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Motivational Interviewing

Problems, such as drug and substance abuse are very common in human society as they negatively affect the social life of people. There is a need for interventional methods to relieve the victims from such problems. Some of the most effective techniques for alleviating the problem of substance abuse include Motivational Interviewing counseling and Behavior Modification. Motivational Interviewing refers to as a client-centered directive technique for changing intrinsic motivation through exploration and resolution of ambivalence (Moyers & Martin, 2006). Behaviors Modification refers to as to the application of empirically demonstrated techniques of behavior change to decrease or increase the frequency of behaviors (Martin & Pear, 2010). The study of theoretical tenets of both Motivational Interviewing and Behavior Modification can help an individual understand the counseling techniques. Motivational Interviewing and Behavior Modification have similarities and differences in their theoretical tenets and the manner in which they help the victims of drug and substance abuse recover.

Moyers & Martin (2006) define Motivational Interviewing as a client-centered directive technique for changing intrinsic motivation through exploration and resolution of ambivalence. According to Moyers & Martin (2006), Motivational Interviewing includes a combination of clinical and philosophical aspects that together constitute the whole of Motivational Interviewing. The three basic aspects of Motivational Interviewing include its spirit, which forms the basis for clinical strategies; general principles that give direction to the clinical practice; and early techniques for arousing motivational statements and establishing rapport (Bundy, 2004). The designed strategies enable clients to study their ambivalence, regarding change, with the aim of increasing their inclination towards change, the identification of the significance of change, and their feeling in the ability to create change. When clients articulate the arguments for change, they experience an increase in their intentions to change, which, in turn, results in subsequent behavior change (Hodgins, Ching, & McEwen, 2009).

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Therefore, Motivational Interviewing includes evocation, collaboration, education, authority, autonomy, and confrontation (Moyers & Martin, 2006). The original methods of Motivational Interviewing included confrontational techniques with applications to health promotion, general medical care, addictions, corrections, and social work (Hodgins, Ching, & McEwen, 2009). The most recent focus of Motivational Interviewing is the behavioral change. According to Moyers & Martin (2006), the Motivational Interviewing counseling is a partnership between the client and counselor that honors the client’s perspectives as well as the counselor’s expertise. The therapist ensures that the atmosphere is conducive and free from coercion (Bundy, 2004). There is an assumption that the client has intrinsic motivation and resources for change that the therapist can enhance by enabling the client to express their values, perceptions, and goals (Hodgins, Ching, & McEwen, 2009). The therapist maintains the right of the client for informed choice and self-direction. Hodgins, Ching, & McEwen (2009) suggest that confrontation is necessary to enable the client to become cognizant of their reality.  

Martin & Pear (2010) define Behavior Modification as the application of empirically demonstrated techniques of behavior change to decrease or increase the frequency of behaviors. For instance, behavior modification is evident, while changing reactions and behaviors of an individual to stimuli through negative and positive reinforcement of adaptive behavior, or the reduction of adaptive behaviors through punishment, satiation, and extinction (Martin & Pear, 2010). Therefore, the basis of behavior modification principles is the use of rewards that target specific negative behaviors. The goal of the reward system is to reshape the motivations of an individual in order to eliminate the current, antisocial behavior for new, beneficial behaviors (Gardner, 2006). Behavior modification is also very useful in reducing the behaviors that have a relationship with substance abuse, such as addiction (Martin & Pear, 2010). Clients are aware of the costs and benefits, associated with either altering their current behaviors, or leaving their current behaviors unaffected. Therefore, it takes a short time for the client to drop unacceptable behaviors, when more benefits than costs accompany the adoption of desired behaviors (Martin & Pear, 2010). This discussion will consider the theoretical tenets of Motivational Interviewing counseling and Behavior Modification, and their similarities and differences.  

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Theoretical tenets of Motivational Interviewing

Motivational interviewing depends on the enhancement of intrinsic motivation to change through exploration and resolution of ambivalence (William & Gary, 2009). Therefore, the identification of the client’s mixed emotions and feelings plays a primary role in motivational interviewing. It is an assumption that most clients, entering motivational interviewing therapeutic relationship. will accommodate conflict motivations (Moyers & Martin, 2006). Clients have good reasons to why they want a change in their current behaviors. On the other hand, clients are aware of the costs and benefits, associated with either altering their current behaviors or leaving their current behaviors unaffected (William & Gary, 2009). This is evident that clients experience decisional conflict, which makes them stuck in a state of being unable to change in spite of the presence of inducements to do so, or to alternate between assuming a new behavior pattern and reverting to hold, undesirable behaviors.  

It is apparent that trying to persuade the victim to change will not be effective because it takes one side of the decisional conflict that the victim is already experiencing (William & Gary, 2009). This will make the client to embrace the opposite stance, which will result in increased resistance and reduction in the likelihood to alter the current, undesirable behaviors. Motivational interviewing enables the client to express their ambivalence in an overt manner in order to direct them to a more satisfying resolution, regarding the conflicting motivations with the primary purpose of eliciting appropriate behavioral changes (Moyers & Martin, 2006).

 
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Therefore, a key assumption that underlies motivational interviewing is that it is not the function of the counselor to directly coerce or persuade the client to undergo a positive change (Moyers & Martin, 2006). Rather it is the client’s responsibility to arrive at a conclusion on whether or not to undergo a positive change and how best to approach situation (Hodgins, Ching, & McEwen, 2009). The role of the counselor in the therapeutic relationship is to enable the client identify and elucidate their motivation for change, provide information and support alternative perspectives, regarding the problems of behavior and effective ways of altering the behavior (William & Gary, 2009). This is evident that motivational interviewing is a client-centered style of counseling. The goal of motivational interviewing is to direct the client toward resolving inconsistencies and ambivalence in their behaviors so that to enhance motivation for change, normally in particular direction (William & Gary, 2009).  

Motivational interviewing consists of four general principles, which support its specific strategies and techniques: development of discrepancy, expression of empathy, support for self-efficacy, and rolling with resistance (Hodgins, Ching, & McEwen, 2009). The counselor’s expression of empathy is a defining and fundamental feature of motivational interviewing counseling (Moyers & Martin, 2006). This draws explicitly on the research, which shows that the treatment success depends on the therapist empathy. The behavior change during motivational interviewing becomes successful, when the clients feel they are personally valued and accepted (Strang & McCambridge, 2004). Therefore, the empathy of a counselor is very essential in providing the conditions needed for successful exploration of an anticipated change.

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The directivity of motivational interviewing is apparent in the development of discrepancy, which is the second principle. This involves the examination of the advantages and disadvantages of the current behaviors and changes to current behaviors, in the accepting and supportive atmosphere to generate or deepen cognizance of the discrepancy, regarding the current behaviors and the client’s broader values and goals. Moyers & Martin (2006) consider this process as the active element that underlies the efficacy of motivational interviewing, and contends that developing discrepancy arouses movement in the direction of consistency between the behaviors and core values of the client. Discrepancy development is an aspect of a strategy that aids the client in the clarification of conflicts, regarding change and his or her possible choices (Hodgins, Ching, & McEwen, 2009).  

Since motivational interviewing counseling is directive, as it enables the clients to become cognizant of the discrepancies that underlie their current behaviors and to guide them in the direction of considering change, avoidance of arguing for behavior change is vital in successful therapy. According to William & Gary (2009), the process of countering the argument of a client or not engaging in conflict against change is evident in the third principle of motivational interviewing, rolling with resistance. Direct argumentations for behavior change will illicit reactance within the client and likelihood of exhibiting greater resistance; thus, reducing the likelihood of positive change in behavior. Instead, people accept resistance and ambivalence as normal. Rather than imposing strategies or goals, the counselor encourages his or her client to consider various perspectives, regarding the problem (William & Gary, 2009).

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It is possible for clients to resist the need for behavior change but the goal is to try to overcome the client and provide them with a peaceful recipient of the therapist’s viewpoint by the force of argument (Moyers & Martin, 2006). The aim is to transfer the obligation for arguing for change in behavior by eliciting self-motivating statements (Hodgins, Ching, & McEwen, 2009). These are observable resolutions by the client that present recognition of the need for behavior change, intention to change, the belief that behavior change is possible, or concern for the current behavior. There is evidence to give more support to the view that an increase in self-motivating statements in the course of therapy anticipates successful treatment results (William & Gary, 2009).

The need to support self-efficacy for behavior change is the final principle of motivational interviewing counseling. Research has shown that even if the counselor motivated the client to modify their current behaviors, there will be no change, unless the clients feel that they have the potentialities and resources to subdue barriers and apply new ways of behaving in a successful manner (Madson & Campbell, 2008). 

Theoretical tenets of Behavior Modification

Behavior modification consists of great deal of principles, namely successful approximation principle, negative reinforcement principle, continuous reinforcement principle, modeling principle, discrimination principle, cueing principle, variable reinforcement principle, substitution principle, decreasing reinforcement principle, satiation principle, punishment principle, incompatible alternative principle, avoidance principle, extinction principle, and fear reduction principle (Martin & Pear, 2010). All these principles enable a victim to recover from the undesirable behaviors and embrace new, useful behaviors. Behavior modification is distinct from motivational interviewing counseling, because the client’s change in behavior exclusively depends on the counselor and not on the client (Martin & Pear, 2010).  

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Negative reinforcement requires a therapist to inform a patient of their unacceptable or inappropriate behavior (Gardner, 2006). The aim of negative reinforcement is to modify the unacceptable behavior to more acceptable level. According to Martin & Pear (2010), negative reinforcement can be mild or very severe, depending on the type of behavior that is under modification. Therefore, in behavior modification approach, a counselor uses direct argumentation for behavior change to ensure that a new behavior is successfully learned (Martin & Pear, 2010).   

Continuous reinforcement requires a therapist to inform the client about the appropriate behavior (Miltenberger, 2008). This will encourage the client to drop the unacceptable behavior, such as the behavior of habitual consumption of drugs. Once the client has exhibited a new, acceptable behavior, the next step is for a therapist to put an effort to strengthen the new behavior (Martin & Pear, 2010). Variable reinforcement principle and decreasing reinforcement principle are very effective in strengthening the acceptable behavior. Treatment programs for drug and substance addiction have found principles of behavior modification very useful (Landy & Conte, 2007).     

Martin & Pear (2010) suggest that the intervention due to behavior modification starts with the identification of the problem behaviors. The principles and practices of behavior modification help individuals develop new, useful behaviors, while doing away with the undesirable and disturbing behaviors (Martin & Pear, 2010). Behavior modification techniques have their basis on behavioral theory, which is a branch of psychology. The bases of behavioral theory are operant conditioning and classical conditioning (Martin & Pear, 2010). Operant conditioning makes use of negative and positive reinforcement practices to discourage an individual from exhibiting undesirable behaviors, while classical conditioning depends on the stimulus-response patterns (Martin & Pear, 2010). Operant conditioning principles depend on a schedule of reinforcement to enhance the desired outcomes (Martin & Pear, 2010). A therapist reinforces the target behaviors as soon as the client exhibits them. On the other hand, negative behaviors are discouraged, once they occur. Punishment and reward tools are useful in strengthening new, acceptable behaviors (Gardner, 2006). These tools aim at redirecting the motivations of an individual toward the desired result.   

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Shaping of the current habit or behavior depends on the actions that happen before and after the execution of the behavior (Martin & Pear, 2010). Extinction works by changing or removing what takes place after the execution of the behavior. In effect, the reward or incentive that motivates an individual to execute a certain behavior is withdrawn. When the withdrawal of rewards or incentives happens for some time, the motivation to engage in a certain behavior starts to fade (Martin & Pear, 2010). Finally, the undesirable behavior becomes extinct, following lack of incentives or rewards. Therefore, the study of behavior modification approach reveals a number of characteristics, which distinguishes it from other behavioral approaches.  

The techniques of behavior modification are useful in everyday life. Such techniques have their bases on principles of learning, especially classical conditioning and operant conditioning (Martin & Pear, 2010). There is a great emphasis on the responsibility for every individual involved in the program of behavior modification. The techniques of treatment are ways of changing an individual’s current behavior to help that individual function in a health manner (Martin & Pear, 2010). There is a special importance to define problems of the measurable behaviors. According to Martin & Pear (2010), with behavior modification approach it is possible to describe the rationales and methods in a precise way.              

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Similarities between Motivational Interviewing and Behavior Modification

Both motivational interviewing counseling and behavioral modification help the client stop exhibiting undesirable behavior and begin to behave appropriately (Hodgins, Ching, & McEwen, 2009). These approaches can work from the perspective of a counselor, presenting rewarding messages to the client in order to encourage him or her to assume acceptable behaviors and drop inappropriate behaviors. The clients feel that they are personally valued and accepted, when they receive rewarding messages from their counselors (Martin & Pear, 2010). Motivational interviewing counseling and behavioral modification are very effective in the treatment of various behavioral problems such as drug addiction. In both approaches, clients are aware of the costs and benefits, associated with either altering their current behaviors or leaving their current behaviors unaffected (Martin & Pear, 2010). Therefore, it takes a short time for the client to drop unacceptable behaviors, when more benefits than costs accompany the adoption of desired behaviors (Martin & Pear, 2010).   

Differences between Motivational Interviewing and Behavior Modification

The two approaches differ from each other, based on the mechanism, through which they enhance behavior change in the clients. Motivational interviewing counseling has a characteristic of being client-centered (Hodgins, Ching, & McEwen, 2009), while in behavior modification, behavior change depends exclusively on the counselor’s interventions (Martin & Pear, 2010). With the motivational interviewing, the role of the counselor in the therapeutic relationship is to enable the client identify and elucidate their motivation for change, provide information and support alternative perspectives, regarding the problems behavior and effective ways of altering the behavior (Hodgins, Ching, & McEwen, 2009). A key assumption that underlies motivational interviewing is that it is not the function of the counselor to directly coerce or persuade the client to undergo a positive change (Hodgins, Ching, & McEwen, 2009). This is contrary to behavior modification approach, in which the counselor plays a role of persuading the patient to drop an aversive behavior and embrace an acceptable behavior (Martin & Pear, 2010). Regarding motivational interviewing, research has shown that even if the counselor motivates the client to modify their current behaviors, there will be no change, unless the client feels that they have the capabilities and resources to subdue barriers and apply new ways of behaving in a successful manner (Hodgins, Ching, & McEwen, 2009).      

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Unlike in behavior modification, in motivational interviewing approach direct argumentations for behavior change will illicit reactance within the client and likelihood of exhibiting greater resistance; thus, reducing the likelihood of positive change in behavior (Hodgins, Ching, & McEwen, 2009). In behavior modification, a counselor uses direct argumentation for behavior change to ensure that a new behavior is successfully learned.

Various approaches such as motivational interviewing and behavior modification are crucial in the treatment of behavioral problems like drug addictions. Therapists in the two approaches use different techniques to elicit behavior change (Martin & Pear, 2010). The aim of both approaches is to ensure that a client drops an aversive behavior and embrace an acceptable one. Therefore, the two approaches have similarities and differences, regarding their functioning. In both approaches, clients are aware of the costs and benefits, associated with either altering their current behaviors or leaving their current behaviors unaffected (Hodgins, Ching, & McEwen, 2009). Therefore, it takes a short time for the client to drop undesired behaviors, when more benefits than costs accompany the adoption of acceptable behaviors (Martin & Pear, 2010).

Motivational interviewing approach is client-centered (Hodgins, Ching, & McEwen, 2009). This is because the role of the counselor in the therapeutic relationship is to enable the client to identify and elucidate their motivation for change, provide information, and support alternative perspectives, regarding the problems behavior and effective ways of altering the behavior (Hodgins, Ching, & McEwen, 2009). Behavior change in behavior modification approach exclusively depends on the therapist (Martin & Pear, 2010). The therapist can either provide rewards to or withdraw from the patient with an aim of encouraging or suppressing the current behavior. Therefore, the client does not have an alternative but follow the counselor’s intended path (Martin & Pear, 2010). 

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