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“Iarussi offers a timely and comprehensive text that impressively situates the
integration of MI and CBT in psychotherapy. Case examples, practice exercises,
and annotated transcripts engage the reader in a joint excursion of the four
options for MI and CBT integration. A centerpiece of this work is the application
of an integrative method with diverse populations. Iarussi provides feasible
recommendations for resolving potential dilemmas in today’s practice settings.
A highly useful text for students and practitioners alike.”
—Cynthia J. Osborn, PhD, Professor of Counselor Education and
Supervision, Kent State University, Ohio, USA

“Written with the practitioner in mind, Dr. Iarussi outlines in superb detail how
to properly integrate two of the most well-researched counseling approaches:
MI and CBT. Readers will find a firm grounding in each approach, followed by a
treasure trove of applications to enhance their practice. With increasing calls for
therapeutic integration, I cannot think of a timelier and more relevant resource on
MI and CBT.”
—Todd F. Lewis, PhD, Professor of Counselor Education at North
Dakota State University, USA

“In this book’s preface, Melanie Iarussi promises an integration of two popular,
evidenced-based approaches to counseling in clinical settings. She succeeds
admirably! Her integration provides clinicians with a fresh, practical perspective
of MI and CBT that encourages creative new approaches to working with mental
health issues. This is a great addition to any mental health practitioner’s library!”
—Charles F. Gressard, PhD, LPC, NCC, Chancellor Professor of
Education at the College of William and Mary, Virginia, USA
 Integrating Motivational
Interviewing and
Cognitive Behavior
Therapy in Clinical
Practice

Integrating Motivational Interviewing and Cognitive Behavior Therapy in Clinical

Practice shows counseling and other mental health professionals how the theoreti-
cal bases and evidence-based practices of motivational interviewing (MI) and cog-
nitive behavior therapy (CBT) can be used together to maximize client outcomes.
Chapters outline effective methods for integrating MI and CBT and show how
these can be applied to clients in a diverse range of mental health, substance use
and addiction, and correctional settings. Written in a clear and applicable style,
the text features case studies, resources for skill development, and “Voices From
the Field” sections, as well as chapters devoted to specific topics such as depres-
sion, anxiety, and more.
Building on foundational frameworks for integrative practice, this is a valuable
resource for counseling and psychotherapy practitioners looking to incorporate
MI and CBT into their clinical practices.

Melanie M. Iarussi, PhD, is an associate professor in the Department of

Counseling at Nova Southeastern University, Florida, USA. She is a member of
the Motivational Interviewing Network of Trainers, and she routinely teaches and
presents on MI and CBT, including on empirical findings related to this integrated
practice.
Integrating Motivational
Interviewing and
Cognitive Behavior
Therapy in Clinical
Practice
Melanie M. Iarussi
First published 2020
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2020 Melanie M. Iarussi
The right of Melanie M. Iarussi to be identified as author of this work has been
asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and
Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in
any form or by any electronic, mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks and are used only for identification and explanation without intent to
infringe.
Library of Congress Cataloging-in-Publication Data
Names: Iarussi, Melanie M., author.
Title: Integrating motivational interviewing and cognitive behavior therapy in clinical
practice / Melanie M. Iarussi.
Description: New York, NY : Routledge, 2020. | Includes bibliographical references
and index. Identifiers: LCCN 2019036207 (print) | LCCN 2019036208 (ebook) |
ISBN 9780815375838 (hbck) | ISBN 9780815375845 (pbk) | ISBN 9781351203234 (ebk)
Subjects: LCSH: Interviewing in psychiatry. | Motivation (Psychology) | Cognitive
therapy.
Classification: LCC RC480.7 .I27 2020 (print) | LCC RC480.7 (ebook) | DDC
616.8900835—dc23
LC record available at https://lccn.loc.gov/2019036207
LC ebook record available at https://lccn.loc.gov/2019036208
ISBN: 978-0-8153-7583-8 (hbk)
ISBN: 978-0-8153-7584-5 (pbk)
ISBN: 978-1-351-20323-4 (ebk)
Typeset in Minion
by Apex CoVantage, LLC
 To Adam, my incredible partner in life, and
to Evelyn and Avery, I am so lucky to be your mommy
 Contents

Preface xi
Acknowledgments xiv

Section I: The Foundations 1

1 The Growing Trend of Integrative Practice 3
2 Motivational Interviewing 17
3 Cognitive Behavior Therapy 34
4 An Introduction to Integrating MI and CBT 46
5 Integrating MI and CBT With Diverse Clients 65

Section II: Methods of Integration 81

6 MI as a Precursor to CBT 83
7 Assimilating MI Into CBT 96
8 Assimilating CBT Into MI 116
9 Seamless Blending of MI and CBT 131

ix
x Contents
Section III: Clinical Applications 151
10 Substance Use and Addictive Disorders 153
11 Mental Health–Related Concerns 189
12 Criminal Behaviors and Correctional Settings 222

Section IV: Clinical Practice Issues 245

13 Reconciling Potential Dilemmas 247
14 Training and Supervision 257

Index 267
 Preface

Welcome to a journey of exploring the integrative practice of motivational inter-

viewing (MI) and cognitive behavior therapy (CBT). Both MI and CBT are pop-
ular, evidence-based approaches with wide applicability in clinical practice. CBT
has been characterized as “the most well-established evidence-based psycho-
therapy,” and it is vastly disseminated (Dozois, Dobson, & Rnic, 2019, p. 3). MI
also boasts strong empirical support, and as a style of counseling that explicitly
addresses discord (formerly known as “resistance”) and client motivation, MI is a
sensible choice for integrating with other approaches. However, methods of doing
so are still developing (Miller & Rollnick, 2013).
At various professional conferences, after conducting presentations on integrat-
ing MI and CBT, I would commonly receive enthusiastic requests from partic-
ipants: “How can I learn more?” Until Naar and Safren published their text on
combining MI and CBT in 2017, there were unfortunately few resources to which
to point professional counselors, social workers, psychologists, and other helping
professionals who were eager to learn more. When I was approached about writing
this book, I considered if another book was needed in addition to Naar and Safren’s
(2017), and I developed the desire to write a book that provided information about
integrating MI and CBT in a variety of ways that were already established in gen-
eral psychotherapy literature (e.g., Norcross, 2005). I also wanted to make the con-
nections explicit of how MI and CBT can be used together to help treat clients with
a range of presenting concerns, including substance use and addictive disorders,
mental health disorders, and criminal behavior. Therefore, in this book, I present
various methods of integrating MI and CBT with explanations for how each type

xi
xii Preface
of integration might work in clinical practice considering the client, presenting
concerns, and the settings in which we work.
This book was written for students and clinicians who provide mental health,
substance use, correctional, or other types of counseling and psychotherapy ser-
vices. Throughout the book, I use terms such as “counselor,” “therapist,” “clinician,”
and “practitioner” interchangeably. It is my hope and understanding that profes-
sionals of various disciplines, including counseling, social work, criminal justice,
and psychology, find this information useful and applicable. Therefore, I used a
variety of terms in an effort to set the tone of inclusivity and applicability for vari-
ous professionals. I hope you will find this book applicable regardless of where you
place yourself on the continuum of experience from novice to seasoned profes-
sional and regardless of your familiarity with MI or CBT—you might know one or
both approaches well separately or not at all.
In Section I, we start by exploring the clinical trend of using integrated practice
in general (as opposed to the singular practice of one theory). This book is aligned
with the trajectory of the helping professions to be trained in and to practice more
than one approach to counseling. Then we visit the foundations of MI and CBT
separately. You may be familiar with or even extensively trained in one, both, or
neither. The purpose of these chapters is to provide you with enough information
about the approaches separately so that you have a foundation for their integration
as discussed in the remainder of the book, regardless of your preexisting knowl-
edge or training. Of course, there is a wealth of information available on these
approaches that is beyond the scope of this book. Therefore, resources to learn
more are included in Chapters 2 and 3. In Chapter 4, we dive into the rationale
for integrating MI and CBT in clinical practice and envision its practice through
a case example. To close Section I, Chapter 5 describes the value and practice of
integrating MI and CBT with diverse populations.
Section II explores various methods to integrate MI and CBT in practice. There
is no “right” or “wrong” approach to integrating MI and CBT, but rather there
are options from which to make sensible choices. First, we explore using MI as
a precursor to CBT treatment, which can be especially useful in settings where
clients are referred to CBT treatment that is offered by another provider. Then, we
will explore two forms of assimilative integration (Norcross, Goldfried, & Arigo,
2016): 1) assimilating MI into an existing CBT practice in which CBT remains the
foundational or primary theory, and 2) assimilating CBT into MI as the founda-
tional or primary approach. If you are currently practicing MI or CBT alone, you
might choose to begin with an assimilated approach, either as your integrative
practice goal or as a stepping stone to full integration. Theoretical integration, or a
true blending of MI and CBT, is described in the final chapter of Section II. In this
type of practice, MI and CBT are no longer considered separate approaches, but
rather they have become a single, unified approach.
In Section III, we explore clinical applications of MI+CBT in three broad areas
of practice: substance use and addictive disorders, mental health–related con-
cerns, and criminal behaviors and correctional settings. Each of these chapters
also includes specific case examples to illustrate its use. These areas were chosen
 Preface xiii
due to each being discussed in the literature, although to varying degrees. Liter-
ature on MI+CBT is most robust in substance use treatment, and applications in
mental health have been on the rise in the past decade. Applications of MI and
CBT are often discussed separately in correctional treatment. My hope is that these
chapters can help encourage the integration of these practices in their respective
settings and within the context of existing frameworks (i.e., Risk-Need-Respon-
sivity in correctional settings). My own experience in clinical practice and in
providing trainings also supported the development of these chapters. Although
only these three broad areas were chosen for this text, the application of MI+CBT
can expand beyond these areas to very worthy topics, such as intimate partner
violence and rehabilitation counseling, and be applied more specifically to dis-
orders and concerns within each area (e.g., specific to gambling addiction and
obsessive-compulsive disorder). The information provided is only a start to many
possible expansions.
Section IV wraps up our exploration of this integrated practice. Chapter 13
describes common dilemmas that providers integrating MI and CBT experience
and guidance to navigate these challenges. Finally, Chapter 14 provides informa-
tion about training and supervision to strive toward competence in practice in
MI+CBT.

References
Dozois, D. J. A., Dobson, K. S., & Rnic, K. (2019). Historical and philosophical bases of the
cognitive-behavioral therapies. In K. S. Dobson & D. J. A. Dozois (Eds.), Handbook of
cognitive-behavioral therapies (4th ed., pp. 3–31). New York, NY: Guilford Press.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change
(3rd ed.). New York, NY: Guilford Press.
Naar, S., & Safren, S. A. (2017). Motivational interviewing and CBT: Combining strategies for
maximum effectiveness. New York, NY: Guilford Press.
Norcross, J. C. (2005). A primer on psychotherapy integration. In J. C. Norcross & M. R.
Goldfried (Eds.), Handbook of psychotherapy integration (2nd ed., pp. 3–23). New York,
NY: The Oxford University Press, Inc.
Norcross, J. C., Goldfried, M. R., & Arigo, D. (2016). Integrative theories. In J. C. Norcross,
G. R. VandenBos, D. K. Freedheim, & B. O. Olatunji (Eds.), APA handbook of clinical
psychology: Theory and research (Vol. 2, pp. 303–332). Washington, DC: American Psy-
chological Association.
 Acknowledgments

This book would be not be possible without the incredible work of the theorists,
researchers, and writers who are cited in these pages. It has been my privilege and
pleasure to bring a breadth of research and scholarship together with the intention
of further disseminating the practice of MI+CBT.
I am incredibly grateful for the opportunity to share this information that has
been shaped and supported through innumerable conversations with professional
colleagues, trainees, various stakeholders, and students about how to teach and
learn these approaches, as well as how to apply MI and CBT in clinical coun-
seling and supervision. This book essentially began with my dissertation work,
and I wholeheartedly appreciate my continuing mentor, Cynthia Osborn, for her
support in pursuing this topic and in general. I am also incredibly grateful to my
colleagues and former students who collaborated with me on various writing and
research projects related to this topic.
This book was enriched by first-person accounts of students and professionals
who shared their own experiences of practicing, learning, and teaching MI and
CBT in the “Voices From the Field” insets. A very special thank you to Vivian
Hariton, whose integrity in work ethic and in character assisted me in proofread-
ing this book and with references, and to Karli Gallo whose diligent work assisted
with the references at the end of each chapter.
I must also acknowledge my dear colleagues (past and present), friends, and
family who supported me throughout this process. Thank you for believing in me
and for being patient with me.
Finally, I am grateful to you, the reader, for being interested in learning more
to serve your clientele in ways that effectively meet their individualized needs.
Because in the end, isn’t that what it’s all about?

xiv
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