Speaker 1: Welcome back everybody.
Speaker 2: Today we're gonna be looking at motivational interviewing. So it's
one of the highest yield psychotherapy approaches on the E
triple P. One of the reasons that combines therapeutic alliance,
behavioral change theory, empathy, stages of change, resistant management, client autonomy.
Motivational interviewing is commonly tested in substance use disorders, health psychology,
behavioral medicine treatment, adherent psychotherapy, integration.
Speaker 1: So what is it well.
Speaker 2: Motivational interviewing was developed by William Miller and later expanded
with Stephen Rolnick. It is collaborative, person centered, goal oriented,
and non confrontational. Motivational interviewing is design to help clients
resolve ambivalence about change. The central idea is people often
know they should change, but simultaneously want to change and
do not want to change.
Speaker 1: This is ambivalence.
Speaker 2: Ambivalence is having mixed or conflicting feelings about behavioral A
smoker says, I know cigarettes are heard of me, but
smoking helps me calm down. Motivation learning interviewing does not
argue against ambivalents, it explores it. A Motivational interviewing is
not a simple technique so the therapeutic stance the therapist
avoids authoritarian control, confrontation, arguing, shaming, or even expert positioning. Instead,
it emphasizes collaboration, evocation, and autonomy. Collaboration is the therapist
and the client work together as partners. Instead of saying
you need to stop drinking, they might say, help me
understand what alcohol does for you. Motivational learning interviewing rejects
the expert versus patient model evocation, drawing out the client's
own motivations and values. What matters most to you about
becoming healthier. A client, not the therapist voice, has reasons
for change. Also autonomy, respecting the client's freedom of choice.
You're the one who ultimately decides what happens. A tip
could be pressure increases resistance, autonomy reduces defensiveness.
Speaker 1: Why it works.
Speaker 2: Motivational interviewing reduces shame, defensiveness, and reactants while increasing intrinsic motivation,
self efficacy, and therapeutic alliance. Intrinsic motivation is the internal
desire to change based on personal values and meaning.
Speaker 1: A client exercises.
Speaker 2: Because they want energy to play with their children, not
because others pressure them. Another tip is intrinsic motivation is
more durable than external pressure self determination theory. Motivational interviewing
strongly overlaps with self determination theory, and there's three core
psychological needs autonomy, competence, and relatedness. Autonomy is feeling in
control of one's decisions. Competence is feeling capable and effective,
somewhat similar to Bandura's self efficacy.
Speaker 1: A client begins believing I can actually do this.
Speaker 2: Relatedness feeling emotionally connected and understood. The client feels expected
rather than judge, by the therapist. The therapeutic alliance, which
we know makes up most of the success of therapy,
is a collaborative emotional bond between therapists and client. One
of the strongest predictors of positive therapy outcomes across treatment models.
It resistant adolescents slowly engages because they feel genuinely heard.
Motivational interviewing places enormous emphasis on alliance building core motivational
skills like ores. This is extremely important for the E
triple p ors stands for open ended questions, A for affirmations,
R for reflective listening, and S for summaries. Let's take
a look at each one. So open ended questions, questions
requiring elaboration rather than binary answers like yes or no.
Speaker 1: Encourage exploration self reflection.
Speaker 2: For instance, what concerns you most about your current situation?
Speaker 1: What would you like your life to look like? You
can't answer these with a yes or no. Why is
it important?
Speaker 2: Because the increase engagement promotes self discovery, reduced defensiveness, and
encourage change. Talk affirmations. These are statements recognizing strengths, efforts,
or values.
Speaker 1: It took courage to come here today.
Speaker 2: Important point affirmations focus on effort, resilience, values, persistence, not
empty praise. Reflective listening is the heart of motivational interviewing.
The therapist reflects back meaning and emotion.
Speaker 1: One of the big reasons is.
Speaker 2: Because the client would feel heard and understood and emotionally safe.
Simple reflections repeating or slightly rephrasing the client's statement. I
just can't stop, says the client. You feel stuck, says
the therapist. A complex reflection.
Speaker 1: Would we be like this?
Speaker 2: You add meaning and emotional depth. The client says, I
keep relapsing. Part of you feels exhausted and discouraged. Complex
reflections deep and emotional processing. Double sided reflection is acknowledging
both sides of the ambivalence. You enjoy drinking because it
helps you relax, and you're also worried about what it's
doing to your health. Summarise is when the therapist reviews
key themes from the conversation. The goals that are reinforced
insight to ORGANI thoughts, strength and motivation, and couldsolidate change talk.
Speaker 1: To make it stronger. Let me see if I understand
so far is the beginning of it.
Speaker 2: The four processes of motivational interviewing unfolded four major stages.
Speaker 1: One is engaging.
Speaker 2: The goal is to build trust and connection, empathy, listening,
alliance building, So engagement comes before advice as a tip.
Speaker 1: Number two is focusing.
Speaker 2: Clarify the target behavior for change the client, I want
to address alcohol, use, medication, diet.
Speaker 1: Number three is evoking.
Speaker 2: The heart of motivational interviewing, you want to elicit as
the goal change talk. Change talk is where the client
statements favor change. For instance, some of the forms of
change talk include desire, I want to, ability, I could,
the reasons this would help me?
Speaker 1: Need? I need to?
Speaker 2: So what's the big deal about change talk? The more
clients verbalize reasons for change.
Speaker 1: The more likely change becomes.
Speaker 2: For instance, I'm tired of losing relationships because of drinking.
This predicts greater readiness for change. Remember, tired is going
to give us the reason writing, So we move on
planning as the fourth step goal move toward concrete behavioral action.
Planning happens only after sufficient motivation exists. Premature advice give
a game increases resistance. Then you have smart goals, often
integrated into motivational interviewing. Smartest specific, measurable, achievable, relevant, and
time limited. You also have sustained talk, supporting continuation of
current behavior.
Speaker 1: It's not that bad.
Speaker 2: As an example, I've tried before, I'm not ready. Sustained
talk is problematic. Change talk moves towards change, Sustained talk
moves away from it. How does that therapist respond to
the state?
Speaker 1: Talk?
Speaker 2: Motivational entering does not argue, shame or confront. Instead, it reflects, explores,
it validates the ambivalence Resistance a traditional view is client
pathology or stubbornness, and the view of motivational interviewing, the
resistance is a relational signal. It often means the therapists
push too hard. Autonomy feels threatened and the client fields misunderstood,
rolling with resistance, responding without confrontation. I don't think therapy
will help, says the client. Therapist says, you've probably had.
Speaker 1: Experiences where people don't really understand what we're going through.
Resistance decreases. When pressure decreases, then we go to the trance.
Speaker 2: Theoretical model the Stages of Change by Prochaska and Di Clemente.
Motivational interviewing aligns closely with the model. You have pre
contemplation where the client does not recognize the problem. I
don't drink too much contemplation. Maybe I should quit someday.
They have ambivalents about change, explore the pros and cons.
Number three is preparation and tending to act soon, and
I'm looking into treatment programs here. Your goal is to
strengthen the commitment. Number four is action, actively making changes,
attending therapy and reducing substance use.
Speaker 1: The goals to support the momentum.
Speaker 2: Number five is maintenance, sustaining behavioral changes, remaining sober for
over six months. The goals prevent relapse and finally relapse
return to previous behavior patterns. Motivational interviewing views relapses common
expected and non moral relapse is not viewed as failure.
Applications of motivational interviewing developed for substance use dis orders,
not widely using health psychology. Common areas include smoking, diabetes, obesity,
exercise adherence, medication compliance, and mental health. It's useful for
treatment engagement, depression, anxiety, psychosis, and bipolar disorder. Adolescence is
highly effective because of their respects, independence, identity, development, and autonomy.
It's great for medication adherence, especially useful in schizophrenia, bipolar
and chronic medical illness often.
Speaker 1: Prepares clients for CBT.
Speaker 2: The important difference, though, is CBT focuses on changing thoughts
and behaviors, while m I focus on increasing readiness change.
MII overlaps with act acceptance and commitment therapy. Both emphasize values, autonomy,
and psychological flexibility. So some common questions which skills consider
the heart of m If you said reflective listening, you're right.
Speaker 1: What is change talk?
Speaker 2: It's client statements favoring change. Which stage includes ambivalence contemplation?
How does motivational interviewing view resistance as a relational signal
not client pathology? And the last one, what does ORRS
stand for? Open ended questions, affirmations, reflective listening, and summaries
high yield pearls. Here am I is collaborative, not confrontational.
The therapist evokes rather than persuades reflective listening. Essential resistance
usually means a therapist is pushing too hard. Change talk
predicts me behavior change. MI is heavily tied to autonomy
and self determination theory, and MI is specially useful for
ambivalent clients. Motivational interviewing is less about convincing clients and
more by helping them hear themselves clearly. Therapist helps uncover
motivation that already exists underneath fear and shame and hopelessness.
Well that's it for today Motivational Interviewing. Hopefully you enjoy that,
and we'll talk to you all next time