Person Centered Motivational Enhancement Therapy (and MI)

The Miller & Rose (2009) article discusses some of the active ingredients in motivational interviewing, and examines some variables that may impact behavior change after participating in MI. Here, the authors emphasize that it is a combination of technical and common factors. I liked their analysis of variables are often under researched such as the efficacy of the trainings provided by the organization and the therapist ability to follow through on protocol. In other theories, I have seen a promotion of their trainings, but not necessarily a follow through on examining their effectiveness on actual behavior change. In this article, the authors talk about how it is the slope of change that truly impacts behavior change, and not just the overall ratio between change talk and sustain talk. I wonder if this specifically has to do with the applicability of MI to certain populations, as the groups who started higher seemed to not have a good ability to change their behavior after. Concerning the rate of conducting this therapy, it is good to know that they do pay attention to if the client is ready to move onto the sessions 3-4 goals of reinforcing the change, for in the previous articles I read about MET, it seemed much more directed and short term necessarily. Toward the middle of the article, the authors used the phrase  'to make sense of these null results'. From a strength of theory perspective, this is interesting, for how far can you parse down into variables until you find a significant effect- is a small to medium effect size enough to declare that a theory is effective? In some ways, I think theories like this have it much easier when trying to figure out if their theory is effective. Although we have many tools to measure internal experiences, being able to measure relapse rates is much more concrete and can be easily done. Lastly, MI seems to advocate itself as a treatment that is applicable across many disciplines. However, if the training makes such an impact, what is the efficacy to disseminating MI to spaces where people don't have the ability to be supervised (hospitals, community and case workers) ?

In the article by Miller, 2012, the author discusses the key tenants of motivational interviewing, discusses a decisional balance procedure, and speaks about if motivational interviewing can be a fully fledged theory on its own. Initially, motivational interviewing was created for a purpose, and as a 'pre-treatment' therapy that addresses ambivalence. I did think it was interesting, he used the language "wants or needs to make a change", which is interesting considering other therapies that push against this idea of need or should. Because MI and MET are often applied to substance use situations, I can understand how the softer language is not necessarily used, for sometime it is necessary to cut down on substance use, even if one does not necessarily want to. I think this is especially applicable in the context of correctional settings where behavior change (mental health, attending parolee meetings, cutting down on substance use) are factors that can help reduce the risk of recidivism but the person may not necessarily want to do it. Therefore, I really appreciate the practicality of MI and MET and how they can be applicable to populations who are typically underserved and are in need of help getting over ambivalence to change. In the middle of the article, Miller talked about the idea of a decisional balance, or using therapy to look at the pros and cons of a behavior in order to make change in a certain direction. I cannot tell if this argument is against CBT, but I wonder if the logic holds challenging a thought or belief. Either way, the quote "Equally exploring both sides would logically reinforce ambivalence, which is where they were to begin with" is funny, and also interesting when considering that an intervention may seem applicable in session but cause difficulties at home. I also think using this framework may make clients feel like they are failing if they don't make the right decision or fall into patterns of relapse, for in therapy it was enumerated to them that there is a clear logical 'correct' choice. One thing that the article did not mention which I think is applicable here is the idea of not giving the client answers, but instead letting them come to it themselves. This feels like something that aligns with many theories. In general, concerning their language assertion, I wonder how much of client language you can thoroughly analyze in four 1 hour sessions. 

In the article by Neukrug and colleagues (2013), the authors discuss the importance of empathy as a basic skill as well as the concept of advanced empathy which can be used to deepen understanding of client perspective. This article talked about types of empathy outside of interpersonal or in-session empathy, which was interesting and I had never heard of before. This aligns with ideas such as perspective taking which can occur outside of therapy settings, but are based in the idea that empathy can impact behavior change and has neural correlates. According to these authors, although advanced empathy is not specifically discussed or explained by Rogers, practicing these skills can help therapists deepen their understandings of client perspectives as well as make assertions and interpretations in sessions that help client see themselves more clearly. Some of the advanced empathy skills that this article points to are reflecting deeper feelings, pointing out discrepancies in emotions, using visual imagery, analogies, and metaphors, and using targeted self-disclosure. I am grateful that there have been many therapists creative enough to think of good analogies and metaphors, for I often think in visual terms but not in a way that is cohesive enough for clients. Therefore, resources like the Big Book of Act metaphors has been useful for me, and I think it can help connect with clients. I wonder if clients with lower levels of insight are helped by images? The article alludes to 'these things help' a lot without a lot of citations, but I can see them being useful. Lastly, this article emphasizes that empathy is a skill to continually learn about. 

Grade: 23/25