Approaches / Motivation and change
Motivational interviewing (MI)
A collaborative conversation style that explores a person's own reasons for change and their ambivalence about it.
Overview
Motivational interviewing is a way of talking with someone about change that attends to their own reasons and ambivalence. It began in work on alcohol use and is now used in health care, social care and counselling more widely.
Core ideas
In their 2023 account, Miller and Rollnick describe a spirit of partnership, acceptance, compassion and empowerment. Earlier accounts used evocation in the fourth position; evoking remains a task of MI. Practitioners use open questions, affirmations, reflections and summaries, and listen for how a person talks about change.
The approach treats ambivalence as ordinary and avoids arguing for change.
What a session can involve
A conversation might explore what the person wants, what worries them about the present situation, and what they might try. The practitioner reflects back what they hear and asks permission before offering information.
Formats and settings
MI can stand alone as a brief conversation or be combined with other treatments. It is used in clinics, primary care, addiction services, schools and community settings.
How it relates to other approaches
MI grew partly from person-centred counselling and adds a deliberate focus on change talk. It is often paired with cognitive behavioural methods. It is related to, but distinct from, the transtheoretical stages-of-change model.
Limits and open questions
Questions remain about which skills carry the effect, how much training is needed, and how well fidelity is kept in routine practice. Directive use of the method can drift from its intended spirit.
NICE guidance for alcohol-use disorders in England recommends a motivational intervention containing key elements of motivational interviewing as part of initial assessment. This recommendation is specific to its context and should not be assumed to apply to every condition or country.
History
William Miller described the approach in 1983 from his work with people with alcohol problems. Miller and Stephen Rollnick published the first full account in 1991, and later editions have revised its description.
Key people
William Miller and Stephen Rollnick developed MI. James Prochaska and Carlo DiClemente's stages-of-change model influenced its early use.
Sources and inspection notes
Supports: The four elements of MI spirit and the distinction between empowerment and evoking. Chapter 1 excerpt read; the complete book was not checked.
Supports: The authors’ explanation of the change from evocation to empowerment in the description of MI spirit and the continued use of evoking as a task.
Supports: Guidance for England recommends a motivational intervention containing key MI elements in the initial assessment of people who misuse alcohol.