What is Motivational Interviewing?

Motivational Interviewing is a method of communication to support respectful, curious and person-centred conversations about change. MI brings together relational and technical elements in a skilful way so that the person and helper can navigate through the dilemmas of change together as equals.

The approach was first developed by William Miller (USA) in the 1980s, building on his own doctorate training and practice foundation in the approach of psychologist Carl Rogers. He then began a decades-long collaboration with Stephen Rollnick (UK), whose early career was in behavioural healthcare.

In August 2023 William Miller and Stephen Rollnick published the fourth edition of Motivational Interviewing, titled Motivational Interviewing: Helping People Change and Grow. The fourth edition was rewritten in full to best capture the accumulated learning since MI began.

If you’re familiar with the third edition, you can read about the updates here: What’s New (and Not New) in the 4th Edition of Motivational Interviewing. MI continues to evolve as we learn more from research and practice, and what we understand to be MI now may be further refined in future.

The approach invites helpers to step out of the expert, directive role into one characterized more by listening and guiding. The way of relating is captured by the spirit of MI:
  • Partnership: Work together as equals
  • Acceptance: Honour the person’s worth and autonomy with accurate empathy
  • Compassion: Work in the person’s interest
  • Empowerment: Draw out the person’s own strengths, motivations, and capacity.
The method of MI requires the helper to attend to four overlapping, cumulative tasks of change:
  • Engage: Settle into a comfortable conversation
  • Focus: Find a useful direction
  • Evoke: Draw out the person’s own reasons to change
  • Plan: Support the person to develop their own plan if needed.

MI relies on four core skills, the most fundamental of which is the ability to form meaningful, complex reflections:

  • Open questions
  • Affirming
  • Reflections
  • Summaries

MI accepts reluctance and ambivalence as normal parts of the change process. Rather than try to ‘fix’ or ‘resolve’ ambivalence, the helper supports the person to safely sit with and explore their mixed feelings about change to discover what direction would be meaningful and align with deeper hopes and desires for themselves.

When a change direction has been identified and agreed on, the helper pays careful attention to the person’s sustain talk (against change) and change talk (in favour of change) to support the person to build their own arguments for change.

It takes time and practice to bring all the components together in an increasingly flowing and flexible way, that continually tunes in to where the client is at and what would be most helpful to them at that point in the conversation. However, the individual elements can in themselves be helpful, even if they are not always being combined in a focused conversation that attends to the client’s language about change.

Miller and Rollnick went some way to clarify what MI is, by defining what it isn’t in their 2009 paper, Ten Things MI is Not:

  1. MI is not based on the transtheoretical model (better known as Prochaska and DiClemente’s Stages of Change)
  2. MI is not a way of tricking people into doing what they don’t want to do
  3. MI is not a technique
  4. MI is not a decisional balance
  5. MI does not require assessment feedback
  6. MI is not a form of cognitive-behaviour therapy
  7. MI is not just client-centred counselling
  8. MI is not easy
  9. MI is not what you were already doing
  10. MI is not a panacea.

MI is being increasingly applied to a broad range of presenting issues. If there is a change to be made, and especially if ambivalence is involved, MI may be of value.

When we are learning MI, the eight stages (or tasks) of learning MI identified by Miller and Moyers (2006) can be a helpful guide:

  • Overview: Spirit of MI
  • OARS: Client-centred counselling skills
  • Recognising sustain talk and discord
  • Eliciting and strengthening change talk
  • Rolling with sustain talk and discord
  • Developing a change plan
  • Consolidating commitment
  • Transition and belonging: Integrating MI with other approaches.

 

For those training MI, there is also a body of research investigating what works in training. The Motivational Interviewing Network of Trainers (MINT) [link https://motivationalinterviewing.org/training-expectations] offers some considerations on what MI training might consist of and what to expect if you are interested in attending or commissioning MI training.MINT is committed to high standards of training and those of us who offer professional development in MI aim to:
  • Model the spirit throughout the workshop
  • Be skilled in MI and be able to demonstrate these skills as appropriate
  • Be up to date in content and methodology
  • Use adult learning principles and multiple modes of teaching
  • Offer opportunities for skill development and interaction
  • Be realistic and informed about the potential and limitations of MI
  • Respect participants’ autonomy, existing skills and experience, and the nature of individual work settings.
A range of practical exercises for teaching MI can be found here.For organisations seeking training for their staff in MI, it is important to consider that MI as a fully utilized, skilful approach cannot easily be acquired in a two day workshop, although some core elements may be. The preparation leading up to training and support for ongoing practice and development of the skills are important factors in effective acquisition of MI skills.Implementation Research: A Synthesis of the Literature offers an in-depth overview of the opportunities and challenges of implementation of treatments into practice.

Research into MI and its potential applications is growing at a significant pace. The evidence to date indicates that the approach is of value and can facilitate change. 

However, it can be hard to navigate the research literature, especially when the term “Motivational Interviewing” has been used to describe a wide range of practices, many of which are not MI. Even where the description of MI was accurate, the fact that MI itself has evolved over the past thirty years can make it hard to compare findings across studies.

Further, even where the description of MI is sound, many studies offer no or insufficient fidelity measures to check whether what was delivered was actually MI. Add to this the challenge of determining meaningful outcome measures that could be considered to originate within the client, rather than the research team, and it can be difficult to draw firm conclusions. 

MI is a skill that takes time and practice. Like learning piano, it’s hard to learn just by reading about it. The Resources page offers a range of avenues for further learning.