1The worldview
So how does change happen? Say both sides, hear your own reasons, then reach commitment
Motivational interviewing (MI; in Chinese also written 動機式晤談 or 動機性訪談) answers that opening situation, knowing you should change and still not moving, from experience with problem drinkers: it was proposed by the American psychologist William R. Miller in the early 1980s and developed into its present form with Britain's Stephen Rollnick. It is defined as a collaborative, goal-oriented style of communication with particular attention to the language of change: in an atmosphere of acceptance and compassion, it elicits and explores the person's own reasons for change, to strengthen their motivation and commitment to a specific goal.[1,2,3]
Its roots are person-centred: Hettema and colleagues describe it as an evolution of Rogers's person-centred counselling, with the same weight on empathy and acceptance. But it differs from purely non-directive counselling: MI has a direction, and the practitioner notices and responds to talk that leans towards change rather than treating every statement alike. Its starting point is an everyday observation: when people consider changing, they usually have two voices at once, one wanting to and one not. That is ambivalence.[1,7]
Ambivalence is normal, not a defect and not "resistance". Trouble starts when others try to help: seeing someone who ought to change, we instinctively correct, advise and explain the risks. MI calls this the righting reflex. Yet when people are urged, they often defend the "no change" side, and the more they say it aloud, the more they believe it. A 1993 study by Miller and colleagues saw this in two-session interviews with heavy drinkers: the more the therapist confronted, the more the client resisted and the more they drank a year later. MI does the opposite: it doesn't argue, but listens with curiosity and helps the person hear their own side that favours change.[1,5,6]
"Hearing your own reasons" is easy to misread, in three common ways. MI is not a trick for getting people to do what they don't want to do; it is not a set of techniques but a way of talking and a spirit; and it is not built on the stages-of-change model (see the questions below). Miller and Rollnick themselves wrote a list of what MI is not.[4]
Back to the person at the start: what MI sees can be reduced to three steps. A person starts out ambivalent. In a conversation without judgement they voice their own reasons to change ("change talk"), and those words move them. As the talk grows more specific, it goes from "I want" to "I will" (commitment). The researchers' theory is that the more people hear themselves argue for change, the more likely they are to change, and the more they argue against it, the less likely. So the MI practitioner's job is to steer the conversation towards the first, rather than to supply the arguments.
