| Motivational Interviewing |
| What is Motivational Interviewing? |
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Motivational interviewing (MI) is a person-centered, goal-oriented counseling style for strengthening a person's own motivation and commitment to change. It is designed to help people resolve ambivalence by partnering with them to explore their own reasons and ability for change within an atmosphere of acceptance and compassion.
First described by William R. Miller, PhD, in his 1983 article "Motivational Interviewing with Problem Drinkers" and fully developed in collaboration with Stephen Rollnick in the 1991 book Motivational Interviewing: Preparing People to Change Addictive Behavior (Guilford Press), MI was initially viewed by its creators as a brief intervention that could be offered as a prelude to formal treatment for alcohol and drug problems. However, as it became apparent that MI could be helpful in a variety of contexts and difficulties, and that it could serve either as an adjunct to other treatments or as a stand-alone therapy, Miller and Rollnick (in 2002) published a second edition of their text, titled Motivational Interviewing: Preparing People for Change. In the decade that followed, research on the moment-to-moment process of MI led to new understandings of how MI works, and in 2013 Miller and Rollnick published their third edition, Motivational Interviewing: Helping People Change, in which they introduced a new "four processes" model to better capture these new understandings.
MI starts from the observation that ambivalence, or being torn between competing alternatives, is normal for people contemplating important life decisions. Moving forward requires that the decisional balance tip in the direction of change: the perceived advantages of change must outweigh the disadvantages and be onsistent with the person's values (resulting in a high level of importance for change), and the person must believe in his or her ability to succeed in changing (resulting in a high level of confidence for change). Unfortunately, people often get stuck in ambivalence. Working in a spirit of acceptance (recognition of the absolute worth of every person, an affirming attitude, support for the person's autonomy, and expression of accurate empathy with the person's inner world), compassion, and partnership, the MI practitioner engages the client into a mutually trusting and respectful relationship; collaboratively develops a focus or shared agenda and direction; evokes the person's own desire, ability, reasons, and need for change in the form of change talk; and helps the person develop a plan for change and commitment to carrying it out. "Resistance" to change is viewed as the natural tendency people have to protect themselves from negative judgments or efforts to control them; in response to discord (tension in the counseling relationship) or sustain talk (the perfectly normal expression of attachment to the status quo), the MI practitioner does not challenge or confront but accepts and rolls with it to defuse it.
Hundreds of controlled studies conducted over the past three decades have demonstrated the efficacy of MI in helping people to change troubling, counter-produtive, or unhealthy behavior, and MI has been adopted in contexts as varied as substance use treatment, mental health counseling, medical and public health settings, and criminal justice services.
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| Motivational Interviewing for Treatment Engagement and Adherence |
MI interventions have traditionally addressed motivation to change problematic behavior without directly focusing on additional factors that might influence whether an individual seeks out and engages in treatment as a way of changing that behavior. These factors include practical barriers (e.g., cost, accessibility, conflicting obligations), symptom barriers (e.g., low energy, social anxiety), negative perceptions of the treatment offered (e.g., too long, too demanding, wrong type), negative past treatment experiences (e.g., treatment didn’t work, felt disrespected), negative attitudes about help-seeking (e.g., threat to privacy or self-sufficiency, guilt about accepting care), negative relationship expectations (e.g., expecting others to act in authoritarian, neglectful, manipulative, or intrusive ways), or negative cultural attitudes about treatment (e.g., stigma, perceptions of providers as culturally ignorant or insensitive).
Starting from the premise that motivation for change and motivation for treatment are related but distinct dimensions of overall motivation, motivational engagement and motivational adherence interventions developed and tested by Dr. Zuckoff and colleagues are designed to address the full range of motivational factors that influence whether an individual enters, adheres to, and benefits from a clinical intervention.
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