Psychotherapy

Review of "Motivational Interviewing: Preparing People For Change"

By William R. Miller and Stephen Rollnick
Guilford Press, 2002
Review by Jürgen Klecker on Jan 31st 2003
Motivational Interviewing: Preparing People For Change

More than ten years have passed since Miller and Rollnick introduced the concept of Motivational Interviewing (MI) as an effective counselling style for addicts. Since then, MI has steadily gained support among counsellors, has spread to new patient groups and new treatment settings, and its effectiveness has been tested empirically. The new edition of Motivational Interviewing contains all you need to know about these new developments while still giving an accessible, easily readable introduction to the theory and practice of MI.

To understand what the introduction of MI meant, it helps to remember what traditional addiction treatment was like. Many people -- both laypeople and professionals -- held the view that as long as an addict hadn‘t hit the gutter, he/she would never change. Many professionals saw their main task as trying to break their patients’ resistance. Only when the patient stopped resisting and accepted the diagnosis could therapy even begin. Some counsellors would altogether refuse to work with addicts because they were seen as “difficult and unthankful patients” or as unwilling to change.

In their original work, Miller and Rollnick suggested that it was probably not the patients who were to blame for such difficult processes but more likely the unsuitable therapeutic style. As an alternative, they introduced Motivational Interviewing, a non-confrontational but still directive style of interaction on the basis of Prochaska & DiClemente’s trans-theoretical model and Bandura’s self-efficacy concept, among others.

While the first edition had largely defined MI by contrasting it with other therapeutic styles, the second edition takes a slightly different approach by trying to define MI without resorting to what it is not. There is now more conceptual clarity than in the first book. But the general principles of MI practice remain the same: 1) express empathy, 2) develop discrepancy, 3) roll with resistance and 4) support self-efficacy.

The book doesn’t only elaborate on what these principles mean, it also gives numerous illustrations of how they can be applied in the form of client-interviewer dialogue. In addition, the authors point out what traps to avoid (e.g. “righting reflex,” “expert trap”). For most clinicians, parts II (Practice) and III (Learning Motivational Interviewing) will probably be the most valuable parts of the book. 

The remainder of the book deals with conceptual issues and empirical evidence. These chapters, making up almost half of the book’s volume, were written by different contributing authors. As in the first edition, Carlo Di Clemente’s chapter on how to use MI in different stages of change is probably the most readable. However, some of the other chapters are less convincing, and sometimes the collection of issues they deal with seem a bit fragmented. Occasionally the reader can’t help wondering if different authors mean the same thing when they talk about MI in its various applications or adaptations. It seems that MI has branched out so much that one can lose sight of the genuine article. This possible conceptual confusion is dealt with in a separate chapter by Rollnick and coworkers.

There are two chapters that deal with the empirical support for MI and its adaptions in which contributing authors, rather than Miller and Rollnick, review the studies. This works well. After all, sometimes others are better suited than parents to describe a child’s strengths and weaknesses. The current status of empirical research on MI, gleaned from the chapters by Burke, Arkowitz & Dunn and by Zweben & Zuckoff, is that MI works well but no one knows exactly how it works. While it’s plausible to assume that MI is better suited than other approaches to ensure treatment adherence, this has not really been convincingly demonstrated.

The chapters dealing with MI with couples (Burke et al.) and especially the closing chapter about MI in group settings, show the limitations of MI. These chapters should be a consolation for those who, after practising MI with individual patients, found themselves wondering why the therapy group doesn’t work.

In sum, the second edition of Miller & Rollnick’s Motivational Interviewing should be valuable for everyone who works with sceptical, ambivalent clients. It should be especially valuable for those working in the addiction field. Readers who already own the first edition might still want to get the new book because, though the chapters about practicing MI are rather similar to those in the old edition, the conceptual issues and possible adaptations of MI are now dealt with in more depth.

Finally, some of the chapters might even be of interest to general readers who wonder why people sometimes change -- and why they more often don’t.

 

© 2003 Jürgen Klecker

                               

Jürgen Klecker, Dipl.-Psych., is a clinical psychologist trained at the University of Würzburg, Germany and at Trinity College Dublin, Ireland. He’s worked as a teaching assistant in clinical psychology and held several seminars on applied cognitive behavior therapy. He now works as a drug therapist in a privately owned clinic.

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