Magazine article Addiction Professional

The Latest in Motivational Interviewing

Magazine article Addiction Professional

The Latest in Motivational Interviewing

Article excerpt

I recently had the pleasure of spending three days in a "train the trainer" workshop presented by William Miller, whose 1983 article on Motivational Interviewing (MI) changed the world. (1) MI is a person-centered, goal-directed counseling method for resolving ambivalence and promoting positive change by eliciting and strengthening the client's own motivation for change. It has revolutionized the face of addiction treatment, as well as many other human services industries.

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Several exciting developments have made MI easier to learn and easier to teach. Also, supervision instruments that measure fidelity to the MI approach have been developed. Much of the MI information that I summarize below comes from lectures, discussions and handouts at Miller's workshop, presented in November 2008 and sponsored by the New York State Office of Alcoholism and Substance Abuse Services (OASAS).

The acronym D-A-R-N C-A-T

MI focuses on change talk, which is any speech that favors movement toward change. (Change talk was referred to as self-motivational statements in early MI literature.) Some change talk is preparatory, and this includes talk about the Desirability of change, the Ability to change, expression or affirmations of Reasons to change, and talk about Needing to change.

Counselors are instructed in the use of MI techniques to fan the flames of preparatory change talk until the client breaks into mobilizing change talk. Mobilizing change talk includes talk of a Commitment to change, signs of Activation that include talk about being willing to change, and reports that the client has actually begun Taking Steps toward change.

In MI, a distinction is made between "resistance" and "sustain talk." Sustain talk is any talk that supports the status quo, and is not a major cause for concern. It is just the other side of the client's ambivalence toward change, and is to be expected. Ambivalence is a counselor's friend, and MI techniques help counselors tip that ambivalence in favor of positive change. On the other hand, resistance is not related to ambivalence and manifests itself as an unwillingness to participate.

Techniques employed

Motivational Interviewing is client-centered, but differs from other therapies because it is goal-directed. There is a target behavior to extinguish, a target behavior to develop, or both. The techniques provide direction by carefully selecting questions, reflections, elaborations, summaries and affirmations that gently guide the client toward the goal.

The acronym used for these techniques is O-A-R-S, referring to Open-ended questions, Affirmations, Reflections and Summaries.

Open-ended questions are used to help explore client ambivalence and to develop discrepancy. Open-ended questions encourage the client to elaborate, since they can't be answered by a "yes" or "no" or other short answer. For example, "Do you want help in quitting drugs?" will probably result in less useful information than something such as "Tell me what your concerns are about continued drug use." (In MI, "Tell me about ..." counts as an open-ended question, even though it is not technically an interrogative.)

Counselors generally ask too many questions, and too many of the questions they ask are closed. As a general guideline, counselors should ask more open than closed questions, and offer two reflections (see below) for each question asked. …

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