30 Jahre Motivational Interviewing: Eine Übersicht und Standortbestimmung

 

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Zusammenfassung

Der Begriff „Motivational Interviewing“ (MI) bzw. „Motivierende Gesprächsführung“ bezeichnet einen inzwischen international weit über den Suchtbereich hinaus in Wissenschaft und Praxis verbreiteten Ansatz der Gesprächsführung. MI ist charakterisiert durch einen personenzentriert-geschmeidigen und gleichzeitig zielgerichteten Dialog. Ziel von MI sind Veränderungen in Verhalten, Denken und Einstellungen des Gesprächspartners durch Stärkung von dessen Eigenmotivation. MI ist in den letzten 30 Jahren diversen theoretischen Weiterentwicklungen und empirischen Überprüfungen unterzogen worden. Neuerdings wird die Durchführung von MI um 4 Prozesse herum gruppiert (Kontaktbildung, Themenfokussierung, Förderung änderungsbezogener Äußerungen und Planung des Änderungsvorgehens). Die praktische Umsetzung dieser Prozesse erfolgt auf der Basis von 4 Änderungsprinzipien und einer Kombination von 7 Methoden. Fundamental für MI ist neben diesen „technischen“ Komponenten sein „spirit“ (partnerschaftlich, „entlockend“, Autonomie wahrend, Anteil nehmend). Gemäß 10 Meta-Analysen ist MI wirksamer als keine oder eine unspezifische Intervention und mindestens so effektiv wie bewährte andere Interventionen. Die MI-Prozessforschung legt nahe, in Äußerungen pro Veränderung („change talk“) und verbaler Selbstverpflichtung zum Handeln („commitment talk“) wichtige Vorbedingungen einer tatsächlicher Verhaltensänderung zu sehen. Zum Erwerb eines ausreichenden Maßes an MI-Kompetenz bedarf es außer MI-Trainings der übenden MI-Umsetzung und MI-Supervision. Um MI als Basisintervention in Einrichtungen zu implementieren, sind neben MI-Schulungen i.d.R. Veränderungen von Behandlungsparadigmen und Arbeitsabläufen vonnöten.

Abstract

Motivational interviewing (MI) is a collaborative conversation style designed to strengthen personal motivation for and commitment to change by eliciting and exploring the person’s own reasons for change. Originated from the field of addiction treatment MI has seen a steady rise in popularity worldwide in treating health-related and psychiatric problems. During the last 3 decades more than 200 randomized controlled trials on MI have been carried out and MI underwent several modifications of its basic concepts. Theoretical advancements concern the restructuring of MI around 4 processes (engaging, focusing, evoking, planning). 4 principles of intervention (like expressing empathy), 7 groups of methods (like reflective listening) and – most important – a special kind of spirit (collaborative, evocative, honoring autonomy, compassionate) are assigned to these processes. 10 meta-analyses show that MI works moderately well for almost every problem area, and that there is often no difference in effectiveness between MI and other treatments. As an important active ingredient of MI in-session client speech in favor of change (i. e., change/commitment talk) has received research support. For an effective use of MI extensive trainings and supervision of professionals as well as changes in organizational processes are needed.

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