Making Sense of Motivational Interviewing: Part 1

APRIL 13, 2016
Bruce A. Berger, PhD, and William A. Villaume, PhD
A 2-Part Series
This article is the first of a 2-part series. This part will (1) briefly describe motivational interviewing (MI), (2) provide an example of how it works, (3) explain our approach to MI, and (4) explain why it is so effective in helping patients engage in health behaviors (eg, taking their medications, losing weight, quitting smoking). Part 2 will describe the clinical and economic effectiveness of MI compared with traditional counseling and information giving methods used by health care professionals (HCPs). The reader is referred to our book, Motivational Interviewing for Health Care Professionals: A Sensible Approach,1 and our 8-hour continuing education accredited MI e-learning program ( for further elaboration on these concepts and their evolution in health care.
The Origins of Motivational Interviewing
MI was originally developed by psychologist William Miller. 2 Miller’s insightful reaction to the typical confrontational approach widely used in the field of addiction counseling in the 1980s was the start of MI.

Here is Miller’s principle in his own words:

Counsel in a way that evokes defensiveness and counter-argument, and people are less likely to change. . . I set out, then, to discover how to counsel in a way that evokes people’s own motivation for change rather than putting them on the defensive. A simple principle that emerged from our earliest discussions was to have the client, not the counselor, voice the reasons for change.2

Miller’s new counseling approach was eventually called MI because the term “interviewing” carries the sense of (1) respecting patients, and (2) inviting patients to talk about their own motivation to change.3

MI was widely adopted in addiction counseling and proved to be very effective in helping patients to change their behavior. Many people thought that it could be effective for other health behavior issues. In fact, subsequent research has shown MI to be effective in helping patients to change a wide range of health behaviors.4

MI was developed specifically for patients who are ambivalent about change (individuals who might say, “I’m not sure I want to quit smoking now”), or resistant to change (individuals who might say, “I am not going to quit smoking. Stop bugging me.”).

Only by valuing and supporting the patient, as a person, does the patient have the freedom and safety to examine his or her behaviors and their consequences on self and others.5
MI does 3 important things: (1) it accurately and nonjudgmentally reflects the concerns and emotions of the patient, (2) it provides insight or new information to address these concerns in a nonjudgmental and nonthreatening manner, and (3) it places ultimate decision making where it belongs…with the patient. This combination of actions is powerful. It creates safety so that the patient can be open to learning new ideas, drawing new conclusions, and, consequently, engaging in new behaviors.