Motivational Interviewing

Also known as: MI

framework · psychology · structured-empirical

Miller and Rollnick's collaborative method for evoking change talk and resolving ambivalence.

Motivational Interviewing was developed by William R. Miller in his work with problem drinkers in the early 1980s and substantially codified in Miller and Stephen Rollnick's Motivational Interviewing: Preparing People to Change Addictive Behavior (1991), with subsequent editions broadening application beyond addiction. MI is a person-centered, directive counseling style for evoking change through resolution of ambivalence — explicitly designed to address resistance and lack of engagement that confronted other counseling approaches. The method's spirit comprises Partnership, Acceptance, Compassion, and Evocation (PACE), and four central processes structure the conversation: Engaging, Focusing, Evoking, and Planning. Specific techniques include Open questions, Affirmations, Reflective listening, and Summarizing (OARS), eliciting and reinforcing change talk while rolling with resistance rather than confronting it. MI has accumulated substantial empirical support across substance use, health behavior, treatment adherence, and criminal justice domains, with effect sizes typically modest but consistent.

Originators

William R. Miller; Stephen Rollnick high

Year / Decade

1980s development; 1991 (first edition); 2002 (second edition); 2013 (third edition) high

Primary sources

Miller, W.R. & Rollnick, S. (1991, multiple editions). Motivational Interviewing: Helping People Change, Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.) high

Core components

Spirit (PACE: Partnership, Acceptance, Compassion, Evocation)
Four processes (Engaging, Focusing, Evoking, Planning)
OARS micro-skills (Open questions, Affirmations, Reflections, Summaries)
Change talk vs sustain talk
DARN-CAT (Desire, Ability, Reasons, Need, Commitment, Activation, Taking steps)
Rolling with resistance
Developing discrepancy
Person-centered foundation (Carl Rogers' influence)

Primary use case

Addiction treatment (origin domain); health behavior change including weight management, smoking cessation, medication adherence; clinical intervention for treatment ambivalence; criminal justice and parole settings; healthcare communication training; integration with CBT and other evidence-based therapies; widespread use in primary care.

Common criticisms

Effect sizes meta-analytically modest and decay over follow-up
direct comparisons with structured CBT show inconsistent advantage
treatment fidelity is critical and often poor in non-research settings, with manualized application losing the spirit
commercialization through MI training and certification industry varies in quality
works less well with severe pathology requiring more directive intervention
less consistent evidence for non-addiction domains than for original substance-use applications
some 'MI' as practiced in the field is difficult to distinguish from generic supportive counseling.

Lineage

Siblings: Cognitive Behavioral Therapy, Transtheoretical Model, Self-Determination Theory