MOTIVATIONAL INTERVIEWING: Preparing People to Change Addictive Behavior, and the most recently revised third edition, are books written by William R. Miller & Stephen Rollnick.  These publications contain a wealth of information for professionals working with people who are working on change, including a host of contributions from a variety of colleagues offering unique perspectives and experiences when using motivational interviewing (MI).

Although the authors acknowledge that one approach is not appropriate for all populations, this MI focuses on the professional’s ability to foster a person’s motivation to change. It is particularly useful with those struggling with ambivalence to change and addictive behaviors.

Motivational interviewing draws on strategies from client-centered counseling, cognitive therapy, systems theory, social psychology of persuasion, and can be used in conjunction with other therapeutic approaches. It is been based upon James Prochaska and Carlo DiClemente’s “transtheoretical” model and recommends helping the client to determine what stage of change they are in as part of the therapeutic process.

Stage of Change, and focusing treatment specifically at that stage.

    • Precontemplation Stage: Not considering change
    • Contemplation Stage: Considering change, but is ambivalent
    • Preparation Stage: Has the desire to change, makes some effort/has some success
    • Action Stage: Extended periods of abstinence and intrinsically motivated to work
    • Maintenance Stage: Stable and abstinent
    • Relapse Stage: Begins to use after a period of stability and abstinence

The following is a general outline of the principles, strategies and skills used in MI.

The Five General Principles of MI:

    • Communicate emphatically
    • Develop discrepancy
    • Avoid of argumentation
    • Roll with resistance
    • Support self-efficacy

Strategies to enhance motivation for change: (A-H)

    • Give Advice
    • Remove Barriers
    • Provide Choice
    • Decrease Desirability
    • Provide Empathy
    • Provide Feedback
    • Clarify Goals
    • Active Helping

Examples of some of the basic skills and strategies used in MI:

*Communication strategies

    • Reflective Listening
    • Open-ended Questions
    • Affirmation – Genuine and matching both the rhythm and tone of the client
    • Summarization – Summary statements, which link together and reinforce what has been said, involving the client.

*Examination of the advantages and disadvantages of making a change

(Sample Chart)

  Making a change: Continuing to drink:
Advantages
  • Will save my marriage
  • Less money problems
  • It relaxes me

  • I like partying with friends
Disadvantages
  • Boredom

  • I’d need to change my whole lifestyle.
  • Upsets my spouse/family

  • Harmful to my health
  • Spend too much money

Occupational Therapists are encouraged to increase their understanding of MI. Many occupational therapists working in mental health treatment settings have added it to their repertoire of therapeutic approaches.

References:

Miller, W. R., & Rollnick, S. R. (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, NY: Guilford Press.

Miller, W. R., & Rollnick, S. R. (2012).  Motivational Interviewing: Helping People Change (3rd Edition). New York, NY: Guilford Press.

 

Motivational Interviewing, Third Edition: Helping People Change (2012) by William R. Miller (Author), Stephen Rollnick

Motivational Interviewing, Third Edition: Helping People Change (2012) by William R. Miller (Author), Stephen Rollnick