Facilitating Change: Combining

Motivational Interviewing and

Dialectical Behavior Therapy

Robert L. Smith, Ph.D., NCC, FPPR Professor and Dept Chair, TAMUCC

Saumya Arora, M.A. Doctoral Student, Texas A&M Univ.-Corpus Christi

Michelle H. Hollenbaugh, Ph.D., LPCS, Texas A&M Univ.- Corpus Christi

DEPARTMENT OF COUNSELING AND

EDUCATIONAL PSYCHOLOGY

COLLEGE OF EDUCATION

6300 Ocean drive, Unit 5834

Corpus Christi, Texas- 78412-5834

Motivational Interview

Motivational Interviewing is a therapeutic method of helping

individuals make change in their lives

Builds on Carl Rogers humanistic approach emphasizing free choice

and the process of self actualization

Activates the capability for change

Motivational Interview

It is a combination of:

An engaged understanding of clients internal frame of reference

A clear change focus

Evoking clients own motivation for change

It may also include a collaborative plan to implement this change

Key Concepts of MI

Collaboration rather than confrontation

Drawing out rather than imposing ideas with clients

Autonomy rather than authority

Underlying Assumptions

Presence of ambivalence as an obstacle to recovery

Ambivalence in clients can be resolved by working with their intrinsic

motivations and values

Both the counselor and client bring important expertise to counseling

sessions and that the alliance between the two can bring about

change

Ambivalence

Most individuals are aware of the dangers of abusing substances

But most continue to use

Most want to stop while at the same time not wanting to stop

They enter treatment stating their problems are not serious

Ambivalence

Understand and accept the clients ambivalence

Ambivalence is often the central problem

Ambivalence manifests itself through a lack of motivation

It is a mistake to interpret ambivalence as denial or resistance

Evoking the client's motivation

A clients balance of change talk and sustain talk predicts change, and

is substantially influenced by the interviewer.

Open ended questions eliciting change talk are an important tool

Desire Questions

Ability Questions

Reason Questions

Need Questions

The Wrong Questions

Principles of MI

Express empathy through reflective listening

Bring out the discrepancy between the clients goals or values and

their current behavior

Avoid argument and direct confrontation

Roll with resistance- use reflection

Support self-efficacy- provide hope and a belief in change

Handling Discrepancy

Goal-status discrepancy is tremendous source of motivation for

change

Change begins to occur when a person is able to perceive the

discrepancy between important goals or values and the status quo

Motivation is assisted when this discrepancy is significant to

encourage than discourage or demoralize

Explore goals and values for further clarity

Honor Autonomy

Video of Miller Using MI in session

Dialectical Behavior Therapy

Developed by Marsha Linehan (1993)

A multifaceted, cognitive-behavioral approach that includes aspects

of mindfulness meditation, behaviorism and dialectics.

Created for clients with Borderline Personality Disorder

Helps clients gain insight and skills to manage their thoughts,

emotions, and behaviors

Dialectics

A synthesis of opposites

Many therapist strategies in DBT are dialectical

Also help clients identify dichotomous thinking and how to find the

dialectic in a given situation

DBT Treatment

DBT training is intensive and focuses on how to conduct skills groups

and individual therapy

Two types of DBT treatment

Individual

Group Skills Training

Homework and Diary Cards

24 hour phone coaching

DBT Treatment

In this session, we will review a few techniques from group skills

training

Biosocial Theory of BPD

Biological Predisposition for Emotional

Sensitivity/Reactivity

Invalidating Environment

Pervasive Emotion Dysregulation

DBT INTERVENES

CUE EMOTION DYSREGULATION

AVOIDANCE OR ESCAPE

PROBLEM BEHAVIOR

TEMPORARY RELIEF

Teach skills on how to regulate emotions and

reduce vulnerability to cues

Teach how to stop the

behavior; which stops

reinforcement

DBT teaches how to avoid or

distract without problem behavior

Assumptions about BPD and Therapy

Clients are doing the best they can

Clients want to improve

Clients need to do better, try harder, and be more motivated to change

Clients may not have caused all of their problems, but they have to solve

them anyway

The lives of suicidal, borderline individuals are unbearable as they are

currently being lived

Clients must learn new behaviors in all relevant contexts

Clients cannot fail therapy

Therapists treating BPD need support

Group DBT Treatment

Four Skills Training Modules

Mindfulness

Interpersonal Effectiveness

Emotion Regulation

Distress Tolerance

Mindfulness -States of Mind

WISE MINDREASONABLE MIND EMOTIONAL MIND

MINDFULNESS

Taking Hold of Your Mind: What Skills

Observe

Describe

Participate

Taking Hold of Your Mind: How Skills

Non-Judgmentally

One Mindfully

Effectively

Mindfulness Practice

o Notice one event or thought that you experienced today or yesterday,

and contemplate that event or thought.

o Observe thoughts, feelings, and sensations surrounding this event or

thought.

o Try to do this one-mindfully, non judgmentally, and effectively.

o If you get distracted, just notice this, and bring yourself back to the

thought or event.

Accepting RealityDistress Tolerance

Radical Acceptance

Freedom from suffering

Being non-judgmental

Accepting pain

Turning the Mind

Choice

Commitment

Willingness vs. Willfulness

DEAR MANInterpersonal Effectiveness

Objective Effectiveness

Describe

Express

Assert

Reinforce

Mindfully

Broken record

Ignore

Appear confident

Negotiate

Turn the table

Linehan Video

Combining DBT- MI

Client Centered

Importance of therapists speech on client

Change Talk (Ambivalence and Dialecticism )

Two Phases of therapy with underlining concept of cultivation and

expression of empathy:

MI-

Building Motivation for change

Strengthening Commitment to change

DBT-

Validation

Problem Solving

Combining DBT- MI

Resistance is not challenged by both therapies, rather used a an

opportunity to explore personal resources

Therapist Behavior might lead to resistance

Working towards improving clients protective factors

Use clients intrinsic motivation towards achieving a goal

Both theories can be used complementarily

References

Miller, W.R., Rollnick, S. (2013). Motivational Interviewing: helping

people change. The Guilford Press. NY

Osborn, C. J. (2011). Bilingual Therapeutics: Integrating the

Complementary Perspectives and Practices of Motivational

Interviewing and Dialectical Behavior Therapy.(Report). Journal

Of Contemporary Psychotherapy, (2), 81.