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|Clinicians Digest Jan/Feb 2008 - Page 3|
They then became interested in ethnographic interviewing (EI), a technique used by sociologists to interview people of other cultures that helps interviewers keep their own cultural biases from distorting the conversations. They wondered whether they could combine principles of EI and MI to develop an intake session that would help enhance depressed African American women's intrinsic motivation to change.
Zuckoff and Swartz developed a single-session intake session that helps therapists open their ears and clients fully express their ambivalence about therapy. In their small study of the intake model at a community clinic, 23 of 24 depressed African American women who received the session kept their first therapy appointment, while only 7 of 33 who didn't receive the intake session did.
They describe the session in the August Professional Psychology: Research and Practice. Therapists first elicit the client's story, using reflective listening and empathic questioning, and making sure to ask both about feelings--"You're stuck with all these bills and busy all the time. How's that affecting you?"--and the situation--"You've been feeling hopeless lately. What's been going on in your life that might be causing this?" They invite clients to fully air their ambivalence, talking about both their hopes and fears about treatment, and any external barriers, such as transportation problems, lack of child care, or unsupportive spouses. They tie feedback and information to what the client has said, never using it to push or persuade. Finally, summarizing both the situation and anything the clients have said that indicates their readiness to change, they ask whether they'd like to give therapy a try.
The paradox of the MI approach is that clients who fully express ambivalence are more likely to locate their intrinsic motivation to change. "MI is really about therapeutic humility," says Zuckoff. "It helps therapists stay out of their own way."