Process of Change and Motivational Interviewing
FamilyLightsm: Successor to Bridge to Understanding
People reading this website almost invariably are interested in the process of change for themselves or for another human being. Schools and programs that suggest that they have an interest in change too often are not prepared to explain how their process of change works. We suggest that schools and programs that are about change need to be able to describe their process of change, clearly coherently, and succinctly so that a lay person can understand.
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Our experience tells us that the most important single ingredient in a process of change is that the change is facilitated through quality relationships. Conventional thinking is that the relationship with one key person, frequently identified as the client's therapist. We agree that is important, but more important relationships are with the frontline staff the client interacts with hour-by-hour. The quality of the relationships developed by frontline staff is too often overlooked. We believe that the frontline staff people rather than the therapists are usually the real agents of change in a facility. See our Guidelines for Staffing and, in the parent article of this, Guidelines for Basic and Core Issues.
How change in people occurs is something we know more about currently than we did twenty years ago. Because we know that, we also know more about how to promote change. We believe that schools and programs that promote change need to pay attention. We believe that schools, programs, therapists and others who promote change without having given careful and deliberate consideration of how these insights might be relevant to their work are simply not staying current with optimal practice methods.
There are two innovations that opened up new ways of thinking about the process of change that we think draw too little attention. The first was a study by James O. Prochaska, Carlo DiClemente and John Norcross. Much published material about this study is available on the web and in libraries. Perhaps the best insight into this research comes from the book Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. We emphasize that this is just one of many published items to describe what has become known as the "Transtheoretical Model" or simply "The Stages of Change." The significance of this research is that – as the term "transtheoretical" implies – it appears to be applicable to any process of change regardless of the process or theory behind the self help or therapeutic approach. This insight is equally applicable to a process where a person simply goes through a self change process or a twelve step group or a course of therapy with a psychiatrist.
The transtheoretical model does not involve the creation of new techniques. It helps us to understand where a person is his or her own process of change and to be able to assess what existing techniques will be beneficial at set points in the process. To be sure, we have seen published references to this as if it is a new group of techniques, or a new strategy or a new therapy. We think it is more descriptive to think of this new insight as a tool or group of tools to better refine and better focus the methods of change that have been available for years and to better monitor and assess the process of change in individuals, regardless of the approach to change that they are pursuing.
The second insight is known as Motivational Interviewing. Unlike what we have been discussing, Motivational Interviewing does involve a new set of techniques but more than that, might be considered a way of thinking. It is better defined by a set of principles than by a set of techniques. On page 25 of Motivational Interviewing, Second Edition, by William R. Miller and Stephen Rollnick, we find the following:
We define motivational interviewing as a client-centered, directive method for enhancing intrinsic motivation by exploring and resolving ambivalence. (Emphasis original)
Like the transtheoretical model, motivational interviewing does not stand alone, but is an enhancement to other tools of change. in particular it substitutes for much of the confrontation that has dominated much of the methodology of change for several decades. It is not independent of the transtheoretical model, but has been strongly influenced by it.
We value these two innovations for the fact that they add strength and effectiveness to other approaches. We do not mean that they should be rigidly implemented in all facilities even as a supplement to other methods. We do think that in order to maximize impact on change, all programs today should study these methods and adopt them where applicable, and set them aside where there is a well grounded reason for so doing.
Our guidelines for change are not broadly observed currently, we are sorry to say. We urge that strong preference be given to facilities that meet these guidelines, and we encourage all facilities to reconsider their approaches so these guidelines are observed.
Feedback is invited. We will publish selected feedback. Email FamilyLightResponse@yahoo.com
Disclaimer: No program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation. When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree. When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source. We have also set the bar very high, and do not expect any school or program to be in total compliance. It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines. Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.
Last revised 10-03-08; Menu update 10-07-08
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