What is motivational interviewing?
Jackie Webb In their book Motivational Interviewing (2023), Miller and Rollnick define Motivational Interviewing as ‘a particular way of talking with people about change and growth to strengthen their own motivation and commitment’.
Motivational interviewing is not a new approach and it first gained an evidence base for working with people with substance use problems. The first essay naming it and describing Dr William Miller’s own observations of using the approach was published in 1983.
William Miller had been influenced by Carl Rogers in his early career and this undoubtedly affected his experience of working in the field of alcohol treatment as a young psychologist. He noticed that the common approaches used by other professionals in this field to try and convince, warn or shame people into making people change their alcohol use were frequently unsuccessful and often seemed to have the opposite effect. A sabbatical in Norway helped William Miller consolidate his observations. A group of psychology students asked searching questions and asked him to demonstrate his approach. This made him see that he was being selective and strategic in his use of listening skills. The empathic, compassionate aspects of Rogerian practice were still present and there was a new element that guided the conversation towards change, using the thoughts and motivation of the service user, which avoided the worker making the arguments for change. In his first essay in 1983, he gave the approach the name ‘motivational interviewing’.
Since that time, an ever-expanding range of professionals and practitioners have wondered if this way of having conversations with people might be helpful in their field of practice.
Understanding that most people are not ‘unmotivated’ but ambivalent about making change can help us think about how we approach conversations with people who often appear to be unmotivated. A shift in the interviewer’s approach often leads to a totally different conversation, where the interviewee, rather than the interviewer, voices the reasons for change and in so doing often starts to feel more inclined to make that change. In other words, they begin to feel more motivated not by the interviewer, but by themselves. In motivationaI interviewing, the service user becomes their own expert on their experiences, not the professional.
Often, when people start learning motivational interviewing, it feels very familiar. People know for themselves that they generally do not like unsolicited advice. The learners recognise the lack of engagement that usually follows when people experience over-questioning and the clarity that often emerges when someone experiences deep listening. Motivational interviewing moves the conversation to building motivation for change, rather than focusing on finding the solutions. Professionals often express the burden they feel at having to come up with all the ideas or answers for their service users and the relief they feel when they realise it is much more helpful to stop doing this.
While the concepts of motivational interviewing are pretty straightforward to understand, learners can find it difficult to put into practice. It often involves unlearning certain ways of helping people that seem hardwired. In learning Motivational Interviewing, we find that it is an approach that is as much about avoiding certain practices as developing new skills, tuning into different aspects of the service user’s conversation that we often pay little attention to.
Motivational interviewing now has over 2000 randomised control trials (Miller and Rollnick, 2023) evidencing its efficacy in a variety of different settings. It is a generalisable approach that seems to lend itself to many different settings and conversations. It seems particularly helpful when the service user or worker has become ‘stuck’. For example, diabetes clinics can use the approach to help patients make lifestyle changes, while professionals working with families can help parents ambivalent about making changes to their parenting. It has been implemented in stop smoking services as well as in helping engage young people in a range of conversations, including returning to education or desisting from carrying a knife. New applications of motivational interviewing seem to be emerging every year as more people find success in rethinking the way they have conversations about change or personal growth.
Learning motivational interviewing is an ongoing process. There is no manual to memorise but a set of principles and skills to apply. Proficiency is achieved through deliberate practice and reflection. People who learn Motivational Interviewing frequently comment that it fundamentally changes how they feel about their work. They often feel less stressed, without the pressure to be the one to have all the answers. The communication skills and principles that underpin the approach also seem useful to support improved conversations in general life. Motivational interviewing works well in combination with other approaches such as cognitive behavioural therapy (CBT), solution-focused brief therapy and trauma-informed approaches.
Interested in expanding your skill set?
Join our Motivational interviewing courses, and learn how a person-centered, collaborative approach can assist people in achieving behavioural or attitudinal change. Combining didactic teaching, live demonstrations, audio, video, and coaching, this training is suitable for professionals working with adults, young people, children, or families.
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CPD certificate 
Motivational interviewing (CPD5a)
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CPD certificate
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CPD certificate
Motivational interviewing: advanced module (CPD5b)