Motivational Therapy - History

History

First publicized by Miller and Rollnick in 1991, motivational therapy is now seen as a highly effective treatment strategy for substance abuse, especially in the case of opiate and euphoric-enhancement drugs, where users tend to resist traditional negative reinforcement strategies. Motivational Therapy was brought to public awareness by William Miller in a 1983 article published in Behavioural Psychotherapy. In 1991, Miller and Stephen Rollnick expanded on the fundamental approaches and concepts, while making more detailed descriptions of procedures in the clinical setting. He later defined it as a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, Motivational Therapy is more focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal. Since Miller and Rollnick, other psychologists have introduced models and various techniques to try to implement within the Motivational Therapy realm to help with substance abuse. Carlo DiClemente introduced models that linked motivation with change, proposing the Stages of Change Model, and using it to explain relapse, and the struggle of addiction being a matter of behavior change. The model states seven different stages of change, and a brief description of each stage:

Precontemplation -- Not ready to change; Contemplation -- Thinking about change; Preparation -- Getting ready to make a change, planning and commitment; Action -- Making the change, implementing the plan, taking the action; Maintenance -- Sustaining behavior change until integrated into lifestyle, maintaining, integrating; Relapse/recycling -- Slipping back to previous behavior and re-entering the cycle of change; and Termination -- Leaving the cycle of change

The models, along with the techniques formulated by Rollnick and Miller have helped create a client-driven form of therapy that has been known to help clients with substance abuse and different caliber athletes in achieving success. Motivational Therapy was designed to be less confrontational than other therapies that encourage clients to realize that they have a problem that they need to confront in order to change. MT is different than those therapies that:

Argue that the person has a problem and needs to change Offer direct advice or prescribes solutions to the problem without the person's permission or without actively encouraging the person to make his or her own choices Use an authoritative/expert stance leaving the client in a passive role Do most of the talking, or functions as a unidirectional information delivery system Impose a diagnostic label Behave in a punitive or coercive manner

The aforementioned therapy techniques are known to violate the essential spirit of motivational therapy. MT is designed to be an interpersonal style of therapy that is not restricted to formal counseling settings. It focuses on the understanding of what initiates change while utilizing a guiding philosophy, and fosters a balance of components that are both directed and client-centered.