Motivational Interviewing and Self-Determination Theory (summary)

Motivational Interviewing and Self–Determination Theory

Markland, D., Ryan, R., Tobin, V., & Rollnick, S. (2005). Motivational Interviewing and Self–Determination Theory. Journal Of Social And Clinical Psychology, 24(6), 811-831.

Motivational Interviewing and adaptations of motivational interviewing (AMIs) have become extensively accepted as a counseling style changing maladaptive behaviours such as problems with alcohol and drugs, smoking cessation, HIV prevention among drug users, and other behaviours, mostly in a clinical setting. Motivational Interviewing has evolved from clinical experience in the treatment of alcohol abuse and was first described by Miller (1983). The problem with Motivational Interviewing is that it lacks theoretical underpinnings. This article proposes that Self Determination Theory offers theoretical framework for a better understanding of its processes and effectiveness.

The principles of motivational Interviewing

According to Miller and Rollnick (2002) Motivational Interviewing is a client-centered method for enhancing intrinsic motivation by recognizing and resolving ambivalence. Clients often begin therapy with conflicting motivations. They often want to change, but also see the benefits and disadvantages associated with changing or staying the same. The counselor’s role in this process is to help the client locate and define the ambivalence, provide support, offer some alternatives, and motivate the client to change. Counselors should not try to directly persuade the client to change because doing so would be taking one side of the client's own internal decisional conflict, which may cause the client to rebel and argue against change. There are four general principles of motivational interviewing described by Miller and Rollnick (2002):

1.The expression of empathy

Expression of the empathy by the counselor is the most important feature of the method and predictor of the treatment success. Motivational interviewing draws on the ideas of Rogers, that in order to change, the client must feel personally accepted and valued, a sense that is fostered by a counselor's expression of empathy.

2. The development of discrepancy

Development of discrepancy involves discussing positive and negative sides of client’s current behavior and of changes to current behavior in order to make the gap between the client’s current behavior and his wider goals and values more obvious to him.

3. Rolling with resistance

Rolling with resistance is the process of not engaging in conflict because often times, pushing the client to make a change will make him exhibit even greater resistance. Counselors are trained to accept ambivalence and resistance as normal. An important part of motivational interviewing is proposing alternatives in a neutral manner, provoking change talks, statements of recognition that clients make when he/she expresses the need or intention to change, concern for his/her current position, or the belief that change is possible.

4. Support for self-efficacy

In order to change, the client must believe that he/she is capable of making a change.

Self-Determination Theory

Self-determination theory (STD) is a theory of personality development and self-motivated behavioural change, developed out of testing the effects of rewards, praise, or directives on intrinsic motivation (Markland, Ryan, Tobin & Rollnick, 2005). Of special interest is how people incorporate extrinsic motivations and manage to self-regulate their behaviors in order to autonomously engage in daily actions. All the behaviors range from heteronomy/external regulation to autonomy/true self-regulation. It is believed that autonomous self-regulation is more stable and has a more positive effect than controlled regulation. Parents, teachers, and clinicians can either encourage or avert self-motivation for new behaviors.

The Continuum of Autonomy

Self-determination theory explains all behaviors as lying on the continuum of relative autonomy. At the controlled end of this continuum is behavior that is motivated by external regulations (rewords/punishments controlled by others). According to SDT, external regulators may temporarily control behaviour, but since the motivation to change comes from an external source, the person being controlled will only exhibit the desired behaviours when the external motivator is present. External motivation has also been shown to result in poorer performance and a lower willingness to put effort into a task.  

Slightly more autonomous is introjected regulation - when a person is driven by internalized self-esteem-related contingencies. It is an ambivalent and unstable form of motivation accompanied by a negative emotional tone, tension, and an inner conflict. Introjection reflects a partial internalisation of the behaviour's value.

Identification is more self-determined form of regulation that involves acceptance of the target behavior as important in order to achieve personally valued outcomes. It is also likely to be more relevant than intrinsic motivation in maintaining behaviors that are not very enjoyable. Studies show that identification is a stable and persistent form of motivation.

Integrated regulation is the most autonomous form of extrinsic motivation, where a person both identifies with regulation and also co-ordinates this identification with their other core values and beliefs.

Intrinsically motivated behaviors are fun and enjoyable in their own light.

The latter two forms of motivation are similar in that the subject engages in behaviours willingly, and is therefore fully self-determined.  More autonomously regulated behaviors are more stable and done with greater pleasure.

A vital component of SDT is the importance of relative autonomy. Studies have shown that students who were more self-directive in classrooms were less likely to show signs of anxiety and conflict, showing better coping in an educational environment. Additionally, patients that expressed more autonomy for following a particular treatment regimen were more likely to persistently and accurately take their prescribed medications. Thus, in order for therapy to be successful, clients need to have a certain level of perceived autonomy.

The Facilitating Environment

According to SDT there are three fundamental psychological needs as the basis for self-motivation and personality integration:

1. The need for competence –refers to the psychological need to experience confidence in one’s ability and capacity to achieve desired outcome.

2. The need to feel autonomous –in acting rather than feeling controlled

3. The need to feel related –it refers to the basic need to have supportive social relationships.

According to STD, depending on the person’s social environment the process of integrating new regulations over behavior can be helped or inhibited. There are three dimensions of the social environment that can promote satisfaction of the psychological needs for competence, autonomy and relatedness:

1. Structure –regarding the structural dimension, competence is being developed in individuals when they are encouraged to believe that they are able and capable of engaging in proper behaviors and when positive feedback is provided.

2. Autonomy support – in its contexts individuals are encouraged to initiate actions themselves and pressure to engage in specific behavior is minimized.

3. Involvement –refers to the quality of relationships between individuals. Satisfaction of this need is crucial for the process of internalization.

Self-Determination Theory and Motivational Interviewing

As already argued, SDT can provide a theoretical framework for understanding how motivational interviews support change in behaviors. Support for the need for competence is contained in motivational interviewing by providing clear information about behavior, by helping the client to set realistic expectations and goals and giving nonjudgmental feedback. Autonomy support is provided by avoiding confrontations and persuasion, making the gap between current and desired behavior more obvious, exploring alternative behavioural options, and encouraging client to choose actions they prefer. Placing an emphasis on having the motivation to change come from within the person is a common element in both Motivational Interviewing and the SDT framework. The need for relatedness is promoted by empathy shown by the counselor and by the avoidance of criticism and blame. According to the SDT framework, intrinsic motivation is an important form of autonomous motivation but extrinsic motivation can also be autonomous. It is important to be aware of this because in most cases regarding behvaioural change (such as giving up alcohol, smoking, or drugs) it is often unrealistic to have clients really be intrinsically motivated to engage in a new behavior. From that perspective, it is more accurate to define Motivational Interviewing as a method of promoting autonomous motivation for change, rather than intrinsic motivation.

Developing Discrepancy: A double-edged Sword

In an ideal case, developing discrepancy will help clients change their behaviour by helping them become aware of differences between their current behaviors and their core values and beliefs. But such a realisation could lead the client into the partially internalized and self-controlling regulatory state characterized by introjection, where he/she puts pressure on him/herself to change. All three ambient supports (structure, autonomy, involvement) are necessary to promote optimal internalization of behavioral regulation and integration into the self. It was found that if only one of these factors was present, behavioral integration was introjected. It is essential that clinicians are not too focused on technical components of Motivational Interviewing; emphasis should be placed on helping clients express desires to change and helping them identify the path to such changes.