Splitting hairs or parsing concepts, fuzzy thinking or fuzzy categories:

where does MI end and client-centered therapy begin?

David B. Rosengren, Ph.D.Director, Research & Evaluation Services

Prevention Research institute

ICMI – 2 Stockholm, SEJune 7, 2010

How did we get here?

• MI grew from empirical observations and..• Self observations by W.R. Miller• A set of concepts & precepts followed• Data, revision, data, revision & a beginning theory• MI extended beyond addictive behaviors • Along the way, interest exploded

Where do the tent pegs go?

Definitions Current

MI is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

Evolving MI is a person-centered, guiding method of communication

to elicit and strengthen motivation for change. Person-centered therapy/approach

Three conditions: genuineness, acceptance & unconditional positive regard

Assists the person in moving towards self-actualization

The Trouble With Definitions A creationist can embarrass an evolutionist by asking

for a definition of species. Walter Lang

As a rule we disbelieve all the facts and theories for which we have no use.

Gustave Flaubert

And then there was equipoise…

Back to the Trouble with Definitions Definition of Equipoise

Equality of distribution in weight, relationship or emotional forces Synonyms

Calmness, balance, equilibrium, poise, composure, equanimity, etc...

Dr. Dunn’s conclusions – it refers to two states Counselor demeanor/inner state Counselor behavior

Dr. Miller’s response “…never…thought of equipoise in relation to general demeanor.” “…exists in relationship to a specific behavior.”

So, equipoise… about what?

Fuzzy thinking or Fuzzy categories?

Boolean Logic vs. Fuzzy Logic… Or why I didn’t become a computer scientist… Boolean Logic

Typically is a binary logic system It takes into account two possible states: 0 and 1.

Fuzzy Logic Fuzzy logic is a form of multi-valued logic Derived from fuzzy set theory Deals with approximate rather than precise reasoning Values between 0 and 1

Huh? Examples

What in the world does this have to do with MI?

It seemed like a good idea at the time Maybe we’ve been using the wrong logic Do we need a new metaphor? Four concepts:

Engaging Guiding Evoking Planning

Remind me… why does this matter? Clinicians?

It probably doesn’t Research on EBPs

We need to define what it is When it is done well

Implementation Done with fidelity Systems to implement, coach and assess

It will help Allan sleep at night