Мотивациялық сұхбаттасу: психологиялық кеңес беру тәсілі

Approach to psychological counseling

Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non directive counseling, it is more focused and goal directed, and departs from traditional Rogerian client centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal. MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship. 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. Miller and Rollnick elaborated on these fundamental concepts and approaches in 1991 in a more detailed description of clinical procedures. MI has demonstrated positive effects on psychological and physiological disorders according to meta analyses.

Motivational interviewing (MI) is a person centered strategy. It is used to elicit patient motivation to change a specific negative behavior. MI engages clients, elicits change talk and evokes patient motivation to make positive changes. For example, change talk can be elicited by asking the patient questions such as: "How might you like things to be different?" or "How does interfere with things that you would like to do?" Unlike clinical interventions and treatment, MI is the technique where the interviewer (clinician) assists the interviewee (patient) in changing a behavior by expressing their acceptance of the interviewee without judgement. Change may occur quickly or may take considerable time, depending on the client. Knowledge alone is usually not sufficient to motivate change within a client, and challenges in maintaining change should be thought of as the rule, not the exception. 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. At the same time, it can be seen that MI ensures that the participants are viewed more as team members to solve a problem rather than a clinician and patient. Hence, this technique can be attributed to a collaboration that respects sense of self and autonomy. To be more successful at motivational interviewing, a clinician must have a strong sense of "purpose, clear strategies and skills for such purposes". Such skills are used in a dynamic where the clinician actively listens to the patient then repackages their statements back to them while highlighting what they have done well. In this way, it can improve their self confidence for change. Furthermore, at the same time the clinician needs to keep in mind the following five principles when practicing MI.

This means to listen and express empathy to patients through the use of reflective listening. In this step, the clinician listens and presents ideas the patient has discussed in a different way, rather than telling the patient what to do. This aims to strengthen the relationship between the two parties and ensures it is a collaboration, and allows the patient to feel that the clinician is supportive and therefore will be more willing to be open about their real thoughts.

This means to assist patients in developing discrepancies between the current self and what they want to be like in the future after a change has taken place. The main goal of this principle is to increase the patient's awareness that there are consequences to their current behaviors. This allows the patient to realize the negative aspects and issues caused by the particular behavior that MI is trying to change. "Resistance", as the idea was previously conceptualized before it was abandoned in MI, can come in many forms such as arguing, interrupting, denying and ignoring. and that it is their choice when it comes to their change.

Strong self efficacy can be a significant predictor of success in behavior change.

Behaviour change counselling (BCC) is an adaptation of MI which focuses on promoting behavior change in a healthcare setting using brief consultations. BCC's main goal is to understand the patient's point of view, how they're feeling and their idea of change. It was created with a "more modest goal in mind", as it simply aims to "help the person talk through the why and how of change" The data obtained is then presented on: item characteristics, sub scale characteristics, interrater reliability, test retest reliability and construct validity. Based on a study conducted by Vallis, the results suggest that BCCS is a potentially useful tool in assessing BCC and aid to training practitioners as well as assessing training outcomes. This may include technological devices and creations such as computers, mobile phones, telephones, videos and animations. A review of multiple studies shows the potential effectiveness of the use of technology in delivering motivational interviewing consultations to encourage behavior change. However, some limitations include: the lack of empathy that may be expressed through the use of technology and the lack of face to face interaction may either produce a positive or negative effect on the patient. Further studies are required to determine whether face to face consultations to deliver MI is more effective in comparison to those delivered via technology. 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. Some of the patients may act like listening to the interviewer just to veil their underlying mental health issue. When working with these patients, it is important to recognize the limitations of behaviorally focused counseling and motivational interviewing. 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.

Professionals attempting to encourage people to make a behavioral change often underestimate the effect of motivation. Simply advising clients how detrimental their current behavior is and providing advice on how to change their behavior will not work if the client lacks motivation. Many people have full knowledge of how dangerous smoking is yet they continue the practice. Research has shown that a client's motivation to alter behavior is largely influenced by the way the therapist relates to them.

Clients who don't like or trust their health care professionals are likely to become extremely resistant to change. In order to prevent this, the therapist must take time to foster an environment of trust. Even when the therapist can clearly identify the issues at hand it is important that the patient feels the session is collaborative and that they are not being lectured to. Confrontational approaches by therapists will inhibit the process.

Although studies are somewhat limited, it appears that delivering motivational interviewing, in a group may be less effective than when delivered one on one.

Motivational interviewing was initially developed for the treatment of substance use disorder, Due to speculation in the health industry the use of brief intervention has been deemed to be used too loosely and the implementation of MI is increasing rapidly.

Motivational interviewing has been incorporated into managing a classroom. Due to the nature of MI where it elicits and evokes behavioral change within an individual it has shown to be effective in a classroom especially when provoking behavior change within an individual. In association with MI, the classroom check up method is incorporated which is a consultation model that addresses the need for classroom level support.

Motivational interviewing has been implemented in coaching, specifically health based coaching to aid in a better lifestyle for individuals. A study titled "Motivational interviewing based health coaching as a chronic care intervention" was conducted to evaluate if MI had an impact on individuals health who were assessed as chronically ill. 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". is being implemented to aid in these issues. Research suggests that with collaborating motivational interviewing and CBT has proved to be effective as they have both shown to be effective. 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". Motivational interviewing is used as a preventative measure for individuals suffering from both a mental health issue and substance misuse due to the nature of MI eliciting behavioral change in individuals.

Gambling issues are on the rise and it is becoming a struggle for therapists to maintain it. Research suggests that many individuals "even those who actively seek and start gambling treatment, do not receive the full recommended course of therapy". 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. The goal of using MI in an individual who is having issues with gambling is to recognize and overcome those barriers and "increase overall investment in therapy by supporting an individual's commitment to changing problem behaviours". In this study the experimental group was parents who received MI education in a "pamphlet, watched a videotape, as well as received an MI counselling session and six follow up telephone calls". However, MI has been implemented in other substance use or dependence treatments. Research that was conducted utilized MI with a cocaine detoxification program. 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".

Stigma is the deleterious, structural force that devalues members of groups that hold undesirable characteristics. In the case of people living with HIV (PLHIV), HIV related stigma has negative effects on health outcomes, including non optimal medication adherence, lower visit adherence, higher depression, and overall lower quality of life. HIV related stigma causes PLHIV to lose social standing due to their HIV positive status, and therefore, eliminating stigma against PLHIV, is a high priority. A study conducted in 2021 found that Healthy Choices, an intervention that was developing using Motivational Enhancement Therapy, an adaptation of Motivational Interviewing, was associated with reductions in stigma among youth living with HIV. While the authors suggest that their findings should be replicated, this study provides a basis for including Motivational Interviewing in stigma reduction research.