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Introduction
It has been 26 years since the first description of motivational interviewing (MI) appeared in this journal. The number of publications on MI has been doubling every 3 years, and there are now MI trainers and translations in at least 38 languages. Within the Motivational Interviewing Network of Trainers (MINT) alone, more than 1,500 people have completed training as MI trainers. If each of them has trained 100 clinicians, and each clinician has practiced MI with 100 people, then at least 15 million people have already been intended recipients of MI as a result of MINT alone.
When a complex method disseminates as widely and rapidly as has happened with MI, it is not surprising that its boundaries become unclear. With the diffusion of any complex innovation (Rogers, 2003) there is a natural process of "reinvention" whereby practitioners adapt the innovation to their own understanding and style. Some such modifications may improve the innovation or render it more accessible for a particular population (Miller, Villanueva, Tonigan and Cuzmar, 2007). It is also possible that reinvention removes some critical elements of the innovation, "active ingredients" in its efficacy. It is therefore important to understand what the essential elements are, and what components can be altered without disrupting the defining nature of a method. Good progress is being made in understanding what makes MI work (Amrhein, Miller, Yahne, Palmer and Fulcher, 2003; Moyers, Miller and Hendrickson, 2005), but clearly there is still a long way to go.
It also sometimes happens that an innovation is altered so fundamentally that it no longer resembles, or is even contradictory to its pristine form. The confrontational, authoritarian and coercive forms of addiction treatment described as "disease model" and "12-step" in the late 20th century were quite at variance with original descriptions of the program of Alcoholics Anonymous (Miller and Kurtz, 1994; White and Miller, 2007). At some point, such a reinvention no longer contains and may even violate the spirit and elements that defined the original approach. This does not necessarily mean that the reinvention is ineffective; merely that it has become something different.
We have sought to define clearly what MI is, and our descriptions have evolved over time (Miller and Rollnick,...