Motivational Interviewing Programme as a Pre-Therapy


“Motivational Interviewing is a style of talking pre-therapy that can be utilised in response to an individual presenting ambivalence or resistance to Positive Change” (Moyers, 2000)

As a Consultant Academic for Lord Ashcroft’s Veterans’ Transition Review, I was asked to comment on “dual diagnosis care”, in relation to Veterans presenting symp-toms of PTSD and using self-medication as a treatment (Ashcroft et al, 2014; Meis-ler, 1996).  It is generally accepted that those with addiction/habit issues often present “ambivalent” and “resistant” behaviours that prevents positive behaviour change (Kemp, 2011, p434).  This is supported by my own experiences as a counsellor as I have experienced ambivalence and resistance in clients, and at first they are strongly motivated for positive change, but frustratingly change takes a long time to material-ise.  

This ‘approach-avoidance conflict’ can lead to the individual engaging in risky be-haviours (drug, alcohol, self harm, food abuse) to reduce the feelings of inadequacy, behaviours that may be eventually be accepted as beneficial behaviours, as it briefly alleviates negative feelings and thoughts (relatively speaking).  It can also give a sense of control i.e. it is my decision to do what I do, because that is what I want to do, therefore I am in control.  Even if these behaviours are very risky they can be-come acceptable behaviours if they avoid ‘psychological discomfort’, especially if the negative feelings and thoughts are of a negative childhood memory, or a negative life experience nature.   

A paradox occurs when the behaviour that prevents the original discomfort starts to generate its own discomfort, as the individual will not want to give up the risky be-haviour as it is beneficial to their well-being, but will also want to stop the risky be-haviour for reasons of their well-being.  This ambivalence is a serious barrier to posi-tive change, and therefore the need to end the risky behaviour will be reduced by the need for that risky behaviour to avoid discomfort.  This is the carousel; and this ‘ca-rousal’ can be stopped by the individual gaining an insight and identifying the pro-cesses that they use to live with this paradox.   Ambivalence and resistance are seri-ous barriers to positive self-change, and there is a need for them to be identified and understood as it is generally accepted that:

‘…change is motivated primarily by avoidance of discomfort…’ Miller & Rollnick (2002) 

Problems occur when the motivation to change becomes the creator of discomfort (physical or psychological).

We at Cheshire Therapy Service’s offer programmes of Motivational Interviewing that are non-judgemental, offer insight and understanding into ambivalent and re-sistant behaviours, are non-confrontational, and supports the individual’s ability to reach their desired and intended goal (self-efficacy).   We also use Motivational In-terviewing as a pre-therapy measure of ‘readiness’ to make positive change.  The un-derstanding of ambivalence and resistance strategies that negatively impact on plans to change behaviour positively, places the individual in a better place for any future counselling sessions, and can reduce the number of counselling hours required.   Mo-tivational Interviewing is carried out at Cheshire Therapy Services based at the Hope Street Centre, Sandbach.  

For more information please contact Kevin:

Mobile: 07723099334


Ashcroft, Lord KCMG PC (2014), The Veterans’ Transition Review; London: Ministry of Defence

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change in Psychological Review;  84:pp191-215

Bandura, A. (1982). Self-efficacy mechanism in human agency in American Psychologist:  37:pp122-147.

Kemp, R. (2011), The symbolic constitution of addiction: Language, alienation, ambivalence in Health: 16:4:pp434-447: London: Sage Publishers

Meisler, A.W., (1996) Trauma, PTSD and Substance Abuse in PTSD Research Quarterly7:4:pp1-6: Vermont USA: VA Press

Miller, W.M. & Rollnick, S. (2002), Motivational Interviewing: Preparing People for Change: London: Guildford Press

Moyers, T. B. (2000). New perspectives on motivation and change in D.B. Cooper (Ed.), Alcohol use (pp.151-160). Abingdon, UK: Radcliff Medical Press.

About us

The Hope Street Centre is an independent centre located in the attractive rural market town of Sandbach in South Cheshire, with easy access to the M6 motorway and the railway network at Crewe.  The centre is readily accessible from the neighbouring towns of Congleton, Alsager, Middlewich, Holmes Chapel, Knutsford, Crewe, Kidsgrove, Winsford, Northwich, Warrington and Stoke on Trent.

To contact one of our therapists click this link
Our Address: 10 Hope Street, SANDBACH, Cheshire, CW11 1BA
Telephone:      01270 764003 (weekday afternoons only)

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