Motivational Interviewing to promote self-awareness and engagement in rehabilitation following acquired brain injury: A conceptual review

Abstract

The benefits of rehabilitation following acquired brain injury (ABI) are all too often disrupted by a lack of engagement in the process, variously attributed to cognitive, emotional and neurobehavioural sequelae, and prominently to impaired self-awareness of deficits. Motivational Interviewing (MI) has been widely applied to address treatment adherence in health settings, including a small but emerging evidence base in brain injury contexts. A conceptual review of the literature is offered, examining the interplay of neurological and psychosocial determinants of engagement difficulties after ABI, and discussing the possibilities and limitations of MI as a therapeutic strategy to enhance motivation. The theoretical bases of MI are outlined, focusing particularly on the transtheoretical stages of change model and self-determination theory. The converging evidence suggests that the guiding philosophy and principles of MI – characterised by non-confrontation, collaboration and self-efficacy – might help to foster readiness for participation in rehabilitation. A dynamic motivational model of engagement is presented, identifying MI's potential contribution in three key areas: firstly, to set the stage for therapeutic alliance and case formulation; secondly, to facilitate acceptance of deficits and realistic goal-setting; and thirdly, to promote constructive engagement in the range of clinical interventions that comprise a holistic neurorehabilitation programme.

Keywords:

• Treatment adherence
• Motivation
• Stages of change
• Therapeutic alliance

Notes

¹Metacognitive knowledge refers to declarative knowledge about task characteristics stored in long-term memory, as well as knowledge about one's own cognitive capabilities.

²On-line awareness refers to ongoing monitoring and regulation of actual task performance, and is mediated and influenced by the situational context and subjective beliefs and feelings about one's capabilities.