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Motivational Interview

What is the motivation?

Motivation is defined by Miller and Rollnick as ready to change or being eager for change.

Who are improve the motivational interview?

While Miller was working on alcoholic addicts (1983), he proposed motivational interview due to his experiences. After that, this therapy form was developed by Miller and Rollnick.

What is the motivational interview?

Motivational interview helps to individuals to understand their problems and step in to change their unwanted behaviors. This method is useful for people who are not willing to change or who have ambivalence. (ambivalence: a person’s thoughts, aims, and wishes that all contradict each other.)

The aim of motivational interview is supporting the self-efficacy of a client and to increase their beliefs to themselves.

In this method, therapists focus on clients’ current interests, anxieties, and worries.

The obvious difference between cognitive behavioral therapy (CBT) and motivational interview is that; motivational interview influences a client to prepare themselves for change, CBT accepts the client is already ready to change.

In which cases motivational interview is used?

In the first times of this method, it was thought that it is useful for only alcohol and drug addicted, but now the area of application has expanded: obesity, chronic aches, diet, diabetes, protection from HIV/AIDS.

What are the features of motivational interview?

Motivational interview is an effective method to better see advantages of change, and disadvantages of staying the same.

If the client does not decide to change, the therapist should not make suggestions for the solution.

Direct persuasion, creating discussion, offensive confrontation are against the principles of motivational interview.

In this method, the person directing the interview is the client.

What are the principles of motivational interview?

1. Showing the Empathy: Therapists emphasizes they understands the behavior of clients, and respects clients, and accept their situation. (However, the acceptance of situation should not be a kind of approval.)

2. Appearance of the Contradictions: Therapists help clients to notice the contradictions of their wishes and behaviors. Therapists should not create a debate; clients should discuss for their change.

3. Working with Resistance: Clients see and accept new perspectives with help of therapists. Therapists should not force clients to change, instead the therapists should change clients’ perception and keep pace.

4. Supporting the Self-efficacy: The clients’ belief that they can make changes is significant for the whole process.

What are the methods used in the motivational interview?

1. Asking open-ended questions: It helps to clients to express themselves in a better way.

2. Listening by reflection: The aim of this method to feel that clients, their therapist tries to understand themselves. In addition, therapists can check if they correctly understand their client’s thoughts.

3. Approval: If therapists say to clients that: “I appreciate you to come here regularly, and continue the sessions.”, clients may be notice that they strive for the change, and they feel better.

4. Summarizing: It effective to convey emotions and content. If therapists want to summarize, they can do that, or they can ask their clients to summarize. In summarizing can address whole interview or a certain part of interview.

5. Uncovering Speech of Change: It separate into four.

5.1. Noticing the disadvantages of current situation.

5.2. Noticing the advantages of change

5.3. Expressing optimism about the change (Clients can say “If I decided to do this, I could do that.”)

5.4. Expressing the intention of change (Clients realize they must do something for change)

The methods of uncovering speech of change:

- Asking associative questions: “What do you think is the reason that you came here? Do you think you have a problem in your life?”

- Using importance scale: It is significant to understand clients’ ambivalence. Asking questions with using the scale which is prepared the area of 0-no matter and 10-very important, and questioning clients’ score.

- Investigating the balance of decision: Talking about the positive and negative aspects of current situation. It is effective in helping clients see negative aspects.

- Detailing: Therapists ask clients to explain the reasons for the change.

- Investigating the aims and the values: The aim of this method to reveal the contradiction in current behaviors by asking clients telling their values in their lives.

- Questioning endpoints: If clients have a little desire for change, this method can be helpful for thinking about endpoints in their worries or imagining the best comings after the change.

- Looking into the past: With this method, clients remind their life before the problems, and questioning their current situation, and noticing that their life will be better.

- Looking into the future: With this method, it is assumed that clients do change and how they see their life with change, or clients do not change and how they see their life without change.

Transtheoretical Model

Transtheoretical model suggests that changing behaviors is a process, change has stages. This model was developed by psychologist James Prochaska and Carlo Diclemente.

In this model, the change has 5 steps:

(Note: The given examples are based on drug addiction.)

1. Pre-Intentional Stage: The clients do not aware of harms of their behavior, and do not think about the change. They do not have any bad experience about drug use, and they did not listen to their environment.

1.1 Aim and Appropriate Motivational Strategies in Pre-Intentional Stage: Helping the clients to think about possible harms in drug use. Between therapists and clients occur trust bond, and therapists tell they can give objective information about addiction if clients want, and clients approve that they attend the sessions, and therapists try to understand the reasons clients come therapy.

2. Intentional Stage: Clients accept their problems and think for change. Generally, they are in a dilemma and aim of this step pull of the dilemma towards to change.

2.1 Aim and Appropriate Motivational Strategies in Intentional Stage: Therapists help to clients to notice contradiction between their aims and behaviors, and therapists help to clients to progress on change. Ambivalence is normalized.

3. Preparatory Stage: Clients decide on a change and think positive outcomes of change. They set goals and share these goals with valuable people for them.

3.1 Aim and Appropriate Motivational Strategies in Preparatory Stage: Therapists give an awareness to clients about they can make changes. Therapists help to clients to explain negative aspects of change.

4. Action Stage: Therapists try to give clients new habits. In this stage, change is starting. Because of the possibility of back to the old habit, this phase takes at least 3 at most 6 months. In this phase is defined as hardest stage because clients try to change their old habits and their environment.

4.1 Aim and Appropriate Motivational Strategies in Action Stage: Therapists support change progress of clients and provide clients to reach support of society. Also, therapists help to client to deal with unpredictable negative outcomes of change.

5.Maintenance Stage: It is the last phase in which the behaviors are gained in action stage are strengthened. In this stage, clients changed their habits, and their new behavior continued for more than 6 months.

5.1 Aim and Appropriate Motivational Strategies in Maintenance Stage: Therapists aim to help clients create new methods to be protected from repetition of old habits. The motivational strategies of this step include, therapists should confirm self-efficacy of clients. Also, therapists state the willingness to assist the client in case of repetition of old behavior, and mention that they keep in contact.

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