Motivating conversation

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Motivational interviewing ( Motivational Interviewing , MI) is defined as a client-centered but directive counseling approach with the aim of intrinsic motivation to build behavior change. Motivation should be achieved through exploring and resolving ambivalence . The concept was originally developed in 1991 by William Miller and Stephen Rollnick to provide advice to people with addiction problems . In contrast to many more conventional procedures in this area, MI explicitly dispenses with a confrontational approach.

application

MI is aimed primarily at people with initially little or ambivalent willingness to change and can therefore be at the beginning of addiction treatment. Meanwhile, MI is also used in the field of psychotherapeutic work, in general medical treatment, in health promotion, social work and in law enforcement . In addition to the dependence on alcohol , opioids , cannabis and other psychotropic substances , specific fields of application are also HIV prevention, probation assistance , development aid , sexual offenses , occupational addiction prevention , mental disorders in childhood and adolescence, eating disorders ( anorexia , bulimia ), obesity , Diabetes , suicidality .

Action

It is generally assumed that every addict has good reasons for and against consumption, as well as advantages and disadvantages of changing consumer behavior. For example, a smoker can assume that smoking, on the one hand, promotes sociability, but on the other hand, increases the risk of lung cancer. There are two phases:

  • Phase 1: Building willingness to change
  • Phase 2: Strengthening the commitment

If you do not yet have your own (intrinsic) willingness to change, this must first be established in phase 1. As soon as there is a motivation for change, concrete goals and change plans should be formulated in phase 2.

Phase 1: In the first phase of the MI, it is the counselor's task to raise awareness on both sides, which leads to a certain ambivalence and conflict among the consumer. It is assumed that direct urging, confrontation and argumentation in the direction of a change in consumption, as is often practiced by relatives and laypeople, is counterproductive, since it primarily arouses resistance in the client. MI is primarily about creating clarity by reflecting on one's own consumer behavior by illuminating all the pros and cons. This should serve the client to overcome his ambivalence regarding his consumption and its change in the next step. It is essential that the client provides all the arguments himself instead of being persuaded to change his behavior by outsiders.

Phase 2: In the second phase of the MI, concrete goals and ways to achieve them should be worked out.

techniques

The motivating conversation follows 5 principles. Four of these are positively formulated instructions and one principle describes what should be avoided:

  1. Show empathy ( express empathy ): The therapist adopts a client-centered , accepting attitude and tries to look at and understand the situation from the client's point of view through active listening ( reflective listening ).
  2. Generate discrepancy ( develop discrepancy ): This is a directive approach with the help of specific (open) questions in order to help the patient to develop arguments for a change ( change talk ). If it becomes clear to the client that his current behavior is in conflict with important goals and ideas for his future ( cognitive dissonance ), this can strengthen the willingness to change.
  3. Flexible handling of resistance ( roll with resistance ): Ambivalence or resistance are viewed as a normal part of the change process (and not as "pathological"), and a confrontational approach is avoided. Instead, various de-escalating strategies can be used ("simple reflection", "amplified reflection", "double-sided reflection", "shifting focus", " reframing ", "agreeing with a twist" etc.). With the help of active listening , finding your own solutions is again supported.
  4. Self-efficacy strengthen ( support self-efficacy ) by the client is encouraged in the confidence that we can achieve change. This is a central aspect of motivation that has generally proven to be important for the success of the treatment.
  5. Avoiding evidence: On the one hand, this means that the problem behavior should not be proven on the basis of facts and that one should be more cautious with diagnostic terms such as "alcoholic", because experience has shown that both can generate resistance.

Other therapeutic principles in MI are:

  • Signaling genuine interest in the client and his situation, especially through active listening ( reflective listening )
  • change talk : using open questions to draw attention to the disadvantages of the current (addictive) behavior and the advantages of a change ("What are the advantages of quitting?")
  • Convey acceptance and confirmation
  • Elicit and selectively strengthen self-motivating attitudes of the client with regard to problem insight, concerns and willingness to change
  • approach the client with the attitude that he always has the free choice and can decide for himself what he wants

Theoretical background

Originally, motivating conversations were not derived theoretically, but rather arose through observation and specification of the effective factors of intuitive clinical practice. Subsequently, however, attempts are made to embed them in a theoretical context. MI is based on Rogers' approach of non-directive, client-centered interviewing ( Carl Rogers , 1946). Accordingly, an individual strives for personal responsibility and development. According to Rogers, the principles to support a client in this are authenticity ( congruence ), empathy and acceptance . However, motivating conversation also uses more active, cognitive-behavioral strategies that are directive oriented towards a target behavior (e.g. smoking) (in the sense of the change model of Prochaska and DiClemente).

Furthermore, MI builds on the theory of self-perception by Daryl J. Bem (1972). Its basic postulate assumes that attributions and attitudes follow open behavior. As a result, people recognize their identity, attitudes, feelings and other internal processes by observing themselves under certain circumstances or by listening to relevant content and drawing conclusions from them. In addition, MI is conceptually close to the theory of cognitive dissonance ( Leon Festinger , 1957). In MI, people are encouraged to make change-related statements that are (still) in contrast to the current problem behavior. The cognitive dissonance generated in this way now creates the need to actually change the behavior and to adapt to one's utterances.

effectiveness

Burke et al. (2003) carried out a meta-analysis of 30 randomized controlled trials on MI. This showed that MI is effective in alcohol and drug addiction, as well as in adhering to diets and increasing physical activity (e.g. in patients with hyperlipidae , high blood pressure and / or obesity ), but not in smokers or people with HIV -Risk behavior. According to a study by Knowles and others (2013), the technique is not very effective in eating disorders.

The motivating conversation can be taught as a technique in a two-day training course, but further supervision is required afterwards. More attention must also be paid to the inner therapeutic attitude (MI spirit) and not just to the technology.

See also

literature

  • Ralf Demmel: Motivational Interviewing. In: M. Linden , M. Hautzinger (Eds.). Behavioral Therapy Manual. 7., completely revised. and exp. Edition. Springer, Heidelberg et al. 2011, ISBN 978-3-642-16196-4 , pp. 233-237.
  • David B. Rosengren: Workbook motivational interviewing. GP Probst, Lichtenau Westf. 2012, ISBN 978-3-9813389-3-5 .
  • Antoine Douaihy, Thomas M Kelly, Melanie A Gold (Eds.): Motivational Interviewing. Oxford University Press, Oxford 2014, ISBN 9780199958184 .
  • William Miller, Stephen Rollnick: Motivational Conversation. Lambertus, Freiburg im Breisgau 2015, ISBN 978-3-7841-2545-9 .
  • Ralf Demmel, G. Kemeny: Motivational Interviewing: Aids for Therapy and Counseling. With a preface by Stephen Rollnick. Lambertus, Freiburg im Breisgau 2017, ISBN 978-3-7841-2932-7 .

Web links

Individual evidence

  1. ↑ Alcoholism-specific psychotherapy: manual with treatment modules; with 4 tables; all worksheets and therapist checklists on CD-ROM . Deutscher Ärzteverlag, 2007, ISBN 978-3-7691-1227-6 , p. 9 ( limited preview in Google Book search).
  2. ^ WR Miller, S. Rollnick: Motivational interviewing: Preparing people to change addictive behavior. Guilford Press, New York 1991.
  3. ↑ Herry Zerler: Motivating conversation and suicidality . In: Hal Arkowitz, Henny A. Westra, William R. Miller, Stephen Rollnick (Eds.): Motivational conversation in the treatment of mental disorders . Beltz, Weinheim 2010, ISBN 978-3-621-27705-1 , pp. 183-204 .
  4. ↑ Theory and practice of “motivational interviewing” in addiction help . diplom.de, 2015, ISBN 978-3-95820-535-2 , p. 46 ( limited preview in Google Book search).
  5. ↑ Clinical Psychology and Psychotherapy for Bachelor: Volume II: Therapy Methods Reading, Listening, Learning on the Web . Springer-Verlag, 2012, ISBN 978-3-642-25523-6 , pp. 19 ( limited preview in Google Book search).
  6. ↑ Basics of self-management therapy in adolescents: SELF - Therapy program for adolescents with self-esteem, performance and relationship disorders . Hogrefe Verlag, 2007, ISBN 978-3-8409-1901-5 ( limited preview in Google book search).
  7. ↑ Practical guide for the care and advice of children and adolescents . Forum Verlag Herkert, ISBN 978-3-89827-845-4 ( limited preview in Google book search).
  8. ^ A. Bandura: Self-efficacy: The exercise of control. Freeman & Company, New York 1997.
  9. ↑ Clinical Psychology & Psychotherapy (textbook with online materials) . Springer-Verlag, 2011, ISBN 978-3-642-13018-2 , Sp. 507 ( limited preview in Google Book search).
  10. ↑ Multi-dimensional family therapy: treating adolescents with substance abuse and behavior problems effectively . Vandenhoeck & Ruprecht, 2011, ISBN 978-3-647-40214-7 , pp. 80 ( limited preview in Google Book search).
  11. ↑ Conducting conversations in social work: Basics and design aids . Springer Science & Business Media, 2012, ISBN 978-3-531-18573-6 , pp. 129 ( limited preview in Google Book search).
  12. ↑ BL Burke, H. Arkowitz, M. Menchola: The efficacy of motivational interviewing: A Meta-Analysis of Controlled Clinical Trials. In: Journal of Consulting and Clinical Psychology. 71 (5), 2003, pp. 843-861.
  13. ↑ Psychosomatics and behavioral medicine . Schattauer Verlag, 2015, ISBN 978-3-7945-3045-8 , Sp. 289 ( limited preview in Google Book search).
  14. ↑ a b Active and healthy ?: Interdisciplinary perspectives on the connection between sport and health . Springer-Verlag, 2014, ISBN 978-3-531-19063-1 , pp. 269 ( limited preview in Google Book search).