Change Theory and Motivational Interviewing
Change Theory, otherwise known as the Transtheoretical Model (TTM) and Motivational Interviewing (MI) are two approaches utilized by clinicians to assess, identify, and understand the need for behavior change in a variety of contexts, and subsequently act as a framework to help guide the change process. While some of the principles overlap, the different stages within TTM and MI have specific focuses through use of different elements. TTM utilizes a range of change theory conceptual models to guide the included constructs, which led to the name â€œâ€™transtheoreticalâ€™ (Prochaska & Norcross, 2003, p. 516)â€ (Udod & Wagner, 2022). For instance, linear and non-linear change theories, such as those proposed by theorists Lewin, Havelock, and Rogers, have influenced the TTM and its recognized stages of changes and process of change (Udod & Wagner, 2022). TTM stages of change are the following: precontemplation, contemplation, preparation, action, and maintenance. These stages guide the clinician by providing criteria about the thought process and behaviors related to the problem in a specific time frame (Raihan & Cogburn, 2022). For instance, the first stage of TTM, precontemplation criterion includes thought process, denial that a problem exists, and behavior, there is no intention to take action to make a change, within a specific time frame, the next six months (Zakhari, 2020). Further, there are certain strategies recommended for each TTM stage, as well as integration of decisional balance and self-efficacy. Continuing with the precontemplation example above, the strategies of consciousness raising, and dramatic relief are reportedly most effective for individuals in this stage (Jones-Smith, 2021). The remainder of TTM stages, contemplation, preparation, action, and maintenance, include the same thought process and behavior within a particular time. Contemplation is when acknowledgement of the problem is made and intention to make actions to change in the next six months. Preparation is intention to act on change within the next thirty days, as well as planning of steps to achieve behavior change. Action is when behavior change has been congoing for six months or less, which becomes maintenance when behavior change has continued more than six months (Zakhari, 2020).
Conversely, MI is a technique aimed at encouraging behavior change with use of cognitive behavioral therapy (CBT), the Health Belief Model (HBM), and frequently combined with TTM. MI is less based on change theories compared to TTM and was deduced primarily from evidence based clinical insights (Angelini & Efran, 2021). The specific focus on MI is to help the client identify internal motivation for change and benefits of such change in relation to the clientâ€™s values (Zakhari, 2020). Whereas TTM has five stages of change, MI has four stages of change, each with its own goal and recommended communication skills to meet the goal. The MI phases of change include the following: Engagement, the goal to establish the therapeutic relationship; Focusing, the goal to identify the focus of the change; Evoking, the goal to initiate client voicing their motivation for change; Planning, with the goal to elicit a realistic plan to carry out (Wheeler, 2022). MI is also built upon four principles and advice on how to listen for change talk when working with a client; MI principles instruct the clinician on how to act while engaging in a partnership with a patient in which the client is guided to elicit their intrinsic motivation to change. Although MI can help clients enhance intrinsic motivation to participate in behavior change, MI does not contain a structured strategy for how to set and track progress and specific outcomes (Lewis et al., 2017). This is when focused elements of TTM are beneficial in conjunction with MI communication techniques of open-ended questions, affirming, reflecting, and summarizing. TTMâ€™s concept of self-efficacy is different than that in the HBM within TTM because it highlights clinician use of two scales, on a zero to ten continuum, the importance ruler and confidence ruler. In the process of forming a collaborative relationship with the patient, which can use both MI and TTM, measurement scales can be a helpful guide for the clinician to use throughout the behavior change process. Getting a baseline number correlated with how important change is to the client, and how confident the client is in making this change, is critical to inform the most effective therapeutic intervention. Measuring client outcomes of goal attainment and progress toward a goal is needed in nursing practice, especially within the advanced practice nursing role of a psychiatric mental health nurse practitioner (PMHNP). TTM has these two scales to assessment importance and confidence of the client concerning behavior change, though does not have a specific objective, evidence-based collaborative goal attainment scale. Recent literature has indicated goal attainment scaling (GAS) can be used to enhance the stages/processes of change in MI and TTM to measre effectiveness of therapeutic interventions (Lewis et al., 2017).
Angelini, F., & Efran, J. (2021) Motivational interviewing: contributions from structure determinism. Professional
Psychology: Research and Practice 52 (4), 368â€“375
Jones-Smith, E. (2021). Chapter 10: Motivational Interviewing and the Stages of Change Theory. In Theories of
counseling and psychotherapy: An integrative approach. essay, SAGE.
Lewis, T.F., Larson, M.F., & Korkuska, J.S. (2017). Strengthening the planning process of motivational interviewing
using goal attainment scaling. Journal of Mental Health Counseling, 39(3), 195â€“210.
Raihan, N., & Cogburn, M. (2022). Stages of Change Theory. StatPearls. Retrieved September 8, 2022, from
Wagner, J. (2022). Leadership and influencing change in nursing. University of Regina Press.
Wheeler, K. (2022). Psychotherapy for the advanced practice psychiatric nurse. A how-to guide for evidence-
based practice (3rd ed.). Springer.
Zakhari. R., (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
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summer 2023 week 2 discussion |
Change Theory and Motivational Interviewing