Motivational interviewing

(from the chapter) There are a number of reasons why a chapter that focuses on the integration of Ericksonian approaches and motivational interviewing (MI) is a fitting culmination for a book on hypnotic approaches to pain control. The first reason arises from the shared focus of both chronic pain treatment and MI treatment: lifestyle behavior change. The management of chronic pain is a challenging task from any clinical perspective. Often, the most parsimonious route in improving the quality of life in such patients is to help them decrease their use of pain medications, reverse a sedentary lifestyle, and engage in challenging physical therapy exercises. A number of hypnotic suggestions enable patients to alter their perception of pain; yet effective treatment also requires that patients follow through with disciplined adherence to behavioral programs that focus on changes in lifestyle. MI is an evidence-based approach that enhances patients’ intrinsic motivation to entertain alternative models and pursue behavioral treatment strategies. Previous chapters have argued that Ericksonian hypnosis holds promise as an evidence-based treatment for pain control because many of its underlying principles have been substantiated by social–psychological research. Both MI and Ericksonian hypnosis share empirically supported components of brief therapies, such as exchanging information with patients to change perceptions, offering a menu of options rather than a single suggestion to reduce resistance, and emphasizing that the patient is free to choose whether to change. Accordingly, a second reason to consider blending MI and Ericksonian hypnosis is that a large body of scientific evidence supports the feasibility and effectiveness of using MI in combination with treatment as usual for behavior change. At least two systematic reviews of MI outcome research have shown that MI’s effects are stronger (Dunn, Deroo, & Rivara, 2001) and longer lasting (Hettema, Steele, & Miller, 2005) when used additively to enhance another treatment. Perhaps the most compelling reason to blend MI and Ericksonian hypnosis is the untapped but potentially powerful synergy from combining two clinical approaches that are complementary in task and similar in their styles of being with patients. Both styles are regarded as being easy on the patient and the clinician. Both approaches remove the struggle between the therapist and the patient by tailoring clinician statements to patients’ needs and viewpoints. Not only does the interpersonal style of MI mirror that of Ericksonian hypnosis, but each therapy seems to pick up where the other leaves off. Hypnosis, for example, by evoking perceptual changes, confusion, or disequilibrium, aims to help patients release rigid viewpoints (“all of my suffering comes from my pinched nerve”) and embrace alternative views or insights (“there’s a lot I can do to reduce my own suffering”). Once new perspectives render patients more accepting of lifestyle change, MI can significantly enhance their motivation to initiate and sustain behavior change. Successful lifestyle behavior change is characterized by chronic relapses to both old behaviors and old viewpoints, hence the need to alternately deploy these two complementary treatments with such compatible interpersonal styles. The potential additive effects of combining MI and Ericksonian hypnosis are ones that should be explored thoroughly on a theoretical and clinical basis. This chapter offers a tentative agenda for such an endeavor. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (chapter)