Motivational Interviewing in therapy
-By Timothy Lyons
I recently watched Motivational Interviewing from psychotherapy.net. In this video, one of the founders of using Motivational Interviewing in therapy, Dr. William Miller discusses his technique and demonstrates it in dealing with a volunteer client. Dr. Miller uses the technique to help a man who is suffering from substance use disorder. Dr. Miller is able to convert the client’s ambivalence about whether he needs help into the client arguing that he does need help.
I have read some of Dr. Miller’s books on Motivational Interviewing in therapy and was interested in seeing how he performs what he describes in the video as a dance with the client. His main ideas are rules for interaction. These are using reflective listening, which is repeating back the content of what has been said to ensure understanding and empathy. Next is helping the person to develop discrepancy between where they are now and where they want to be by having them look at how their problem behavior fits in with their goals and values. Third, avoiding argument which can be as simple as not jumping to the bait, or can be more complex in the form of taking the clients position in the argument so that they must then move to see it for the problem that exists. Next is rolling with any resistance which is really about changing the therapeutic stance in the moment so that the therapist moves from confrontation to a more a more neutral tact. Last is supporting the individual’s self-efficacy and choice in the process. This involves instilling hope in the client by modeling that hope for them. Showing that the therapist has hope for the client can assist the client in seeing it for themselves.
In essence this skill is about seeing the client for who they are. Thinking and acting in a positive manner, focusing on the positive and allowing the client to make their own choices in their lives can move the client to make better decisions. It is also important to understand that ambivalence will continue throughout treatment and for the therapist to recognize this and roll with it. This is accomplished by getting the client to discuss the change that they want to occur rather than discuss the changes that the therapist sees for the client.
The presenter was Dr. Miller and he is one of, if not the top expert in the use of Motivational Interviewing in therapy. His skillful demonstration and use of the technique was masterful. This video cemented some of the ideas that I have about the use of motivational interviewing and it also allowed me to consider how much more and for what purpose I will use Motivational Interviewing in therapy in the future.
The point is that if a therapist wants a client to be resistant then the therapist can be confronting, directive and teaching. If the therapist takes a stance of listening reflectively then the resistance will lessen. With this idea resistance then becomes a therapist problem. In this way the therapist can take ownership of his or her role in the interaction and begin to reduce the barriers to treatment such as resistance by changing the interaction style with the client.
I think that I have tried to better understand the role of physiological psychology in clinical treatment and therefore have tried to relate this DVD to this subject. What I can see is that if I have someone who has been diagnosed with a particular disorder that has a biological basis, I may be able use that knowledge to inform my use of Motivational Interviewing in therapy in particular the area of avoiding argument and rolling with resistance when I know that the physiological problem creates certain behaviors.
References for Motivational Interviewing in therapy
[Video file]. (2000). Psychotherapy.net. Retrieved January 30, 2017, from Counseling and Therapy in Video: Volume I.