MI’s Efficacy

Ideas Suggesting MI’s Efficacy

Bem’s Self Perception Theory, Self Determination Theory, Neural Integration Enhancement

MI did not develop from any particular theory, but from analyzing and systematizing conversations that were effective with individuals with drinking problems, helping them resolve their ambivalence about going into treatment. There are a number of theories that could be mentioned that might help explain the reason MI seems to work; there are two that are likely the most compelling: Bem’s Self Perception Theory and Self Determination Theory. There is also ever-growing understanding that is emerging from neuroscience related to the specialization of the brain as it relates to resolving ambivalence which is a theoretical possibility in explanation MI efficacy, which we will call Neural Integration Enhancement.

Bem’s Self-Perception Theory

This theory is not well known, but Dr. William Miller, who came up with MI and co-founded the approach we now practice (with Dr. Stephen Rollnick) suggests that this theory helps explain the value of helping individuals think and then talk about change, often referred to as “change talk.” The theory suggests that people develop their attitudes and belief about themselves by observing their own behavior (including speech). They simply infer their attitudes from their own behavior in the same way that an outside observer might. So, when a person who is ambivalent about a certain behavior speaks about their own behavior change, they hear themselves talk and that helps them re-evaluate their position toward change. As a result they are more likely to follow through on that change since they have determined they are different than before.

More information on Bem’s Self-Perception Theory

Self Determination Theory

This theory of motivation can help explain some of the strengths of MI, since the approach (core skills and spirit) can help meet the psychological needs for autonomy, competency and relatedness that this theory says is universal to all people of all ages and cultures. SDT explains and supports the importance of having these three natural inclinations of humans honored or being provided through our social interaction, which increases intrinsic motivation to move in the direction of positive growth. Proposed initially by Richard M. Ryan and Edward L. Deci it has been researched, refined and elaborated by scholars from around the world.

More information on Self-Determination Theory

Lets explore how MI helps meet these needs:

  • Autonomy is imbedded in the MI conversations, by providers taking care to acknowledge and support choices as well as avoiding the tendency to provide solutions (the righting reflex) which can threaten autonomy. By asking permission before providing any suggestion or information, threats to autonomy can be minimized.
  • Competence is acknowledged with use of the core skill of affirmations that recognizes the person’s competence by acknowledging their effort, values, skills or strengths. And the skill of reflections which shows acceptance and a non-judgmental attitude by telling them back parts of their narrative they provided about themselves which affirms and acknowledges the legitimacy of their situation and their thoughtfulness for dealing with the challenge(s) before them; treating them as competent individuals.
  • Relatedness: By engaging with students in a curious, attentive manner that makes it clear that they are being listened to, allows them to feel an interpersonal connection that supports their feeling of being valued.

Neural Integration Enhancement— There is limited understanding of the human brain and even less studies related directly to MI or talk therapies in relation to the brain. So, we enter relatively unchartered territory in the exploration of brain structure in relation to limitations and potentialities imposed on our minds as humans struggle to resolve ambivalence, making decisions when you are of two minds. This in fact may help explain why MI conversations help in the decision-making process. The growing understanding of the human brain from neurobiology that include brain studies with PET and fMRI scans, the effect of injuries, strokes or disease on particular regions or even minute structures, on experiments done on other mammals, on probes and surgical procedures on conscious individuals, suggest that the brain does not only have lateralized dominance regarding motor ability (right or left handedness), but it seems to have a lateralized dominance for other processes of the brain as well.

We know that MI helps with the hard mental work required for resolving ambivalence, which requires the integration of competing thoughts and feelings. A comparison of the specialization or lateralized dominance and an understanding of the MI approach with its specific skills may hint at how MI may be supporting the processes of the mind. Here is a chart that depicts some of the lateralized dominance:

LEFT CORTEX

RIGHT CORTEX

  • Responsible for verbal-linguistic
  • Focuses on facts, logical, linear thinking, planning, organization and self-regulation.
  • Approach state allowing us to face challenges.
  • Outwardly focused to the world
  • Is responsible for social display rules and moral decision-making
  • Culturally sanctioned way we communicate
  • More activated when having feelings of a positive outlook.
  • Stores autobiographical memory
  • Holds our emotional feelings & needs
  • Receives signals that arise from our bodies
  • Dominant connections to the lower subcortical parts
  • Intuition emerges from input
  • Interprets non-verbal communication
  • Withdrawal response to new things
  • Inward focused of oneself and others (empathy)
  • Active when changing action planning

The process helps the individual connect these hemispheres therefore integrating the two sides which have different roles or dominances regarding the functions of the brain. This likely includes the process that the individual goes through in talking about themselves, as well as what MI does to facilitate the integration. Since the left is the side that is the dominant side for verbal-linguistic exchanges and it is also the side that is logical and forward thinking, the process of reflecting or telling them back what they have said, helps the individual integrate their thoughts and becomes an alternative connection which normally would need to go through the corpus callosum, which connects the hemispheres. Daniel Segal suggests:

“Telling a story is the linear telling of a sequence of events involving the left hemisphere’s linguistic, logical, linear diver to explain the cause-effect relationship of things in life. The ability to understand our mental lives are predominately right-sided affairs, suggesting that to tell a coherent story of our lives we need collaboration between these two differentiated, lateralize ways of seeing and being in the world. Creating the connections necessary for a coherent narrative of who we are and want to be.” (The Developing Mind, p. 383.)

This in fact can help integrate the more reflective conscious aspects of the mind as well as the more reflexive autopilot or subconscious levels.

This all suggested that MI can help enhance neural integration to support resolving problems and lead to create the life that they want. MI conversations help enhance the persons thought process to resolve the issue which require neural connections for making the decisions and for taking action.

Neural Integration and MI Conversations (PDF)