MI is a collaborative, goal oriented style of communication which pays particular attention to the language of change and is designed to strengthen personal motivation for commitment toa specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion (Turner, Welches, & Conti, 2010). MI assumes that (O’Donohue, Cummings, & Cummings, 2006)·
Clients are ambivalent about changing their behaviour· It is this ambivalence that keeps clients immobilized and resist change· the primary task of the therapist is to help clients understand and resolve this ambivlance in a manner that produces behavioral change. In the past 30 years, interest in and use of MI have surged within substance use treatment settings as well as other contexts and within moutiple professions (Madson et al. , 2016). MI approach evolved from the humanistic existential tradition, particularly from person centred therapy and it engages clients whenever they are on the readiness to change continuum and helps them process their ambivalence regarding behavoural health of lifestyle change (Turner et al. , 2010). When we are making changes in life, many of us feel ambivalent, ie we feel two ways about it. MI is based on partnership. Empathy is the basic feature of MI involving active listening, or acceptance.
Activity is listening and understanding the feelings, views of the client without making an assessment, criticizing and blaming (Lipczynski & Kinal, 2018). Empathetic therapist tries to understand the client’s feelings and accept the client’s views as understood and, atleast within hierarchy of values. The below report has been written detailing the components and rationale of the MI (role-play) that I conducted on a friend who has issues with Alcohol. The aim of this MI is to motivate my friend decrease his alcohol intake and thus take back control of his life. Over the weekend, he does not drink in moderation and hence has had a few fights with other people in the bar. For the purpose of this report, I would refer him as the client. A referral has been sent by his GP to my clinic and this is his first session with a counsellor. Phases if the InterviewThe client has come to me in denial mode. He does not agree with the doctor’s recommendation that he has issues with alcohol and did not want to come to see a counsellor in the first place. He does not see that he has issues with alcohol and hence is I pre-contemplation phase, where he does not want to take any steps to decrease his alcohol intake. He is not even ambivalent, but is denying the fact that he drinks a lot of alcohol and he needs to decrease his intake.
Thus, in order to prepare him to either reduce drinking or give up alcohol, it is important that I make him understand that he has a problem. This is the first step of the interview and I would need to make him understand that he has problems, which would enable me to help him set a goal for himself. Motivational Interviewing Skills UsedMost questions asked by myself were in the form of open questions. Open questions lead to more active elaboration by the patients, rather than closed questions (Chanut et al. , 2005). A counsellor can establish better rapport and elicit more informative response from the client by use of open questions. Developing open questions requires a lot of counselling skills and experience. Paraphrasing was used effectively during the whole interview process.
Active listening is a common intervention for MI. Paraphrasing in the context of MI can be defined as an attempt to repeating information the client has disclosed in whole or part in their own words (Evans, Roberts, Price, & Stefek, 2010). A counseller not only needs to listen, but at times, paraphrase what the client states as well. This can serve dual purposes a) The client knows that therapist is interested in the conversation and understands him well. b) The therapist can re-emphasize important parts of the conversation, sometimes listening the same thing from other person would help a person realise his/her own mistake. Near the end of the interview, I used paraphrasing to make him understand the amount of alcohol that he consumes on a weekly basis. Hearing this, he did acknowledge that he was an alcoholic and required to make changes to his drinking habit. During the interview, I constantly empathised with him using my body language. Empathy is a fundamental to all talk therapies. Demonstrating empathy is conveying a real, ie informed, understanding of the person’s predicament and what maintains the ambivalence and involves active listening and reflection so that the terapist can provide consise statements that encapsulate what the patient has tried to convey (Bundy, 2004). I did emapthise with the client throughout the the interveiw process. This conveys understanding, acceptance and interest in the person – conditions that are highly important if change was to occur (Bundy, 2004). During the interview, client was incharge of his own decisions. I did help him arrive at the decision, but he was well aware that he was totally incharge of making the decisions for his treatment.
According to Miller (1983), the councellor is a resource to the decision making process as the counsellor presents reality in clear fashion, but leaves it to the client to decide what do about it. Thus MI approach treats the individual as a responsible adult, capable of making responsible decisions and coming to the right solution (Miller, 1983). This is more consistent with humanistic psychology, believing in individual’s own wisdom and the ability to choose their own path to healthy living and counsellor providing such sufficient support and an atmosphere in which the difficult decision for change can be made more easily (Miller, 1983). The indivudual is thus expected to make the final decision, rather than simply to agree with a decision already reached by the counsellor. I did not, at any point in time argue with the client or disagree with his beliefs. This is an important skill in MI. Arguments are usually counterproductive as by arguing, the therapist can quickly lose rapport with the client.
MI in itself is a challenging process for the client. On top of that, if the therapist actively challenges the patient’s position then the patient will defend themselves by presenting arguments for not changing (Bundy, 2004). Whereas, the goal of MI is to encourage the patient to hear themselves say why they want to change, rather than the therapist listing reasons why change is necessary. By not arguing with the client, I also showed the client that I do empathise with him and fully understand the situation that he is in at the moment. I also used the technique of making him write down the pros and cons of him changing. THis enabled him to compare the advantages and disadvantages for himself and make a more informed decision. I think, that at this point, he started cooperating with me to a greater extent so that the remaining sessions would be a easier. By the end of the interview, the client had reached the planning phase. I am really happy with the progress made in this interview.
Although I do acknowledge that this was a roleplay, and that real clients may not be willing to cooperate to this extent, but I do think that the methodology was appropriate and I would look to using the methodology during my future counselling sessions as well. Conclusion:I think that I did use some MI skills successfully which helped me gain good rapport with the client and made my counselling session a successful one. MI is a highly valuable tool available with the counsellors in treatment of alcoholism and drug dependencies. The primary task of the therapist is to help clients understand and resolve the ambivalance that exists within the client’s mind with respect to the change. It is imperative that therapist use techniques like showing empathy, asking open questions and placing emphasis on individual responsibility. This can be done by employing strategies like affirmation, paraphrasing and conciousness raising. Learning these skills require a lot of practice and experience.
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