Understanding Motivational Interviewing Effectiveness: Contributions From Rogers' Client-Centered Approach

International audienceThe object of this article is to gain a better understanding of motivational interviewing (MI) effectiveness using the framework of Rogers' approach. Examining MI's common points and differences with Rogers' client-centered therapy can make it possible to identify some of MI's active ingredients and its underlying process of effectiveness, especially related to MI relational component. In return, MI, a strongly evidence-based approach, could provide empirical basis and support of effectiveness for Rogers' client-centred therapy. The review of literature on Rogers' therapy and MI shows strong links between the two approaches. MI applies most of Rogers' therapy attitudes and techniques such as empathy, acceptance, autonomy support, collaborative style, and confidence in the client's ability to change. The article further presents a review of research data related to the therapeutic effects of each of these attitudes. Finally, implications for clinical practice and further research are discussed. MI and Rogers' client-centered approach have much to offer each other. The strong process and outcome research tradition in MI could bring about evidence on Rogers' therapy effectiveness. Rogers' work provides a testable theoretical basis for the mechanisms of MI effectiveness. Further MI research should operationalize more than just empathy in the relational component

Positive Motivational Interviewing: Activating Clients' Strengths and Intrinsic Motivation to Change

International audienceMotivational interviewing (MI) is a widely disseminated, scientifically-tested method of psychotherapy, which combines a supportive, collaborative and empathic counselling style with a consciously directive method as a means to positively resolve tension created by unresolved ambivalence about change. This article outlines MI as a positive approach to psychotherapy and considers some of its core concepts: the client-centered attitudes and its links with positive psychology interventions (PPIs). The objective of this article is to present MI in the light of positive psychology (PP) in order to build bridges between the two and to gain a better understanding of the processes involved in positive behavior change with both MI and PPIs. The review of the literature shows the strong links that exist between PP and MI: they have much to offer each other. MI is a strength-focused approach that builds on client's resources and skills and is an important example of how client-centered approaches to psychotherapy operate their effects. MI has a theoretical and practical flexibility and is a well proven approach for increasing intrinsic motivation to change. PPIs could be used combined with MI, in order to increase adherence to psychotherapy, as the PPIs, often delivered in self-help format, request effort and motivation. Integrating MI with the PPIs could also produce synergistic effects and lead thus to better outcomes. We propose several examples of how MI can be integrated with other forms of PPIs. Finally, implications for clinical practice and further research are discussed

Nouvelles applications du modèle transthéorique~: la pratique d'une activité physique régulière

International audienceDe nombreuses études ont montré les effets bénéfiques de l'exercice physique au niveau physiologique et psychologique. Cependant, les mécanismes de l'adoption et du maintien d'une pratique physique régulière restent mal connus, d'où les difficultés rencontrées dans la mise en oeuvre d'interventions efficaces à court et long termes. Le modèle transthéorique, mis au point par Prochaska et DiClemente, permet de mieux comprendre les différents mécanismes du changement intentionnel de comportement. Ce modèle postule que les différentes stratégies d'intervention devraient être adaptées au stade de changement d'un individu. L'objectif de cet article est de présenter ce modèle avec ses différentes composantes et la façon dont elles s'articulent à travers le continuum de la motivation au changement. Les nouvelles applications, dont notamment l'activité physique régulière et les méthodes d'interventions, seront ensuite passées en revue. Enfin, des perspectives et orientations futures de recherche seront présentées. Numerous studies have shown the beneficial effects of physical exercise on physiological and psychological dimensions. However, the mechanisms for adopting and maintaining regular physical practice remain little known, hence the difficulties encountered in the elaboration of effective interventions in the short and long term. The transtheoretical model, developed by Prochaska and DiClemente, provides a better understanding of the different mechanisms of intentional behavior change. This model, developed from a comparative analysis of all major psychotherapeutic theories, distinguishes 10 processes of change, which corresponds to the covert and overt activities that individuals use to modify their behavior. Moreover, the different processes of change are hypothesized to correspond to specific stages of change. Theses stages of change (precontemplation, contemplation, preparation, action, and maintenance) correspond to the temporal and motivational aspect of change. Other concepts, such as self-efficacy and decisional balance, are used to facilitate the progression through the stages of change. The objective of this article is to present the concepts of the transtheoretical model applied to physical exercise, to review the effectiveness of interventions tailored to the stages of change on physical activity levels. Finally, we address the perspectives and future directions of research. Interventions based on the components of the transtheoretical model generally prove more effective than traditional "action-oriented" interventions to promote the practice of physical activity for diabetics, elderly, sedentary adults and teenagers, etc. However, it seems that repeated interventions are more effective than brief ones when it comes to achieving results in the long term. We propose that research take into account all the components of the model (stages of change, processes of change, self-efficacy, and decisional balance) in order to meet the specific requirements of each stage and thus obtain a larger effect. Despite of its initial developed in the field of addiction, the transtheoretical model is much more complex and its new applications are numerous and promising. The model has been particularly promising in the study of the mechanisms related to behavior change, as well as in the development of interventions to encourage healthy behaviors and especially the practice of regular physical activity among sedentary individuals. In terms of research directions, it would be interesting to integrate and explore the mechanisms of action of other potential processes of change that emerge from new empirically based therapies, such as the enlargement produced by the specific work on positive emotions in positive psychotherapy, increasing the capacity to be attentive and conscious of the present moment used in mindfulness based therapies etc. Future research should allow us to answer questions about the evaluation, implementation, and evolution of the model

L'écoute réflective : un nouvel usage en psychothérapie, spécificités de l'entretien motivationnel

International audienceReflection, a key element of empathic listening, initially developed by Carl Rogers, has found new purposes and applications in modern psychotherapy. The aim of this article is to explain this technique in more depth and to examine its role and main forms in Rogers’ client-centered therapy and motivational interviewing (MI), and to review empirical studies based on the influence of reflection and empathy in the effectiveness of empirically validated psychotherapies, and in particular MI. In fact, in the Rogers’ approach, (Rogers et Kinget, 1962 [2]), as well as in MI and in CBT, in spite of their orientation towards change and a certain directivity, reflection is considered as the main way to express accurate empathy. Empathy is a central feature in several therapeutic approaches and has been particularly associated with positive results in the treatment of various problems (Miller et Rollnick, 2002; Miller et Baca, 1982; Greenberb et al., 2001 [8], [9], [10]). This therapeutic attitude, widely used by Rogers (1951, 1959, 1968 [11], [12], [13]), has been adopted by the authors of MI, Miller et Rollnick (2002, 1991 [4], [8]), as well as by other forms of effective psychotherapies. Reflective listening plays a central role in both MI and the Rogers's client-centered approach; in MI, it was adopted and enriched with new, more complex forms, as well as with objectives which differ from Rogers’ approach. In MI, the client's talk which reflect their intentions to change (change-talk) are predominantly reflected upon. MI requires thus a selective method of response to the client's speech to reduce ambivalence and guide the person towards change. Four sub-categories, including cognitive, emotional and behavioral dimensions of commitment to change, constitute the preparatory change-talk: the desire, ability, reason and need to change, “commitment” and the “first steps”. The sustain talk consists of statements opposing change, and resistance talk consists of interruptions and disagreements with the therapist. According to Miller et Rose (2009 [18]), the effectiveness of MI is based on its influence on change-talk. These authors hypothesized that behavioral change is directly linked to client change-talk during MI sessions, and that it is inversely linked to sustain talk. According to those authors, the effective use of the MI technique increases change-talk in clients and reduces sustain talk, which predicts effective change in behavior. Studies comparing MI to more traditional treatment models or minimal intervention show the links between MI-consistent behaviors and the emergence of more change-talk compared with other approaches or minimal intervention (Apodaca et Longabaugh, 2009; Moyers et al., 2007 [23], [24]). Current research by Amrhein et al. (Amrhein et al., 2003; Amrhein, 2004 [14], [26]) shows that the intensity of commitment to change by the client and the first steps predict long-term change in behavior. Expressions of change-talk such as desire, ability, the reason and the need to change do not systematically initiate change but they announce the reinforcement of commitment to change. The effect of the intensity of client commitment talk on behavior change has been verified in a study on CBT for hospitalized cocaine addicts (Aharonovich et al., 2008 [27]). In conclusion, reflection allows the therapist to evoke the client's statements in the direction of the desired change, and to reinforce it, which should then lead to an effective change in behavior. However, it is still too early to make any conclusions about the efficiency of reflective listening. Despite its frequent use in psychotherapy, the specific therapeutic effectiveness of reflecting is still rarely assessed in empirical studies. It would thus be interesting to assess the role that reflective listening, a central technique in MI, plays in the production of the client's change-talk, in the building of the therapeutic alliance and in the effectiveness of MI and other empirically validated psychotherapies. Finally, it is important to expand its use to different types of psychotherapy and to assess its impact.La reformulation, marque d’une écoute empathique initialement développée par Rogers, trouve aujourd’hui de nouvelles orientations et applications dans le champ de la psychothérapie. L’objet de cet article est d’expliquer plus avant cette technique et d’examiner son rôle et ses principales formes dans la thérapie centrée sur la personne de Rogers et l’entretien motivationnel (EM), et de faire le point sur les études empiriques portant sur l’influence de la reformulation et de l’empathie dans l’efficacité des psychothérapies validées scientifiquement, et notamment de l’entretien motivationnel. Les changements et enrichissements apportés par l’entretien motivationnel à la reformulation sont mis en évidence à travers les nouveaux objectifs visés et techniques employées, et notamment en lien avec la production de discours-changement. Les effets du discours-changement sont étudiés à travers une revue de la littérature et notamment des études psycholinguistiques. Enfin, de nouvelles pistes de recherche sont proposées. Ainsi, il est intéressant de vérifier quel rôle joue l’écoute réflective, technique centrale de l’EM, dans la production du discours-changement du client et dans l’efficacité de l’EM et des psychothérapies. Enfin, il semble important d’élargir son utilisation aux différents types de psychothérapie et d’en évaluer ses effets

L'intelligence psychologique et son utilité clinique

International audience[No abstract

Rôle de l'intelligence psychologique dans la prise en charge psychothérapeutique de la dépression

Un intérêt croissant a été accordé dernièrement, notamment dans le cadre de la psychologie positive, aux ressources psychologiques et au caractère positif. L’objectif de cette étude est donc d’apporter un éclairage sur certains des facteurs permettant aux patients souffrant de dépression d’exploiter ou non leurs forces de signature (il s’agit des traits de personnalité positifs et moralement valorisés, les plus prédominants chez un individu). L’argumentation est ici dirigée spécifiquement sur l’intelligence psychologique ainsi que sur l’implication des proches dans la détection des forces de signature. Trente-trois participants ont été inclus dans cette étude et répartis en deux groupes : un groupe clinique, composé de 19 patients (moyenne d’âge 46,56 ; σ = 14,34) atteints de troubles dépressifs (BDI ≥ 16) et un second groupe, composé de 14 personnes (moyenne d’âge 34,79 ans ; σ = 16,99) de l’entourage de ces patients. Les proches des patients qui ont accepté d’intégrer cette étude font partie du groupe « entourage » et ont rempli les mêmes questionnaires d’auto-évaluation que les patients. Les résultats montrent que l’intelligence psychologique (IP) est impliquée dans la détection de nos propres forces de signature et cette détection des forces est liée à leur connaissance et à leur utilisation. L’IP joue également un rôle dans la reconnaissance des forces de signature d’autrui, ce qui nous ouvre une perspective intéressante quant à la possibilité d’impliquer les proches dans le travail de détection des forces de signature des patients. Enfin, les résultats indiquent que la dépression est liée à un plus faible niveau d’IP et de connaissance des forces de signature. / Objectives A growing interest in human sciences has emerged with respect to positive psychological resources and signature strengths within the new field of positive psychology (Seligman and Csikszentmihalyi, 2000; Peterson and Seligman, 2004). Positive psychology (PP) is the scientific study of positive experiences and positive individual traits and the institutions that facilitate their development. It aims to broaden the focus of psychology beyond suffering and psychopathology in order to promote well-being by building strengths and not just by correcting an individual's weaknesses. The purpose of this study is to better understand the role of the psychological resources which may be involved in the identification and use of positive attributes, especially of character strengths and signature strengths, which are considered as adaptive and related to well-being. Psychological mindedness (PM) may play an important role in the well-being as well as in the identification of character and signature strengths and facilitate their use in everyday life as it involves a degree of access to one's feelings; a willingness to try to understand oneself and others; an interest in one's own motivations, thoughts, feelings and behaviors as well as those of others; and an ability to change (Conte et al., 1996). For these reasons, the study focused mainly on the use of this psychological resource. Therefore, it is expected that PM also promotes the ability to perceive one's character and signature strengths as well as those of other people. Furthermore, to date, few studies have examined the impact that depression can have on the identification of positive attributes. It is indeed probable that people suffering from depressive disorders find it difficult to identify their strengths due to negative self-image. Method Thirty-three participants from different mental health treatment centers were included in the study. They were divided into two groups: a clinical group consisting of 19 patients with depressive disorders (mean age 46.56 years; σ = 14.34; BDI ≥ 16) and a second group consisting of 14 people who were friends and family members of the patients, the “support” group (mean age 34.79 years; σ = 16.99). Patients completed self-assessment measures of character and signature strengths, psychological mindedness and depression. The friends and family of the patients who agreed to participate in the study formed the “support” group and completed the same questionnaires with the exception of the depression scale. In addition, each patient was asked to assess their own signature strengths and then to estimate the signature strengths of their respective friend or family member using a questionnaire. Each friend or family member also performed the same task. Results In the clinical group, the degree to which character strengths were present was found to be positively correlated with the ability to use them (r = 0.66; P < 0.05) and also with the level of PM (r = 0.49; P < 0.05). In the “support” group, a positive correlation between the degree to which signature strengths were present and the level of their use was found (r = 0.63; P < 0.05). The level of knowledge of these strengths showed a high positive correlation with firstly, their level of use (r = 0.85; P < 0.05) and secondly, the degree to which they were present (r = 0.78; P < 0.05). For patients and their respective friend or family member (n = 28), the total number of signature strengths determined in common was positively correlated with the level of global PM (r = 0.45; P < 0.02). Furthermore, the level of depression was negatively correlated with the level of PM (r = −0.53, P < 0.05) and with the level of knowledge of one's signature strengths (r = −0.55; P < 0.05). Conclusion Psychological mindedness is involved in the detection of one's own strengths and this detection of signature strengths is related to an individual's knowledge of them and to their use. These are particularly important in positive psychotherapy, which aims to help people use their character and signature strengths. PM also plays a role in recognizing the signature strengths of others. Finally, the results suggest a negative impact of depression on PM and on the identification of one's signature strengths. It is thus important to focus on these aspects from the beginning of therapy

Les effets de la mindfulness et des interventions psychologiques basées sur la pleine conscience

International audienceRésumé Depuis plus de vingt ans, un concept psychologique connaît un intérêt croissant dans les sciences humaines~: il s'agit de la mindfulness, qui désigne la faculté d'attention et de conscience à l'expérience présente. Jusqu'à récemment, le concept de mindfulness a été assimilé, voire confondu avec les pratiques de méditation. Selon Brown et Ryan (2003), la mindfulness est une capacité innée présente chez tous les individus à des degrés divers, qui a montré une utilité conceptuelle et empirique, dans des études portant sur le bien-être psychologique, la santé physique, le travail et le sport, et dans le domaine des relations interpersonnelles. L'objet de cet article est de présenter ce concept psychologique, ainsi que les résultats des études portant sur les effets de cet attribut sur le bien-être et la régulation émotionnelle et du comportement. Nous nous proposons également de présenter et analyser les principales interventions thérapeutiques s'appuyant sur ce concept ainsi que leurs effets principaux. En effet, plusieurs méta-analyses portant sur l'efficacité de ces interventions montrent des tailles d'effet modérées, voire importantes, de ce type de prise en charge sur les symptômes de la dépression et de l'anxiété (Hofmann et al., 2010). Enfin, nous proposons des orientations pour des futures recherches portant sur cet attribut. A growing interest in the human sciences has emerged in the last twenty years with respect to mindfulness. Until recently, there were confusions of the concept of mindfulness with the meditation practices. According to Brown and Ryan (2003), mindfulness is an innate tendency of all individuals, present at different degrees, that demonstrated both conceptual and empirical utility in the last years, in studies on psychological well-being, physical health, work and sport performance, and the field of the interpersonal relationships. The object of this article is to present this psychological concept as well as the results of the studies relating to the effects of this attribute on well-being and on emotional and behavioural regulation. In the second part of the article, we present a review of the literature of the principal therapeutic interventions based on mindfulness. Several meta-analyses show moderate to important effect sizes of this type of approach on the symptoms of depression and anxiety (Hofmann et al., 2010). Lastly, we propose orientations for future research on mindfulness and on related interventions

Psychologie positive, entre plaidoyer pour le bonheur et orientation scientifique

La psychologie positive est une discipline qui a le vent en poupe. Pourtant, derrière la littérature foisonnante qui lui est consacrée, il est parfois difficile de s'y retrouver..

Évaluation comparative des composantes de l entretien motivationnel dans la prise en charge de patients alcoolodépendants

Cette étude évalue qualitativement les effets des composantes principales de l entretien motivationnel, afin de trouver leur meilleur mode d utilisation. Les patients alcoolodépendants inclus (29 hommes et 16 femmes) étaient à la recherche d un traitement, et 34 ont suivi le protocole thérapeutique jusqu à son terme. Les stratégies principales de l entretien motivationnel ont été introduites à trois moments différents auprès des trois sous-groupes formés. Les résultats montrent une augmentation significative du sentiment d efficacité personnelle et de la motivation interne au changement, de la satisfaction de vie et de l estime de soi ainsi qu une progression des patients à travers les stades de changement en fin de thérapie. Une diminution significative importante de la tentation et de la consommation d alcool est également constatée. Dans le troisième groupe, celui qui a bénéficié de toutes les stratégies de l entretien motivationnel on observe le taux le plus élevé d efficacité thérapeutique. Les stades de changement et les anciennes tentatives de changement, ainsi que la motivation au traitement s avèrent être des bons prédicteurs des résultats du traitement.This study assesses qualitatively the effects of Motivational Interviewing (MI) components, in order to find their best manner of application. The sample was a group of 29 male and 16 female alcoholics seeking treatment of whom 34 followed the therapeutic program until its end. The principal MI strategies were introduced into three sub-groups at three different moments. Results revealed a significant increase in self-efficacy, of internal motivation to change, of satisfaction with life and self-esteem as well as a progression of the patients through the stages of change at the end of the therapy. A significant reduction in temptation and alcohol consumption are also noted. In the third group, offered all MI components, one observes the highest rate of therapeutic effectiveness. The stages of change and former attempts to change, as well as motivation to treatment are good predictors of treatment results.NANTERRE-BU PARIS10 (920502102) / SudocSudocFranceF

Psychothérapie positive de la dépression~: spécificités et apports cliniques

International audienceDepression is one of the most prevalent disorders of our time. Depression remains nowadays in France and worldwide a major public health problem, still relatively difficult to treat, despite the important ongoing therapies currently available (anti-depressants, cognitive-behavioral therapy, etc). While antidepressant drug therapies are helpful for many depressed people, they also have many drawbacks and side effects. The maintenance in the longer term of treatment effects poses a particular problem, given the high probability of occurrence of depressive relapse, very difficult to avoid. However, research show that relapses are lower in psychotherapy. The positive psychology interventions offer some novel and promising perspectives for clinical practice. They prove indeed effective and complementary to other treatments of depression previously proposed and their effects seem to last longer. The aim of this article is to present positive psychology, and especially the new emerging positive psychotherapy and to underline its key features and benefits in the treatment of depression. The results of empirical studies and meta-analysis are promising; we thus encourage French clinicians to integrate positive psychotherapy and interventions promoted by Martin Seligman et al. to cultivate a lasting sense of well-being, which is a valuable resource for more effective and sustainable eradication of depression.La dépression est un important problème de santé publique qui demeure, encore de nos jours, difficile à traiter en dépit de l’arsenal thérapeutique existant (antidépresseurs, thérapies cognitivo-comportementales…). Les approches psychothérapiques reposant sur les préceptes de la psychologie positive offrent aujourd’hui de nouvelles perspectives cliniques prometteuses. Cet article vise à mieux faire connaître la psychologie positive et à présenter les principales spécificités et les effets positifs de la psychothérapie positive utilisée dans le cadre du traitement de la dépression. Force est de constater qu’elle se révèle particulièrement efficace et complémentaire aux prises en charge cognitivo-comportementales de la dépression dont elle est susceptible de potentialiser les bienfaits. Aussi, résultats d’études empiriques à l’appui, nous promouvons l’usage par les cliniciens français d’exercices thérapeutiques préconisés par Martin Seligman et al. pour cultiver un sentiment de bien-être permettant de faire face de manière plus optimale à la dépression