We often think that the various psychological interventions focused on treating mental health problems are simply the therapies themselves. However, an interview can also be a psychological technique and part of therapy, as we will see.
In this article, we will learn more about the motivational interview of William Miller and Stephen Rollnick., Developed in 1999 and focused on the management of addictive behavior. We will know its phases, its principles and the strategies it uses to bring about a therapeutic change.
Motivational interview: characteristics
Motivational interviewing was developed by W. Miller and S. Rollnick in 1999 and was aimed at treat addictive disorders such as dependence on alcohol or other substances (As well as various addictive behaviors). This interview was originally conceived as a brief therapeutic approach, to respond to the ambivalence vis-à-vis the change characteristic of this type of patient.
The interview is based on a theoretical basis which considers that the motivation for change is not imposed from the outside, But arises from the ambivalence of the patient.
It is also an approach according to the transtheoretical model of Prochascka and DiClemente (Which we will see later), also in agreement with the results of contemporary research on the factors which explain the effectiveness of psychotherapy.
For their part, their authors W. Miller and S. Rollnick have always maintained that motivational interviewing is an approach with a particular philosophy, and not so much a technique.
Who is he talking to?
Motivational interviewing has been applied and applies to patients who have some kind of addictive disorder, either due to abuse or problematic substance use, in order to encourage adherence to treatment also people with mental health problems and chronic health problems.
In addition, it also makes it possible to adopt healthier lifestyles (exercise, balanced diet, safe sex, etc.)
Motivational interviewing is based on a number of principles; are the following:
1. Expression of empathy
The first principle states that empathy of the therapist is essential; thus, the therapist’s acceptance of both the patient’s problems and his addiction itself and his behaviors facilitates therapeutic change.
2. Develop a gap
The change appears as a consequence of the discrepancy that the patient perceives between his actions, his thoughts and what he really wants to achieve in the long term (partial or total abstinence).
3. Accept resistance
The third principle of motivational interviewing maintains that the therapist should not confront the patient with his differences, nor provide arguments about the need for change; consider that the therapist must play a more “free or neutral” role in this way.
4. Support for self-efficacy
The fact that the patient truly believes that change is possible motivates him. the therapist you will have to support this feeling of self-efficacy when it appears.
Motivational interviewing takes place in two distinct phases:
1. Building motivation for change
The first phase will aim to help build real motivation for change, permanently giving up the drink or drug in question (Or reduce consumption, depending on the agreed therapeutic goal).
In this phase, the following techniques are used: the use of open-ended questions, reflections, summaries, recognition, acceptance of resistance and provocation of divergence.
2. Strengthen commitment to change
In this phase of the motivational interview, the patient’s commitment developed during the previous phase is reinforced. Here is a summary of everything that has been worked on so far, and also: goals or objectives are set, The various change options are considered, an action plan is designed and the patient’s commitment is extracted.
Motivational interviewing has been found to be more effective than not treating addictions; it is particularly useful for potentiating other treatments, Improved patient compliance, participation and satisfaction.
When is it used?
This type of interview is used at the contemplation stage of a person dependent on a substance; the stage of contemplation is that in which the patient has doubts about the change process.
The stages through which a person with a certain type of dependence passes have been proposed in the transteorico model of Prochaska and Diclemente. Let’s see what they are (in order of appearance over time):
- precontemplation: No intention to change at this time.
- contemplation: The option of change is being considered.
- Preparing for action: The person is preparing to act.
- action: The person goes into action and leaves the substance.
- maintenance: The person stays sober for at least 6 months.
- relapse: The person is consuming again.
- Completion stage: Addiction is overcome.
According to Prochaska and Diclemente, people with some kind of addiction to certain substances go through these phases; they would normally go in order, but they can produce regressions in stages, turns, changes, repetitions, etc. For example, a person can go from maintenance to relapse, from relapse to maintenance, and again to relapse.
Horse (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Flight. 1 and 2. Madrid. 21st century. Miller, W. (1995) Motivational Enhancement Therapy with Addicts. Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Alburquerque: University of New Mexico. Pacheco, M. (2011). Motivational interview with William Miller and Stephen Rollnick. Center for the Development of Brief Strategic Psychotherapy, 1-43.