Motivational interviewing

Motivational interviewing refers to a counseling approach initially developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D.. It 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. If the counseling is mandated, they may never have thought of changing the behavior in question. Some may have thought about it but not taken steps to change it. Others, especially those voluntarily seeking counseling, may be actively trying to change their behavior and may have been doing so unsuccessfully for years.

Motivational interviewing is non-judgmental and non-confrontational. The approach attempts to increase clients’ awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternately, therapists help clients envisage 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 is considered to be both client-centered and semi-directive. It 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 non-directively explore themselves. Motivational interviewing is based upon four principles.

1. Express empathy, guides therapists to share with clients their understanding of the clients' perspective.
2. Develop discrepancy, guides therapists to help clients appreciate the value of change by exploring the discrepancy between how clients want their lives to be vs. how they currently are (or between their deeply-held values and their day-to-day behavior).
3. Roll with resistance, guides therapists to accept client reluctance to change as natural rather than pathological.
4. Support self-efficacy, guides therapists to explicitly embrace client autonomy (even when clients choose to not change) and help clients move toward change successfully and with confidence.

Adaptations of motivational interviewing include Motivational Enhancement Therapy, 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 80 randomized clinical control trials across a range of target populations and behaviors, including substance abuse, health-promotion behaviors, medical adherence, and mental health issues.

Training in motivational interviewing methods is available through the Motivational Interviewing Network of Trainers (MINT).

Effectiveness

Teaching practitioners

Studies of the effectiveness of teaching motivational learning

Trial	Patients	Intervention	Comparison	Outcome	Results		Comment
					After	Before
Cucciare 2012	Staff in the United States Veterans Health Administration	"Three sessions—a half-day, in-person workshop, followed by a 60-minute virtual training, followed by a second, half-day, in-person training workshop. Each session was spaced two weeks apart"	Not applicable in this before-after study	Questionnaire asking knowledge, confidence, attitudes, and responses to vignettes			Increases in knowledge, confidence, and written responses to the vignettes
Childers 2012	Medical residents (third year of training)	"Groups of two to four residents met for a half-day session weekly for four weeks with a faculty internist trained in MI." 12 hours	Not applicable in this before-after study	Helpful Responses Questionnaire			Increased residents’ use of core MI communication skills
Bell 2008	Medical students	four 2-h sessions	Not applicable in this before-after study	• Video Assessment of Simulated Encounters-Revised (VASE-R) • Commitment to Change (CTC) statements			Improved knowledge, confidence, and skills
White 2007	Medical students	Unclear number and duration of sessions.	Not applicable in this before-after study	Motivational Interviewing Treatment Integrity scoring tool (MITI)			As compared to professional counselors, "students reached a proficiency level on the rate of reflections, were just below proficiency in assessment of empathy and motivational interviewing spirit and substantially below proficiency in the percent of open ended questions."
Martino 2007	Medical students	Single 2-hour training session of 'brief motivational interviewing' (BMI	Not applicable in this before-after study	Helpful Response Questionnaire			Students increased their knowledge, interest, confidence, and BMI-consistent behaviours

Effect on behavior change in clients

Trials have yielded both positive and negative results.

The efficacy in older studies has been summarized in a meta-analysis.

Applications of Motivational interviewing

Examples of motivational interviewing being applied include:

• MIDAS Trial - Motivational Interventions for Drugs & Alcohol misuse in Schizophrenia, a Randomized controlled trial in Manchester, United Kingdom.[1]
• CapOpus - Cannabis and Psychosis - Randomized clinical trial: Specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis in Copenhagen, Denmark.[2]

• Telephone quitlines for smoking cessation or alcohol abuse.

Sources

• Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People to Change. NY: Guilford Press, 2002.
• Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. 'Motivational Enhancement Therapy Manual. Washington, DC:National Institute on Alcohol Abuse and Alcoholism, Project MATCH Monograph Series, Volume 2.
• Motivational interviewing
• Brief Intervention Techniquesde:Motivierende Gesprächsführung