Motivational Interviewing
Ambivalence is normal and resolving it is the client’s work, so the therapist evokes and strengthens the client’s own arguments for change rather than supplying them — because arguing for change reliably produces arguments against it.
People are persuaded more by what they hear themselves say than by what they are told.
Who built it
William R. Miller
Psychologist, University of New Mexico
Developed MI after observing that therapist empathy predicted drinking outcomes far better than any technique, and that confrontational approaches produced worse outcomes than doing nothing.
MIStephen Rollnick
Psychologist, Cardiff University
Co-developer; brought MI into healthcare and made it usable in brief consultations.
MI
Theory of personality
MI has a deliberately thin theory and a very specific one about a single phenomenon: ambivalence. Wanting and not wanting the same thing is the normal human condition, not a defect, and it is what makes change difficult. People stuck in ambivalence are not in denial and not lacking insight; they are holding two genuine positions.
The psychological reactance problem
When one person argues for change, the ambivalent other reliably takes up the opposing position — and, in doing so, talks themselves further out of changing. Self-perception theory explains the rest: we infer our attitudes from our own speech. A client who spends a session defending their drinking leaves more committed to it than when they arrived.
Theory of psychopathology
MI does not have one. It addresses a state — ambivalence about a specific change — rather than a disorder, which is why it transfers across medication adherence, exercise, substance use, offending behaviour and engagement with therapy itself.
Theory of change
Four processes, in sequence and recursively
- 1Engaging — establishing a working relationship. Without it nothing else is possible.
- 2Focusing — agreeing what change is being discussed. Frequently skipped, and skipping it is why MI conversations wander.
- 3Evoking — eliciting and strengthening the client’s own change talk. The distinctive process.
- 4Planning — moving to a specific plan, only when the client’s language signals readiness.
Change talk and sustain talk
| Type | Mnemonic | Examples |
|---|---|---|
| Preparatory change talk | DARN | Desire ("I want to"), Ability ("I could"), Reasons ("it would help my son"), Need ("I have to") |
| Mobilising change talk | CATs | Commitment ("I will"), Activation ("I am ready to"), Taking steps ("I poured it away") |
| Sustain talk | — | Arguments for the status quo. Normal, expected, and a signal to change what you are doing |
Key concepts
The vocabulary you need to read the literature and to be understood in supervision.
Where it sits in the transtheoretical grid
Which change processes the system leans on, and at what level of content it aims.
- Consciousness raising
Increasing information about oneself and the problem - feedback, interpretation, education, observation.
- Self-reevaluation
Appraising how one thinks and feels about oneself with respect to the problem; values clarification.
- Self-liberation (choosing)
Choosing and committing to act, plus the belief that one can change - the deliberate exercise of agency.
- Helping relationship
Being open and trusting about problems with someone who cares; the relationship as vehicle, and as medicine in its own right.
- Environmental reevaluation
Appraising how the problem affects one’s physical and social environment, including the people in it.
- Symptom & situational problems
- Maladaptive cognitions