17 - Motivational interviewing

Summary

Summary Motivational interviewing is a style of patient-centred counselling developed to facilitate change in health-related behaviours. The core principle of the approach is negotiation rather than conflict. In this chapter I review the historical development of motivational interviewing and give some of the theoretical underpinnings of the approach. I summarise the available evidence on its usefulness and discuss practical details of its implementation, using vignettes to illustrate particular techniques.

Motivational interviewing was conceived when Bill Miller, a psychologist from the USA, sat with colleagues from Norway and described what sort of therapeutic approach worked for people with alcohol problems. The process of discovery may have been like the technique itself: a gradual process of listening, reflecting to check understanding, and clarification. Once the form was crystallised it was subjected to a detailed academic analysis. Questions concerning what, how, when, why and for whom have been studied. The approach has been fitted with various theoretical models relating to interpersonal processes and behaviour change. The resultant technique was described in a textbook co-written with Steve Rollnick, a South African psychologist working in Wales (Miller & Rollnick, 1991). International training has meant that the approach has been widely disseminated and evaluated in a variety of settings.

What is motivational interviewing?

Motivational interviewing is a directive, patient-centred counselling style that aims to help patients explore and resolve their ambivalence about behaviour change. It combines elements of style (warmth and empathy) with technique (e.g. focused reflective listening and the development of discrepancy). A core tenet of the technique is that the patient's motivation to change is enhanced if there is a gentle process of negotiation in which the patient, not the practitioner, articulates the benefits and costs involved. A strong principle of this approach is that conflict is unhelpful and that a collaborative relationship between therapist and patient, in which they tackle the problem together, is essential. The four central principles of motivational interviewing are shown in Box 17.1.