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
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 hadnt 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 & DiClementes
trans-theoretical model and Banduras 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 doesnt 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 books volume, were
written by different contributing authors. As in the first edition, Carlo Di
Clementes 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 cant 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 childs 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 its 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 doesnt
In sum, the second edition of Miller & Rollnicks 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
Jürgen Klecker, Dipl.-Psych., is a
clinical psychologist trained at the University of Würzburg, Germany and at
Trinity College Dublin, Ireland. Hes 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.