Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed, and departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non-directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal. MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship.
Core concepts evolved from experience in the treatment of problem drinkers, and MI was first described by Miller (1983) in an article published in Behavioural Psychotherapy. Miller and Rollnick elaborated on these fundamental concepts and approaches in 1991 in a more detailed description of clinical procedures.
MI recognizes and accepts the fact that clients who need to make changes in their lives approach counseling at different levels of readiness to change their behavior. During counseling, some clients may have thought about making a behavior change, but may not yet have taken steps to make that change themselves. Alternatively, other clients may be actively trying to change their behavior and may have been doing so unsuccessfully for years.
For a therapist to succeed at motivational interviewing, they should first establish four basic interaction skills. These skills include: the ability to ask open-ended questions, the ability to provide affirmations, the capacity for reflective listening, and the ability to periodically provide summary statements to the client. These skills are used strategically, while focusing on a variety of topics, such as looking back, reflecting on a typical day, the importance of change, looking forward, and examining one's confidence about behavior changes.
Motivational interviewing is non-judgmental, non-confrontational and non-adversarial. The approach attempts to increase the client's awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternatively, or in addition, therapists may help clients envision a better future, and become increasingly motivated to achieve it. Either way, the strategy seeks to help clients think differently about their behavior and ultimately to consider what might be gained through change. Motivational interviewing focuses on the present, and entails working with a client to access motivation to change a particular behavior that is not consistent with a client's personal value or goal. Warmth, genuine empathy, and acceptance are necessary to foster therapeutic gain (Rogers, 1961) within motivational interviewing. Another central concept is that ambivalence about decisions is resolved by conscious and unconscious weighing of pros and cons of change vs. not changing (Ajzen, 1980).
The main goals of motivational interviewing are to engage clients, elicit change talk, and evoke client motivation to make positive changes. For example, change talk can be elicited by asking the client questions, such as "How might you like things to be different?" or "How does ______ interfere with things that you would like to do?" Change may occur quickly or may take considerable time, depending on the client. Knowledge alone is usually not sufficient to motivate change within a client, and challenges in maintaining change should be thought of as the rule, not the exception.
Ultimately, practitioners must recognize that motivational interviewing involves collaboration not confrontation, evocation not education, autonomy rather than authority, and exploration instead of explanation. Effective processes for positive change focus on goals that are small, important to the client, specific, realistic, and oriented in the present and/or future.
While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points:
- Motivation to change is elicited from the client, and is not imposed from outside forces.
- It is the client's task, not the counselor's, to articulate and resolve the client's ambivalence.
- Direct persuasion is not an effective method for resolving ambivalence.
- The counseling style is generally quiet and elicits information from the client.
- The counselor is directive, in that they help the client to examine and resolve ambivalence.
- Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction.
- The therapeutic relationship resembles a partnership or companionship.
Four Processes of Motivational InterviewingEdit
There are four overlapping processes that comprise Motivational Interviewing: engaging, focusing, evoking and planning. They are both sequential and recursive, and often depicted in diagrams as stair steps, with engaging at the bottom as the first step.
- Engaging: the process of establishing a working relationship based on trust and respect. The client should be doing most of the talking, as the counselor utilizes the skill of reflective listening throughout the process. Both the client and counselor make an agreement on treatment goals and collaborate on the tasks that will help the client reach those goals.
- Focusing: the ongoing process of seeking and maintaining direction.
- Evoking: eliciting the client's own motivations for change, while evoking hope and confidence.
- Planning: involves the client making a commitment to change, and together with the counselor, developing a specific plan of action.
Motivational enhancement therapyEdit
Motivational enhancement therapy is a time-limited four-session adaptation used in Project MATCH, a US-government-funded study of treatment for alcohol problems and the Drinkers' Check-up, which provides normative-based feedback and explores client motivation to change in light of the feedback.
Motivational interviewing is supported by over 200 randomized clinical control trials across a range of target populations and behaviors including substance abuse, health-promotion behaviors, medical adherence, and mental health issues.
MI groups are highly interactive, focused on positive change, and harness group processes for evoking and supporting positive change. They are delivered in four phases:
- Engaging the group
- Evoking member perspectives
- Broadening perspectives and building momentum for change
- Moving into action
Many studies using MI have specific inclusion/exclusion criteria. For example, Project MATCH excluded those who were homeless and involved in the criminal justice system. A randomized trial in drug abuse services Miller and Rollnick conducted in 2002 provided motivational interviewing sessions to clients in order to elicit behavior change by exploring and resolving ambivalence. They enrolled 152 outpatient and 56 inpatient clients who were entering a public agency for drug problems. The researchers excluded clients who reported insufficient residential stability.
A critic of these studies argues that to represent real world clinical activities, such studies must include every client entering the facility under study (within the parameters of informed consent) (Patterson, 2008 & 2009).
Examples of fields in which motivational interviewing is being applied include:
- "Dr. William Miller, "Motivational Interviewing: Facilitating Change Across Boundaries"".
- Shannon, S; Smith VJ; Gregory JW (2003). "A pilot study of motivational interviewing in adolescents with diabetes. Arch Dis Child". 88: 680–683.
- Rollnick, Stephen; Miller, William R. (October 1995). "What is Motivational Interviewing?". Behavioural and Cognitive Psychotherapy. 23 (4): 325–334. doi:10.1017/S135246580001643X.
- Handmaker, NS; Miller WR; Manicke M (2001). "Pilot study of motivational interviewing". 86: 680–683.
- "Motivational Interviewing".
- "Motivational Interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations". American Journal of Nursing. October 2007.
- Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. (1992) Motivational Enhancement Therapy Manual. Washington, DC:National Institute on Alcohol Abuse and Alcoholism
- Brodie, D.A.; Inoue, A.; Shaw, D. G. (2008). "Motivational interviewing to change quality of life for people with chronic heart failure: A randomised controlled trial". International Journal of Nursing Studies. 45 (4): 489–500. doi:10.1016/j.ijnurstu.2006.11.009. PMID 17258218.
- Cummings, S.M.; Cooper, R.L.; Cassie, K.M (2009). "Motivational interviewing to affect behavioral change in older adults". Research on Social Work Practice. 19 (2): 195–204. doi:10.1177/1049731508320216.
- Hanson, M; Gutheil, I. A. (2004). "Motivational strategies". 49.
- Freedman, J; Combs, G. (1996). "Narrative Therapy: The Social Construction of Preferred Realities". New York:Norton.
- Miller, W. R.; Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press. ISBN 9781609182274.
- Miller, W.R.; J. J. Onken, L. S., & Carroll, K. M. (Eds.) (2000). "Motivational Enhancement Therapy: Description of Counseling Approach". National Institute on Drug Abuse: 89–93.CS1 maint: Multiple names: authors list (link) CS1 maint: Extra text: authors list (link)
- Miller, W. R.; Rollnick, S. (2002). Motivational Interviewing: Helping People Change (2nd ed.). Guilford Press. ISBN 978-1572305632.
- Miller, W.R.; Zweben, A.; DiClemente, C.C.; Rychtarik, R.G. (1994). "Motivational Enhancement Therapy Manual". Washington, DC:National Institute on Alcohol Abuse and Alcoholism.
- Wagner, C.C., Ingersoll, K.S., and contributors (2013). Motivational interviewing in groups. New York: Guilford Press, Inc.
- Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. ISBN 978-0139364358.
- Brennan, T. (1982) Commitment to Counseling: Effects of Motivational Interviewing and Contractual Agreements on Help-seeking Attitudes and Behavior. Doctoral Thesis:University.of Nebraska.
- Herman, K. C., Reinke, W.M., Frey, A.J., & Shepard, S.A. (2013). Motivational interviewing in schools: Strategies for engaging parents, teachers, and students. New York: Springer. ISBN 978-0826130723
- Miller, W. R., & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press. ISBN 978-0-89862-566-0
- Miller, W. R. and Rollnick, S. (2002). Motivational Interviewing: Preparing People to Change, 2nd ed. New York: Guilford Press. ISBN 978-1572305632.
- Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing, Helping People Change, 3rd ed. New York: Guilford Press. ISBN 978-1-60918-227-4.
- Rollnick, S., Heather, N., & Bell, A. (1992). Negotiating behaviour change in medical settings: The development of brief motivational interviewing. Journal of Mental Health, 1, 25-37.
- Patterson, D. A. (2008). Motivational interviewing: Does it increase retention in outpatient treatment? Substance Abuse, 29(1), 17-23.
- Patterson, D. A. (2009). Retaining Addicted & HIV-Infected Clients in Treatment Services. Saarbrücken, Germany: VDM Publishing House Ltd. ISBN 978-3639076714.
- Prochaska, J. O. (1983). "Self changers vs. therapy changers vs.Schachter." American Psychologist 38: 853-854.
- Reinke, W. M., Herman, K. C., & Sprick, R. (2011). Motivational Interviewing for Effective Classroom Management: The Classroom Check-Up. New York: Guilford Press. ISBN 978-1609182588.
- Rogers, Carl (1961). On becoming a person: A therapist's view of psychotherapy. London: Constable. ISBN 1-84529-057-7.
- Rollnick, S., Miller, W. R., & Butler, C. C. (2007). Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press. ISBN 978-1-59385-613-7.
- Wagner, C. C., Ingersoll, K. S., With Contributors (2012). Motivational Interviewing in Groups. New York: Guilford Press. ISBN 978-1-4625-0792-4
- Motivational Interviewing Glossary and Fact Sheet Kathleen Sciacca
- "Dual Diagnosis Treatment and Motivational Interviewing for Co-occurring Disorders" in National Council Magazine 2007
- NIAAA web site: Project MATCH, MET treatment manual
- Steve Rollnick official website
- Motivational Interviewing Network of Trainers (MINT) website