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RE: motivational interviewing
MI has been validated in multiple controlled trials, with three results: 1)
it has repeatedly been shown to be superior to no treatment, even when
conducted in a very brief format (e.g., one session); 2) it has been shown
equivalent to other more intensive treatments, in Project MATCH and
elsewhere (e.g., 2 or 4 sessions of MI vs. 12 of CBT); and 3) it has been
shown to lead to improvements in engagement and outcome for persons entering
inpatient treatment programs. For a bibiliography (that does not include
2001 papers), as well as other information, see
http://www.motivationalinterview.org/. It has not yet been evaluated with a
maltreatment population--Mindy Hohman's work is descriptive.
The questions that have been raised regarding its potential usefulness are
all empirical. There are at least three ways in which it could be of use
and should be studied, given its success with substance abuse: 1) most
simply, in addressing substance abuse, a major predictor of maltreatment; 2)
in enhancing engagement and retention in parenting classes and other
treatment programs; and 3) prevention (e.g., working with parents at risk of
maltreatment due to substance abuse, depression, domestic violence, etc.).
MI is also frequently used with persons who are mandated to receive
treatment; it does not depend on voluntary treatment, but on a non-coercive
relationship with the therapist who is outside of the entity mandating
treatment.
MI does not depend on manipulation of cognitive structures of any kind, but
rather on: 1) the power of non-specific factors (e.g., optimism, empathy),
which have been repeatedly emphasized in the therapy outcome literature; 2)
the negative effects of providing the change argument for the client, which
usually results in their taking the opposite side ("Scared Straight"
reliably made the delinquents worse, as shown in 8 controlled studies); 3)
the positive effects of eliciting from the client reasons they might wish to
change, and focusing on those as a means of tipping the balance of
ambivalence; and 4)natural recovery, which is far more common than
previously suspected, at least in substance abuse (contrary to previous
beliefs, the majority of persons who recover from addiction do so without
any professional help).
Motivation for change is of great importance in the child maltreatment
field. The identification of effective brief models of intervention,
regardless of motivation, is also of great importance. We currently have
little other than clinical lore to guide us regarding motivation, and no
validated brief interventions; we should look for validated models from
other areas as a starting point. How useful those models are in CM, with
whom and when, will become clear with good research.
Steve
___________________________________
Steven J. Ondersma, Ph.D.
Assistant Professor--Research
Merrill-Palmer Institute
Wayne State University
71 E. Ferry Ave.
Detroit, MI 48202
Office: (313) 872-2706
Fax: (313) 875-0947
S.Ondersma@wayne.edu
www.mpi.wayne.edu
-----Original Message-----
From: owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu
[mailto:owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu]On Behalf Of
Julia H. Littell
Sent: Monday, May 14, 2001 4:10 PM
To: Child Maltreatment Researchers
Subject: motivational interviewing
Have there been any controlled trials of motivational interviewing other
than in Project MATCH? (In that study, there were no clear advantages of
"motivational enhancement" and no treatment matching effects based on
initial motivation.) Are there any studies of MI in child welfare samples?
What is its potential for the child maltreatment field?
At 02:37 PM 5/14/2001 -0400, you wrote:
>Paul Meehl, in a classic paper with the wonderful title of "Theoretical
>risks and tabular asterisks: Sir Karl, Sir Ronald, and the slow progress
of
>soft psychology" (JCCP, 1978), provides the following insight: "It is
>simply a sad fact that in soft psychology theories rise and decline, come
>and go, more as a function of baffled boredom than anything else."
>
>He was right, of course, as are Julia and other critics (see also Davidson,
>R. 1998, The transtheoretical model: A critical overview, in W.R. Miller &
>N. Heather (Eds.), Treating addictive behaviors [2nd ed.]) for calling the
>stage model into question. It is important, however, to not throw the baby
>out with the bathwater and (1) discount the ability of the better continous
>measures to predict retention and outcome; or (2) forget that with the
stage
>model came a deeper awareness that most persons at any given point in time
>may require something other than action-based advice for how to change.
MI,
>although a separate literature, dovetails with this very well and has shown
>remarkable efficacy in many settings, including in increasing engagement
and
>outcome in existing substance abuse treatment programs. The potential for
>the child maltreatment field is clear.
>