http://en.wikipedia.

org/wiki/Motivational_interviewing
From Wikipedia, the free encyclopedia

Motivational interviewing (MI) refers to a counseling approach in part developed by clinical

psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. The
concept of motivational interviewing evolved from experience in the treatment of problem
drinkers, and was first described by Miller (1983) in an article published in Behavioural
Psychotherapy. These fundamental concepts and approaches were later elaborated by Miller
and Rollnick (1991) in a more detailed description of clinical procedures. Motivational
Interviewing is a method that works on facilitating and engaging intrinsic motivation within
the client in order to change behavior.[2] MI is a goal-oriented, client-centered counseling
style for eliciting behavior change by helping clients to explore and resolve ambivalence.
Compared with non-directive counseling, it's more focused and goal-directed. 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.[1] The examination and resolution of ambivalence is a central purpose, and the
counselor is intentionally directive in pursuing this goal.[2]

MI 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.[3] During
counseling, some patients may have thought about it but not taken steps to change it while
some may be actively trying to change their behavior and may have been doing so
unsuccessfully for years. In order for a therapist to be successful at motivational interviewing,
four basic interaction skills should first be established.[4] These skills include: the ability to
ask open ended questions, the ability to provide affirmations, the capacity for reflective
listening, and the ability to periodically provide summary statements to the client.[5] These
skills are used strategically, while focusing on a variety of topics like looking back, a typical
day, the importance of change, looking forward, confidence about change, and so on.

Motivational interviewing is non-judgmental, non-confrontational and non-adversarial.[6] The

approach attempts to increase the client's awareness of the potential problems caused,
consequences experienced, and risks faced as a result of the behavior in question. Alternately,
therapists help clients envision a better future, and become increasingly motivated to achieve
it.[7] Either way, the strategy seeks to help clients think differently about their behavior and
ultimately to consider what might be gained through change.[8] Motivational interviewing
focuses on the present, and entails working with a client to access motivation to change a
particular behavior, that is not consistent with a client's personal value or goal.[9] Warmth,
genuine empathy, and acceptance are necessary to foster therapeutic gain (Rogers, 1961)
within motivational interviewing. Another central concept is that ambivalence about
decisions is resolved by conscious or unconscious weighing of pros and cons of change vs.
not changing (Ajzen, 1980).

The main goals of motivational interviewing are to engage clients, elicit change talk, and
evoke motivation to make positive changes from the client. For example, change talk can be
elicited by asking the client questions, such as "How might you like things to be different?"
or "How does ______ interfere with things that you would like to do?" Change may occur
quickly or may take considerable time, and the pace of change will vary from client to client.
Knowledge alone is usually not sufficient to motivate change within a client, and challenges
in maintaining change should be thought of as the rule, not the exception. Ultimately,
practitioners must recognize that motivational interviewing involves collaboration not
confrontation, evocation not education, autonomy rather than authority, and exploration
instead of explanation. Effective processes for positive change focus on goals that are small,
important to the client, specific, realistic, and oriented in the present and/or future.[10]

While there are as many variations in technique as there are clinical encounters, the spirit of
the method, however, is more enduring and can be characterized in a few key points:[6]

1. Motivation to change is elicited from the client, and is not imposed from outside
forces
2. It is the client's task, not the counselor's, to articulate and resolve his or her
ambivalence
3. Direct persuasion is not an effective method for resolving ambivalence
4. The counseling style is generally quiet and elicits information from the client
5. The counselor is directive, in that they help the client to examine and resolve
ambivalence
6. Readiness to change is not a trait of the client, but a fluctuating result of interpersonal
interaction
7. The therapeutic relationship resembles a partnership or companionship

Contents
 1 Four general processes
 2 Adaptations of motivational interviewing
o 2.1 Motivational enhancement therapy [11]
o 2.2 MI Groups [14]
 3 Limitations of motivational interviewing
 4 Applications of Motivational interviewing
 5 References
 6 Sources
 7 External links

Four general processes

MI uses four general processes to achieve its ends:

1. Engaging - used to involve the client in talking about issues, concerns and hopes, and
to establish a trusting relationship with a counselor.
2. Focusing - used to narrow the conversation to habits or patterns that clients want to
change.
3. Evoking - used to elicit client motivation for change by increasing clients' sense of the
importance of change, their confidence about change, and their readiness to change.
4. Planning - used to develop the practical steps clients want to use to implement the
changes they desire.

Adaptations of motivational interviewing

Motivational enhancement therapy [11]
Motivational Enhancement Therapy is 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.[12]

Motivational interviewing is supported by over 200 randomized clinical control trials [13]
across a range of target populations and behaviors including substance abuse, health-
promotion behaviors, medical adherence, and mental health issues.

MI Groups [14]

MI groups are highly interactive, focused on positive change, and harness group processes for
evoking and supporting positive change. They are delivered in four phases:

1. Engaging the group

2. Evoking member perspectives
3. Broadening perspectives and building momentum for change
4. Moving into action

Limitations of motivational interviewing

Many studies using MI have specific inclusion/exclusion criteria. For example, Project
MATCH excluded those who were homeless and involved in the criminal justice system. A
randomized trial in drug abuse services conducted by Miller and Rollnick (2002) provided
motivational interviewing sessions to patients in order to elicit behavior change by exploring
and resolving ambivalence. They enrolled 152 outpatient and 56 inpatient clients who were
entering a public agency for drug problems. The researchers excluded clients who reported
insufficient residential stability.

A critic of these studies argues that to represent real world clinical activities, such studies
must include every client entering the facility under study (within the parameters of informed
consent) (Patterson, 2008 & 2009).

Applications of Motivational interviewing

Examples of fields in which motivational interviewing is being applied include:

 Brief intervention for behaviour change

 Substance dependence
 Health Coaching
 Mental disorder
 Problem gambling
 Dual Diagnosis
 Classroom Management
 Parenting

References
 1.

 "Dr. William Miller, "Motivational Interviewing: Facilitating Change Across

Boundaries"".
  Shannon, S; Smith VJ; Gregory JW (2003). "A pilot study of motivational interviewing
in adolescents with diabetes. Arch Dis Child" 88. pp. 680–683.
  Handmaker, NS; Miller WR; Manicke M (2001). "Pilot study of motivational
interviewing" 86. pp. 680–683.
  "Motivational Interviewing".
  "Motivational Interviewing: An evidence-based approach to counseling helps patients
follow treatment recommendations". AJN, American Journal of Nursing. October 2007.
  Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. (1992) Motivational
Enhancement Therapy Manual. Washington, DC:National Institute on Alcohol Abuse and
Alcoholism
  Brodie, D.A.; Inoue, A.; Shaw, D. G. (2008). "Motivational interviewing to change
quality of life for people with chronic heart failure: A randomised controlled trial".
International Journal of Nursing Studies 45 (4): 489–500.
doi:10.1016/j.ijnurstu.2006.11.009. PMID 17258218.
  Cummings, S.M.; Cooper, R.L.; Cassie, K.M (2009). "Motivational interviewing to
affect behavioral change in older adults". Research on Social Work Practice 19 (2): 195–204.
doi:10.1177/1049731508320216.
  Hanson, M; Gutheil, I. A. (2004). "Motivational strategies" 49.
  Freedman, J; Combs, G. (1996). "Narrative Therapy: The Social Construction of
Preferred Realities". New York:Norton.
  Miller, W.R.; J. J. Onken, L. S., & Carroll, K. M. (Eds.) (2000). "Motivational
Enhancement Therapy: Description of Counseling Approach". National Institute on Drug
Abuse: 89–93.
  Miller, W.R.; Rollnick, S. (2002). "Motivational Interviewing: Preparing People to
Change'". Guilford press.
  Miller, W.R.; Zweben, A.; DiClemente, C.C.; Rychtarik, R.G. (1994). "Motivational
Enhancement Therapy Manual". Washington, DC:National Institute on Alcohol Abuse and
Alcoholism.

14.  Wagner, C.C., Ingersoll, K.S., and contributors (2013). Motivational interviewing
in groups. New York: Guilford Press, Inc.

Sources
 Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social
behavior. Englewood Cliffs, NJ: Prentice-Hall. ISBN 978-0139364358.
 Brennan, T. (1982) Commitment to Counseling: Effects of Motivational Interviewing
and Contractual Agreements on Help-seeking Attitudes and Behavior. Doctoral
Thesis:University.of Nebraska.
 Herman, K.C., Reinke, W.M., Frey, A.J., & Shepard, S.A.(2013). Motivational
interviewing in schools: Strategies for engaging parents, teachers, and students. New
York: Springer. ISBN 978-0826130723
 Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people for
change. New York: Guilford Press.
  Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People to Change,
2nd ed. NY: Guilford Press, 2002. ISBN 978-1572305632.
 Miller, W.R., & Rollnick, S. Motivational Interviewing, 3rd ed. Guilford Press, 2012.
ISBN 978-1-60918-227-4.
 Rollnick, S., Heather, N., & Bell, A. (1992). Negotiating behaviour change in medical
settings: The development of brief motivational interviewing. Journal of Mental
Health, 1, 25-37.
 Patterson, D. A. (2008). Motivational interviewing: Does it increase retention in
outpatient treatment? Substance Abuse, 29(1), 17-23.
 Patterson, D. A. (2009). Retaining Addicted & HIV-Infected Clients in Treatment
Services. Saarbrücken, Germany: VDM Publishing House Ltd. ISBN 978-
3639076714.
 Prochaska, J. O. (1983). "Self changers vs. therapy changers vs.Schachter." American
Psychologist 38: 853-854.
 Reinke, W. M., Herman, K. C., & Sprick, R. (2011). Motivational interviewing for
classroom management: The Classroom Check-Up. New York: Guilford Press. ISBN
978-1609182588.
 Rogers, Carl (1961). On becoming a person: A therapist's view of psychotherapy.
London: Constable. ISBN 1-84529-057-7.
 Rollnick, S., Miller, W.R., & Butler, C.C. "Motivational Interviewing in Health Care:
Helping Patients Change Behavior". NY: Guilford Press, 2007. ISBN 978-1-59385-
613-7.
 Wagner, C.C., Ingersoll, K.S., & contributors (2013). Motivational Interviewing in
Groups. New York: Guilford Press.

External links
 Motivational Interviewing Glossary and Fact Sheet Kathleen Sciacca
 "Dual Diagnosis Treatment and Motivational Interviewing for Co-occurring
Disorders" in National Council Magazine 2007
 NIAAA web site: Project MATCH, MET treatment manual
 Steve Rollnick official website
 Motivational Interviewing Network of Trainers (MINT) website