Motivational interviewing as a prelude to psychotherapy of depression

There are many possible contributors to limited treatment participation by depressed and vulnerable women. Practical barriers include cost, clinic inaccessibility, and problems with child care. Depressed people suffer, by definition, from low energy, hopelessness, and cognitive slowing, symptoms that may make them more vulnerable to the "time and hassle" factors associated with treatment seeking. While treatment preparation interventions have educated patients about treatment and/or problem-solved pragmatic barriers, they have rarely attended to patients' agendas-including a wish to tell their story, understand the nature of their problems, and specify the kind of help they wish to receive-or to the psychological and cultural barriers they might face. Motivational interviewing (MI) emphasizes the meeting of the treatment aspirations of patient and therapist within a client-centered relationship. Furthermore, many barriers to treatment can be understood in terms of ambivalence about accepting and changing the problem to be addressed, participating in treatment, or both. As a method for resolving ambivalence in the context of an empathic understanding of individuals' perspectives, hopes, and concerns, MI provides a promising framework for adherence intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)