Motivational Interviewing (MI) is a non-confrontational, client-centred approach to enhancing motivation for change.
MI was originally used with clients with alcohol and other substance use problems. Research supports efficacy of MI in the supporting clients to make other lifestyle changes (e.g., increasing physical activity, dietary change), treating diabetes. There is also a growing evidence base to suggest that MI is useful as an adjunctive treatment to enhance treatment outcomes for patients with mental health problems (e.g., anxiety disorders, eating disorders) and concurrent mental health and substance use problems.
Three definitions of MI
A layperson's definition
MI is a collaborative conversation style for strengthening a person's own motivation for and commitment to change.
A practitioner's definition
MI is a person-centred counselling method for addressing the common problem of ambivalence about change.
A technical definition
MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion.Source: Adapted from Miller & Rollnick (2013), p. 29.
A glossary of terms used in motivational interviewing is available on the Motivational Interviewing Network of Trainers (MINT) website.
Spirit of MI
MI is as much a "way of being with people" as a set of skills. The spirit guides the way the skills are used
The four critical MI elements:
- partnership: active collaboration (client does most of the talking)
- acceptance (honour absolute worth and potential; recognize and support autonomy; understand client's perspective; affirm strengths and effort)
- compassion: commitment to best interests of client (rephrase?)
- evocation: motivation for change is within the client—MI is about evoking what is already present, not installing what is missing.
MI-consistent and MI-inconsistent behaviours relating to MI Spirit : Reprinted from Fundamental of Addiction
Behaviours consistent with MI
Behaviours inconsistent with MI
Emphasizes and respects clients autonomy
Actively collaborates with client
Elicits client's perspectives, ideas, hopes, concerns
Demonstrates non-judgmental acceptance and conveys empathy through words, body language and tone of voice
Asserts authority about what is best for this client, pursues won agenda in the session
Mandates specific goals (e.g., abstinence)
Provides unsolicited advice, feedback or information without client's permission
Confronts or threatens client with negative consequences if change does not occur
William Miller acknowledges that he developed MI based on decision rules he had been using intuitively in clinical practice. He described MI as "a clinical method, and later a growing bodly of empirical findings, in need of theoretical explanation."(Ten Things that Motivational Interviewing Is Not)
A cohesive theory base for MI has started to take shape. Influences on the development of motivational interviewing include:
- Self-determination theory, which posits that autonomy support, autonomous motivation and perceived competence predict health and behavioural outcomes, appears especially congenial to the spirit and strategies of MI (Vansteenkiste & Sheldon, 2006; Williams et al., 2006).
- Cognitive dissonance theory (e.g., the gap between current behaviours and future goals) is relevant to some aspects of MI, especially the clinical skill of developing discrepancy (Draycott & Dabbs, 1998; Lundahl & Burke, 2009).
- Self-perception theory, which posits that hearing oneself argue for change affects motivation, relates to MI's focus on eliciting client change talk (the elements in clients' speech that favour change) (Lundahl & Burke, 2009).
How MI affects change
Two specific types of components seem to work together to effect change:
- relational (or empathic, interpersonal) components
- the technical components that elicit and reinforce clients' own reasons for behaviour change. Miller and Rose (2009)
An emerging causal chain model for MI links together therapist training, MI skills, client responses and treatment outcomes (Miller & Rose, 2009).
These various theoretical strands are still being debated and discussed. Further iterations of MI will no doubt be grounded in more robust models and frameworks.
The four processes of MI
The processes of MI are both sequential and recursive. The components follow a logical sequence, with each one building on the one that precedes it. However, practitioners may return to earlier processes throughout the helping relationship.
Without engagement it is not possible to proceed—the client makes a decision about whether to join with the practitioner and actively participate in treatment
With the client as equal partner, "this strategic centring" process hones in on the possible targets or directions for change. Refocusing may be needed as goals evolve or change over time.
The practitioner's task is to evoke from the client his or her ambivalence about changing, reasons for change and strategies for change. In this stage the skills of MI become strategic in guiding the client in the direction of change by paying special attention to evoking change talk.
The process of planning can occur when—and only when—the client is ready to make a commitment to change.
View video clip: Four processes in MI