure, language, and use of citations and referencing consistent with APA 7 style guidelines.
( /10 marks) 8 to 10 marks
Essay is very well structured.
Format is completely in alignment with APA style.
Expression is very clear and concise.
Accurate grammar and spelling with no errors.
No errors in APA style requirements for in-text citations and reference list
Strong introduction to the essay that includes a thesis statement, sets the scene, and entices the reader to continue.
Strong conclusion that synthesises the main points and considers the thesis statement. 5 to 7.5 marks
Essay is appropriately structured.
Format is generally in alignment with APA style.
Expression is adequately clear.
Acceptable grammar and spelling with some errors.
Some errors in APA style for in text citations and reference list .
Includes an introduction to the essay that sets the scene.
Includes a conclusion to the essay that summarises the main points 0 to 4.5 marks
Essay lacks appropriate structure.
Essay is not presented in APA style format.
Expression is poor and impacts negatively on comprehension.
Significant errors in grammar and spelling.
Significant errors in APA style requirements for in-text citations and reference list.
No introduction to the essay.
No conclusion to the essay.
The scenario(Note: This scenario can be adapted to any gender.)
The client is 35 years old, has been with their partner for ten years and has three children aged 8, 6 and 4.
The client is feeling gloomy and down about their life and have been referred by their GP for counselling as they have become very negative in their thinking and have begun using alcohol on a daily basis to cope with how they are feeling. They use to be quite social with their friends and worked out regularly at the gym but they no longer are motivated to do this. Instead they spend all their spare time watching television alone.
While their job as an IT technician for Computer Whiz is going well they do not find their work exciting any more. In fact they feel very bored at work and the days seem terribly long. The client wants to move into a different work role but are unsure how to go about this. They are reluctant about changing their job as it might mean further training and they are not sure if they can cope with this at present and feel overwhelmed just thinking about it.
While their partner seems happy with their relationship and family life, they feel they want more but dont know what more might be. The client use to laugh lots and usually enjoyed doing fun things with their friends and family but they feel they dont know how to play anymore.
The GP is worried about their alcohol intake and how it might be impacting on their mood, their work and family life. The GP says that they need some counselling to assist them to regain a better sense of well-being and get some positivity back into their life.
This is your second session and you need to explore some of these issues a little further and if relevant, provide them with some activities to do before coming to your next session.
End of scenario -
