Motivational interviewing
Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick.[2] Core concepts evolved from experience in the treatment of problem drinkers, and MI was first described by Miller (1983) in an article published in the journal Behavioural and Cognitive Psychotherapy.The incorporation of MI can help patients resolve their uncertainties and hesitancies that may stop them from their inherent want of change in relation to a certain behavior or habit.Additionally, clinicians need to have well-rounded and established interaction skills including asking open ended questions, reflective listening, affirming and reiterating statements back to the patient.[8] Part of successful MI is to approach the "resistance" with professionalism, in a way that is non-judgmental and allows the patient to once again affirm and know that they have their autonomy[15][page needed] and that it is their choice when it comes to their change.[11] Therefore, it is clear to see how important it is for the patient to believe that they are self-efficacious and it is the clinician's role to support them by means of good MI practice and reflective listening.By highlighting and suggesting to the patient areas in which they have been successful, this can be incorporated into future attempts and can improve their confidence and efficacy to believe that they are capable of change.[10] While there are as many differences in technique, the underlying spirit of the method remains the same and can be characterized in a few key points:[8] Ultimately, practitioners must recognize that motivational interviewing involves collaboration not confrontation, evocation not education, autonomy rather than authority, and exploration instead of explanation.Effective processes for positive change focus on goals that are small, important to the client, specific, realistic, and oriented in the present and/or future.[17] The clinician must ask open ended questions which helps the patient to give more information about their situation, so they feel in control and that they are participating in the decision-making process and the decisions are not being made for them.[15][page needed] This is where the clinician helps the patient find and focus on an area that is important to them, where they are unsure or are struggling to make a change.[15][page needed] The clinician must resist arguing or the "righting reflex" where they want to fix the problem or challenge the patient's negative thoughts.[23] Motivational interviewing is supported by over 200 randomized controlled trials[8][additional citation(s) needed] across a range of target populations and behaviors including substance use disorders, health-promotion behaviours, medical adherence, and mental health issues.Motivational interviewers in this situation are trained to use processes like rolling with resistance which reduces a client's need to repeat and reframe their own sustain talk.It focuses on patient-centered care and is based on several overlapping principles of MI, such as respect for patient choice, asking open-ended questions, empathetic listening and summarizing.A review of multiple studies shows the potential effectiveness of the use of technology in delivering motivational interviewing consultations to encourage behavior change.[29] In a case where the patient has an underlying mental illness such as depression, anxiety, bipolar disorder, schizophrenia or other psychosis, more intensive therapy may be required to induce a change.In these instances, the use of motivational interviewing as a technique to treat outward-facing symptoms, such as not brushing teeth, may be ineffective where the root cause of the problem stems from the mental illness.The treating therapists should, therefore, ensure the patient is referred to the correct medical or psychological professional to address the cause of the behavior, and not simply one of the symptoms.Some patients, once treated, may not return for a number of years or may even change practitioners or practices, meaning the motivational interview is unlikely to have sufficient effect.The study's results showed that the group that MI was applied to had "improved their self-efficacy, patient activation, lifestyle change and perceived health status".[38] Initially, in the early 1980s, motivational interviewing was implemented and formulated to elicit behavioral change in individuals suffering from substance use disorder.[2] However, MI is based on the work of Psychologist Carl Rogers, Unconditional Positive Regard, and has shown to be applicable in hundreds of behavioral use cases.Applications have included use by citizens for interacting with elected representatives on climate policy, interfamilial discussions based on listening instead of judgement and education.Motivational interviewing was originally developed by William R. Miller and Stephen Rollnick in the 1980s in order to aid people with substance use disorders.A study was conducted as a randomized cluster trial that suggests that when MI was implemented it "associated with improved depressive symptoms and remission rate".[42] Motivational interviewing has been widely used and adapted by therapists to overcome gambling issues, it is used in collaboration with cognitive behavioral therapy and self-directed treatments.A research study was conducted using motivational interviewing to help promote oral regime and hygiene within children under the supervision of a parent.[45] This research had found that for the 105 randomly assigned patients, "completers who received MI increased use of behavioural coping strategies and had fewer cocaine-positive urine samples on beginning the primary treatment".[49] While the authors suggest that their findings should be replicated, this study provides a basis for including Motivational Interviewing in stigma reduction research.