Motivational Interviewing and change theory

Critique this post noting any agreement or differences of opinion.  Also include how MI and Change Theory will help in PMHNP practice.  Please use at least two or more scholarly references.


   We are investigating change theory and motivational interviewing this week as distinct psychotherapeutic modalities. These methods have been applied across psychological fields from substance abuse counseling to organizational psychology (Magill et al., 2018; Udod & Wagner, 2018). The goal of these modalities is to help affect a desired change. As future psychiatric mental health nurse practitioners (PMHNPs), we may work in diverse settings with diverse client populations. Learning how and when to apply these modalities can strengthen our practice as PMHNPs and help us to empower our patients to make positive changes in their lives, such as reducing substance use.

              There are numerous change theory models cited in the literature, however Kurt Lewin’s three-step change model is most frequently referred to for clinical application (Udod & Wagner, 2018). Lewin’s change model involves three steps: unfreezing, change, and refreezing (Udod & Wagner, 2018). These steps occur in a linear method and respectively describe the process of stopping a current behavior, moving towards or learning a new behavior, and then continuing this new behavior in the future (Udod & Wagner, 2018). For example, a patient might come in expressing negative self-image. Using this model, the PMHNP might guide the patient to “unfreeze” negative thoughts by interrogating their validity, then the patient would “change” their self-talk to focus on positive/successful aspects of themselves, and thirdly, they would “refreeze” this behavior by practicing it frequently over time. This model is relatively simplistic, which makes it easy to understand but also limits its application to complex behaviors. I think there may be some clinical relevance for this three-step change model when a client has good insight and is ready for change, as this model has little room for nuanced human behaviors. This may be an appropriate model to utilize in supportive therapeutic settings where risk is low and the need for change is not functionally impairing.

              Motivational interviewing (MI) is another evidence-based model for eliciting behavioral change with excellent outcome data, especially in addiction services (Angelini & Efran, 2021; Magill et al., 2018). MI consists of a systematic communication model that is meant to put clients at the helm of their behavioral change (Angelini & Efran, 2021). MI communication strategies guide patients from “sustain talk” to “change talk” using their own words (Angelini & Efran, 2021). Providers trained in MI techniques help their clients to recognize behavioral goals that may lead to improved psychosocial functioning.  In an alcohol use disorder, for example, the PMHNP might ask their client about desired outcomes or goals to encourage “change talk,” such a desire to reduce alcohol consumption. In this way, the client is guided rather than directed by the mental health provider (Angelini & Efran, 2021). The communication techniques utilized in MI work when actively applied but the outcomes tend to rely on continual use of MI in treatment (Magill et al., 2018). Because of the rigorous structure involved in utilizing MI communication strategies, providers may not maintain these techniques in chronic clients or may fall back into normative behaviors such as the “righting reflex,” where they may give too much direction in an effort to help the client (Angelini & Efran, 2021; Magill et al., 2018). I have had some experience in mock interviews utilizing MI techniques and have found the structure to be a helpful approach to the client interview, especially while learning psychotherapy. I can see how this structure may feel limiting once I have developed my own interview style. However, I believe the evidence supporting the technical approach of MI at engendering client change behaviors is worth the effort that it may take to utilize this modality (Magill et al., 2018).

              Hopefully, we have seen how different psychotherapeutic models can be employed in our practices as PMHNPs to assist our patients in adaptive change behaviors. Positive behavioral changes promote resiliency and allow our patients to function better psychosocially. In substance/alcohol use disorders, as an example, behavioral changes can also lead to marked improvements in physiologic wellness. I hope to practice holistic wellness as a PMHNP and plan to utilize these modalities when they are appropriate for the client(s) I am treating.


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