The Ambivalence Mire | Get Out of the Mud with Motivational Interviewing

Major Depressive Disorder

Maybe substance use or compulsive behavior are bringing you down. Perhaps major depressive disorder or another mind-woe have left you chin-deep in the mire. Ambivalence has hit and “Bam!” you’re stuck! Sure seems like it’s time to change. Let’s chat Motivational Interviewing.

We’ve swirled-around a variety of therapies and counseling approaches here on Chipur. Let’s see: Cognitive/Cognitive Behavioral Therapy (CBT),  Mindfulness Based Cognitive Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Future-Directed Therapy, Interpersonal Psychotherapy, Dialectical  Behavior Therapy (DBT), Thought Field Therapy (TFT), Art Therapy, and more.

I think it’s time to add another to the Chipur-mix – one that’s super-popular these days because it flat-out works…

Motivational Interviewing

“Ambivalence,” according to…
1: Simultaneous and contradictory attitudes or feelings (as attraction and repulsion) toward an object, person, or action
2 a: continual fluctuation (as between one thing and its opposite)
b: uncertainty as to which approach to follow

Doesn’t take Uncle Siggy to tell us ambivalence can put the kibosh on any needed emotional, mental, or physical recovery project. I mean, we can be all kinds of sick, but if we haven’t decided what to do about it – or if we really even want to do anything about it – well, all kinds of sick we’ll remain.

So let’s get busy!

Motivational Interviewing (MI) is an evidence-based approach to counseling largely developed by psychologists William R. Miller and Stephen Rollnick. Seems Miller kicked things off in the early-1980s, his efforts grounded in work with problem drinkers.

The goals of MI are very simple, actually – engage the client, generate talk of positive behavior change, and create the motivation to make the decided-upon change. Given motivation is crucial here, gaining insight into – and resolving – ambivalence is just huge. And resolution is found in the conscious and unconscious weighing of the pros and cons of changing v. staying the same.

So how does one come to the conclusion change is indicated? Well, increasing awareness of potential problems, consequences, and assumed risks of the behavior in question go a long way toward painting a very realistic picture.

Let’s take a look at what lies at the foundation of MI – its spirit…

  • Motivation to change is elicited from the client, and is not imposed from outside forces
  • It’s the client’s task, not the counselor’s, to articulate and resolve her/his ambivalence
  • Direct persuasion is not an effective method for resolving ambivalence
  • The counseling style is generally quiet and elicits information from the client
  • The counselor is directive, in that s/he helps the client examine and resolve ambivalence
  • Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction
  • The therapeutic relationship resembles a partnership or companionship

Within that spirit, it’s on to the work at hand. A few highlights…

  • The client discovers her/his own interest in considering and/or making a life change
  • The client expresses the desire to change in her/his own words
  • Ambivalence about change is openly discussed
  • A plan is drafted to facilitate change, to include the initial steps
  • Change-talk is elicited and strengthened
  • Enhancement of the client’s confidence in taking action, and noticing that even small, incremental changes are important
  • Strengthen the commitment to change

So what do you think? Can you sense the power of MI?

For the record, MI is supported by over 200 randomized clinical control trials across a range of target populations and behaviors. These include substance abuse, compulsive behaviors, health-promotion behaviors, medical adherence, emotional/mental challenges, vocational rehabilitation, and criminal justice.

All Done

Alrighty, then. Thinking you’re an “addict?” (By the way, the term is falling by the wayside). Major depressive disorder got ya’ down? “Bam!” – ambivalence has hit and you’re stuck in the mire? I’m asking you to consider Motivational Interviewing as a way out.

If you’re thinking about participating in counseling, ask the counselor candidate (yes, you can interview) if s/he can facilitate MI. Already working with a counselor? If you’re not getting what you just read, ask her/him if you can change course and go with MI.

After all, change – it’s always your call. K?

image courtesy

Plenty more Chipur articles where this came from. Here ya’ go!

  • Cathy | Treatment Talk February 25, 2014, 1:33 pm

    This is a great explanation of motivational interviewing, Bill. MI sounds like it works well with just about anyone. I would think teenagers and young adults who are abusing substances would have a much better chance if they found the motivation from within, and that it would be the key to long lasting change. I can sense the power of MI and can also see how it can really make a difference for individuals and families. Take care!

    • chipur February 25, 2014, 5:31 pm

      Thanks for your visit and comment, Cathy. Indeed, MI is a highly efficacious approach that produces results in a variety of settings. By the way, Foote and Wilkens at The Center for Motivation and Change are big on MI. Sure makes sense to me, right? If someone isn’t motivated to embrace change, creatively work on the guts of that lack of motivation. Why even bother going anywhere else unless and until that’s handled? Oh, and as a facilitator, why not employ kindness and respect along the journey? Good common sense, I’d say…

  • Patricia Miller February 25, 2014, 9:23 pm

    This is great information and really worth passing on to a number of people I work with who serve high risk adolescent populations in a support fashion. While none of us are trained counselors this is a great reminder that we can support others as they seek to make meaningful changes in their lives. I can certainly see the power within the therapeutic relationship. I love learning from these posts.

    • chipur February 25, 2014, 9:49 pm

      Yep, Patricia, MI is the real deal. Cool thing is, it can work in so many ballparks. And I’ll tell ya’ what – one doesn’t have to be a credentialed counselor – or whatever – to facilitate it. Only thing I’d ask (as a counselor) is that the facilitator do her/his due diligence on MI. What I’ve presented is obviously a thumbnail. And there are plenty of places to start. Here’s just one I love that you “love learning from these posts.” And I’m always pleased when you pay us a visit and contribute. Thanks, k?

  • Leslie Ferris March 1, 2014, 12:31 pm

    Thanks Bill, this is very interesting, and it all sounds quite logical. It actually reminds me quite a bit of coaching, where we believe that all answers for our clients are within them, and we as coaches are there to help them find those answers and serve as a catalyst to execute those answers. The coach client is a peer to peer relationship, as you mention here. There is a lot of power in this, and I am so glad that it is becoming more mainstream! I enjoyed reading about the other modalities as well. Love it Bill. You are such a wealth of knowledge!

    • chipur March 1, 2014, 1:21 pm

      Hey, thanks, Leslie. Sitting here reading Beyond Addiction by Foote, Wilkens, Kosanke. “The first, critical step in helping people change is to understand the motivation for their behavior in the first place…what, in the here and now, makes sense about their behavior to them.” So simple, but motivation is just about the whole ball of wax. Always glad to see you’ve stopped by – and participated…

  • Dr. Herby Bell March 1, 2014, 8:58 pm

    Wow, am I attracted to MI. The simpler, the better for this complexity making mind. And I love the image, as my first thought was immersing myself in the mantle of the Earth while your article helped me understand it’s immersing myself in what’s true for me. Also so great to see you write that the pejorative term, “addict” is falling by the wayside. God, the more we understand-or maybe remember? how the brain works, the kinder we are to one another. Great, informative piece, Bill. Thank you.

    • chipur March 2, 2014, 9:52 am

      Thanks for stopping-by and commenting, Herby. Glad you like the image. It was taken during some sort of wild competition in Australia. Yuck, actually. Yes, just one of the beauties of MI is its simplicity. And as it applies to your field, think about it – it used to be said that intervention can’t begin until s/he hits bottom. Current thinking is valuable time is wasted. And so MI can come into play to help her/him find the motivation to move forward toward recovery. A large dose of kindness and respect to be thrown in for good measure. Very proactive – and sensible. Best, Herby!

  • Jody Lamb March 2, 2014, 1:16 pm

    Wow – interesting! Thanks for the glimpse inside counseling and what’s working effectively today! You’ve taught me a lot, Bill!

    • chipur March 2, 2014, 1:26 pm

      Ah, to serve and protect. The only mission here. Thanks for visiting and commenting, Jody…