MOTIVATIONAL INTERVIEWING IN THE TREATMENT OF PSYCHOLOGICAL PROBLEMS Applications of Motivational Interviewing Stephen Rollnick and William R. Miller, Series Editors Since the publication of Miller and Rollnick’s classic Motivational Interviewing,MI has become hugely popular as a tool for facilitating many different kinds of positive behavior change. This highly practical series demonstrates MI approaches for a range of applied contexts and with a variety of populations. Each accessible volume reviews the empirical evidence base and presents easy-to-implement strategies, illu- minating concrete examples, and clear-cut guidance on integrating MI with other interventions. Motivational Interviewing in the Treatment of Psychological Problems Hal Arkowitz, Henny A. Westra, William R. Miller, and Stephen Rollnick, Editors Motivational Interviewing in Health Care: Helping Patients Change Behavior Stephen Rollnick, William R. Miller, and Christopher C. Butler Motivational Interviewing in the Treatment of Psychological Problems Edited by HAL ARKOWITZ HENNY A. WESTRA WILLIAM R. MILLER STEPHEN ROLLNICK THE GUILFORD PRESS New York London © 2008 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number:987654321 Library of Congress Cataloging-in-Publication Data Motivational interviewing in the treatment of psychological problems / edited by Hal Arkowitz ... [et al.]. p. ; cm. — (Applications of motivational interviewing) Includes bibliographical references and index. ISBN-13: 978-1-59385-585-7 (hardcover : alk. paper) ISBN-10: 1-59385-585-0 (hardcover : alk. paper) 1. Interviewing in psychiatry. I. Arkowitz, Hal, 1941– II. Series. [DNLM: 1. Nondirective Therapy—methods. 2. Interview, Psychological. 3. Mental Disorders—therapy. 4. Motivation. WM 420.5.N8 M918 2008] RC480.7.M68 2008 616.89—dc22 2007015396 About the Editors About the Editors Hal Arkowitz, PhD, is Associate Professor of Psychology at the Univer- sity of Arizona. His main interests are in understanding how people change and why they don’t. Dr. Arkowitz has published widely in the areas of anxiety, depression, psychotherapy, and psychotherapy integra- tion. Most recently, he coauthored Ambivalence in Psychotherapy: Facili- tating Readiness to Change (with David E. Engle; 2006, Guilford Press). Along with Scott O. Lilienfeld, Dr. Arkowitz is a co-columnist for the magazine Scientific American Mind. For 10 years, he served as Editor of the Journal of Psychotherapy Integration. Since receiving his doctorate, he has also maintained an active clinical practice and values the inter- play between research and practice. Henny A. Westra, PhD, is Associate Professor in the Department of Psychology and the Director of the Anxiety Research Clinic at York Uni- versity in Toronto. Prior to this, she was the Clinical Director of the Anxiety and Affective Disorders Service at the London Health Sciences Centre. Dr. Westra has published over 30 peer-reviewed articles and book chapters, as well as given over 100 presentations and workshops, on the treatment of anxiety. She has received funding from the National Institute of Mental Health and the Canadian Institutes of Health Re- search for her research on motivational interviewing, expectations for change, and engagement with treatment. William R. Miller, PhD, is Emeritus Distinguished Professor of Psychol- ogy and Psychiatry at the University of New Mexico. With over 400 publications, including 35 books, Dr. Miller introduced the concept of v vi About the Editors motivational interviewing in a 1983 article. He was named by the Insti- tute for Scientific Information as one of the world’s most cited scientists. Stephen Rollnick, PhD, is a clinical psychologist and Professor of Health Care Communication in the Department of Primary Care and Public Health, Cardiff University, Wales, United Kingdom. He has pub- lished widely on motivational interviewing and health behavior change and has a special interest in challenging consultations in health and so- cial care. Contributors Contributors Hal Arkowitz, PhD, Department of Psychology, University of Arizona, Tucson, Arizona Brian L. Burke, PhD, Department of Psychology, Fort Lewis College, Durango, Colorado Patrick W. Corrigan, PsyD, Institute of Psychology, Illinois Institute of Technology, Chicago, Illinois Katherine M. Diskin, PhD, Addiction Centre, Foothills Medical Centre, Calgary, Alberta, Canada David J. A. Dozois, PhD, Department of Psychology, University of Western Ontario, London, Ontario, Canada Carl Åke Farbring, MA, National Prison and Probation Administration, Stockholm, Sweden Nancy K. Grote, PhD, School of Social Work, University of Washington, Seattle, Washington David Hodgins, PhD, Department of Psychology, University of Calgary, Calgary, Alberta, Canada Wendy R. Johnson, MS, Department of Psychology, University of New Mexico, Albuquerque, New Mexico Nicholas Maltby, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut Steve Martino, PhD, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare System, West Haven, Connecticut vii viii Contributors Stanley G. McCracken, PhD, School of Social Service Administration, University of Chicago, Chicago, Illinois William R. Miller, PhD, Department of Psychology, University of New Mexico, Albuquerque, New Mexico Theresa B. Moyers, PhD, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico Ronald T. Murphy, PhD, Department of Psychology, Francis Marion University, Florence, South Carolina Stephen Rollnick, PhD, Department of General Practice, Cardiff University School of Medicine, Cardiff, United Kingdom Ulrike Schmidt, MD, PhD, Section of Eating Disorders, Institute of Psychiatry, London, United Kingdom Holly A. Swartz, MD, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut, and Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut Janet Treasure, MD, PhD, Department of Academic Psychiatry, Kings College London, London, United Kingdom Henny A. Westra, PhD, Department of Psychology, York University, Toronto, Ontario, Canada Harry Zerler, MA, Hunterdon Medical Center, Flemington, New Jersey Allan Zuckoff, PhD, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Preface Preface Motivational interviewing (MI) is an approach to helping people change that was originally developed by William R. Miller and Stephen Rollnick. It has had a tremendous impact on research and prac- tice in the fields of substance abuse and health-related problems in the United States and many other countries. There are several reasons for its appeal. First, it directly addresses a significant problem common to all therapies: resistance to change. In MI, resistance is seen as a result of ambivalence about change. Its pri- mary goals are to help clients increase their intrinsic motivation and re- solve ambivalence in order to facilitate behavior change. Second, it is flexible and can be used as a “stand-alone” approach, in combination with other therapies, or as an adjunct to other therapies. Third, there is a considerable body of research evidence supporting both the efficacy and effectiveness of MI with substance use and health-related problems. Fourth, research has demonstrated that MI is learnable, and achieves significant therapeutic effects in relatively few sessions. Given all of these appealing features, it is rather surprising that MI has hardly been employed or studied outside of the fields of substance use and health-related problems. There have been some stirrings of in- terest in the field of psychotherapy. MI has been presented at several symposia and workshops at psychotherapy conferences, and we are aware of several grant applications in preparation or submitted that study MI with different clinical populations. The time has come for clinical researchers and practitioners to seri- ously consider MI as a way to increase readiness to change and to en- hance treatment outcomes with psychological problems. We hope that this book facilitates this goal. We invited researchers and practitioners who were already exploring MI for a variety of different clinical prob- ix x Preface lems to contribute chapters describing their work. Each chapter de- scribes the clinical problem and its usual treatments, how MI has been used, any modifications that were necessary to tailor MI to the problem and population, detailed clinical case histories, and a summary of rele- vant research. This book represents a truly collaborative effort on the part of the coeditors. Miller and Rollnick, the originators of MI, have done a great deal of research and clinical work using MI with substance use disorders and health-related problems. Arkowitz and Westra have done clinical work and research extending the use of MI to depression