WHAT IS MI?

A brief overview of MI

Motivational interviewing is a form of collaborative conversation for strengthening a person's own motivation and commitment to change (Miller & Rollnick, 2013). 

It is a person-centered counseling style for addressing the common problem of ambivalence about change by paying particular attention to the language of change. It is designed to strengthen an individual's motivation for and movement toward a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion. 

William Miller and Stephen Rollnick offer three levels of definitions of MI in their book, Motivational Interviewing: Helping  People Change (3rd edition, 2013).
  1. Layperson’s definition: Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
  2. Practitioner’s definition: Motivational Interviewing is a person-centred counseling style for addressing the common problem of ambivalence about change.
  3. Technical definition: Motivational Interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.
The third edition of this core text offers significant revisions to earlier versions of MI, including the introduction of four processes for communicating about change. It is helpful to keep in mind that MI continues to evolve as we learn more from research and practice, and what we understand to be MI now may be further refined in five years time.

Miller and Rollnick went some way to clarify what MI is, by defining what it isn’t in their 2009 paper, Ten Things MI is Not:
  1. MI is not based on the transtheoretical model (better known as Prochaska and DiClemente’s Stages of Change)
  2. MI is not a way of tricking people into doing what they don’t want to do
  3. MI is not a technique
  4. MI is not a decisional balance
  5. MI does not require assessment feedback
  6. MI is not a form of cognitive-behaviour therapy
  7. MI is not just client-centred counseling
  8. MI is not easy
  9. MI is not what you were already doing
  10. MI is not a panacea.
In a basic sense, MI is the art of bringing together the relational and technical elements of MI together in a skillful way so that both client and clinician can navigate through the dilemmas of change. 

The approach invites clinicians to step out of the expert, directive role into one characterized more by guiding. The way of relating is captured by the spirit:
  • Partnership: Work together as equals
  • Acceptance: Honour their worth and autonomy with accurate empathy and affirmation
  • Compassion: work in the person’s interest
  • Evocation: draw out what already lies within the person.
The method of MI requires the clinician to attend to four overlapping, cumulative processes of change:
  1. Engage: Settle into a comfortable conversation
  2. Focus: Find a useful direction
  3. Evoke: Draw out their own good reasons to change
  4. Plan: Support them to develop their own plan if needed.
Finally, MI relies on four core skills, the most fundamental of which is the ability to form meaningful, complex reflections:
  • Open questions
  • Affirming
  • Reflections
  • Summaries.

It takes time and practice to bring all three components together in an increasingly flowing and flexible way, that continually tunes in to where the client is at and what would be most helpful to them at that point conversation. However, the individual elements can in themselves be helpful, even if they are not always being combined in a focused conversation that attends to the client’s language about change.
A short clip from 'Motivational Interviewing - An M.I. Learning Resource' where members of MINT talk about what Motivational Interviewing is to them. 
Stephen Rollnick explores what might make MI easier to learn, by looking at the implications for "me", "my skills" & "my setting". 
Helen Mentha (MINT) talks about the edge of motivational interviewing and where it intersects with other interventions.
Ken McMaster - Discord is by its very nature, often the starting point for conversations when men are mandated to address issues of abusive behaviour within their relationships.
Mark Wallace-Bell interviews Mike regarding health concerns raised by his doctor.

Clinical application 

MI is being increasingly applied to a broad range of presenting issues. If there is a change to be made, and especially if ambivalence is involved, MI may be of value.

For the clinician learning MI, the eight stages (or tasks) of learning MI identified by Miller and Moyers (2006) can be a helpful guide:
  • Overview: Spirit of MI
  • OARS: Client-centred counseling skills
  • Recognising change talk and resistance (now conceptualized as sustain talk and discord)
  • Eliciting and strengthening change talk
  • Rolling with sustain talk and discord
  • Developing a change plan
  • Consolidating commitment
  • Transition and belonging: Integrating MI with other approaches

Training

For those training MI, there is also a body of research investigating what works in training. MINT offers some considerations on what MI training might consist of and what to expect. Click here for more information

MINT is committed to high standards of training and those of us who offer professional development in MI would be expected to:
  • Model the spirit throughout the workshop
  • Be skilled in MI and be able to demonstrate these skills as appropriate
  • Be up to date in content and methodology
  • Use adult learning principles and multiple modes of teaching
  • Offer opportunities for skill development and interaction
  • Be realistic and informed about the potential and limitations of MI
  • Respect participants’ autonomy, existing skills and experience, and the nature of individual work settings.

A range of practical exercises for teaching MI can be found here.

For organisations seeking training for their staff in MI, it is important to consider that MI as a fully utilized, skillful approach cannot easily be acquired in a two day workshop, although some core elements may be. The preparation leading up to training and support for ongoing practice and development of the skills are important factors in effective acquisition of MI skills.

Implementation research: a synthesis of the literature offers an indepth overview of the opportunities and challenges of implementation of treatments into practice.

Research

Research into MI and its potential applications is growing at a significant pace. The growing body of evidence indicates that the approach is of value and can facilitate change.

However, it can be hard to navigate the research literature, especially when the term “Motivational Interviewing” has been used to describe a wide range of practices, many of which are not MI. Even where the description of MI was accurate, the fact that MI itself has evolved over the past thirty years can make it hard to compare findings across studies.

Further, even where the description of MI is sound, many studies offer no or insufficient fidelity measures that check whether what was delivered was actually MI. Add to this the challenge of determining meaningful outcome measures that could be considered to originate within the client, rather than the research team, and it can be difficult to draw firm conclusions.

Watch William Miller speak on the topic of MI research at the 2012 ICMI conference for a fascinating insight into the complexities of conducting and interpreting research into MI: Spectacular Failures with MI. 
"The bird is powered by its own life and by its motivation."
- A. P. J. Abdul Kalam -