ANGER ON MY MIND

Method of motivational interviewing

Posted on: July 6, 2007

Introduction

Motivational interviewing techniques aim to encourage the individual to decide to change their behaviour where ever an individual is ambivalent about changing that behaviour. For example, an individual may be uncertain about starting a treatment strategy that a clinician believes will benefit them, or may be stuck in a persistent pattern of behaviour that is harmful (even when they are aware of the damaging consequences of that behaviour).

While motivational interviewing techniques can be applied in a wide range of mental disorders and problems, they were first developed for use with individuals with substance use disorders. Motivational interviewing was based on the assumption that most individuals are still ambivalent about changing their drinking or drug taking when they consult for treatment. Therefore diagnosis of a problem or confrontation leads to “defensive” reactions (e.g., “I don’t have a problem”). In contrast, motivational interviewing aims to help individuals themselves to be aware of the reasons for concern and the arguments for change.

Method of motivational interviewing

The implementation of motivational interviewing techniques are varied and should reflect the treatment goals of the individual. Outlined below are two key strategies for expressing concern. Each strategy can take between 5 and 15 minutes.

Exploring the good and less good aspects of a behaviour

This strategy is a good first step in building rapport.

  • Good things: Build rapport by beginning the session by asking “What are some of the good things about …”. Acknowledge and summarise all the good things about the behaviour.
  • Less good things: Assist the individual to identify “less good” aspects of the behaviour by asking “what are some of the less good things about …”. Prompt for specific reasons why the individual believes these things to be less good. Acknowledge and summarise all the less good things about the behaviour.
  • Exploring concerns: You should not assume that a “less good thing” is a concern for the individual. Prompt for the level of concern about the “less good things”, for example “How do you feel about that?”, “Is that a problem for you?”. It is only the areas of concern which are likely to motivate an individual to change.
  • Summarising: Summaries the information elicited above in the individuals own words. Do not simply list all the “less good things”, rather summaries those that are of concern. The aim is to assist the individual in feeling that the concerns and worries out weigh the good things.

Life Satisfaction

This strategy deploys discrepancy between how things are and how they were or could be; and contrast the true self with the “individual with the behaviour”, the parent role with the “individual with the behaviour” etc.

  • Looking back: begin with the following type of question “When you were [age] what did you think you would be doing now?”. It is then possible to explore discrepancies between past expectations and the current situation. The aim is to guide links between substance use and goals and aspirations.
  • Looking forward: Similarly ask “How would you like things to be different in the future?” The aim is to produce expressions of concern about the behaviour. · Summarise: Summarise past and future aspirations in relation to the present and emphasis the role of the behaviour.

Helping with decision-making:

This step is about assisting the individual in the Preparation stage of change who has expressed concerns to take action.

  • Summarise: The first step is to summarise the concerns the individual holds about their behaviour, this acknowledges any ambivalence about change which may still exist.
  • Encouraging action: The following types of questions may be used to encourage the concept of action “Where does this leave you now?”. If the individual indicates that they wish to change their behaviour it is extremely important that the clinician does not “take over”. Alternatively a range of goals and treatment options should be outlined.

Summary

  • Motivational interviewing is particularly useful when people are reluctant to change or are ambivalent about change.
  • Motivational interviewing does not always proceed to action and determination in one session and can take many sessions.
  • Motivational interviewing is applicable in brief encounters like general practice settings, and the effect may build up over time.
  • The lack of actual obvious change does not mean that effort is wasted. It may be part of an eventual and final change attempt in the future.
  • The techniques aim to maximise the chance of change, but won’t work for everyone.
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1 Response to "Method of motivational interviewing"

Motivational interviewing is critical for use with unmotivated anger management clients. When the Conover Assessment Map determines that a client has deficits in anger management, stress management, assertive communication or emotional intelligence, motivation must be used to elicit the clients willingness to engage in the process of change.

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