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Motivational interviewing (MI) is a directive, person-centered clinical method for helping clients resolve ambivalence and move ahead with change. It can be applied as a preparation for treatment, a freestanding brief intervention, an enduring clinical style, or a fallback approach when motivational obstacles are encountered. A psycholinguistic theory is emerging to account for the efficacy of MI that has been demonstrated in numerous clinical trials. For cognitive therapists, MI provides an evidence-based alternative to direct disputation of client cognitions.
Keywords: motivational interviewing; confrontation; change; addiction; client-centered; ambivalence
Ever since motivational interviewing (MI) was introduced two decades ago (Miller, 1983), there have been some common themes that characterize this approach. These have been refined over the years with accumulating experience and research (Miller & Rollnick, 1991, 2002; Rollnick & Miller, 1995), and might be summarized in the following four points.
Motivational Interviewing Is Client-Centered
MI owes much to the client-centered approach of Carl Rogers (1959; Truax & Carkhuff, 1967). Many of the therapeutic methods that are applied in MI (e.g., reflective listening or accurate empathy) derive from client-centered therapy, but the parallels extend well beyond technique. Central to MI is a collaborative approach, relying upon clients as the experts regarding themselves. In contrast to deficit models of treatment that imply, "I have what you need," MI works from the assumption that "You have what you need." It draws upon the client's own values, motivations, abilities, and resources. It shares with humanistic psychotherapies (and more recently, positive psychology) the underlying confidence that, given the proper supportive atmosphere, people will naturally change in a positive direction. In this way, MI is firmly grounded within the humanistic "third force" in psychotherapy.
Motivational Interviewing Addresses Ambivalence
Ambivalence is a key obstacle to change, and a central focus of MI. In many situations that call for positive change, people feel two ways about changing: they want to, and they don't. That is, both arguments reside within the person. Most people presenting for treatment still have their reservations ("resistance") about change. Similarly, many people who are coerced into treatment nevertheless have a part of them that can see reasons for change. Being conflicted (ambivalent) is a common point for people to get stuck for long periods of time. MI is...