Motivational Interviewing: Preparing People for Change

Motivational Interviewing: Preparing People for Change

Motivational Interviewing: Preparing People for Change

Motivational Interviewing: Preparing People for Change


Since the initial publication of this breakthrough work, Motivational Interviewing (MI) has been used by countless clinicians. Theory and methods have evolved apace, reflecting new knowledge on the process of behavior change, a growing body of outcome research, and the development of new applications within and beyond the addictions field. Extensively rewritten, this revised and expanded second edition now brings MI practitioners and trainees fully up to date. William R. Miller and Stephen Rollnick explain how to work through ambivalence to facilitate change, present detailed guidelines for using their approach, and reflect on the process of learning MI. Chapters contributed by other leading experts then address such special topics as MI and the stages-of-change model, applications in medical, public health, and criminal justice settings, and using the approach with groups, couples, and adolescents.


Interest in the topic of motivation often begins with wondering why people don't change. It is a common frustration for health professionals and teachers, counselors and parents, and those who work in social service and judicial systems. It seems apparent that what a person is doing either isn't working or is self-destructive; you can see a better way, yet the person persists in the same behavior. In a way, it is captured in the words, "You would think …"

You would think that having had a heart attack would be enough to persuade a man to quit smoking, change his diet, exercise more, and take his medication.

You would think that hangovers, damaged relationships, an auto crash, and memory blackouts would be enough to convince a woman to stop drinking.

You would think that it would be apparent to any teenager that getting a good education is important to how one spends and enjoys the rest of one's life.

You would think that time spent in the dehumanizing privations of prison would dissuade people from reoffending.

You would think so, and yet medication compliance problems are the norm, even with life-threatening conditions such as diabetes, heart disease, and HIV infection. It is the hallmark of addictive behaviors that they persist despite what seems overwhelming evidence of their destructiveness. Increasing the severity of punishment seems to offer little deterrence. We are not always sensible creatures.

A more productive and fascinating question, we believe, is why people do change, for change also is the norm. In time, people adjust to new lifestyles. Most people with alcohol, drug, or gambling problems ultimately escape them and go on to lead reasonably normal lives, often without formal treatment. In spite of themselves, teenagers usually grow up. What is it that awakens us and causes a gradual course correction—or even a dramatic turnabout?

Why do people change?

Those who work in the helping professions often are inclined to believe that what causes change is the service provided, be it counseling, treating, advising, or teaching. Our own journey that led to motivational interviewing began with treating alcohol and other drug problems, which is why some of the research and examples we draw on in this book come from the addiction field. Addictive behavior is a wonderful field in which to study the phenomena of change, and research in this area has caused us to question many of our early assumptions about how and why change occurs. Here are some pieces of a puzzle, some of which emerged from research on addictive behaviors.

It is now widely accepted that in many problem areas, positive change often occurs without formal treatment. Most people who quit smoking or recover from alcohol and other drug problems do so without assistance from health professionals, or even from the widely available mutual-help groups. Such treatment-free recovery was once referred to as "spontaneous remission" and was considered to be a relatively rare and anomalous event. Yet the stages and processes by which people change seem to be the same with or without treatment. In this sense, treatment can be thought of as facilitating what is a natural process of change.

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