Thursday, June 24, 2010
Path to Success is a program that provides a new way to life coach, in fact, to coach life for you. You might say, “I need help, I need life purpose.†It is a coaching life program for those who don’t know who to ask to ‘show me the way; hey, what is purpose for me?’ Can there be a life training for me? If there is, I need to get training for a life of purpose, you know…purpose in life. P2S not only answers these questions, but provides a program of leadership coaching. If you say, “my life sucks†and “what is the purpose of life†and need to find your life purpose, then a good dose of performance coaching might be just the thing for you through P2S4me. We will step up to the plate in your ballgame of sucky life, to answer your question of show me the way to live through this awesome life coach training for purpose for life and how to change your life. We will help you in your quest to know who am I and who I am through life training, that you will get training because you say: "my life sucks.†In fact, your life DOES suck. You know it, we know it, even your mother knows it. So come check us out at www.P2S4me.com We can help you. No one else can.
Friday, June 18, 2010
Journal of Psychology and Christianity
2009, Vol. 28, No. 1, 71-77
Copyright 2009 Christian Association for Psychological Studies
ISSN 0733-4273
71
Johnson, 2005; Tan, 2007) has argued persuasively
for the use and integration of CBT within Christian
contexts and practice, as well as for the development
and promotion within the church of the special
servant heart and effective helping spirit (Tan,
2006)—a spirit that could be seen as foundational
to the philosophy and practice of MI.
Finally, the so-called “3rd Wave†of CBT (e.g.,
Hayes, 2004; Linehan, 1993) has, in fact, incorporated
profound spiritual concepts as well as therapeutic
methods within CBT—a combination that
would seem to fit well into the goals and orientation
of Christian therapy and ministries. However,
MI—as a separate and distinct style from both traditional
(2nd wave) and 3rd Wave CBT—may
hold even greater promise for Christian therapy
and church ministry. Other conceptualizations of
integration of psychology, therapy methods and
Christian faith and spirituality have been discussed
elsewhere (e.g., McMinn & Campbell,
2007; Stevenson, Eck, & Hill, 2007) and will not
be addressed in this article. The present article
represents one of the first, if not the first, to focus
on the integration of MI with Christian therapy,
Christian spirituality and, by extension, Christian
church ministry.
The ‘Spirit’ in Motivational Interviewing
Motivational interviewing has been defined, as
well as described at least in part in spiritual terms
—although falling short of what might be considered
Christian-based spirituality. Miller & Rollnick
(2002) state that the spirit of MI can be considered
as resting on three factors, including collaboration,
evocation, and autonomy. In MI the counselor
and the client collaborate with each other in
a spirit of love and equality, in which a partnerlike
relationship is established. The counselor
does exploration rather than exhortation, supporting
the client rather than persuading or arguing
with the client. In the sense of evocation, it is
believed that resources and motivation of change
reside within the client. By drawing on a client’s
own perceptions, goals, and values, normal
ambivalence about changing or not is addressed,
while intrinsic motivation for change is tapped
and enhanced. Motivation is not imparted or
installed but elicited and evoked from within the
person and his or her mind and spirit. Out of the
spirit of autonomy the client is encouraged to
Motivational Interviewing: Applications to
Christian Therapy and Church Ministry
John E. Martin and Eunhyang Priscilla Sihn
Graduate School of Psychology
Fuller Theological Seminary
Helping people change may be considered the
primary goal not only of Christian psychology
practice, but also of Christian ministries as well.
Motivational interviewing (MI) (Miller & Rollnick,
1991, 2002) is an increasingly empirically supported
approach to motivating and helping people
change (Hettema, Steele, & Miller, 2005), for
the treatment of psychological disorders
(Arkowitz, Westra, Miller, & Rollnick, 2008), and
health risk prevention and intervention (Rollnick,
Miller & Butler, 2008). Because of MI’s usefulness
in facilitating behavior change across a variety of
problem and population areas, and due to its
incorporation of what appear to be biblicallysound
spiritual concepts and approaches, it may
be particularly suitable for application to Christian
therapy and church ministry as a whole.
Spiritual integration: From BT to CBT to MI
Approximately 25 years ago, in collaboration
with W.R. Miller, I (jm) put together and chaired
a symposium at the national convention of the
Association for Advancement of Behavior Therapy
(AABT; now: Association for Behavioral and
Cognitive Therapies, ABCT) on integrating behavioral
and spiritual approaches to change (Martin,
1984). This groundbreaking (for behavior therapists,
that is) symposium was followed by an
edited book based on its individual papers and
discussion (Miller & Martin, 1988). While behavioral
and cognitive behavioral therapy (CBT)
approaches to helping people change have been
promoted for Christian therapists and pastors for
some time (Miller & Jackson, 1996), they have
also been critiqued from a Christian perspective
(Jones & Buttman, 1991). Conversely, Tan (Tan &
RESEARCH INTO PRACTICE
The authors wish to express their appreciation to Siang-
Yang Tan, Ph.D. and Scott Walters, Ph.D. for their reading
of a previous version of the manuscript and their
helpful editorial comments and suggestions. Please
address correspondence to: John E. Martin, Ph.D., Professor
of Psychology, Graduate School of Psychology,
Fuller Theological Seminary, 180 North Oakland Ave,
Pasadena, CA 91101. (jmartin@fuller.edu).
take responsibility for making choices and
changes. Thus, change arises within the person
rather than from extrinsic motivators. The counselor
affirms the right and capacity of the client
for self-direction and facilitates informed choices.
The Spirit of MI in Christian Ministry
While MI has a strong relationship to spirituality
in general, it would appear to reflect at least in
some respects a more specific association with
certain Christian spiritual concepts. For example,
Miller (2000) has noted the critical role of the
Christian concept of agape love in the change
process, as related to the active MI component of
expressed empathy (Miller & Rollnick, 2002). Similarly,
Yahne and Miller (1999) have discussed the
biblically consistent concept of “hope†in relation
to motivation and change.
Miller (2000) has reviewed the effects of motivational
interviewing and compared them with
behavioral self-control training and Christian spirituality.
He noted that even one brief session of
motivational interviewing could bring about significantly
positive outcomes. He concluded that it
was a deeper form of empathy, or agape, of the
therapist which triggered the change in clients.
This form of ‘motivational agape love’ is well
illustrated in the apostle Paul’s classic love letter
to the Corinthians in 1 Cor 13.
Finally, Miller and C’de Baca (2001) have also
shown the parallel between sudden, profound life
change in individuals and what has been
described as spiritual and religious motivational
epiphanies and processes in their lives. Yet, MI
has not been specifically addressed or empirically
tested as a Christian approach to therapy, personal
change or in application to Christian ministries
beyond Miller and Jackson’s Practical Psychology
for Pastors (1996).
Research on Motivational Interviewing and
Christianity/Ministry
But what does the literature say? To determine
if there are any studies or writings on MI and
Christian therapy and church ministries, studies
on MI were searched through the PsycINFO
database. A total of 760 articles on MI were
found. Yet, when the search combined “motivational
interviewing†with key words such as Christianity,
ministry, and spirituality, only 4 citations
could be found.
In the most recent study, Miller, Forcehimes,
O’Leary, and LaNoue (2008) evaluated the additive
efficacy of spiritual guidance for addiction
treatment. A specific form of manualized spiritual
counseling was designed and integrated with MI.
It was discovered that there were relatively small
changes in spirituality and that there was a correlation
between the number of spiritual guidance
sessions and a differential gain in percent days
abstinent from opiates. Nevertheless, in both studies,
negative overall results question the efficacy
of attempting to manualize and accelerate spiritual
processes and enlist important changes in addictive
behavior.
The Christian church setting has also been used
in which MI was employed as at least part of the
intervention. In a series of studies in African-American
church settings, Resnicow et al. (2002, 2005)
employed MI to promote healthy nutrition and
physical activity, although it was not directly about
MI and Christianity per se. They reported the clear
additive effect of the MI in modifying dietary
habits, while the effect of MI on physical activity
did not seem so clear (Resnicow et al., 2005).
Two other articles are relevant in addressing
the spirit and approach of MI and Christianity.
Walters and Delaney (2001) point out that therapist
factors suggestive of motivational interviewing
characteristics are very powerful in bringing
about client change. For example, ‘accurate
empathy’ may be redefined in spiritual terms as
possibly agape (Miller, 2000). When exhibited by
therapists, this agape-type empathy can make a
significant difference in client progress, and problem
behavior outcomes, especially in terms of
spiritual development. Even the core values in
their life changed after such deeply spiritual, positive
experiences with the therapist (Walters &
Delaney, 2001).
Finally, Yahne and Miller (1999) have pointed
out the importance of evoking another key spiritual
experience, hope, from clients in the course of
psychotherapy. According to them, “Evoking hope
has to do with helping clients discover that there
is more to them than they currently realizeâ€
(Yahne & Miller, 1999, p. 226). Here meet the spirit
of MI (evocation) and the biblical virtue (hope)
together. This task is not about installing hope but
about “evoking it, calling it from the client’s own
rich resources†(Yahne & Miller, 1999, p. 229).
Interestingly, no studies or articles were found
discussing or directly relating MI to Christianity,
Christian ministries or even pastoral counseling.
We hope in this article, therefore, to address this
potentially important and useful application to
Christian life and purposes of one of the more
empirically supported, effective methods of brief
intervention.
72 RESEARCH INTO PRACTICE
Motivational Interviewing
MI is a brief counseling approach to motivating
and helping people change. It has been
defined as a person-centered, directive
approach to enhancing one’s internal motivation
through addressing, processing and resolving
ambivalence about whether, how and when to
change (Miller & Rollnick, 2002). Its primary
principles for helping others be motivated and
committed to changing consist of four core components:
(1) expressing empathy for the individual
(through active listening and accurate
reflections); (2) developing discrepancy for the
status quo (not changing); (3) rolling with resistance
to change (not arguing for change or pressuring
the person in any way); and (4)
supporting/ affirming self-efficacy, or the sense
that the individual could indeed change if/when
he or she decided to.
The communication style and process of MI rest
on the foundations of Rogerian client-centered
therapy, while incorporating directive motivational
communication strategies. As a part of that
basic process, the MI practitioner is taught to
keep his or her “oars†rowing gently, and
throughout the process and methods of MI, in the
waters of change, so to speak. These common
OARS include: (a) asking mainly Open-ended
questions (“tell me about …†“what else?â€) to give
wide latitude and respect for what the client has
to say and think; (b) giving personal Affirmations
or “blessings†that express valuing and worth of
the individual, and understanding and accepting;
and (c) gently guiding the person through the differential
and strategic use of regular and accurate
empathic Reflections, and (d) reflective Summaries.
A type of motivational empowerment is
created when the person hears back what he or
she is saying about him or herself and/or a problem
area of their life—listening to one’s own
‘story’ as told by another using his or her words
in a strategic fashion.
In general, up to three-quarters of the motivational
counselor’s time may be devoted to building
motivation for change. This is termed Phase I.
Next, Phase II consists of strengthening commitment
for change and maintenance of change, following
the decision to change. Bridging the
critical gap between the two phases of effective
motivation for change is the transitional phase.
The Big Book of Alcoholics Anonymous calls this
a “turning point.†In the Christian world, this has
been described as coming to repentance—turning
about and going in the opposite direction.
In MI, counselors are specially trained to discern
when the individual is ready for commitment
for change, at a decision point in his or her life.
Readiness for transition to Phase II is observed
when the counselor/interviewer sees that the
signs of resistance to change (e.g. arguing, withdrawing,
disagreeing, avoiding change talk) are
no longer present, or greatly reduced, and at the
same time that signs of readiness for change are
more apparent (e.g. asking questions about
change, spontaneous talk about changing, nonverbal
resolve/quietness, etc.). At this point—
which may even be in the first session with the
individual—a directed summary is conducted by
the counselor of the interaction, in the client’s or
person’s words, and stressing reasons for change.
Building motivation for change of Phase I, and
the consolidating motivational summary, is followed
immediately by the key question. This critical
question nudges the person gently in the
direction of making a decision for and possible
commitment to change. Some possible alternative
key questions include: “So what now? Given what
we have talked about, what do you think you need
to do now? Where does this leave you? What’s the
next step for you? What if anything do you think
you’d like to do now?†and so on.
Once the individual indicates interest or willingness
in doing something or changing, then a
problem-solving strategy and change plan can be
invoked, negotiated and activated as appropriate
and desired.
Importantly, the motivational interviewer does
not address or talk about change, or need for
change, until signs of readiness for change are
clearly observed, and resistance against change
are no longer apparent. Otherwise, individuals
will likely increase their resistance to any and all
efforts to talk about the need for change and how
change needs to happen—e.g. giving them scripture
of what is wrong with them and how they
are commanded to change. In contrast, MI has
been described as a ‘way of being with’ a person,
using ‘gentle guidance’ but never pressure, shame
or threats (Miller & Rollnick, 2002)—the latter
which can often backfire into more entrenched
resistance against change.
MI Methods and Exercises
A brief listing of some of the specific methods
and exercises of MI includes: 1) Developing Discrepancy
and Eliciting Change Talk: 2) Rolling
with Resistance; and 3) Supporting Self-Efficacy.
The following section provides a basic, albeit
RESEARCH INTO PRACTICE 73
incomplete, discussion and some illustration of
how the MI style might be employed:
1. Developing discrepancy/eliciting change
talk. We know that people consider changing
when the reasons for change outweigh the reasons
for staying the same. This may occur particularly
when a person begins talking about why and
how he might and should change. The counselor
or pastor might select several approaches that
could help nudge or gently guide the individual in
a direction away from being “stuck†in an ambivalent
state, including the decisional balance. A
briefer way to tip the balance toward change,
heighten discrepancy and possibly elicit change
talk, is the good things/not so good things about
not changing question (emphasizing the latter, to
tip the balance toward change).
Another very useful strategy, with special application
in Christian therapy, is the values clarification
exercise. Here the client or individual is
asked to come up with and order his or her top 5
or 10 personal core values (e.g., family, church,
health, loving God, job success, etc.), or to select
from a values card-sort (see htttp://casaa.unm.edu
for a free download of the values card-sort). The
individual is then asked to assess whether a certain
problem or change possibility area, such as
drinking or marital conflict, either enhances or
potentially harms that life value. Discussion of
these results may then help to build further discrepancy
for remaining with the status quo, as
well as for eliciting talk about change. Particularly
useful in the Christian or spiritual context, is to
add a second core value list of God’s values for
the person or couple, for further and perhaps
more potent motivational contrast and comparison
(S.Walters, personal communication, 2000).
We also know that many individuals first imagine
or envision what change would look and feel
like before they might experiment with action and
change. One way to prompt this ‘motivational
envisioning’ is to ask the hypothetical questions
of: “What if you were to decide to make this
change. What would your life look like in say, a
year or 5 years? What would be the best case scenario?
What would be the worst case scenario if
you decided not to change?
2. Rolling with Resistance. In every communication
opportunity there is resistance. Sometimes
referred to as “denial,†in which the person
rejects or argues with efforts to change her mind
about a thing, we now believe that this is merely
normal resistance to pressure to change thinking
and/or behavior. There are several motivationally
consistent approaches to dealing indirectly with
resistance, including emphasizing personal freedom
and choice (“only you can decide whether to
do anything about thisâ€) and affirming the individual’s
personal autonomy and freedom to
choose. Other methods of dealing with resistance
include reframing the issue in less problematic
ways. Shifting focus, or changing the subject, is an
additional way of meeting resistance. When the
interaction has reached a resistant “dead-end,â€
one of the best ways to get back on track without
offending the individual with an abrupt change of
subject is to summarize what he or she is saying.
This is followed immediately by an open-ended
question, shifting focus to a more relevant topic
(e.g. “so you feel this and that … about … Now,
would it be OK if you told me more about...?â€).
Two intriguing approaches to meeting resistance,
which would not be considered MI per se,
may otherwise be useful when meeting higher
levels of resistance. These somewhat paradoxical
exercises would seem almost counterintuitive, and
do not come without risk. First, is to argue
against change in some way (e.g., “maybe this is
something that you will never do, or is not really
worth doingâ€) to invite, in a way, the person to
resist the push away and come back in the opposite
direction, toward the counselor (e.g., “I don’t
know. Maybe it could be worth doing some
time…â€). It’s like giving the person a sort of a
gentle nudge away from the positive change
direction to tempt him to push back in your direction,
the direction of desirable change.
Second, the reverse debate exercise is a motivational
challenge procedure that can elicit change
talk while addressing higher levels of resistance.
In this exercise, the counselor or pastor also
‘takes the negative’ or argues for not changing.
But in this case the individual is asked to participate
in a debate or ‘argument’—that is, arguing
for change, while the counselor or pastor (who
has already discussed the individual’s resistances
and reasons for not changing the problem behavior
or lifestyle choices) argues against change.
This role play can be used in a one-to-one counseling
session, or in a group setting, where it can
be an especially lively and even fun exercise. The
counselor makes a strong case and encourages
the client to make an equally strong case for the
opposite. Either with an individual or group (see
Walters, Ogle & Martin, 2002, for a discussion of
MI in group settings), the motivational interviewer
hopes to evoke positive change talk from the perspective
and words of those to be influenced for
74 RESEARCH INTO PRACTICE
change. The point is: It’s hard to argue against
yourself, and even more difficult to have resistance
against what you say.
3. Supporting/Enhancing Self-Efficacy. Helping
the person to believe that change is possible, if
not that he or she can change upon deciding to, is
a critical phase in the process of MI. This sense of
self-efficacy, or ability to do something successfully,
is key to whether any attempt will be made.
There are several MI approaches that can enhance
a person’s self-efficacy about change, but perhaps
one of the best brief strategies is that of importance/
confidence ratings.
The importance/confidence rating may be an
especially useful exercise when time is more limited,
to bolster personal self-efficacy as well as to
produce change talk and personal change
empowerment. Individuals are asked to rate the
importance of and then their confidence in changing
on a 1 to 10 scale. This is followed by asking
the individual for positive reasons for why a particular
area of change is important and then why
he or she could be confident in making the
change after deciding (including reflections and
summaries of the responses). Finally, to determine
what help might be needed, any rating less
than 7 would be followed by the question: “What
would it take to be a 7 or an 8 (avoiding the ‘perfect
10’)/what would have to happen to have it
reach a 7 or 8?
Transition from Building Motivation
to Action Commitment
The motivational interviewer can transition to
Phase II with a summary and key question once
he or she sees that the individual shows signs of
readiness for change, little or no signs of resistance
to change, and/or spontaneous change and
commitment talk.
Change Plan. At this point a change plan may
be informally discussed, or more formally negotiated
and developed. In this step, reasons for
changing are reviewed and discussed once
again, the specific change desired is defined,
along with a detailing of the barriers to avoid
and resources to employ in the planned change
process. Also included should be when the plan
will start and what is the time-line for evaluating
results. Thus, the change plan can either be an
unwritten and gradual process engaged by the
individual with gentle guidance from the MI
practitioner, or formally written, like a contract,
with copies going to the individual and the interviewer/
counselor.
MI and Jesus
While Jesus used many contrasting methods of
communicating with and motivating people in the
gospels, one example suggestive of motivational
interviewing is his conversation with the Samaritan
woman (John 4: 1-26). It is not hard to see
that Jesus showed deep, loving acceptance and
empathy for this woman throughout their conversation.
His attitude was respectful and non-judgmental
even when he was talking about her
previous husbands. This experience of acceptance
(agape love) empowered her to engage more
with him and to see herself. Then, Jesus developed
discrepancy by noting the high values in
her life—ancestor Jacob, worshipping the one
true God, a well of continuous life-giving water,
and eternal life—and then changed the topic to
her husband(s)—her shameful reality and problem.
She was gently influenced to see for herself
the discrepancy between her life predicament and
her core values and goals. Yet, she was ambivalent
about change, and probably believed she
could not change even if she wanted to. That
seemed to be why she changed the topic into the
place of worship. Jesus did not argue with her.
Instead, he rolled with her resistance or defensiveness.
He maintained a respectful attitude
toward her; he invited her to see the new perspective
of life, not imposing or forcing his higher
perspective. He supported her self-efficacy and
enhanced her confidence in her own capability to
cope with her problems and to make a commitment
to change. He eventually encouraged her to
turn to him as the Messiah or Savior.
Do No Harm: Non-Motivational
Communication Habits, Snares and Traps
Finally, a critical part of training in MI is learning
what not to do, how not to motivate for
change. Miller and Rollnick (2002) and MI training
overall address a number of potentially problematic
communication patterns and habits – that
may have been modeled and taught in a variety
of educational and training institutions, including
the church. What MI is not is also important to
keep in mind. Regrettably, and somewhat problematically,
MI has been falsely conceptualized,
attributed to or practiced, as merely a form of
the transtheoretical stages of change model, CBT,
or even “a way of tricking people into doing
what you want them to do!†(Miller & Rollnick,
in press).
Many, if not most, MI trainers such as myself
(jm) spend considerable time addressing a
RESEARCH INTO PRACTICE 75
number of these potentially ineffective and
often counterproductive communication styles.
Before ‘training in’ those more empirically supported
motivational styles and strategies consistent
with MI, it is important to attempt to bring
to awareness, and begin to ‘train out’ as many
communication barriers and roadblocks, traps
and snares as possible. These non- or countermotivational
communication patterns could be
apparent in counselors and ministry workers
who may be unaware of them and therefore
unconsciously and habitually practice. These
barriers to motivation can include arguing prematurely
or too forcefully for change, excessive
questioning of or warning the client, or talking
down to the individual from a position as an
expert or authority. All of these motivational
‘errors’ can evoke an opposite, reciprocal reactance
effect in the person who feels pushed
and is quite naturally resisting the experience of
being pressured into change. Ironically, these
understandable, and well-meaning efforts to
help a person change may actually push the
individual away from the very direction desired
or which might be best for him or her. The
reader is referred to Miller and Rollnick (2002)
for a more complete discussion of those basic
communication styles opposing as well as associated
with motivation.
MI in Christian Ministry:
Some Concluding Thoughts
In all forms and practices of Christian ministry,
effective communication and motivation
are crucial. As such, might MI play a potentially
important role in the training and effective practice
of pastoral counseling, Christian ministry
and discipleship, as well as in training others in
adhering to the various spiritual disciplines (e.g.,
Foster, 1978)? Further, could Bible study and
even evangelism training approaches, as well as
preaching/teaching and prayer methods, benefit
from MI training and practice? This remains to
be seen, and perhaps evaluated systematically in
the future.
Nevertheless, the MI approach and method
might be of real value in enhancing the effectiveness
of Christian therapy as well as specific
church ministries—limited only by the level of
training and expertise of the practitioner. Indeed,
doing more good, or at least less harm, depends
on more than one’s heartfelt, positive motive, or
sheer determination to help.
MI may be an extremely helpful approach to
helping people to come out of their spiritual and
lifestyle ambivalence, to make a decision and
commitment to change direction, perhaps to seek
God and Truth. Competent and effective employment
of one of the most empirically supported
forms of brief communication styles may not only
be desirable but perhaps warranted considering
the ultimate, profound eternal significance of a
decision for Christ.
Another area of Christian ministry functioning
that may potentially benefit from MI approaches
and training is the mercy and helps ministries.
The MI communication style stimulates the practitioner
to engage others in highly empathic and
loving fashion, while also knowing how to deal
with normal human resistances in our therapeutic
and organizational environments. MI can provide
critically-timed, strategic guidance of the
most needy individuals into and through the
positive personal change process (e.g. not just
giving them a fish; but motivating them to learn
how to fish).
Finally, while it may be seen as an encroachment
of sorts into the ‘protected’ religious activities
of Christian teaching, preaching, exhortation
and even mutual prayer, MI may hold special
promise for the effective promotion of those functions
and goals as well. For example, I (jm) have
found myself using motivational reflections and
summaries, and even the key question, when I
pray for another while they are listening alongside.
I try to use not only reflections but also affirmations
and summaries, and may even include a
recognition of the individual’s readiness or relative
resistance to change, adding when possible a
key question.
It is believed that motivational interviewing
strategies discussed and illustrated in this article
could be effectively employed by a well-trained
Christian counselor, pastor or minister across a
variety of ministry responsibilities, settings and
problem areas. But training in MI to competence
levels takes time and hard work. We refer the
reader to the excellent text by Miller and Rollnick
(2002) for a thorough presentation of the style,
approach and methods of motivational interviewing,
to the recent book on MI in healthcare by
Rollnick, Miller and Butler (2008), and the very
informative and helpful resource website for MI
(http://ping.fm/XQOZC), which provides
information on the MI training video/DVD series,
as well as the schedule of training workshops
available around the world.
76 RESEARCH INTO PRACTICE
References
Arkowitz, H., Westra, H.A., Miller, W.R., & Rollnick, S.
(Eds.). (2008). Motivational interviewing in the treatment
of psychological disorders. New York: Guilford Press.
Foster, R. (1978). Celebration of discipline. New York:
Harper & Row.
Hayes, S. C. (2004). Acceptance and commitment
therapy and new behavior therapies: Mindfulness,
acceptance, and relationship. In S.C. Hayes, M.V. Follette,
& M.M. Linehan (Eds.), Mindfulness and acceptance:
Expanding the cognitive-behavioral tradition
(pp. 1-29). New York: Guilford Press.
Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational
interviewing. Annual Review of Clinical Psychology,
1, 91-111.
Jones, S., & Butman, R. (1991). Modern psychotherapies:
A comprehensive Christian critique. Downers
Grove, IL: Inter Varsity Press.
Linehan, M. M. (1993). Skills training manual for
treating borderline personality disorder. New York: Guilford
Press.
Martin, J. E. (1984). Integrating spiritual and behavioral
approaches to change. Symposium presented before the
national convention of the Association for Advancement
of Behavior Therapy, April, Philadelphia, PA.
McMinn, M. R., & Campbell, C. D. (2007). Integrative
psychotherapy: Toward a comprehensive Christian
approach. Downers Grove, Ill.: InterVarsity.
Miller, W. R. (2000). Rediscovering fire: Small interventions,
large effects. Psychology of Addictive Behaviors,
14 (1), 6-18.
Miller, W. R., & Martin, J. E. (Eds.) (1988). Behavior
therapy and religion: Integrating spiritual and behavioral
approaches to change. Woodland Hills, CA: Sage
Press.
Miller, W. R., & Rollnick, S. (1991). Motivational interviewing:
Preparing people to change addictive behavior.
New York, NY: Guilford Press.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing:
Preparing people for change (2nd ed.). New
York: Guilford Press.
Miller, W. R., & Jackson, K. (1996). Practical psychology
for pastors. New York: Wiley.
Miller, W. R., Forcehimes, A., O’Leary, M.J., & LaNoue,
M.D. (2008). Spiritual direction in addiction treatment:
Two clinical trials. Journal of Substance Abuse Treatment,
35, 434–442.
Miller, W. R., & C’de Baca, J. (2001). Quantum
change: When epiphanies and sudden insights transform
ordinary lives. New York: Guilford Press.
Miller, W. R., & Rollnick, S. (in press). Ten things MI is
not. Behavioural and Cognitive Psychotherapy.
Resnicow, K., Jackson, A., Braithwaite, R., Dilorio,
C., Blisset, D., Rahotep, S., & Periasamy, S. (2002).
Healthy body/healthy spirit: A church-based nutrition
and physical activity intervention. Health Education
Research, 17, 562-573.
Resnicow, K., Jackson, A., Blissett, D., Wang, T.,
McCarty F., Rahotep, S., & Periasamy, S. (2005). Results
of the Healthy Body Healthy Spirit Trial. Health Psychology,
24, 339-348.
Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational
interviewing in health care. New York: Guilford
Press.
Stevenson, D. H., Eck, B. E., & Hill, P. C. (2007).
Psychology & Christianity integration: Seminal
works that shaped the movement. Batavia, IL.: CAPS
International.
Tan, S.Y. (2006). Full service: Moving from self-serve
Christianity to total servanthood. Grand Rapids, MI:
Baker.
Tan, S. Y. (2007). Use of prayer and scripture in cognitive-
behavioral therapy. Journal of Psychology and
Christianity, 26, 101-111.
Tan, S. Y., & Johnson, W. B. (2005). Spiritually oriented
cognitive-behavioral therapy. In L. Sperry, & E.P.
Shafranske (Eds.), Spiritually oriented psychotherapy
(pp. 77-103). Washington, D.C.: American Psychological
Association.
Walters, S. T. (2000). Personal communication. San
Diego, CA.
Walters, S. T., & Delaney, H. D. (2001). Addiction
and health: A (not so) new heuristic for change. Journal
of Psychology and Christianity, 20, 240-249.
Walters, S. T., Ogle, R., & Martin, J. E. (2002). The
perils and possibilities of a group-based M.I. In W. R.
Miller & S. Rollnick (Eds.). Motivational interviewing:
Preparing people for change (2nd ed.) (pp. 377-390).
New York: Guilford Press.
Yahne, C. E., & Miller, W. R. (1999). Evoking hope.
In W. R. Miller (Ed.), Integrating spirituality into treatment:
Resources for practitioners (pp.217-233). Washington
DC: American Psychological Association.
Authors
John E. Martin, Ph.D. is Professor of Psychology at the
Graduate School of Psychology, Fuller Theological Seminary
in Pasadena, California, USA.
Eunhyang Priscilla Sihn, M.A., M.Div, is a graduate
student in the Ph.D. program in Clinical Psychology at
the Graduate School of Psychology, Fuller Theological
Seminary in Pasadena, California, USA.
RESEARCH INTO PRACTICE 77
2009, Vol. 28, No. 1, 71-77
Copyright 2009 Christian Association for Psychological Studies
ISSN 0733-4273
71
Johnson, 2005; Tan, 2007) has argued persuasively
for the use and integration of CBT within Christian
contexts and practice, as well as for the development
and promotion within the church of the special
servant heart and effective helping spirit (Tan,
2006)—a spirit that could be seen as foundational
to the philosophy and practice of MI.
Finally, the so-called “3rd Wave†of CBT (e.g.,
Hayes, 2004; Linehan, 1993) has, in fact, incorporated
profound spiritual concepts as well as therapeutic
methods within CBT—a combination that
would seem to fit well into the goals and orientation
of Christian therapy and ministries. However,
MI—as a separate and distinct style from both traditional
(2nd wave) and 3rd Wave CBT—may
hold even greater promise for Christian therapy
and church ministry. Other conceptualizations of
integration of psychology, therapy methods and
Christian faith and spirituality have been discussed
elsewhere (e.g., McMinn & Campbell,
2007; Stevenson, Eck, & Hill, 2007) and will not
be addressed in this article. The present article
represents one of the first, if not the first, to focus
on the integration of MI with Christian therapy,
Christian spirituality and, by extension, Christian
church ministry.
The ‘Spirit’ in Motivational Interviewing
Motivational interviewing has been defined, as
well as described at least in part in spiritual terms
—although falling short of what might be considered
Christian-based spirituality. Miller & Rollnick
(2002) state that the spirit of MI can be considered
as resting on three factors, including collaboration,
evocation, and autonomy. In MI the counselor
and the client collaborate with each other in
a spirit of love and equality, in which a partnerlike
relationship is established. The counselor
does exploration rather than exhortation, supporting
the client rather than persuading or arguing
with the client. In the sense of evocation, it is
believed that resources and motivation of change
reside within the client. By drawing on a client’s
own perceptions, goals, and values, normal
ambivalence about changing or not is addressed,
while intrinsic motivation for change is tapped
and enhanced. Motivation is not imparted or
installed but elicited and evoked from within the
person and his or her mind and spirit. Out of the
spirit of autonomy the client is encouraged to
Motivational Interviewing: Applications to
Christian Therapy and Church Ministry
John E. Martin and Eunhyang Priscilla Sihn
Graduate School of Psychology
Fuller Theological Seminary
Helping people change may be considered the
primary goal not only of Christian psychology
practice, but also of Christian ministries as well.
Motivational interviewing (MI) (Miller & Rollnick,
1991, 2002) is an increasingly empirically supported
approach to motivating and helping people
change (Hettema, Steele, & Miller, 2005), for
the treatment of psychological disorders
(Arkowitz, Westra, Miller, & Rollnick, 2008), and
health risk prevention and intervention (Rollnick,
Miller & Butler, 2008). Because of MI’s usefulness
in facilitating behavior change across a variety of
problem and population areas, and due to its
incorporation of what appear to be biblicallysound
spiritual concepts and approaches, it may
be particularly suitable for application to Christian
therapy and church ministry as a whole.
Spiritual integration: From BT to CBT to MI
Approximately 25 years ago, in collaboration
with W.R. Miller, I (jm) put together and chaired
a symposium at the national convention of the
Association for Advancement of Behavior Therapy
(AABT; now: Association for Behavioral and
Cognitive Therapies, ABCT) on integrating behavioral
and spiritual approaches to change (Martin,
1984). This groundbreaking (for behavior therapists,
that is) symposium was followed by an
edited book based on its individual papers and
discussion (Miller & Martin, 1988). While behavioral
and cognitive behavioral therapy (CBT)
approaches to helping people change have been
promoted for Christian therapists and pastors for
some time (Miller & Jackson, 1996), they have
also been critiqued from a Christian perspective
(Jones & Buttman, 1991). Conversely, Tan (Tan &
RESEARCH INTO PRACTICE
The authors wish to express their appreciation to Siang-
Yang Tan, Ph.D. and Scott Walters, Ph.D. for their reading
of a previous version of the manuscript and their
helpful editorial comments and suggestions. Please
address correspondence to: John E. Martin, Ph.D., Professor
of Psychology, Graduate School of Psychology,
Fuller Theological Seminary, 180 North Oakland Ave,
Pasadena, CA 91101. (jmartin@fuller.edu).
take responsibility for making choices and
changes. Thus, change arises within the person
rather than from extrinsic motivators. The counselor
affirms the right and capacity of the client
for self-direction and facilitates informed choices.
The Spirit of MI in Christian Ministry
While MI has a strong relationship to spirituality
in general, it would appear to reflect at least in
some respects a more specific association with
certain Christian spiritual concepts. For example,
Miller (2000) has noted the critical role of the
Christian concept of agape love in the change
process, as related to the active MI component of
expressed empathy (Miller & Rollnick, 2002). Similarly,
Yahne and Miller (1999) have discussed the
biblically consistent concept of “hope†in relation
to motivation and change.
Miller (2000) has reviewed the effects of motivational
interviewing and compared them with
behavioral self-control training and Christian spirituality.
He noted that even one brief session of
motivational interviewing could bring about significantly
positive outcomes. He concluded that it
was a deeper form of empathy, or agape, of the
therapist which triggered the change in clients.
This form of ‘motivational agape love’ is well
illustrated in the apostle Paul’s classic love letter
to the Corinthians in 1 Cor 13.
Finally, Miller and C’de Baca (2001) have also
shown the parallel between sudden, profound life
change in individuals and what has been
described as spiritual and religious motivational
epiphanies and processes in their lives. Yet, MI
has not been specifically addressed or empirically
tested as a Christian approach to therapy, personal
change or in application to Christian ministries
beyond Miller and Jackson’s Practical Psychology
for Pastors (1996).
Research on Motivational Interviewing and
Christianity/Ministry
But what does the literature say? To determine
if there are any studies or writings on MI and
Christian therapy and church ministries, studies
on MI were searched through the PsycINFO
database. A total of 760 articles on MI were
found. Yet, when the search combined “motivational
interviewing†with key words such as Christianity,
ministry, and spirituality, only 4 citations
could be found.
In the most recent study, Miller, Forcehimes,
O’Leary, and LaNoue (2008) evaluated the additive
efficacy of spiritual guidance for addiction
treatment. A specific form of manualized spiritual
counseling was designed and integrated with MI.
It was discovered that there were relatively small
changes in spirituality and that there was a correlation
between the number of spiritual guidance
sessions and a differential gain in percent days
abstinent from opiates. Nevertheless, in both studies,
negative overall results question the efficacy
of attempting to manualize and accelerate spiritual
processes and enlist important changes in addictive
behavior.
The Christian church setting has also been used
in which MI was employed as at least part of the
intervention. In a series of studies in African-American
church settings, Resnicow et al. (2002, 2005)
employed MI to promote healthy nutrition and
physical activity, although it was not directly about
MI and Christianity per se. They reported the clear
additive effect of the MI in modifying dietary
habits, while the effect of MI on physical activity
did not seem so clear (Resnicow et al., 2005).
Two other articles are relevant in addressing
the spirit and approach of MI and Christianity.
Walters and Delaney (2001) point out that therapist
factors suggestive of motivational interviewing
characteristics are very powerful in bringing
about client change. For example, ‘accurate
empathy’ may be redefined in spiritual terms as
possibly agape (Miller, 2000). When exhibited by
therapists, this agape-type empathy can make a
significant difference in client progress, and problem
behavior outcomes, especially in terms of
spiritual development. Even the core values in
their life changed after such deeply spiritual, positive
experiences with the therapist (Walters &
Delaney, 2001).
Finally, Yahne and Miller (1999) have pointed
out the importance of evoking another key spiritual
experience, hope, from clients in the course of
psychotherapy. According to them, “Evoking hope
has to do with helping clients discover that there
is more to them than they currently realizeâ€
(Yahne & Miller, 1999, p. 226). Here meet the spirit
of MI (evocation) and the biblical virtue (hope)
together. This task is not about installing hope but
about “evoking it, calling it from the client’s own
rich resources†(Yahne & Miller, 1999, p. 229).
Interestingly, no studies or articles were found
discussing or directly relating MI to Christianity,
Christian ministries or even pastoral counseling.
We hope in this article, therefore, to address this
potentially important and useful application to
Christian life and purposes of one of the more
empirically supported, effective methods of brief
intervention.
72 RESEARCH INTO PRACTICE
Motivational Interviewing
MI is a brief counseling approach to motivating
and helping people change. It has been
defined as a person-centered, directive
approach to enhancing one’s internal motivation
through addressing, processing and resolving
ambivalence about whether, how and when to
change (Miller & Rollnick, 2002). Its primary
principles for helping others be motivated and
committed to changing consist of four core components:
(1) expressing empathy for the individual
(through active listening and accurate
reflections); (2) developing discrepancy for the
status quo (not changing); (3) rolling with resistance
to change (not arguing for change or pressuring
the person in any way); and (4)
supporting/ affirming self-efficacy, or the sense
that the individual could indeed change if/when
he or she decided to.
The communication style and process of MI rest
on the foundations of Rogerian client-centered
therapy, while incorporating directive motivational
communication strategies. As a part of that
basic process, the MI practitioner is taught to
keep his or her “oars†rowing gently, and
throughout the process and methods of MI, in the
waters of change, so to speak. These common
OARS include: (a) asking mainly Open-ended
questions (“tell me about …†“what else?â€) to give
wide latitude and respect for what the client has
to say and think; (b) giving personal Affirmations
or “blessings†that express valuing and worth of
the individual, and understanding and accepting;
and (c) gently guiding the person through the differential
and strategic use of regular and accurate
empathic Reflections, and (d) reflective Summaries.
A type of motivational empowerment is
created when the person hears back what he or
she is saying about him or herself and/or a problem
area of their life—listening to one’s own
‘story’ as told by another using his or her words
in a strategic fashion.
In general, up to three-quarters of the motivational
counselor’s time may be devoted to building
motivation for change. This is termed Phase I.
Next, Phase II consists of strengthening commitment
for change and maintenance of change, following
the decision to change. Bridging the
critical gap between the two phases of effective
motivation for change is the transitional phase.
The Big Book of Alcoholics Anonymous calls this
a “turning point.†In the Christian world, this has
been described as coming to repentance—turning
about and going in the opposite direction.
In MI, counselors are specially trained to discern
when the individual is ready for commitment
for change, at a decision point in his or her life.
Readiness for transition to Phase II is observed
when the counselor/interviewer sees that the
signs of resistance to change (e.g. arguing, withdrawing,
disagreeing, avoiding change talk) are
no longer present, or greatly reduced, and at the
same time that signs of readiness for change are
more apparent (e.g. asking questions about
change, spontaneous talk about changing, nonverbal
resolve/quietness, etc.). At this point—
which may even be in the first session with the
individual—a directed summary is conducted by
the counselor of the interaction, in the client’s or
person’s words, and stressing reasons for change.
Building motivation for change of Phase I, and
the consolidating motivational summary, is followed
immediately by the key question. This critical
question nudges the person gently in the
direction of making a decision for and possible
commitment to change. Some possible alternative
key questions include: “So what now? Given what
we have talked about, what do you think you need
to do now? Where does this leave you? What’s the
next step for you? What if anything do you think
you’d like to do now?†and so on.
Once the individual indicates interest or willingness
in doing something or changing, then a
problem-solving strategy and change plan can be
invoked, negotiated and activated as appropriate
and desired.
Importantly, the motivational interviewer does
not address or talk about change, or need for
change, until signs of readiness for change are
clearly observed, and resistance against change
are no longer apparent. Otherwise, individuals
will likely increase their resistance to any and all
efforts to talk about the need for change and how
change needs to happen—e.g. giving them scripture
of what is wrong with them and how they
are commanded to change. In contrast, MI has
been described as a ‘way of being with’ a person,
using ‘gentle guidance’ but never pressure, shame
or threats (Miller & Rollnick, 2002)—the latter
which can often backfire into more entrenched
resistance against change.
MI Methods and Exercises
A brief listing of some of the specific methods
and exercises of MI includes: 1) Developing Discrepancy
and Eliciting Change Talk: 2) Rolling
with Resistance; and 3) Supporting Self-Efficacy.
The following section provides a basic, albeit
RESEARCH INTO PRACTICE 73
incomplete, discussion and some illustration of
how the MI style might be employed:
1. Developing discrepancy/eliciting change
talk. We know that people consider changing
when the reasons for change outweigh the reasons
for staying the same. This may occur particularly
when a person begins talking about why and
how he might and should change. The counselor
or pastor might select several approaches that
could help nudge or gently guide the individual in
a direction away from being “stuck†in an ambivalent
state, including the decisional balance. A
briefer way to tip the balance toward change,
heighten discrepancy and possibly elicit change
talk, is the good things/not so good things about
not changing question (emphasizing the latter, to
tip the balance toward change).
Another very useful strategy, with special application
in Christian therapy, is the values clarification
exercise. Here the client or individual is
asked to come up with and order his or her top 5
or 10 personal core values (e.g., family, church,
health, loving God, job success, etc.), or to select
from a values card-sort (see htttp://casaa.unm.edu
for a free download of the values card-sort). The
individual is then asked to assess whether a certain
problem or change possibility area, such as
drinking or marital conflict, either enhances or
potentially harms that life value. Discussion of
these results may then help to build further discrepancy
for remaining with the status quo, as
well as for eliciting talk about change. Particularly
useful in the Christian or spiritual context, is to
add a second core value list of God’s values for
the person or couple, for further and perhaps
more potent motivational contrast and comparison
(S.Walters, personal communication, 2000).
We also know that many individuals first imagine
or envision what change would look and feel
like before they might experiment with action and
change. One way to prompt this ‘motivational
envisioning’ is to ask the hypothetical questions
of: “What if you were to decide to make this
change. What would your life look like in say, a
year or 5 years? What would be the best case scenario?
What would be the worst case scenario if
you decided not to change?
2. Rolling with Resistance. In every communication
opportunity there is resistance. Sometimes
referred to as “denial,†in which the person
rejects or argues with efforts to change her mind
about a thing, we now believe that this is merely
normal resistance to pressure to change thinking
and/or behavior. There are several motivationally
consistent approaches to dealing indirectly with
resistance, including emphasizing personal freedom
and choice (“only you can decide whether to
do anything about thisâ€) and affirming the individual’s
personal autonomy and freedom to
choose. Other methods of dealing with resistance
include reframing the issue in less problematic
ways. Shifting focus, or changing the subject, is an
additional way of meeting resistance. When the
interaction has reached a resistant “dead-end,â€
one of the best ways to get back on track without
offending the individual with an abrupt change of
subject is to summarize what he or she is saying.
This is followed immediately by an open-ended
question, shifting focus to a more relevant topic
(e.g. “so you feel this and that … about … Now,
would it be OK if you told me more about...?â€).
Two intriguing approaches to meeting resistance,
which would not be considered MI per se,
may otherwise be useful when meeting higher
levels of resistance. These somewhat paradoxical
exercises would seem almost counterintuitive, and
do not come without risk. First, is to argue
against change in some way (e.g., “maybe this is
something that you will never do, or is not really
worth doingâ€) to invite, in a way, the person to
resist the push away and come back in the opposite
direction, toward the counselor (e.g., “I don’t
know. Maybe it could be worth doing some
time…â€). It’s like giving the person a sort of a
gentle nudge away from the positive change
direction to tempt him to push back in your direction,
the direction of desirable change.
Second, the reverse debate exercise is a motivational
challenge procedure that can elicit change
talk while addressing higher levels of resistance.
In this exercise, the counselor or pastor also
‘takes the negative’ or argues for not changing.
But in this case the individual is asked to participate
in a debate or ‘argument’—that is, arguing
for change, while the counselor or pastor (who
has already discussed the individual’s resistances
and reasons for not changing the problem behavior
or lifestyle choices) argues against change.
This role play can be used in a one-to-one counseling
session, or in a group setting, where it can
be an especially lively and even fun exercise. The
counselor makes a strong case and encourages
the client to make an equally strong case for the
opposite. Either with an individual or group (see
Walters, Ogle & Martin, 2002, for a discussion of
MI in group settings), the motivational interviewer
hopes to evoke positive change talk from the perspective
and words of those to be influenced for
74 RESEARCH INTO PRACTICE
change. The point is: It’s hard to argue against
yourself, and even more difficult to have resistance
against what you say.
3. Supporting/Enhancing Self-Efficacy. Helping
the person to believe that change is possible, if
not that he or she can change upon deciding to, is
a critical phase in the process of MI. This sense of
self-efficacy, or ability to do something successfully,
is key to whether any attempt will be made.
There are several MI approaches that can enhance
a person’s self-efficacy about change, but perhaps
one of the best brief strategies is that of importance/
confidence ratings.
The importance/confidence rating may be an
especially useful exercise when time is more limited,
to bolster personal self-efficacy as well as to
produce change talk and personal change
empowerment. Individuals are asked to rate the
importance of and then their confidence in changing
on a 1 to 10 scale. This is followed by asking
the individual for positive reasons for why a particular
area of change is important and then why
he or she could be confident in making the
change after deciding (including reflections and
summaries of the responses). Finally, to determine
what help might be needed, any rating less
than 7 would be followed by the question: “What
would it take to be a 7 or an 8 (avoiding the ‘perfect
10’)/what would have to happen to have it
reach a 7 or 8?
Transition from Building Motivation
to Action Commitment
The motivational interviewer can transition to
Phase II with a summary and key question once
he or she sees that the individual shows signs of
readiness for change, little or no signs of resistance
to change, and/or spontaneous change and
commitment talk.
Change Plan. At this point a change plan may
be informally discussed, or more formally negotiated
and developed. In this step, reasons for
changing are reviewed and discussed once
again, the specific change desired is defined,
along with a detailing of the barriers to avoid
and resources to employ in the planned change
process. Also included should be when the plan
will start and what is the time-line for evaluating
results. Thus, the change plan can either be an
unwritten and gradual process engaged by the
individual with gentle guidance from the MI
practitioner, or formally written, like a contract,
with copies going to the individual and the interviewer/
counselor.
MI and Jesus
While Jesus used many contrasting methods of
communicating with and motivating people in the
gospels, one example suggestive of motivational
interviewing is his conversation with the Samaritan
woman (John 4: 1-26). It is not hard to see
that Jesus showed deep, loving acceptance and
empathy for this woman throughout their conversation.
His attitude was respectful and non-judgmental
even when he was talking about her
previous husbands. This experience of acceptance
(agape love) empowered her to engage more
with him and to see herself. Then, Jesus developed
discrepancy by noting the high values in
her life—ancestor Jacob, worshipping the one
true God, a well of continuous life-giving water,
and eternal life—and then changed the topic to
her husband(s)—her shameful reality and problem.
She was gently influenced to see for herself
the discrepancy between her life predicament and
her core values and goals. Yet, she was ambivalent
about change, and probably believed she
could not change even if she wanted to. That
seemed to be why she changed the topic into the
place of worship. Jesus did not argue with her.
Instead, he rolled with her resistance or defensiveness.
He maintained a respectful attitude
toward her; he invited her to see the new perspective
of life, not imposing or forcing his higher
perspective. He supported her self-efficacy and
enhanced her confidence in her own capability to
cope with her problems and to make a commitment
to change. He eventually encouraged her to
turn to him as the Messiah or Savior.
Do No Harm: Non-Motivational
Communication Habits, Snares and Traps
Finally, a critical part of training in MI is learning
what not to do, how not to motivate for
change. Miller and Rollnick (2002) and MI training
overall address a number of potentially problematic
communication patterns and habits – that
may have been modeled and taught in a variety
of educational and training institutions, including
the church. What MI is not is also important to
keep in mind. Regrettably, and somewhat problematically,
MI has been falsely conceptualized,
attributed to or practiced, as merely a form of
the transtheoretical stages of change model, CBT,
or even “a way of tricking people into doing
what you want them to do!†(Miller & Rollnick,
in press).
Many, if not most, MI trainers such as myself
(jm) spend considerable time addressing a
RESEARCH INTO PRACTICE 75
number of these potentially ineffective and
often counterproductive communication styles.
Before ‘training in’ those more empirically supported
motivational styles and strategies consistent
with MI, it is important to attempt to bring
to awareness, and begin to ‘train out’ as many
communication barriers and roadblocks, traps
and snares as possible. These non- or countermotivational
communication patterns could be
apparent in counselors and ministry workers
who may be unaware of them and therefore
unconsciously and habitually practice. These
barriers to motivation can include arguing prematurely
or too forcefully for change, excessive
questioning of or warning the client, or talking
down to the individual from a position as an
expert or authority. All of these motivational
‘errors’ can evoke an opposite, reciprocal reactance
effect in the person who feels pushed
and is quite naturally resisting the experience of
being pressured into change. Ironically, these
understandable, and well-meaning efforts to
help a person change may actually push the
individual away from the very direction desired
or which might be best for him or her. The
reader is referred to Miller and Rollnick (2002)
for a more complete discussion of those basic
communication styles opposing as well as associated
with motivation.
MI in Christian Ministry:
Some Concluding Thoughts
In all forms and practices of Christian ministry,
effective communication and motivation
are crucial. As such, might MI play a potentially
important role in the training and effective practice
of pastoral counseling, Christian ministry
and discipleship, as well as in training others in
adhering to the various spiritual disciplines (e.g.,
Foster, 1978)? Further, could Bible study and
even evangelism training approaches, as well as
preaching/teaching and prayer methods, benefit
from MI training and practice? This remains to
be seen, and perhaps evaluated systematically in
the future.
Nevertheless, the MI approach and method
might be of real value in enhancing the effectiveness
of Christian therapy as well as specific
church ministries—limited only by the level of
training and expertise of the practitioner. Indeed,
doing more good, or at least less harm, depends
on more than one’s heartfelt, positive motive, or
sheer determination to help.
MI may be an extremely helpful approach to
helping people to come out of their spiritual and
lifestyle ambivalence, to make a decision and
commitment to change direction, perhaps to seek
God and Truth. Competent and effective employment
of one of the most empirically supported
forms of brief communication styles may not only
be desirable but perhaps warranted considering
the ultimate, profound eternal significance of a
decision for Christ.
Another area of Christian ministry functioning
that may potentially benefit from MI approaches
and training is the mercy and helps ministries.
The MI communication style stimulates the practitioner
to engage others in highly empathic and
loving fashion, while also knowing how to deal
with normal human resistances in our therapeutic
and organizational environments. MI can provide
critically-timed, strategic guidance of the
most needy individuals into and through the
positive personal change process (e.g. not just
giving them a fish; but motivating them to learn
how to fish).
Finally, while it may be seen as an encroachment
of sorts into the ‘protected’ religious activities
of Christian teaching, preaching, exhortation
and even mutual prayer, MI may hold special
promise for the effective promotion of those functions
and goals as well. For example, I (jm) have
found myself using motivational reflections and
summaries, and even the key question, when I
pray for another while they are listening alongside.
I try to use not only reflections but also affirmations
and summaries, and may even include a
recognition of the individual’s readiness or relative
resistance to change, adding when possible a
key question.
It is believed that motivational interviewing
strategies discussed and illustrated in this article
could be effectively employed by a well-trained
Christian counselor, pastor or minister across a
variety of ministry responsibilities, settings and
problem areas. But training in MI to competence
levels takes time and hard work. We refer the
reader to the excellent text by Miller and Rollnick
(2002) for a thorough presentation of the style,
approach and methods of motivational interviewing,
to the recent book on MI in healthcare by
Rollnick, Miller and Butler (2008), and the very
informative and helpful resource website for MI
(http://ping.fm/XQOZC), which provides
information on the MI training video/DVD series,
as well as the schedule of training workshops
available around the world.
76 RESEARCH INTO PRACTICE
References
Arkowitz, H., Westra, H.A., Miller, W.R., & Rollnick, S.
(Eds.). (2008). Motivational interviewing in the treatment
of psychological disorders. New York: Guilford Press.
Foster, R. (1978). Celebration of discipline. New York:
Harper & Row.
Hayes, S. C. (2004). Acceptance and commitment
therapy and new behavior therapies: Mindfulness,
acceptance, and relationship. In S.C. Hayes, M.V. Follette,
& M.M. Linehan (Eds.), Mindfulness and acceptance:
Expanding the cognitive-behavioral tradition
(pp. 1-29). New York: Guilford Press.
Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational
interviewing. Annual Review of Clinical Psychology,
1, 91-111.
Jones, S., & Butman, R. (1991). Modern psychotherapies:
A comprehensive Christian critique. Downers
Grove, IL: Inter Varsity Press.
Linehan, M. M. (1993). Skills training manual for
treating borderline personality disorder. New York: Guilford
Press.
Martin, J. E. (1984). Integrating spiritual and behavioral
approaches to change. Symposium presented before the
national convention of the Association for Advancement
of Behavior Therapy, April, Philadelphia, PA.
McMinn, M. R., & Campbell, C. D. (2007). Integrative
psychotherapy: Toward a comprehensive Christian
approach. Downers Grove, Ill.: InterVarsity.
Miller, W. R. (2000). Rediscovering fire: Small interventions,
large effects. Psychology of Addictive Behaviors,
14 (1), 6-18.
Miller, W. R., & Martin, J. E. (Eds.) (1988). Behavior
therapy and religion: Integrating spiritual and behavioral
approaches to change. Woodland Hills, CA: Sage
Press.
Miller, W. R., & Rollnick, S. (1991). Motivational interviewing:
Preparing people to change addictive behavior.
New York, NY: Guilford Press.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing:
Preparing people for change (2nd ed.). New
York: Guilford Press.
Miller, W. R., & Jackson, K. (1996). Practical psychology
for pastors. New York: Wiley.
Miller, W. R., Forcehimes, A., O’Leary, M.J., & LaNoue,
M.D. (2008). Spiritual direction in addiction treatment:
Two clinical trials. Journal of Substance Abuse Treatment,
35, 434–442.
Miller, W. R., & C’de Baca, J. (2001). Quantum
change: When epiphanies and sudden insights transform
ordinary lives. New York: Guilford Press.
Miller, W. R., & Rollnick, S. (in press). Ten things MI is
not. Behavioural and Cognitive Psychotherapy.
Resnicow, K., Jackson, A., Braithwaite, R., Dilorio,
C., Blisset, D., Rahotep, S., & Periasamy, S. (2002).
Healthy body/healthy spirit: A church-based nutrition
and physical activity intervention. Health Education
Research, 17, 562-573.
Resnicow, K., Jackson, A., Blissett, D., Wang, T.,
McCarty F., Rahotep, S., & Periasamy, S. (2005). Results
of the Healthy Body Healthy Spirit Trial. Health Psychology,
24, 339-348.
Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational
interviewing in health care. New York: Guilford
Press.
Stevenson, D. H., Eck, B. E., & Hill, P. C. (2007).
Psychology & Christianity integration: Seminal
works that shaped the movement. Batavia, IL.: CAPS
International.
Tan, S.Y. (2006). Full service: Moving from self-serve
Christianity to total servanthood. Grand Rapids, MI:
Baker.
Tan, S. Y. (2007). Use of prayer and scripture in cognitive-
behavioral therapy. Journal of Psychology and
Christianity, 26, 101-111.
Tan, S. Y., & Johnson, W. B. (2005). Spiritually oriented
cognitive-behavioral therapy. In L. Sperry, & E.P.
Shafranske (Eds.), Spiritually oriented psychotherapy
(pp. 77-103). Washington, D.C.: American Psychological
Association.
Walters, S. T. (2000). Personal communication. San
Diego, CA.
Walters, S. T., & Delaney, H. D. (2001). Addiction
and health: A (not so) new heuristic for change. Journal
of Psychology and Christianity, 20, 240-249.
Walters, S. T., Ogle, R., & Martin, J. E. (2002). The
perils and possibilities of a group-based M.I. In W. R.
Miller & S. Rollnick (Eds.). Motivational interviewing:
Preparing people for change (2nd ed.) (pp. 377-390).
New York: Guilford Press.
Yahne, C. E., & Miller, W. R. (1999). Evoking hope.
In W. R. Miller (Ed.), Integrating spirituality into treatment:
Resources for practitioners (pp.217-233). Washington
DC: American Psychological Association.
Authors
John E. Martin, Ph.D. is Professor of Psychology at the
Graduate School of Psychology, Fuller Theological Seminary
in Pasadena, California, USA.
Eunhyang Priscilla Sihn, M.A., M.Div, is a graduate
student in the Ph.D. program in Clinical Psychology at
the Graduate School of Psychology, Fuller Theological
Seminary in Pasadena, California, USA.
RESEARCH INTO PRACTICE 77
Second Chances:
Do They Work?
Some years ago a friend of mine visited the Soviet Union (Russia, actually) back before the “wall†was torn down (by people on both sides who had had enough of that, and who either knew freedom or had a taste of it and wanted more). He happened to have a good deal of experience in treating addictions, especially alcoholism, and was interested in what treatments for alcoholism there were in Russia, and how did they work. So he asked to visit an alcoholism treatment center. Seemed a pretty reasonable request. But he was told (I think with some irritation) there was no treatment for chronic alcoholism. Nothing worked. They just locked them up when they became too unruly or problematic to their society. They hid them away since they didn’t know what else to do with them. What else could they do?
So my friend was directed to a group of Russian psychologists and psychiatrists and physicians, who were frankly shocked (and incredulous) to hear that in the U.S. and other western countries, there were many types of treatment and recovery programs – many of them effective in helping the alcoholics to regain their lives. These Russian “specialists†didn’t believe in second chances. Why try, they reasoned, if nothing worked. Save your money, time and energy.
But things have changed, no doubt, in Russia these days, including giving her people this kind of second chance. It’s a good thing, no?
Not everyone believes in second chances. Kind of like “sudden death†in a sports overtime contest, or what’s known as ‘single elimination.’ One loss, fall or slip and you’re out. Sort of a: “If at first you don’t succeed, don’t try again†(OK, I changed that old saying a bit).
Isn’t it nice that most of us are given second chances at most things in life. We fail at something, we get knocked down, we can get back up. Not that everyone does get back up. Some don’t. Sad. This has a lot to do with personal beliefs about one’s abilities with respect to the circumstances…and hope for the future. Did you know that hopelessness about the future is one of the most critical ‘red flag’ risks psychologists and counselors look for in those who may be at risk for suicide? It is. When someone loses hope, he or she does not believe in that second chance. And what about those of us who have had many second chances – either over the same issue (such as multiple marriages and relationships), or different issues? Is there such a thing as ongoing second chances? Is there a plentiful supply of second chances in life that never runs out, or do each of us have a quota that once we reach it, there is no more chance to overcome, or succeed.
Life provides multiple examples, in a free society such as most of us live in, for an infinite supply of second chance. I once owned a boat that I named “Second Chance†after my own second, second, second chance in life happiness and fulfillment. To this day, there continues to be evidence that it might even be a single, ongoing, never-ending process of second chance. It’s like I can never use up my potential to pick myself up and try, try again. And there are many people around me – unquenchable resources, helpful encouragers available to my life - that are brought across my life path, or can be tapped by me when I reach various levels of deprivation and desperateness.
Many forms of counseling, psychotherapy and intervention have been developed and found helpful with a variety of clinical conditions such as anxiety and depression, addictions and life breakdowns. But what of those of us who’s lives are not in some major pathological state of need, but for whom life has become or is not so satisfying or fulfilling. We are at catch-points, perhaps stuck at some crossroads in life and we don’t know what to do or which way to go. There was an old song by Patty Page that described it: “Is that all there is (to life)?†We’re held up at the “what’s next†4-way stop.
A new program called Path2Success4Me.com was developed to especially provide that life analysis and motivational path to personal fulfillment and success. It takes a person from the discovery step of what’s most and least important in life (which only the individual can decide), through to the change process, including accountability to others. You don’t have to wait for things to get really bad, or even hopeless. You can begin this life re-direction, and purpose focus early rather than later, now rather than tomorrow. Think about it: tomorrow never comes, does it? (there is a fish restaurant never where I live that keeps a sign up outside, every day: “Free Fish Tacos Tomorrow.†Sounds pretty good. Except tomorrow the sign is still up. Tomorrow’s not here yet.
Check it out today. And remember the old Fram oil filter commercial saying that you can see me now (change your filter now) or you can see me later (change it sometime in the future) but it’s going go be a lot more expensive later. I like that.
P2Success4Me.com may be like doing life maintenance today, not waiting for some harsher tomorrow. And don’t wait for God to send a whale. That can be pretty stinky.
Do They Work?
Some years ago a friend of mine visited the Soviet Union (Russia, actually) back before the “wall†was torn down (by people on both sides who had had enough of that, and who either knew freedom or had a taste of it and wanted more). He happened to have a good deal of experience in treating addictions, especially alcoholism, and was interested in what treatments for alcoholism there were in Russia, and how did they work. So he asked to visit an alcoholism treatment center. Seemed a pretty reasonable request. But he was told (I think with some irritation) there was no treatment for chronic alcoholism. Nothing worked. They just locked them up when they became too unruly or problematic to their society. They hid them away since they didn’t know what else to do with them. What else could they do?
So my friend was directed to a group of Russian psychologists and psychiatrists and physicians, who were frankly shocked (and incredulous) to hear that in the U.S. and other western countries, there were many types of treatment and recovery programs – many of them effective in helping the alcoholics to regain their lives. These Russian “specialists†didn’t believe in second chances. Why try, they reasoned, if nothing worked. Save your money, time and energy.
But things have changed, no doubt, in Russia these days, including giving her people this kind of second chance. It’s a good thing, no?
Not everyone believes in second chances. Kind of like “sudden death†in a sports overtime contest, or what’s known as ‘single elimination.’ One loss, fall or slip and you’re out. Sort of a: “If at first you don’t succeed, don’t try again†(OK, I changed that old saying a bit).
Isn’t it nice that most of us are given second chances at most things in life. We fail at something, we get knocked down, we can get back up. Not that everyone does get back up. Some don’t. Sad. This has a lot to do with personal beliefs about one’s abilities with respect to the circumstances…and hope for the future. Did you know that hopelessness about the future is one of the most critical ‘red flag’ risks psychologists and counselors look for in those who may be at risk for suicide? It is. When someone loses hope, he or she does not believe in that second chance. And what about those of us who have had many second chances – either over the same issue (such as multiple marriages and relationships), or different issues? Is there such a thing as ongoing second chances? Is there a plentiful supply of second chances in life that never runs out, or do each of us have a quota that once we reach it, there is no more chance to overcome, or succeed.
Life provides multiple examples, in a free society such as most of us live in, for an infinite supply of second chance. I once owned a boat that I named “Second Chance†after my own second, second, second chance in life happiness and fulfillment. To this day, there continues to be evidence that it might even be a single, ongoing, never-ending process of second chance. It’s like I can never use up my potential to pick myself up and try, try again. And there are many people around me – unquenchable resources, helpful encouragers available to my life - that are brought across my life path, or can be tapped by me when I reach various levels of deprivation and desperateness.
Many forms of counseling, psychotherapy and intervention have been developed and found helpful with a variety of clinical conditions such as anxiety and depression, addictions and life breakdowns. But what of those of us who’s lives are not in some major pathological state of need, but for whom life has become or is not so satisfying or fulfilling. We are at catch-points, perhaps stuck at some crossroads in life and we don’t know what to do or which way to go. There was an old song by Patty Page that described it: “Is that all there is (to life)?†We’re held up at the “what’s next†4-way stop.
A new program called Path2Success4Me.com was developed to especially provide that life analysis and motivational path to personal fulfillment and success. It takes a person from the discovery step of what’s most and least important in life (which only the individual can decide), through to the change process, including accountability to others. You don’t have to wait for things to get really bad, or even hopeless. You can begin this life re-direction, and purpose focus early rather than later, now rather than tomorrow. Think about it: tomorrow never comes, does it? (there is a fish restaurant never where I live that keeps a sign up outside, every day: “Free Fish Tacos Tomorrow.†Sounds pretty good. Except tomorrow the sign is still up. Tomorrow’s not here yet.
Check it out today. And remember the old Fram oil filter commercial saying that you can see me now (change your filter now) or you can see me later (change it sometime in the future) but it’s going go be a lot more expensive later. I like that.
P2Success4Me.com may be like doing life maintenance today, not waiting for some harsher tomorrow. And don’t wait for God to send a whale. That can be pretty stinky.
Subscribe to:
Posts (Atom)
