Motivational interviews: everything you need to know

I was fortunate to be among the first wave of people in the UK to receive training in motivational interviewing from the creators of this counseling approach, Dr Bill Miller and Dr Steve Rollnick. It is difficult to explain now, thirty years later, how exciting it was to be at the beginning of something that was so important in the world of psychotherapy. I change my life.

Regardless, this little article contains everything you really need to know about the mysterious art of motivational interviewing and why it is so important in the world of counseling and psychotherapy.

The motivational interview was originally conceived by Dr. Bill Miller, an American university professor and psychotherapist, in 1983 in a seminal article discussing health behavior change for problem drinkers. His ideas developed and other people collaborated, most notably Dr. Steve Rollnick, until in the late 1980s and early 1990s a new therapeutic discipline called Motivational Interviewing emerged.

IM (as it is known) is important as it is one of only two complete forms of counseling. The other is what is known interchangeably as Humanist Counseling or Rogerian Counseling or, more commonly, Person-Centered Counseling. This style was developed by Carl Rogers in the 1950s as an alternative to medical aid and medication for emotional problems.

Why is MI important?

Before MI appeared, the world of psychological intervention was really dominated by only three forms of help. At one end of the spectrum were physicians, psychiatrists, and medications, and at the other end was “counseling,” and somewhere in between were clinical therapies, such as cognitive behavioral therapy (along with several hundred other variations) that believed that change depended on you. or more assumptions, such as that the change depends on education, or training or knowledge of behavior, etc.

MI changed all that. A central tenant of MI is that we change when we want to and often the counseling, medication, doctors, therapy, counseling don’t really work, because deep down, we just haven’t decided to change! MI seeks to resolve that ambiguity and believes that when we are truly determined to change, we will. It’s as simple as that.

To give the approach some shape, Bill and Steve developed what they call the 4 principles of MS. These are:

• Develop discrepancy

• Roll with Resistance

• Express empathy

• Support for self-efficacy

A little later in development, they added:

• Avoid arguments (which in therapy is always a good idea!)

Along with these guiding principles, they also quite helpfully put together a list of strategies for MS practitioners. These are:

1. Reflective listening (which is actually a huge and very skilled area of ​​MS)

2. Affirmation

3. Open questions

4. Summarize

5. Obtain self-motivated statements (i.e. talk about change)

Aside from these nuts and bolts, there is what is known as the Spirit of MI. This includes everything else that cannot be easily listed or tagged. As Bill said, “IM is largely a way of being with people.”

What draws people to MI is that they have no preconceptions about why or how people should change, or what should or shouldn’t work. Also, it is a very short therapy. It doesn’t last long and tends to “get to the heart of the matter” (as Bill often says). The standard Motivational Enhancement Therapy (the therapeutic version of MI) for people who have alcohol problems is just four sessions and one evaluation. Compared to CBT or most other forms of help that tend to last at least 16 sessions, and sometimes much, much longer, this one is wonderfully short and just as effective.

I hope this article was helpful and that it summarizes the main elements of MI and puts it in some kind of context.

Thank you for reading.