Motivational Interviewing

Client (lack of) motivation, and resistance may very well be one of the most frustrating aspects of working as a counselor. Since trying to inform alcoholics on the consequences of drinking and benefits of abstinence often provokes the client to offer opposing arguments and resistance, it may be useful to put the job of reasoning the pitfalls of drinking into the client's lap. This is where motivational enhancement therapy (also called motivational interviewing) has gained traction and use in treating clients with addiction.

One helpful acronym when implementing motivational interviewing is:

F      Provide Feedback on behaviour
R      Reinforce the patient’s Responsibility for changing behaviour
A     State your Advice about changing behaviour
M    Discuss a Menu of options to change behaviour
E     Express Empathy for the patient
S     Support the patient’s Self-efficacy

Motivational interviewing is a confrontational form of therapy, yet unique in that the conflict intended to give rise to change does not occur between the therapist and the client; it should arise within the client as they work through brainstorming sessions where they discuss topics that normally the counselor might ask questions to educate and bring the client towards desired changes in thoughts and behavior.

"A guideline suggested by practitioners is that one should aim to increase the proportion and accuracy of reflective listening statements and decrease the proportion of questions. The more thoughtful and understanding is the practitioner, the more likely the patient is to become contemplative and, in doing so, to make new connections... In the example below, a client is engaged in talking about ambivalence. The counsellor’s task is not to jump ahead to any other topic but merely to allow the client to explore this conflict. Simple reflective listening statements are used to do this.

Counsellor: So what have you noticed about the effect of alcohol on your mood?

Client: It’s like my saviour, because you see it is sometimes the only time I really feel at peace with myself, like really relaxed.

Counsellor: It comes over you and you feel so different.

Client: Yes, and this goes on for a long time. There can be all hell breaking loose around me and I won’t let it touch me.

Counsellor: It protects you from all sorts of troubles.

Client: For a while and then it’s like my punishment is not far away, like the time will come when I feel upset, little things, and I get upset and even angry.

Counsellor: You get this lovely lift and you also get these darker moments.

Client: Exactly, but they don’t just last for a moment. You should see what I am like the next day, I feel really down, like my life is a roller coaster of highs and lows, and the drink is my master. I don’t like that."

Having learned the downside of relying on questions as a counselor, motivational interviewing seems like a valuable resource for getting clients to discover the discrepancies in their personal goals and the destruction alcohol is wreaking on those goals.  

For more information and examples see: The Essential Handbook of Treatment and Prevention of Alcohol Problems: Ch. 7 Motivational Interviewing

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