Motivational Interviewing

Overview

MI is a therapeutic approach designed to help individuals explore and resolve ambivalence about change. The approach is both client-centered and directive in its use of techniques to facilitate the exploration of ambivalence and draw out client utterances regarding change. MI can be implemented in a variety of formats and by a range of interventionists. However, it is typically applied as a brief intervention of one to two sessions. Thus, its duration is often much shorter than most other evidence-based substance abuse treatments. MI can be administered as a stand-alone treatment, as a prelude to other treatment approaches, or in combination with other interventions. It is also commonly combined with objective feedback. Treatment agents also vary greatly, ranging from physicians to community layperson volunteers. The flexibility of MI makes it applicable to a wide variety of settings, but this diversity in applications can present some challenges to researchers who wish to draw generalized conclusions regarding its effect.

Brief History

MI was originally conceptualized by William Miller, who was influenced by clinical experience, previous psychotherapy traditions, and empirical findings in cognitive psychology. Miller credits the formal conceptualization of MI with a sabbatical experience in Norway during which he was encouraged by trainees to explain and verbalize decision rules for his clinical approach. This process motivated him to describe the rationale for his approach in writing. After publishing his first description of MI in 1983, Miller joined with Stephen Rollnick to further develop the intervention and to create the first edition of the book Motivational Interviewing in 1991. The book is now in its second edition.

MI has its roots in client-centered, Rogerian therapy, which holds that all individuals house within them the potential to change and that unconditional positive regard by therapists can help germinate positive change. Both techniques rely on the use of reflective listening to communicate empathy and facilitate exploration of change. However, although traditional client-centered therapy is nondirective in its use of reflective listening, MI uses reflective techniques strategically to encourage the exploration of ambivalence and elicit change talk.

Several cognitive psychology principles also influenced the development of MI. Cognitive dissonance theory argues that perceived discrepancies between beliefs and behavior are uncomfortable for individuals and can motivate them to reduce dissonance by changing their behavior. MI relies on this principle in its attempts to help clients identify important goals or values and then develop a discrepancy between these goals and values and their [Page 569]current behavior. In addition, Daryl Bern's self-perception theory holds that individuals' beliefs can be influenced in part by their own verbal behavior. Consequently, MI aims to facilitate change talk and commitment language on the part of the client.

Spirit

The developers of MI point out that, while specific learnable 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 is intended to facilitate change by aiding clients 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. To achieve these goals, the therapist operates within the spirit of MI, relying on certain assumptions regarding the nature of human change. Three important constructs help describe the spirit of MI: collaboration, evocation, and autonomy.

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