Motivational interviewing
Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed, and departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non-directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal.[1] MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship.[2]
Core concepts evolved from experience in the treatment of problem drinkers, and MI was first described by Miller (1983) in an article published in the journal Behavioural and Cognitive Psychotherapy. Miller and Rollnick elaborated on these fundamental concepts and approaches in 1991 in a more detailed description of clinical procedures. MI has demonstrated positive effects on psychological and physiological disorders according to meta-analyses.[3][4]
Limitations[edit]
Underlying mental health conditions[edit]
Patients with an underlying mental illness present one such limitation to motivational interviewing.[29] In a case where the patient has an underlying mental illness such as depression, anxiety, bipolar disorder, schizophrenia or other psychosis, more intensive therapy may be required to induce a change. In these instances, the use of motivational interviewing as a technique to treat outward-facing symptoms, such as not brushing teeth, may be ineffective where the root cause of the problem stems from the mental illness. Some of the patients may act like listening to the interviewer just to veil their underlying mental health issue. When working with these patients, it is important to recognize the limitations of behaviorally-focused counseling and motivational interviewing. The treating therapists should, therefore, ensure the patient is referred to the correct medical or psychological professional to address the cause of the behavior, and not simply one of the symptoms.[30]
Motivation[edit]
Professionals attempting to encourage people to make a behavioral change often underestimate the effect of motivation. Simply advising clients how detrimental their current behavior is and providing advice on how to change their behavior will not work if the client lacks motivation. Many people have full knowledge of how dangerous smoking is yet they continue the practice. Research has shown that a client's motivation to alter behavior is largely influenced by the way the therapist relates to them.[31]
Therapist/client trust[edit]
Clients who don't like or trust their health care professionals are likely to become extremely resistant to change. In order to prevent this, the therapist must take time to foster an environment of trust. Even when the therapist can clearly identify the issues at hand it is important that the patient feels the session is collaborative and that they are not being lectured to. Confrontational approaches by therapists will inhibit the process.[30]
Time limitations[edit]
Time limits placed on therapists during consultations also have the potential to impact significantly on the quality of motivational interviewing. Appointments may be limited to a brief or single visit with a patient; for example, a client may attend the dentist with a toothache due to a cavity. The oral health practitioner or dentist may be able to broach the subject of a behavior change, such as flossing or diet modification but the session duration may not be sufficient when coupled with other responsibilities the health practitioner has to the health and wellbeing of the patient. For many clients, changing habits may involve reinforcement and encouragement which is not possible in a single visit. Some patients, once treated, may not return for a number of years or may even change practitioners or practices, meaning the motivational interview is unlikely to have sufficient effect.[30]
Training deficiencies[edit]
While psychologists, mental health counselors, and social workers are generally well trained and practiced in delivering motivational interviewing, other health-care professionals are generally provided with only a few hours of basic training. Although perhaps able to apply the underpinning principles of motivational interviewing, these professionals generally lack the training and applied skills to truly master the art of dealing with the patient's resistant statements in a collaborative manner. It is important that therapists know their own limitations and are prepared to refer clients to other professionals when required.[32]
Group treatment[edit]
Although studies are somewhat limited, it appears that delivering motivational interviewing, in a group may be less effective than when delivered one-on-one.[29] Research continues into this area however what is clear is that groups change the dynamics of a situation and the therapist needs to ensure that group control is maintained and input from group members does not derail the process for some clients.[33]