Motivational interviewing

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Motivational interviewing refers to a counseling approach initially developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D..[1] It recognizes and accepts the fact that clients who need to make changes in their lives approach counseling at different levels of readiness to change their behavior. If the counseling is mandated, they may never have thought of changing the behavior in question. Some may have thought about it but not taken steps to change it. Others, especially those voluntarily seeking counseling, may be actively trying to change their behavior and may have been doing so unsuccessfully for years.

Motivational interviewing is non-judgmental and non-confrontational. The approach attempts to increase clients’ awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternately, therapists help clients envisage a better future, and become increasingly motivated to achieve it. Either way, the strategy seeks to help clients think differently about their behavior and ultimately to consider what might be gained through change.

Motivational interviewing is considered to be both client-centered and semi-directive. It departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than non-directively explore themselves. Motivational interviewing is based upon four principles.

  1. Express empathy, guides therapists to share with clients their understanding of the clients' perspective.
  2. Develop discrepancy, guides therapists to help clients appreciate the value of change by exploring the discrepancy between how clients want their lives to be vs. how they currently are (or between their deeply-held values and their day-to-day behavior).
  3. Roll with resistance, guides therapists to accept client reluctance to change as natural rather than pathological.
  4. Support self-efficacy, guides therapists to explicitly embrace client autonomy (even when clients choose to not change) and help clients move toward change successfully and with confidence.

Adaptations of motivational interviewing include Motivational Enhancement Therapy, a time-limited four-session adaptation used in Project MATCH, a US-government-funded study of treatment for alcohol problems and the Drinkers' Check-up, which provides normative-based feedback and explores client motivation to change in light of the feedback. Motivational interviewing is supported by over 80 randomized clinical control trials across a range of target populations and behaviors, including substance abuse, health-promotion behaviors, medical adherence, and mental health issues.

Training in motivational interviewing methods is available through the Motivational Interviewing Network of Trainers (MINT).

Effectiveness

The research available is not well done, but the strongest results come form the studies that are well done[2].

Teaching practitioners

Studies of the effectiveness of teaching motivational learning[3][4][5][6][7]
Trial Patients Intervention Comparison Outcome Results Comment
After Before
Cucciare[3]
2012		 Staff in the United States Veterans Health Administration "Three sessions—a half-day, in-person workshop, followed by a 60-minute virtual training, followed by a second, half-day, in-person training workshop. Each session was spaced two weeks apart" Not applicable in this before-after study Questionnaire asking knowledge, confidence, attitudes, and responses to vignettes     Increases in knowledge, confidence, and written

responses to the vignettes

Childers[4]
2012		 Medical residents (third year of training) "Groups of two to four residents met for a half-day session weekly for four weeks with a faculty internist trained in MI." 12 hours Not applicable in this before-after study Helpful Responses Questionnaire[8]     Increased residents’ use of core MI communication skills
Bell[5]
2008		 Medical students four 2-h sessions Not applicable in this before-after study • Video Assessment of Simulated Encounters-Revised (VASE-R)
• Commitment to Change (CTC) statements[9]		     Improved knowledge, confidence, and skills
White[6]
2007		 Medical students Unclear number and duration of sessions. Not applicable in this before-after study Motivational Interviewing Treatment Integrity scoring tool (MITI)[10]     As compared to professional counselors, "students reached a proficiency level on the rate of reflections, were just below proficiency in assessment of empathy and motivational interviewing spirit and substantially below proficiency in the percent of open ended questions."
Martino[7]
2007		 Medical students Single 2-hour training session of 'brief motivational interviewing' (BMI Not applicable in this before-after study Helpful Response Questionnaire[8]     Students increased their knowledge, interest, confidence, and BMI-consistent behaviours
               

Effect on behavior change in clients

Trials have yielded both positive[11][12][13] and negative[14][15] results.

The efficacy in older studies has been summarized in a meta-analysis.[16]

Applications of Motivational interviewing

Examples of motivational interviewing being applied include:

  • Telephone quitlines for smoking cessation or alcohol abuse.

Sources

  1. ↑ Rollnick S, Butler CC, Kinnersley P, Gregory J, Mash B (2010). "Motivational interviewing". BMJ. 340: c1900. doi:10.1136/bmj.c1900. PMID 20423957.
  2. ↑ Copeland L, McNamara R, Kelson M, Simpson S (2015). "Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review". Patient Educ Couns. 98 (4): 401–11. doi:10.1016/j.pec.2014.11.022. PMID 25535015.
  3. ↑ 3.0 3.1 Cucciare MA, Ketroser N, Wilbourne P, Midboe AM, Cronkite R, Berg-Smith SM; et al. (2012). "Teaching motivational interviewing to primary care staff in the Veterans Health Administration". J Gen Intern Med. 27 (8): 953–61. doi:10.1007/s11606-012-2016-6. PMC 3403134. PMID 22370769.
  4. ↑ 4.0 4.1 Childers JW, Bost JE, Kraemer KL, Cluss PA, Spagnoletti CL, Gonzaga AM; et al. (2012). "Giving residents tools to talk about behavior change: a motivational interviewing curriculum description and evaluation". Patient Educ Couns. 89 (2): 281–7. doi:10.1016/j.pec.2012.08.001. PMID 22910139.
  5. ↑ 5.0 5.1 Bell K, Cole BA (2008). "Improving medical students' success in promoting health behavior change: a curriculum evaluation". J Gen Intern Med. 23 (9): 1503–6. doi:10.1007/s11606-008-0678-x. PMC 2518029. PMID 18592322.
  6. ↑ 6.0 6.1 White LL, Gazewood JD, Mounsey AL (2007). "Teaching students behavior change skills: description and assessment of a new Motivational interviewing curriculum". Med Teach. 29 (4): e67–71. doi:10.1080/01421590601032443. PMID 17786734.
  7. ↑ 7.0 7.1 Martino S, Haeseler F, Belitsky R, Pantalon M, Fortin AH (2007). "Teaching brief motivational interviewing to Year three medical students". Med Educ. 41 (2): 160–7. doi:10.1111/j.1365-2929.2006.02673.x. PMID 17269949.
  8. ↑ 8.0 8.1 Miller WR, Hedrick KE, Orlofsky DR (1991). "The Helpful Responses Questionnaire: a procedure for measuring therapeutic empathy". J Clin Psychol. 47 (3): 444–8. PMID 2066417.
  9. ↑ Green ML, Gross CP, Kernan WN, Wong JG, Holmboe ES (2003). "Integrating teaching skills and clinical content in a faculty development workshop". J Gen Intern Med. 18 (6): 468–74. PMC 1494873. PMID 12823654.
  10. ↑ Moyers TB, Martin T, Manuel JK, Hendrickson SM, Miller WR (2005). "Assessing competence in the use of motivational interviewing". J Subst Abuse Treat. 28 (1): 19–26. doi:10.1016/j.jsat.2004.11.001. PMID 15723728.
  11. ↑ Ogedegbe G, Chaplin W, Schoenthaler A, Statman D, Berger D, Richardson T; et al. (2008). "A practice-based trial of motivational interviewing and adherence in hypertensive African Americans". Am J Hypertens. 21 (10): 1137–43. doi:10.1038/ajh.2008.240. PMID 18654123.
  12. ↑ Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR (2011). "Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials". Obes Rev. 12 (9): 709–23. doi:10.1111/j.1467-789X.2011.00892.x. PMID 21692966.
  13. ↑ Lai DT, Cahill K, Qin Y, Tang JL (2010). "Motivational interviewing for smoking cessation". Cochrane Database Syst Rev (1): CD006936. doi:10.1002/14651858.CD006936.pub2. PMID 20091612.
  14. ↑ Rosenbek Minet LK, Wagner L, Lønvig EM, Hjelmborg J, Henriksen JE (2011). "The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial". Diabetologia. 54 (7): 1620–9. doi:10.1007/s00125-011-2120-x. PMID 21455729.
  15. ↑ Solomon DH, Iversen MD, Avorn J, Gleeson T, Brookhart MA, Patrick AR; et al. (2012). "Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial". Arch Intern Med. 172 (6): 477–83. doi:10.1001/archinternmed.2011.1977. PMID 22371876.
  16. ↑ Burke BL, Arkowitz H, Menchola M (2003). "The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials". J Consult Clin Psychol. 71 (5): 843–61. doi:10.1037/0022-006X.71.5.843. PMID 14516234. Review in: Evid Based Ment Health. 2004 May;7(2):52
  • Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People to Change. NY: Guilford Press, 2002.
  • Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. 'Motivational Enhancement Therapy Manual. Washington, DC:National Institute on Alcohol Abuse and Alcoholism, Project MATCH Monograph Series, Volume 2.
  • Motivational interviewing
  • Brief Intervention Techniques

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