Effective methods for behavioral change are at the heart of the criminal justice and human services systems. Two critical approaches are Motivational Interviewing and Cognitive Behavioral Therapy.
Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) drive transformative change through illuminated pathways to rehabilitation and growth. This blog will dig deeper into the principles behind these evidence-based methods and how they can foster positive change for individuals and their communities.
Motivational Interviewing is a client-centered approach and communication style designed to strengthen motivation for people who need to make behavioral changes in their lives – including adults and youth. It is used across a broad range of human services, including justice, child welfare, substance use treatment, and other behavioral health contexts.
Motivational Interviewing roots itself in four fundamental principles (express empathy, develop discrepancy, roll with resistance, and support self-efficacy) across four phases of change: engaging, focusing, evoking, and planning.
Check out this MI fact sheet for a quick overview of Motivational Interviewing.
How do practitioners bring Motivational Interviewing principles into practice? First, there are four basic interviewing methods or techniques that are used.
Open-ended questions require more than a straightforward "yes" or "no" response, prompting deeper reflection on a subject. These inquiries typically begin with words like "how" , "what" or “Tell me more” and allow therapists to gain further insights into the individual.
Examples include questions:
Affirmations acknowledge an individual's strengths and recognize their positive actions. When delivered effectively, affirmations can boost a person's confidence in their capacity for change.
Illustrative affirming statements could include statements such as:
Reflective listening stands out as a fundamental skill practitioners employ, playing a pivotal role in conveying to clients that their therapist is actively listening and seeking to comprehend their perspective. This skill not only allows clients to address any misconceptions but also allows them to delve deeper into their emotions.
Here's an example of reflective listening:
Summaries serve as a specialized form of reflection, indicating the practitioner's attentive listening and comprehension of the client's communication. Practitioners can employ summarizing techniques throughout a conversation through collecting, linking, and transitioning.
These are the basic methods that contribute to the style of interacting with clients using Motivational Interviewing. There are many other approaches within the range of MI techniques that are used to help gently support the client in moving toward behavioral change.
The benefits of Motivational Interviewing are extensive, encompassing the building of self-confidence and trust, fostering client responsibility, reducing the risk of relapse, preparing clients for treatment, reinforcing the belief in one's ability to initiate life changes, and encouraging self-accountability. Relationships are the foundation to this work and are key to supporting clients throughout the process.
Cognitive-behavioral therapy (CBT) is a therapeutic method designed to assist individuals in recognizing detrimental thought and behavior patterns.
The primary goal of CBT is to explore the impact of emotions and thoughts on actions. By identifying these patterns, individuals can initiate the process of changing behaviors and acquiring new coping strategies. CBT predominantly addresses the present moment and places less emphasis on the past.
According to the American Psychological Association, the key concepts of CBT include:
CBT employs various techniques, and practitioners collaborate with clients to identify which one works best.
Standard methods often include:
The aim is to replace unhelpful thoughts with more encouraging and realistic ones. A few popular CBT techniques include:
Homework is a crucial aspect of CBT that often builds on the techniques above, allowing for practice and skill development.
CBT stands out as one of the most extensively researched therapeutic approaches, often regarded as the leading treatment for various mental health conditions. For example, a 2018 review of 41 studies addressing anxiety disorders, PTSD, and OCD indicates that CBT demonstrates efficacy in improving symptoms, particularly in cases of OCD, anxiety, and stress.
Another study, also from 2018, focused on CBT for anxiety in young individuals, revealing favorable long-term outcomes, with over half of participants no longer meeting anxiety criteria in follow-ups occurring two or more years after therapy completion.
Research also shows that CBT is highly effective in various criminal justice settings. In most CBT programs, justice-involved individuals improve social skills, problem-solving, moral reasoning, self-control, self-efficacy, and impulse management.
We know that Motivational Interviewing and CBT are highly effective interventions for behavior change. What happens when the two methods combine?
Motivational Interviewing, renowned for addressing ambivalence about change, is a seamless addition to the exposure components of CBT. According to research, the combination is especially beneficial in the treatment of anxiety disorders.
Integrating Motivational Interviewing navigates the resistance, often accompanying interventions like CBT, becoming a combination that propels individuals towards commitment and motivation for change. This integration addresses the inherent ambivalence that at-risk populations may experience, laying the groundwork for more receptive and engaged participants.
Motivational Interviewing builds initial motivation for change, but once established, it harmonizes seamlessly with more action-oriented treatments like CBT.
Evidence indicates that a more potent behavioral treatment unfolds by incorporating Motivational Interviewing strategies at specific moments during CBT, particularly when discord or ambivalence surfaces. This strategic integration recognizes the fluctuating nature of motivation during the phases of change, creating a dynamic synergy that strengthens the impact of both approaches. Generally, practitioners who use MI will consistently employ the MI style of interacting with clients throughout the process.
Numerous studies show the feasibility and effectiveness of integrating MI with CBT not only for treating mental health-related challenges but physical health as well. The collaborative efforts of these two methodologies have demonstrated significant improvements in physical activity levels and modest changes in body composition.
The evidence underscores the potential for integration and highlights its ability to enhance health-related outcomes.
The future landscape of Motivational Interviewing and CBT is marked by promising advancements, particularly in digital interventions. Recent research from 2020 and 2021 highlights the potential effectiveness of virtual and internet-based CBT, opening avenues for exploring optimal virtual treatment modalities and the benefits of blended techniques.
While the existing evidence supports the efficacy of combined, digital interventions, challenges persist, including user engagement and dropout rates. However, integrating non-specialist providers (like parole officers, for example) with digital intervention skills holds unique promise for overcoming these challenges and expanding the reach and effectiveness of Motivational Interviewing and CBT.
Policies recognizing the critical need for investment in these interventions are essential for the broader social services and criminal justice systems.
At Orbis Partners, we recognize and value the influence and effectiveness of Motivational Interviewing and Cognitive Behavioral Therapy to provide relevant and helpful solutions for at-risk youth and adults.
We help criminal justice and human services professionals implement these interventions through various training programs to strengthen the lives of clients (and those serving them).
By strategically applying Motivational Interviewing and CBT, Orbis Partners can help professionals and constituents navigate the complexities of ambivalence and foster motivation for transformative change.
These evidence-based approaches enhance outcomes for at-risk individuals and set a standard of excellence in the professional landscape. Here are a few trainings that could benefit you and your organization:
Orbis Partners specializes in designing and implementing services for at-risk client groups. Orbis' risk, needs, and strengths assessment tools are designed to guide the casework process by incorporating an individual's unique needs. For more information about our assessments, visit our Assessments page by clicking here.