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Social work theory · Volume H: Integrative & Practice-Oriented

Motivational interviewing

Motivational interviewing (MI) is a collaborative, goal-oriented style of communication designed to strengthen a person's own motivation and commitment to change.

1. What it is

Motivational interviewing (MI) is a collaborative, goal-oriented style of communication designed to strengthen a person’s own motivation and commitment to change. It was developed by William Miller and Stephen Rollnick, initially for work with people who use alcohol and other drugs (AOD). The approach assumes that ambivalence, wanting and not wanting to change at the same time, is a normal part of change. MI helps people explore and resolve that ambivalence by drawing out their own reasons for change, without arguing, persuading or confronting (Miller & Rollnick, 2023). It is now used across health, mental health, justice, child and family services and social work.

The spirit of MI. Miller and Rollnick (2013) describe MI as a way of being with people, expressed through its underlying spirit. In the third edition, the spirit comprised partnership, acceptance, compassion and evocation. In the fourth edition, evocation was replaced by empowerment, which emphasises helping people recognise and use their own strengths and capacity for change (Miller & Rollnick, 2023). Partnership means working with the person as an expert on their own life. Acceptance includes respect for the person’s absolute worth, accurate empathy, support for their autonomy, and affirmation of their strengths. Compassion means actively promoting the other person’s welfare. Without this spirit, the techniques of MI can become manipulative.

OARS. The core communication skills are summarised as OARS: open questions, affirmations, reflective listening and summaries. Open questions invite people to explore their experience. Affirmations recognise strengths and efforts. Reflective listening, which Miller and Rollnick regard as the most important skill, conveys understanding and selectively highlights the person’s own statements about change. Summaries draw together what the person has said and link their reasons for change (Miller & Rollnick, 2013).

Change talk and sustain talk. Change talk is any speech that favours change. Miller and Rollnick (2013) distinguish preparatory change talk, which expresses desire, ability, reasons and need (DARN), from mobilising change talk, which expresses commitment, activation and taking steps (CAT). Sustain talk is speech that favours the status quo. Research suggests that people tend to act in line with what they hear themselves say, so the worker’s task is to evoke and reinforce change talk while responding to sustain talk without arguing (Miller & Rose, 2009). Discord, previously called resistance, refers to tension in the working relationship and signals that the worker should change approach.

The four processes. The third edition described four overlapping processes (Miller & Rollnick, 2013), which the fourth edition calls tasks (Miller & Rollnick, 2023). Engaging establishes a trusting working relationship. Focusing clarifies the direction or agenda of the conversation. Evoking draws out the person’s own motivations for change. Planning develops commitment and a concrete plan. The processes build on one another, but workers return to earlier ones as needed.

The righting reflex. Miller and Rollnick (2013) describe the righting reflex as the helper’s urge to correct a person’s course by advising, warning or arguing. Because ambivalent people tend to argue for the opposite side, this reflex often strengthens sustain talk. MI asks workers to resist it and to let the person voice the arguments for change.

Links to the transtheoretical model. MI developed alongside Prochaska and DiClemente’s (1983) transtheoretical model, which describes stages of change: precontemplation, contemplation, preparation, action and maintenance. The two are often taught together, and MI is particularly useful for people in precontemplation and contemplation. Miller and Rollnick (2013) emphasise, however, that MI is a separate approach and does not depend on the stages model.

Evidence in AOD. MI has a large evidence base, particularly for alcohol and drug use. Project MATCH found that four sessions of motivational enhancement therapy produced outcomes broadly similar to twelve sessions of cognitive-behavioural or twelve-step facilitation therapy (Project MATCH Research Group, 1997). Meta-analyses have found small to moderate effects, with MI generally more effective than no treatment and comparable to other active treatments, often in fewer sessions (Hettema et al., 2005; Lundahl et al., 2010). A Cochrane review reached similar conclusions for substance use (Smedslund et al., 2011). Effects vary widely between practitioners and settings, and fidelity to the method matters.

2. Historical development

Period Development
1950s–1960s Rogers’ client-centred therapy establishes empathy and acceptance as conditions for change
1982–1983 Prochaska and DiClemente publish the transtheoretical model; Miller describes MI with problem drinkers (Miller, 1983)
1991 Miller and Rollnick publish Motivational Interviewing: Preparing People to Change Addictive Behavior
1990s Motivational enhancement therapy is tested in Project MATCH (1997); adapted brief forms enter health care
2002 Second edition broadens MI to other behaviour change
2005–2010 Meta-analyses support effectiveness; Miller and Rose (2009) propose a theory of how MI works
2013 Third edition introduces the four processes and the spirit of partnership, acceptance, compassion and evocation
2023 Fourth edition renames the processes as tasks and replaces evocation with empowerment

MI emerged from Miller’s work with problem drinkers in Norway and the United States. Miller (1983) observed that confrontational approaches then common in AOD treatment tended to increase defensiveness, while empathic listening was associated with better outcomes. He combined Rogers’ client-centred conditions with a deliberate, directional focus on change, and drew on social psychological ideas such as self-perception theory, which suggests that people come to believe what they hear themselves say (Miller & Rose, 2009).

MI became an independent approach because it offered a distinct method with a clear rationale and a testable set of skills. Its collaboration with Rollnick, a clinical psychologist working in primary health care, extended it beyond AOD into health behaviour change (Rollnick & Miller, 1995). Social work adopted MI readily because its spirit matches the profession’s values of respect, self-determination and partnership. In Australia, MI is widely taught in AOD, mental health, corrections and child and family services.

3. Practical guidance

MI is useful whenever a client is uncertain about change, and its skills improve everyday engagement.

4. Critical evaluation

Strengths. MI is respectful, evidence-based and adaptable to brief contacts. It offers a practical alternative to confrontational approaches and gives workers a specific way to engage people who are ambivalent or reluctant. Its emphasis on autonomy and partnership aligns with social work values, and its skills are learnable and measurable through fidelity coding (Lundahl et al., 2010; Miller & Rollnick, 2013).

Limitations. Effect sizes are modest and vary widely between studies and practitioners, and effects can diminish over time (Hettema et al., 2005). The approach focuses on individual motivation and may overlook structural barriers, such as poverty, homelessness or lack of treatment services, that limit what a motivated person can achieve. In statutory settings, tension can arise between MI’s commitment to autonomy and the worker’s legal responsibilities. Brief training without supervision and feedback often fails to produce lasting skill.

Overall importance. MI is one of the most widely adopted practice approaches in AOD and health settings and has influenced social work practice far beyond them. Its spirit and skills give workers a reliable way to discuss change with people who feel ambivalent. It is most effective when combined with attention to the practical and structural conditions that make change possible.

5. References

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