William R. Miller, Ph.D., Stephen Rollnick, Ph.D., and Motivational Interviewing

This is the third in a series of postings on Innovators in Behavioral Health. They are people I have admired from afar for many years. They have changed the lives of millions of others around the world and while they have received many awards and are highly regarded by their peers, they are hardly household names. They should be. Perhaps you or someone you know can benefit from the innovative programs and tools they have created.

"People seem to have an impressive capacity to change themselves if you believe in them, if you tell them they can and give them some help in doing so." — William R. Miller, Ph.D., Emeritus Distinguished Professor of Psychology and Psychiatry, University of New Mexico

William R. Miller, Ph.D.

As Dr. Miller tells it, the story of Motivational Interviewing (MI) is one of serendipity. It began in 1973 when he was in Milwaukee on an internship and "wandered into an alcohol treatment center, knowing absolutely nothing about alcoholism." "Having nothing to offer," he put on "his Carl Rogers hat" and spent the summer listening to the men on the ward. He listened to "their stories of how they had gotten there, where they thought their lives were going and what their hopes and dreams were."

Feeling an "immediate chemistry working with people with alcohol problems," Dr. Miller decided to do his dissertation on problem drinking. After receiving his Ph.D. in clinical psychology from the University of Orgeon, he joined the faculty at the University of New Mexico in 1976. 

Dr. Miller's continued research on alcoholism eventually led him to the conclusion that a person's innate capacity for change was enhanced by counselors who practiced reflective listening and had strong empathic skills. Clients who were in treatment with empathic counselors had significantly better success in stopping drinking than those whose counselors were less empathetic.

In 1991while on sabbatical in Norway, the questions of young psychologists that arose during role play of clinical scenarios "forced" Dr. Miller to verbalize the core principles he used intuitively in practice and prompted him to write down a "conceptual model and some clinical guidelines":

• Client, rather than counselor, should be making arguments for change
• Counselor's role is to 
• Listen reflectively
• Minimize resistance without confrontation (which was the standard in addiction counseling at the time)
• Strengthen the client's motivation for change
• Nurture hope and optimism

Stephen Rollnick, Ph.D.

Fortuitous Meeting with Dr. Stephen Rollnick

Several years later, on a second sabbatical in Australia, Dr. Miller met Stephen Rollnick, Ph.D. who told him MI was being used widely for addiction treatment in the UK and encouraged him to publish more about it. This encounter resulted in their coauthoring the first book on MI.

Their collaboration led to further refinements of MI and Dr. Miller credits Dr. Rollnick with the addition of exploring and resolving a client's ambivalence about change as a key concept.

Dr. Rollnick—who is currently Professor of Health Care Communication, Department of Primary Care & Public Health, School of Medicine, Cardiff University, Wales, UK—has pioneered new applications of MI in healthcare. Like Dr. Miller, he has written a number of books with colleagues on MI and has been published widely in scientific journals. Dr. Rollnick is also one of the cofounders of the MINT (Motivational Interviewing Network of Trainers) and runs workshops in diverse cultures all around the world.

MI is Evidence-Based

Motivational Interviewing is "a collaborative person-centered form of guiding to elicit and strengthen motivation for change." Originally used in substance abuse disorders, MI has be found effective in reducing problem behaviors as well as in promoting healthy behaviors and adherence to treatment in chronic illness. 

MI has been thoroughly evaluated and widely disseminated over the past thirty years:

• More than 200 randomized trials, including 10 multicenter trials, have been conducted
• More than 800 clinical papers have been published
• More than 1200 counselors have been trained in MI and are practicing in 36 languages
• States and nations are adopting MI as part of their strategies for improving the health of their citizens
• The second edition of Miller and Rollnick's book has been published in 16 languages; 10 other books on MI have also been published

Dr. Miller cautions that MI cannot be learned by simply "reading a book, watching a video, or attending a workshop." Counselors undergo intensive training that is centered on both the "spirit of MI" as well as skills and strategies needed to bring that spirit to life. 


How MI Works 

Relationship matters. A person's resolution of ambivalence and movement to change is positively influenced by someone "who is kind to them, who honors them, and offers hope" at a time when they may not have any. Dr. Miller believes there are "two things at work: the spirit of MI and helping clients verbalize and move forward when ready."

With its core principles of empathy, reflective listening, and respect for autonomy, MI crosses cultures very well and requires little adaption. It is brief; specifiable; generalizable to many conditions (addiction, medical, criminal justice); complementary with other therapies, and can be learned by a broad range of providers.

Relevance for Non-Practitioners

If there is a takeaway for those of us who are not counselors or providers, it is in remembering the power of listening and of empathy in our daily interactions and the uselessness of pushing ourselves or others to change before we or they are ready (Changing for Good has excellent advice on this topic).

And for those of us who are recovering fixers, there is a quote by British novelist Terry Pratchett on Dr. Rollnick's website that may apply: "After all, when you seek advice from someone it's certainly not because you want them to give it. You just want them to be there while you talk to yourself."

For greater detail about the spirit and principles of and the research on MI, please explore the following links.


References & Resources

Miller WR. Facilitating Change Across Boundaries, video of lecture presented at Columbia University: http://www.youtube.com/watch?v=6EeCirPyq2w&playnext=1&list=PLF01657B6CF6CE36F

Miller WR, Rollnick. Motivational Interviewing, Second Edition: Preparing People for Change. Available at http://www.amazon.com/Motivational-Interviewing-Second-Preparing-People/dp/1572305630/ref=sr_1_1?s=books&ie=UTF8&qid=1318361565&sr=1-1

Miller WR, Rose GS. Toward a Theory of Motivational Interviewing. Am Psychol 2009;64(6):527-537. Available at http://www.motivationalinterview.org/Documents/nihms146933%20(1).pdf

Dr. Miller's website: http://www.williamrmiller.net/

Rollnick S.  MI: Definition, Principles & Approach. Available at http://www.stephenrollnick.com/

Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. Available at http://www.amazon.com/Motivational-Interviewing-Health-Care-Applications/dp/1593856121/ref=sr_1_2?s=books&ie=UTF8&qid=1318361323&sr=1-2