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MI and CBT Combination, Integration Synergy

MI and CBT Combination, Integration Synergy. Paul Earnshaw Psychological Therapist /Social Worker Sylvie Naar King Associate Professor Clinical Psychologist. Explore combination Integration Synergy in MI CBT. Use an extract from training developed with Rory Allott-thanks.

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MI and CBT Combination, Integration Synergy

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  1. MI and CBT Combination, Integration Synergy Paul Earnshaw Psychological Therapist /Social Worker Sylvie Naar King Associate Professor Clinical Psychologist

  2. Explore combination Integration Synergy in MI CBT • Use an extract from training developed with Rory Allott-thanks. • MI enhances CBT nearly all MINTIES agree • No definitive research to back that up • My clinical experience in a Beckian CT world and in MIDAS trial - MICBT integration suggests that is does. • We are more interested in what you think

  3. Combining/Integrating MI and CBT; Some Questions • Why integrate? • What are similarities and differences between MI and CBT? • How to integrate (prelude, combination, integration)? • Why bother? Is there a synergistic effect? • What are the challenges presented to therapist, clients, and trainer around integration? • Other questions?

  4. CBT & MI: What separates them and brings them together? • Take the cards in front of you and distribute them around your group • Elect three people to collect the cards • One person collects cards that apply to MI and CBT • One person collects cards that apply more to MI • One person collects cards that apply more to CBT • Elect a fourth person to guide the conversation • Consider each card and discuss the placement • Obviously, there are no right or wrong answers or expectations about the size of piles • We will give you 20 mins

  5. Move about • Place your cards on the continuum on the wall • All cards will go on the wall so we can discuss consensus • While you are doing this notice where the cards are going • Debrief • What themes emerged from your group’s discussion • What were the challenges of this activity

  6. Combining/Integrating MI and CBT; Some Questions • Why integrate? • What are similarities and differences between MI and CBT? • How to integrate (prelude, combination, integration)? • Why bother? Is there a synergistic effect? • What are the challenges presented to therapist, clients, and trainer around integration?

  7. MI and CBT “ sort of like cousins ” Peter Prescott “some kinds of Cognitive therapy look a lot like MI” List serve discussions.

  8. But what is different? • Origins • Many ‘kinds’ of cognitive behaviour therapy • Beckian, Padesky, Metacognitive, REBT, CBT for substance use, DBT, ACT, Schema focussed, Compassionate Mind CBT, Method of Levels • Makes comparisons difficult • Only one Motivational Interviewing • Miller and Rollnick • Though many variations: MET, DDMI, AMI’s, Compliance therapy ?

  9. What other differences?

  10. But what is similar? • Origins • Neither grounded in theory • Emerged from detailed phenomenological research • Beck: Dreams • Miller: Client utterances and values • Cognitive-Behavioural journals • Strong evidence-base and culture of evaluation

  11. What else is similar?

  12. What to integrate from CBT? • Agendas • Formulation / Case conceptualisation • Identifying Beliefs • Problem solving • Behavioural experiments • Skills training • Emphasis on self-monitoring

  13. What to integrate from MI? • Listening for & responding to readiness to change • Identifying core values • Working with ambivalence • Developing discrepancy • Autonomy – client as agent of change NOT the therapy • Supporting self-efficacy • Reflective listening • Affirmation

  14. How to integrate? • Combination approaches • MI as a prelude to CBT (Arkowitz et al 2008) • Switching to MI during CBT to explore specific issues around ambivalence • Integrative approaches • Seamless joining together of CBT and MI • “assimilative integration”an ‘Integrative Framework’

  15. Training issues • Is it easier to train a CBT therapist to do MI or an MI therapist to do CBT? • Why • If you could teach both to a naïve counselor, would you do it sequentially or simultaneously. • How would you integrate MI and CBT training • In research trials use an MICT fidelity scale?

  16. Other Challenges • CBT not necessary to be in the Spirit of MI • Irrational thinking that needs to be corrected • MI can result in a cognitive shift is this CBT • CBT experts don’t see the need to integrate MI • CBT models tend to be expert not client led • Switching from one to the other is confusing

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