[Review] Motivational Interviewing

Motivational InterviewingMotivational Interviewing: Preparing People for Change. William R. Miller & Stephen Rollnick, 2002. 428 pages. The Guilford Press. ISBN 1-57230-563-0. 2nd Edition

Why do people change? Or rather, why don’t people change? Change is difficult because it usually involves moving from the known to the unknown. “Better the devil you know…” and all that.

In this work Miller and Rollnick discuss motivation for change. There are at least three elements of change: being ready, being willing, and being able. You can be ready for change but not willing. Take giving up smoking for example. Most smokers I know (including myself) know smoking is bad for you and will agree that quitting would be beneficial. They are willing to change but not yet ready. “I know I need to quit, and I will … one day” (this is me). They may be ready for change but don’t feel able. “I do need to quit but I don’t think I can.” They may not even be willing to change. “Sure cigarettes cause cancer, but so does everything else so I might as well enjoy the short time I have.” Or they may be able to change but not willing. “Of course I could quit if I wanted, but right now I have bigger concerns.”

Miller and Rollnick point out ways in which a person may think about change. There is ambivalence: “I want to change but at the same time I don’t want to change,” and conflict between choices. Three varieties of conflict noted are approach-approach where the person must choose between two attractive choices; avoidance-avoidance where the choice is between two negative choices (think of most elections here and voting for the lesser of two evils); and approach-avoidance where a person is both attracted to and repelled by the same choice. These ways in which people think explain why for many, change is so darn difficult.

Motivational interviewing is a way in which change talk is elicited by the client. Essentially, the client argues on the side of change. The authors define motivational interviewing as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.” Motivational interviewing, or MI, is client-centered and evolved from the work of Carl Rogers. MI differs from Rogers’ work in that it is directive in nature and the direction is for the resolution of ambivalence. Miller and Rollnick stress that MI is not a technique but rather a method of communication. There are no tricks for getting people to do what they don’t want to do.

Motivational Interviewing is divided into four parts: Context, Practice, Learning MI, and Applications of MI. Part One discusses change, why people change, ambivalence, and facilitating change. Part Two is where the real “meat” of the book resides (and where I left a ton of highlighter ink behind). Per Miller and Rollnick there are four general principles to MI: express empathy, develop discrepancy, roll with resistance, and support self-efficacy.

Expressing empathy is a fundamental characteristic of MI and it is here where Rogers’ work is most reflected. Developing discrepancy is where MI branches out from Rogers and encompasses discussing the client’s current behavior and comparing it to their goals and values. The discrepancy is the current state of affairs versus how one wants to be. Rolling with resistance is essentially not getting into a debate with a client about change. Sometimes a counselor advocates for change while the client defends their current position. Rather than moving toward change a client arguing for the status quo simply becomes more entrenched. Self-efficacy is a person’s belief in their ability to succeed in carrying out a specific task.

Throughout Part Two are vignettes of sample dialogue that are quite good at clarifying the author’s point. There are also tables and charts that breakdown lengthier discussions into “sound bytes” useful for review. Part Two ends with a complete chapter of a sample MI session and a chapter on ethical considerations such as when to not use motivational interviewing.

Part Three is quite short, consisting of two chapters, and discusses learning how to effectively use motivational interviewing while Part Four is chock full of research articles pertaining to the use of MI.

I found this book to be an excellent addition to my library and although motivational interviewing was originally designed for substance abuse treatment, the methodology is useful for many other situations. The version I read (and am reviewing here) is the 2nd edition. Recently a 3rd edition was released and can be found here (Amazon.com).

Additionally, while researching motivational interviewing I came across this YouTube video of a presentation from Dr. Miller. Unfortunately the slides he refers to cannot be seen from the camera angle but the presentation is worth viewing.

 

 

I found many ways to use the communication style of motivational interviewing in working with clients and after reading the book, you probably will, too.

Highly Recommended 

Note about ratings:

 Rate  Meaning
 Highly Recommended  Seriously check this out!
 Recommended  I liked it and you might, too.
 Meh  Not bad but not good either
 Yawn  Need something to help you sleep?
 Seriously?  Someone actually wrote this?
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2 replies

  1. One of my favorites.. Love how client centered it is. I use the cost/benefit analysis all the time with the teens I work with. The chapter on ‘change talk’ which I consistently read is great as well.

    • Thank you for your comment! I didn’t realize how client-centered motivational interviewing is until I read the book. Really added to my fondness of the method. 🙂

      The cost/benefit exercise is one my supervisor uses with her group sessions and I have witnessed how effective it is.

      One of these days I’d like to attend a workshop on MI (and CBT and Gestalt). One of these days…

      Thanks again for reading!

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