Motivational Interviewing Narrative Essay

It is one of the most carefully defined and rigorous treatment for substance abuse (Miller, 1991). It was developed my William Miller, Stephen Rollnick, and other colleagues over the past 2 decades. It uses a concise psychotherapeutic intervention for helping people change an addictive behavior such as a substance abuse. It is intended to assist and enhance a person’s intrinsic motivation to change addictive behavior in a highly empathetically supportive but strategically directed conversation about the person’s use of substance and related life events.

Variety of techniques are used that will increase intrinsic motivation for change. Some useful techniques used are micro skills (open – ended questioning, affirmations, reflections, and Summary or OARS) and strategies (creating discrepancies between a person’s current behavior and his or her goals, his values, the way he perceived himself, establishing and exploring ambivalence and handling resistance skillfully.(Miller, 1990)

Initially, Miller and his colleagues developed Motivational Interviewing to treat people who have alcohol substance abuse; they used principles of motivational psychology and clinical research. If clients have options for alternative approaches they are seem to have an improved treatment and a better outcome. This kind of therapy helped people become realistic, have a set of clear goals which are achievable and possible that will help him or her change for the better.

What is motivation? It is the probability that a person will be ready to change, namely, enter into, continue, and adhere to a specific change strategy. Each one of us can be motivated, and those who are lifeless are only considered unmotivated. But, not only motivation will work alone on this kind of therapy, confrontation is also needed, it is a part of all psychotherapies. The question is not solely based if people should be confronted or not, but how to confront effectively and efficiently that eventually will lead to a successful therapy.

Change could not be achieved right away. It takes a lot of time, hard work, and perseverance both for the therapist and the client. Change is hard, but it is essential. Uncertainty or ambivalence is accompanied by change. Every client undergoes this kind of stage where he feels uncertain. This is just a normal part or process of change. Successfully addressing ambivalence is considered to be a crucial skill for a Motivational Interviewing. (Miller, 1990)

There are four basic assumptions of Motivational Interviewing according to Miller (1990), they are as follows:

• Optimistic and humanistic perspective
• Motivation is considered to be a condition, not a trait
• Approaching change where ambivalence is constant, it is a normal, acceptable, and understandable aspect.
• Motivation is an interpersonal phenomenon

Primarily, clients do not seek therapy because they are motivated. It is the sole responsibility of the therapist to initiate change, and help his or her client to be motivated. It shouldn’t come within from the client, rather it is a process imposed by therapy and slowly accepting by the client.

According to Miller (1990) there are 4 key principles of Motivational Interviewing, such as: Empathy should be expressed, develop discrepancy, roll with resistance, and support self – efficacy. This should be applied into 2 phases, while building motivation for change to the client and be able to strengthen his commitment to change. Aside from this, there are 3 critical components of motivation: readiness, willingness and ability.

The client should be ready for change. It is a step by step process, slowly the person begins to adapt new things to his system that leads to changes, and he is ready for change. Thus, readiness is relatively linked to priorities; you prioritize things which are important for you to change. Willingness, one should be willing to commit himself to change, not influenced by any factor rather he is open freely to change. The ability of motivation is of great importance both for the client and the therapist. It should be coming mostly from the therapist, to initiate change and be motivated.

Rational Emotive Behavior Therapy

It was developed by Dr. Albert Ellis; it is a cognitive-behavioral approach to treatment. Therapy was done by identifying some ideas that are problematic and erroneous that is linked with emotional and behavioral problems that are correlated with irrational thoughts, assumptions and beliefs, thus irrational thoughts are then replaced with more rational, reality-based perspectives. In a therapy session, therapist teaches his clients to stay away from negative thoughts, feelings and behaviors for a more positive outlook in life. In this way, the client can achieve self acceptance and life satisfaction because he was able to gain and maintain realistic perception in life. (Dryden, 1990)

Certain beliefs or thoughts that are considered to be irrational are confronted and other options or alternative are made that make more sense especially when it is examined logically and factually. Rather than focusing on historical or abstract theories, the focal point of the therapy is on the present and at the same time using scientific thinking. People who come for REBT are taught and encouraged to accept personal responsibility for their own thoughts, feelings and behavior, and empowered to change beliefs and reactions that are maladaptive, distorted, interfere with their goals and functioning, and thwart their enjoyment of life. With practice, the new ideas become part of the person, integrated into their way of being. (Dryden, 1990)

It is a system of psychotherapy that was designed to help people live longer, decrease their emotional disturbances and self defeating behaviors, and actualize themselves so that they live a more fulfilling, productive, and happier lives ( Ellis & Bernard, 1985)

ABC Model of REBT

Irrational beliefs are defined as rigid, inconsistent, illogical and detrimental to the persons’ pursuit of basic goals and purposes. The ultimate goal of REBT is to replace these irrational thoughts with rational thoughts, because it will help the client to live longer and happier through therapeutic process. Development includes (1) setting up for themselves certain happiness – producing values, purposes, goals, or ideals (2) using efficient, flexible, scientific, logico – empirical easy to achieve such values and goals to avoid contradictory or self – defeating results (Ellis & Bernard, 1985)

ABC Model Approach

The initial component of the ABC Model is the “A” or activating event. A’s are considered to be events that we attend to and that trigger our beliefs or thoughts. However, this doesn’t cause any emotional reactions. It is our beliefs that cause our emotional reponse.activating events could be external or internal to the person, whether the person is directly or indirectly exposed to such event. Events can also refer to the past, present or future events ( Dryden, 1999)

B stands for Beliefs in the ABC Model. Beliefs are fully and explicitly evaluative and are at the core of a person’s emotions and significant behaviors (Dryden, 1999). People take the activating events in their lives and formulate beliefs that could essentially affect their reactions or consequences. These beliefs can be rational or irrational and are usually based on their preferences. Preferences refer to the basic needs, wants, wishes, and desires of the person. When beliefs become unrealistic, illogical and impossible it can considered dysfunctional.

C variable refers to the consequences of our beliefs in the context of a particular situation. When the individual preferences are not met, the person experience healthy negative emotions (Dryden, 1999). Examples of this are remorse, sadness, and sorrow. These negative emotions are regarded as to be healthy because they force people to change. People doesn’t like the way they feel because of these negative emotions, and in turn they seek for changes in their belief system.

There are also unhealthy negative emotions; anxiety, depression, guilt and hurt. These feelings can become severe that they damage normal functioning. Thus, a therapeutic intervention is needed. REBT was designed to help those individuals change the experienced unhealthy negative emotions as a result of the beliefs they hold.

Both therapies are beneficial for the people who are on a substance abuse. One significant difference is that motivational interviewing takes more time and is more in depth because of the actual process the person undergoes. The client should be ready for change, and the therapist gradually imposing change to the person. On the other hand, REBT is more concise and focus; it is directly targeted on the individual’s main problem.

References:

Dryden, W. (Ed.). (1990). The Essential Albert Ellis: Seminal Writing on Psychotherapy. New York: Springer Publishing Company, Inc.

Dryden, W. (1999) Rational Emotive Behavior Therapy: A Training Manual. New York: Springer Publishing Company, Inc

Ellis, A., & Bernard, M.E. (Eds.). (1985) Clinical Applications of Rational – Emotive Therapy. New York: Plenum Press.

Miller, W.R., & Rollnick, S. (1991, 2002) Motiovational Interviewing: Preparing People for Change ( New York, Guilford Press)

Miller, W.R. (1999). Enhancing Motivation for Change in Substance Abuse Treatment TIP Series 35. Rockville, MD: U.S. DHSS Publication No. (SMA)02-3693.