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Motivational Interviewing

Motivational Interviewing is a form of counseling that tries to encourage individuals to make an important but difficult change in their lives. This method was originally developed to help people with alcoholism decide to seek help for their condition, and it continues to be used to motivate individuals will all sorts of addictions to change their ways.

Motivational Interviewing sees real change as being possible only when a person decides for themselves that this what they want and need; change cannot be imposed effectively from an outside source. Most people who face the prospect of an important change, such as trying to quit an addiction, will have ambivalent feelings about this change. On the one hand they likely know about many of the damaging effects that their addictions pose and they may want a healthier lifestyle, yet they will also continue to crave the highs or the short-lived feelings of relief that the addictive substances provide.

Motivational Interviewing will try to zero-in on this area of ambivalence and will encourage the patient to identify all of the pros and cons of their substance use and of the possibility of change. It is the client's task, not the counselor's, to articulate and resolve his or her ambivalence. The counselor's task is to facilitate expression of both sides of the ambivalence impasse and guide the client toward an acceptable resolution that triggers change.

The counselor tries to adopt a nonjudgmental stance and to relate to the client as a partner or companion rather than an expert or authority figure. The counselor will use reflective listening to try to understand the client's perspective and will express acceptance and affirmation of this perspective. The counselor will also try to reinforce those statements made by the client that suggest a desire for change, but will need to be careful not to get ahead of the client's pace. When clients show signs of resistance to change, this is viewed as feedback to the counselor that the client is being pushed too fast or is not being completely understood. At all times, the counselor is expected to affirm the freedom of choice and self-direction.

Presented in this way, Motivational Interviewing is as much a philosophy of how to relate to clients and patients as it is a specific technique. There have been several off-shoots of Motivational Interviewing, including the following:

    The Drinker's Check-up: This method involves conducting a full assessment of a client's drinking and related behaviors, and then offering a systematic feedback to the client of the findings of the assessment. This is thought to help the client more fully appreciate the pros and cons of their drinking behaviors. This method can also be used for other problem areas besides alcoholism. It is the open-minded and nonjudgmental style in which the feedback is offered that makes this approach a form of Motivational Interviewing.

    Motivational Enhancement Therapy (MET): This is a four-session adaptation of the Check-up method described above, with the two first sessions dedicated to the check-up, and the last two sessions used for follow-up. Counselors use the Motivational Interviewing techniques. This intervention was developed specifically for a large clinical trial of treatments for alcohol abuse and dependence, called Project MATCH.

    Brief Motivational Interviewing: This is an adaptation of Motivational Interviewing designed to be used by family doctors in their busy practices, where they can employ some of the generic principles of this counseling style in a single session of around 40 minutes.