Motivational Enhancement Therapy

Motivational Interviewing

MI is therapeutic approach that aids individuals in exploring and resolving ambivalence about change. The approach is consistent with client-centered treatment approaches, as it relies heavily on the expression of empathy through reflective listening. However, MI is also directive in its use of techniques to facilitate the exploration of ambivalence and draw out client arguments for change.

MI operates under the assumption that motivation to change should be elicited from the client, instead of imposed from without. In MI, the interventionist resists taking on the expert role and instead seeks to join patients as a nonjudgmental companion in their exploration of ambivalence. MI is intended to facilitate change by aiding patients in identifying and mobilizing their own intrinsic values, helping them to develop discrepancies between these values and their current behavior, and encouraging and supporting commitment to change. The developers point out that, while specific learn-able skills are an important part of the intervention, if it is seen simply as a collection of techniques, its spirit and likely effectiveness will be lost.

MI was first described by William Miller as an extension of his intuitive clinical perspectives on the nature of change. The intervention was further described and elaborated by Miller and Stephen Rollnick in the book Motivational Interviewing: Preparing People for Change, which is now in its second edition. The first empirical tests of MI were actually tests of MET, as they combined the intervention with reporting of personalized assessment results.

Early Applications

The first empirical tests of MET were conducted by Miller, the codeveloper of MI, in the late 1980s. In multiple clinical trials, MET was tested as part of an intervention labeled the Drinkers Check-up, in which individuals were given a 2-hour battery of assessment instruments that are sensitive to the early effects of alcohol. Assessment instruments included behavioral measures, such as quantity and frequency of alcohol use, neuropsychological measures, such as executive functioning and attention tasks, and biomedical indexes, such as serum samples to be assayed for liver function. Following assessment, Drinker's Check-up participants received personalized [Page 566]objective feedback in which their assessment scores were compared to normative samples or other objective criteria. Participants were given a written personalized feedback report, which was reviewed by a clinician who helped the participant to understand and interpret the feedback relative to normative samples. Consistent with MI, feedback was given in a client-centered, empathie style, and labeling and confrontation were avoided.

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