Motivational Cognitive Behavioural Therapy

Distinctive Features

Cathy Atkinson, Paul Earnshaw

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429665127
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This informative and straightforward book explores the emergence of motivational interviewing (MI)and cognitive behavioural therapy (CBT), with specific attention given to the increasing focus on the central importance of the therapeutic alliance in improving client outcomes.

Comprising 30 short chapters divided into two parts –theory and practice –this entry in the popular "CBT Distinctive Features Series" covers the key features of MI-informed CBT, offering essential guidance for students and practitioners experienced in both MI and CBT, as well as practitioners from other theoretical orientations who require an accessible guide to this developing approach.

Part I

THE DISTINCTIVE THEORETICAL FEATURES OF MICBT

1

The history of motivational interviewing

The first chapter will introduce readers to motivational interviewing (MI). It will chart its emergence via William Miller’s initial articulation of the approach to Norwegian psychology students, through to its development within practice in substance use, healthcare, and a whole range of other contexts. It will highlight the rationale for the focus on resolving ambivalence within therapy. Further it will describe the potential contribution of MI to CBT practice, which will be the main theme of this book.

Background

Miller and Rose (2009) recalled the early work of William Miller who, as Professor of Psychiatry and Psychology at the University of New Mexico (Miller, 2019) in the early 1980s, explored the impact of interpersonal skills on the effectiveness of behavioural therapy for clients who were problem drinkers. Subsequently Miller completed a sabbatical at the Hjellestad Clinic and University of Bergen, Norway, during which his description of his clinical practice to resident psychologists led him to devise the first conceptual model of MI, which was subsequently published (Miller, 1983).

Later, on a sabbatical in Sydney, Australia, Miller met Stephen Rollnick, a South African psychologist working in the UK who was already using MI within clinical practice. This led to production of the seminal text Motivational Interviewing: Preparing People to Change Addictive Behaviour (Miller & Rollnick, 1991). Atkinson and Woods (2017) described how subsequent volumes (Miller & Rollnick, 2002, 2013) further developed the approach, sometimes with quite significant changes to its central structure and theoretical position. Throughout its journey, the concepts of exploring ambivalence and strengthening commitment to behavioural change have remained central to MI (Atkinson & Woods, 2017).

Developments

Early conceptualisation (Miller & Rollnick, 1991) linked MI closely with the transtheoretical model (TTM) (Prochaska & DiClemente, 1982) (see Chapter 6), which proposed that clients pass through a series of stages – from precontemplation, or not really even considering change, through to maintenance and keeping the change going. Later, these ideas become less central (Miller & Rollnick, 2002), although for some practitioners, they had become synonymous (Atkinson & Amesu, 2007). Miller and Rollnick (2009) clarified the distinction between MI and the TTM and proposed that the MI spirit (see Chapter 8) should define practice. Later publications (Miller & Rollnick, 2002, 2013) have emphasised the relational and communicative aspects of MI, introducing processes and skills which are fundamental to developing a strong therapeutic alliance.

MI has become an extremely popular approach. It is widely used within healthcare and drug and alcohol services, but its application now branches to numerous and diverse fields and across international contexts, supported by its strong empirical foundations and the extensive work of researchers across different fields (Miller & Moyers, 2017).

The central role of ambivalence in MI

Miller and Moyers (2017) described how MI addresses the frustrating issue of reluctance to change despite advice to do so. While many therapeutic modalities, including CBT, assume readiness for change, MI acknowledges that clients are often ambivalent about change. Miller and Rollnick (2013) proposed that “ambivalence is simultaneously wanting and not wanting something or wanting both of two incompatible things” (p. 6). For example, a smoker might enjoy the social and relaxation benefits of cigarettes while being concerned about the health and financial costs. MI was designed specifically to strengthen clients’ motivation for change (Miller & Moyers, 2017).

How can MI support CBT?

While CBT should assess motivation (Roth & Pilling, 2007), it places far less emphasis on developing client motivation for change. As such, MI has been seen as both a useful precursor to CBT (Kertes, Westra, Angus, & Marcus, 2011; Marker & Norton, 2018) and a method that can be integrated to engage clients who may not readily engage with CBT approaches (Driessen & Hollon, 2011).

Miller and Rollnick (2009) proposed that cognitive behavioural approaches “generally involve providing clients with something they are assumed to lack” (p. 134) such as psychoeducation or new coping skills. MI instead assumes that the skills and solutions lie with the client and the therapeutic partnership involves working together to find them. We are not suggesting that one of these approaches is wrong and the other is right. Instead, within this book, we hope to illustrate the strengths of both approaches and describe how they can be potentially combined to maximise outcomes for clients.

Summary

1. MI was developed to support problem drinkers, but it has since emerged as a leading therapeutic approach, with a strong evidence base across multiple contexts.
2. At the heart of MI is the concept of ambivalence, or feeling two ways about something. MI seeks specifically to build motivation for change.
3. MI can be combined with CBT to maximise outcomes for clients.

References

1. Atkinson, C., & Amesu, M. (2007). Using solution-focused approaches in motivational interviewing with young people. Pastoral Care in Education, 25, 31–37. doi:10.1111/j.1468-0122.2007.00405.x
2. Atkinson, C., & Woods, K. (2017). Establishing theoretical stability and treatment integrity for motivational interviewing. Behavioural and Cognitive Psychotherapy, 45(4), 337–350. doi:10.1017/S1352465817000145
3. Driessen, E., & Hollon, S. D. (2011). Motivational interviewing from a cognitive behavioral perspective. Cognitive and Behavioral Practice, 18(1), 70–73. doi:10.1016/j.cbpra.2010.02.007
4. Kertes, A., Westra, H. A., Angus, L., & Marcus, M. (2011). The impact of motivational interviewing on client experiences of cognitive behavioral therapy for generalized anxiety disorder. Cognitive and Behavioral Practice, 18(1), 55–69. doi:10.1016/j.cbpra.2009.06.005
5. Marker, I., & Norton, P. J. (2018). The efficacy of incorporating motivational interviewing to cognitive behavior therapy for anxiety disorders: A review and meta-analysis. Clinical Psychology Review, 62(April), 1–10. doi:10.1016/j.cpr.2018.04.004
6. Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11(2), 147–172. doi:10.1017/S0141347 300006583
7. Miller, W. R. (2019). William R. Miller. Retrieved December 31, 2018, from http://www.williamrmiller.net/index.html
8. Miller, W. R., & Moyers, T. B. (2017). Motivational interviewing and the clinical science of Carl Rogers. Journal of Consulting and Clinical Psychology, 85(8), 757–766. doi:10.1037/ccp0000179
9. Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behaviour. New York: Guilford Press.
10. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. 2nd edition. New York: Guilford Press.
11. Miller, W. R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129–140. doi:10.1017/S1352465809005128
12. Miller, W. R., & Rollnick, S. (2013). Motivational interviewing, third edition: Helping People Change. New York: Guilford Press.
13. Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. The American Psychologist, 64(6), 527–537. doi:10.1037/a0016830
14. Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory Research and Practice, 19(3), 276–288.
15. Roth, A. D., & Pilling, S. (2007). The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. London: Department of Health.

2

Defining MICBT

This chapter will set out the core definitions of MI, CBT and MICBT, before looking at how these potentially direct theory and practice.

Definitions of MI

Definitions of MI have evolved over the years (Miller & Rollnick, 1991, 2002, 2013). Most recently (Miller & Rollnick, 2013, p. 29) offered three separate definitions of MI.

Layperson’s definition: “Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change”.

Practitioner’s definition: “Motivational Interviewing is a person-centred counselling style for addressing the common problem of ambivalence about change”.

Technical definition: “Motivational interviewing is a collaborative, goal-orientated style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere or acceptance and compassion.”

Central to all three is the notion of ambivalence, or feeling two ways about something – such as acknowledging the health benefits which might result from losing weight, but not particularly wanting to engage in a diet or exercise regime that might bring about such changes. In their early paper “What is Motivational Interviewing?” Rollnick and Miller (1995) proposed that MI was more focused and goal-directed than non-directive counselling, with the resolution of ambivalence being its central purpose.

Miller and Rollnick (2013) used the metaphor of having an “internal committee inside your mind” (p. 7) to describe ambivalence. Within th...