The ambivalence mire: Escape with motivational interviewing

cIt could be substance dependence. Or maybe it’s depression that has taken its toll. You’re up to your chin in the mud. And yet, you’re not sure you want to do anything about it. That is ambivalence and we need to talk about motivational interviewing.

We have reviewed a variety of therapies and intervention approaches here in Chipur. And yes, here we go with another one.

Motivational interviewing may not get the press of cognitive behavioral therapy, but it is an excellent approach when ambivalence, in the face of change, rears its indifferent head.

Let’s see what we can see…

What is ambivalence?

To gain a solid understanding of motivational interviewing, we must define ambivalence. According to the American Psychological Association…

1. The simultaneous existence of contradictory feelings and attitudes, such as liking and disliking or friendship and hostility, toward the same person, object, event, or situation.
2. Uncertainty or indecision about a course of action.

You don’t need a PhD to know that ambivalence can derail any emotional, mental, or physical recovery mission.

I mean, we can be desperately sick, but if we haven’t decided what to do about it (or if we even want to do something about it), well, that desperately sickness isn’t going anywhere.

Okay, let’s move on to the motivational interview.

What is motivational interviewing?

Motivational interviewing (MI) is a evidence based approach to change developed largely by psychologists William R. Miller and Stephen Rollnick. Miller began in the early 1980s and his efforts were based on work with alcohol-dependent patients.

MI is not exclusive to counseling/therapy as it can be used in settings such as vocational and educational. That’s why I prefer “subject” to “client,” “facilitator” to “counselor/therapist.”

Goals

Together: commitment, generating positive behavior changes, creating motivation

The goals of MI include engaging the subject/facilitator, generating conversations about positive behavioral changes, and creating motivation to make the decided change.

Since motivation is crucial, understanding and resolving ambivalence is huge. And the resolution lies in consciously and unconsciously weighing the pros and cons of changing and staying the same.

Finally, when it comes to change, awareness of the potential problems, consequences, and assumed risks of the behavior in question goes a long way toward painting a realistic picture.

The rules of motivational interviewing.

Let’s take a look at what we’ll call the MI rules…

• The motivation for change is obtained from the subject and is not imposed from external forces.
• It is the task of the subject, not the facilitator, to articulate and resolve the ambivalence.
• Direct persuasion is not an effective method for resolving ambivalence
• The session style is generally calm and elicits information from the subject.
• The facilitator is directive, as he helps the subject examine and resolve ambivalence.
• The disposition to change is not a trait of the subject, but a fluctuating result of interpersonal interaction.
• The helping relationship resembles a partnership or companionship.

Within those rules, it’s time to work. Some highlights…

• The subject discovers his own interest in considering and/or making a life change.
• The subject expresses the desire to change in his or her own words.
• Ambivalence about change is openly discussed
• A plan is written to facilitate the change, including the initial steps.
• The “discourse of change” is raised and strengthened
• It is important to improve the subject’s confidence in taking action, as well as noticing even small, incremental changes.
• Strengthen commitment to change

So what do you think? Can you feel the power of ME?

For the record, MI is supported by hundreds of randomized control clinical trials in a variety of target populations and behaviors. They include substance abuse, compulsive behaviors, health promotion behaviors, medical compliance, emotional and mental challenges, vocational rehabilitation, and criminal justice.

Change: it’s always your decision

Well, substance dependence, depression, anxiety, job problems, and more: you may be stuck in the mire of ambivalence. To escape, why not turn to motivational interviewing?

If you want to try it for an emotional, mental, or substance problem, make sure the counselor/therapist of your choice is proficient in motivational interviewing. There are a variety of certifications and training classes that you can inquire about.

But you may already be seeing a mental health professional. Ask them if they can facilitate motivational interviews. If not, ask for a reference.

You may not have many options with facilitators in a vocational setting. However, it may be different if you are referred to an employee assistance program (EAP).

Bottom line: do what you have to do to take care of yourself. After all, change: it’s always your decision.

This is an update of a previous article by Chipur. Be sure to review and add comments to the comments..

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