This article explores the application of Motivational Interviewing (MI) in couples therapy, focusing on its potential to improve relationship quality, communication, and facilitate behavior change. The text highlights the evolution of MI for couples, addressing initial challenges and showcasing advancements in research and practice, particularly concerning substance use and sexual risk reduction.
Providers support relationship quality and productive communication while exploring potential behavior change . MI with couples is intended for use with couples where one or both partners engage in the behavior of concern.
Motivational interviewing was developed as an approach to engaging individual clients in conversations about behavior change . The application of MI with couples—main or primarypartners—initially encountered challenges and produced mixed results . When relationship partners are not equally ready to change—or desire to achieve change in different ways—MI techniques that work with individuals often fail. Scholarship on MI with couples has expanded vigorously over the past decade, driven largely by research involving male couples at high risk for HIV infection. See my previous posts for more information aboutQualitative analyses of intervention session content have identified unique processes , specific skills , and conflictstrategies , addressing many of the previously identified practice challenges. A small but growing number of quantitative studies suggest that MI with couples has the potential to reduce drug use and sexualThe literature on MI with couples has advanced sufficiently that providers might be interested in learning more about it or developing the skills required to integrate it into their existing practice. Providers who routinely work with couples might use it to engage their existing clients in focused conversations about behavior change. Providers who work with individual clients might use it as one way to involve relationship partners in their clients’ treatment when it becomes evident they are relevant.The practice of MI with groups is well established . Unlike members of most intervention groups, relationship partners interact with one another extensively outside the intervention context. They often rely on one another in important ways in everyday life. By extension, they have a wide range of ways to influence one another’s behavior. The practice of MI with couples embraces this dependence as a potential source ofIn many couple therapies , the relationship outcome is the primary goal. Success is indicated by things like whether partners stay together or their satisfaction with the relationship. Like these therapies, MI with couples attends to relationship quality. Counselors give focusedto drawing out relationship strengths, reinforcing the use of adaptive communication skills, and mitigating conflict in session. This is referred to as the process of facilitating dyadic functioning . What sets MI with couples apart is that it views relationship quality as a means to achieve growth and change in individual behavior instead of as the primary endpoint or goal. Guided by interdependence theory , relationship quality is seen as a factor that influences how partners evaluate their own behavior and react to one another in moments when they disagree. Partners in higher-quality relationships have more motivation to consider the impact of their actions on one another and their relationship. They are more likely to consider one another’s perspective when faced with disagreements that might lead to conflict. All of this means that relationship quality enhances partners’ ability to work together and support one another in the process of behavior change.in problematic ways and the other does not . Research now suggests that one of the best predictors of whether someone in a relationship uses a substance is whether their partner uses it . From its inception, MI with couples was developed for use with couples where one or both partners engage in the target behavior.Despite the rapid development of MI with couples in recent years, it remains firmly grounded in the larger tradition of MI practice. Providers should find that their existing skill set for working with individual clients remains relevant. The differences are primarily additions. Providers seeking to expand their work to couples will need to cultivate a working alliance with each of the partners individually as well as the couple as a whole, skills for speaking to the couple as well as to each of the individual partners, and strategies for mitigating conflict and promoting productive communication. Although that may at first seem like a big adjustment, these additional skills should complement what providers already know about MI.Although the advancement of MI with couples has been facilitated by a large body of new research with male couples who use drugs, it is not inherently-bound or limited to drug use specifically. Recent work has shown promising effects on problematic alcohol use with male couples and also with heterosexual couples in South Africa . The hope is that future research continues to expand the application of MI with couples so that this work that began with one group of LGBTQ+ couples can benefit people in relationships broadly.Apodaca, T. R., Magill, M., Longabaugh, R., Jackson, K. M., & Monti, P. M. . Effect of a significant other on client change talk in Motivational Interviewing.Conroy, A. A., Butterfield, R. M., Chibi, B., Hahn, J. A., Neilands, T. B., Msimango, L., van Heerden, A., Humphries, H., & Starks, T. J. . Pilot results of Masibambisane: Couples motivational interviewing with mobile breathalyzers to address unhealthy drinking and adherence to antiretroviral therapy in South Africa. Gamarel, K. E., Durst, A., Zelaya, D. G., van den Berg, J. J., Souza, T., Johnson, M. O., Wu, E., Monti, P. M., & Kahler, C. W. . ReACH2Gether: Iterative development of a couples-based intervention to reduce alcohol use among sexual minority men living with HIV and their partners.. The Guilford Press. Hillesheim, J. R., & Starks, T. J. . Drug use and condomless sex among sexual minority men in relationships: Whether relationship quality is a risk or protective factor depends upon what they believe their partners do.Magill, M., Mastroleo, N. R., Apodaca, T. R., Barnett, N. P., Colby, S. M., & Monti, P. M. . Motivational Interviewing with significant other participation: Assessing therapeutic alliance and patient satisfaction and engagement.Monti, P. M., Colby, S. M., Mastroleo, N. R., Barnett, N. P., Gwaltney, C. J., Apodaca, T. R., Rohsenow, D. J., Magill, M., Gogineni, A., Mello, M. J., Biffle, W. L., & Cioffi, W. G. . Individual versus signficant-other-enhanced brief motivational intervention for alcohol in emergency care.. Oxford University Press. Starks, T. J., Adebayo, T., Kyre, K. D., Millar, B. M., Stratton, M. J., Jr., Gandhi, M., & Ingersoll, K. S. . Pilot randomized controlled trial of Motivational Interviewing with sexual minority male couples to reduce drug use and sexual risk: The Couples Health Project.Starks, T. J., Dellucci, T. V., Gupta, S., Robles, G., Stephenson, R., Sullivan, P., & Parsons, J. T. . A pilot randomized trial of intervention components addressing drug use in Couples HIV Testing and Counseling with male couples.Starks, T. J., Doyle, K. M., Stewart, J. L., Bosco, S. C., & Ingersoll, K. S. . Development of Motivational Interviewing Treatment Integrity fidelity codes assessing Motivational Interviewing with couples.Starks, T. J., Millar, B. M., Doyle, K. M., Bertone, P. B., Ohadi, J., & Parsons, J. T. . Motivational Interviewing with couples: A theoretical framework for clinical practice illustrated in substance use and HIV prevention intervention with gay couples.Starks, T. J., Robles, G., Doyle, K. M., Pawson, M., Bertone, P. B., Millar, B. M., & Ingersoll, K. S. . Motivational Interviewing with male couples to reduce substance use and HIV risk: Manifestations of partner discord and strategies for facilitating dyadic functioning.Whatever your goals, it’s the struggle to get there that’s most rewarding. It’s almost as if life itself is inviting us to embrace difficulty—not as punishment but as a design feature. It's a robust system for growth.Self Tests are all about you. Are you outgoing or introverted? Are you a narcissist? Does perfectionism hold you back? Find out the answers to these questions and more with Psychology Today.
Motivational Interviewing Couples Therapy Behavior Change Communication Relationship Quality
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