Allan Zuckoff, PhD

Training & Consultation

Motivational Interviewing
What is Motivational Interviewing?
Motivational interviewing (MI) is a way of talking with people about change that strengthens their own motivation and commitment and empowers them to take constructive action. It is a person-centered, goal-oriented method designed to help people resolve ambivalence by paying special attention to the language of change and the person's own values, goals, and strengths. 
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, MI was initially thought of as a brief intervention that could be offered as a prelude to treatment for alcohol and drug problems. However, as it became apparent that MI could be helpful with other issues and in a variety of contexts, either as an adjunct to other treatments or as a stand-alone approach, 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. And after almost another decade of exploring the ways in which MI can facilitate change in settings as diverse as criminal justice, education, management, and sports, and serve as a foundation for many other ways of helping, in 2023 Miller and Rollnick published their fourth edition, Motivational Interviewing: Helping People Change and Grow.
MI starts from the observation that ambivalence, or being torn between competing options, is normal for people contemplating important life decisions: there are almost always good reasons to keep things the same, right alongside the good reasons to make a change. Moving forward requires that the perceived advantages of change outweigh the disadvantages and that the change is consistent with the person's values (resulting in a high level of importance). It also requires that the person believes in their ability to succeed in changing (resulting in a high level of confidence). 

People get stuck in ambivalence when either importance, confidence, or both are low. When people are stuck in ambivalence, they are often sensitive to anything they perceive as pressure to change -- which typically comes in the form of negative judgment of their behavior or efforts to control their choices. What many practitioners think of as "resistance", MI understands as the perfectly natural tendency of people who feel judged or controlled to defend themselves and their right to self-determination. 

To sidestep the unproductive cycle of pressure and resistance and help people become unstuck, MI practitioners accept sustain talk (expression of attachment to status quo) as a natural part of ambivalence and defuse discord (tension in  the relationship with the practitioner) if it arises. Working in a spirit of acceptance (warmth, empathy, affirmation, and nonjudgment), compassion (benevolence), partnership (egalitarian collaboration), and empowerment (autonomy support), the MI practitioner engages the person into a mutually trusting and respectful relationship and negotiates a focus or shared agenda and direction. Building on the key insight that we learn what we think as we hear ourselves speak, the MI practitioner enhances importance and confidence for change by evoking the person's own desire, ability, reasons, and need for change in the form of change talk and then helps them develop a plan for change and commitment to carrying it out.
With more than 2,000 published studies and application in a wide variety of mental health, substance use, health behavior, and other helping settings, MI is an approach whose brevity, adaptability, and clinical wisdom have made it especially appealing to practitioners around the world.

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.