title: 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.
authors.affiliation: School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK. a_medley@o2.co.uk
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Medley
authors.forename: Theresa
authors.initials: T
authors.lastname: Powell
mesh_terms: D001364:Awareness / Q000502:physiology*; D001930:Brain Injuries / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D012649:Self Concept