Motivational Interviewing (MI)

What are the essential elements of the theory?

Motivational interviewing (MI) is a collaborative method that presumes behavioural

change is achieved by utilising the basic elements of Rogers’ (1959) person-centred approach –

empathy, unconditional positive regard and congruence – yet is goal directive in identifying

service users’ intrinsic motivation to change, resolving the ambivalence towards change and

moving through the stages of change (Miller & Rollnick, 2002).

Change can become difficult for service users when they are ambivalent about the extent

to which the change will be beneficial. MI presumes service users will commit to change when

they are motivated, or when they see the importance of making a change, have the confidence

and are ready, and have connected the change to something of intrinsic value (Miller & Rollnick,

2002). Service users’ intrinsic value and ambivalence to change comprise the critical working

elements for the social worker. In exploring service users’ intrinsic value and ambivalence,

social workers should adhere to the following four basic principles:

1. express empathy –a genuine interest in service users’ feelings, experiences and

perspectives;

2. develop discrepancy – listening for discrepancies in current behaviour and present values

or future goals;

3. roll with resistance – avoid arguing for change;

4. support self-efficacy – a genuine belief in service users’ abilities to make a change

(Miller & Rollnick, 2002).

Implementing MI into practice requires an understanding of the Stages of Change model

(Prochaska et al.,1992), which consists of five stages:

 1. Precontemplation – individuals do not see that there is a problem and have no intention of

changing;

2. Contemplation – individuals acknowledge a problem, but are not ready to make the

change;

3. Preparation – individuals take the necessary steps to address the problem and make the

change;

4. Action – individuals make the change;

5. Maintenance – individuals have maintained the change for six months.

Social workers are able to determine the appropriate interventions once they have assessed

service users’ stage of change.

Motivational Interviewing suggests the following techniques for assessing service users’

motivation and to change:

• scaling - service users rate on a scale of 0-10 their importance, confidence and readiness

to change;

• open-ended questions - asking “How would you like things to be different?”;

• decisional balance (Janis & Mann, 1977): this involves asking service users to consider

the pros and cons of changing and staying the same (Miller & Rollnick, 2002).

The development of a plan to make a change should include end goals, specific tasks to

reach the goal, suggestions for maintaining the change and relapse prevention strategies (Miller

& Rollnick, 2002).

What are the origins of MI?

 MI was developed by two clinical psychologists, Dr William Miller and Dr Stephen

Rollnick, and was based on theories from social psychology, such as cognitive dissonance and

self-efficacy, Rogers’ person-centred approach, and the Stages of Change model (Britt et al.,

2004; Prochaska et al., 1992; Rogers, 1959). Dr Miller initiated the MI approach after working

with service users having problematic drinking behaviours who were not responding to

interventions that challenged their behaviour and attempted to persuade them to change. Dr

Miller believed that a more effective method should encompass an acknowledgement of the

stages of change and a collaborative, client-centred approach to help service users identify their

intrinsic motivation to change.

For whom is it designed?

MI is designed for use with service users who need or desire to make a behavioural

change in order to overcome problems or difficulties. MI is often used within drug and alcohol

treatment or health care settings with individuals yet can also be used in group settings. MI is

designed to be used with individuals at any stage of the change process.

What are its limitations?

There are several limitations to incorporating MI into practice. Firstly, MI assumes that

service users will be able to make connections between their current behaviour and their values

or future goals, yet not all service users are able to do so. Secondly, MI may be more difficult to

use with mandated service users and those who do not believe they have a problem. Such

individuals may change immediately, yet resort to normal behaviours after the work together has
ended. Finally, some service users may want the social worker to be more directive in providing

guidance than the ethos of MI suggests (Miller & Rollnick, 2002; Teater, 2010).

In what situation/circumstances can it or can it not be used?

MI is designed to be used in situations or circumstances where service users need or

desire to make a change and is often used in settings that address addictive or potentially harmful

behaviours. MI presumes that service users are the experts in their situation and requires that

they have the ability to link their current behaviours to their actions, intrinsic motivation and

desired future goals. Therefore, MI may not be appropriate for use in situations or circumstances

where service users are unable to make these links or where the problem has been identified by

someone other than the service user.

What is the research evidence for it?

The evidence base of MI has pointed to the effectiveness of the approach when working

with alcohol problems, cigarette smoking, other drugs of abuse, psychiatric treatment adherence

in dually diagnosed patients, treatment compliance, water purification, gambling, relationships,

HIV risk behaviours, diet, exercise and other lifestyle changes and eating disorders (Heckman, et

al., 2010; Lundahl, et al., 2010). The use of MI with service users experiencing alcohol problems

or drug addiction has led to good maintenance over time, treatment adherence and retention, is

more effective than no treatment and is effective as either a stand-alone treatment or as a prelude

to other treatments (Hettema et al., 2005).

Where can I read more about it?

Miller, W.R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for
 change (2nd ed.). New York: The Guilford Press.

Rollnick, S., Miller, W.R., & Butler, C.C. (2008). Motivational interviewing in health

care: Helping patients change behavior. New York: The Guilford Press.

References

Britt, E., Hudson, S.M., & Blampied, N.M. (2004). Motivational interviewing in health

settings: A review. Patient Education and Counseling, 53, 147-155.

Heckman, C.J., Egleston, B.L., & Hofmann, M.T. (2010). Efficacy of motivational interviewing

for smoking cessation: A systematic review and meta-analysis. Tobacco Control, 19,

410-416.

Hettema, J., Steele, J., & Miller, W.R. (2005). Motivational Interviewing. Annual Review

of Clinical Psychology, 1, 91-111.

Janis, I.L., & Mann, L. (1977). Decision-making: A psychological analysis of conflict,

choice, and commitment. New York: Free Press.

Lundahl, B.W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B.L. (2010). A meta-analysis of

motivational interviewing: Twenty-five years of empirical studies. Research on Social

Work Practice, 20, 137-160.

Miller, W.R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change

(2nd ed.). New York: The Guildford Press.

Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people

change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.

Rogers, C.R. (1959). A theory of therapy, personality, and interpersonal relationships as

 developed in the client-centered framework. In S. Koch (Ed.), Psychology: The Study of

Science: Vol. 3. Formulations of the Person and the Social Contexts (pp. 184-256). New

York: McGraw-Hill.

Teater, B. (2010). An introduction to applying social work theories and methods. Maidenhead:

Open University Press.