I was fortunate enough to be amongst the first wave of people in the UK to be trained in Motivational Interviewing by the originators of this counselling approach, Dr Bill Miller and Dr Steve Rollnick. It’s hard to explain now, thirty years on, how exciting it was to be at the very beginning of something which was so important in the world of psychotherapy. It changed my life.
Anyway, this little article contains all you really need to know about the mysterious art of Motivational Interviewing and why it is so important in the world of counselling and psychotherapy.
Motivational Interviewing was originally conceived by Dr Bill Miller, an American university lecturer and psychotherapist, back in 1983 in a seminal article that discussed health behaviour change for problem drinkers. His ideas developed and other people collaborated, most notably, Dr Steve Rollnick, until towards the end of the 1980’s and beginning of the 1990’s when a brand new therapeutic discipline emerged called Motivational Interviewing.
MI (as it is known) is important as it is one of only two complete ways of counselling. The other being what is known interchangeably as either Humanistic Counselling or Rogerian Counselling or, most commonly, Person Centred Counselling. This style was developed by Carl Rogers in the 1950’s as an alternative to medical help and medication for emotional problems.
Why is MI important?
Before MI came along the world of psychological intervention was really dominated by just three forms of help. At one end of the spectrum were doctors, psychiatrists and medication, and at the other end was “counselling” and somewhere in the middle were clinical therapies, like Cognitive Behavioural Therapy (along with several other hundred variations) that believed change was dependent upon one or more assumptions, such as, change is dependent upon education, or behaviour training or insight etc…
MI changed all that. A central tenant of MI is that we change when we want to, and often counselling, medication, doctors, therapy, counselling doesn’t really work, because deep down, we just haven’t really 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 refer to as the 4 principles of MI. These are:
- Develop Discrepancy
- Roll with Resistance
- Express Empathy
- Support Self Efficacy
A bit later in the development they added:
- Avoid Arguments (which in therapy is always a good idea!)
Along with these guiding principles they also, rather helpfully, came up with a list of strategies for MI practitioners. These are:
- Reflective Listening (which is actually a massive and highly skillful area of MI)
- Open Questioning
- Elicit self motivational statements (ie, talking about change)
Apart from these nuts and bolts, there is what has become known as the Spirit of MI. This includes everything else that can’t be easily listed or labelled. As Bill said, “MI is largely just about a way of being with people.”
What attracts people to MI is that it doesn’t have any preconceived ideas about why or how people should change, or what should or shouldn’t work. Also, it’s a very short therapy. It doesn’t last long and tends to “cut to the heart of the matter” (as Bill would often say). The standard Motivational Enhancement Therapy (the therapy version of MI) for people who have problems with alcohol is just four sessions and an assessment. Compared with CBT or most other forms of help that tend to last at least 16 sessions, and sometime much, much more, this is wonderfully brief, and just as effective.
I hope this article has been useful and sums up the main elements of MI and puts it into some kind of context.
Thanks for reading.