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Rogers redux: relevance and outcomes of motivational interviewing across behavioral problems.

Article Excerpt
Approximately 20 years ago, motivational interviewing (MI) was developed by William Miller as an approach to treat problem drinking that was markedly different from the traditional confrontational styles of addictions counseling (Miller, 1983). The use of the phrase problem drinking may seem curious at first glance. This phrase is deliberately used in place of alcohol abuse and dependency because MI does not place an emphasis on diagnosis but rather on the client's unique experience with a problem behavior. Developed through clinical experience and derived directly from clients' struggle with behavior change, MI was founded in response to traditional addictions counseling approaches that typically sought to break through clients' denial as an initial clinical procedure. In conjunction with the goal of refining and applying this new clinical approach, Miller set out a parallel goal to systematically investigate the psychology of the motivation for change.

Most recently, MI has been defined as a client-centered yet directive therapeutic style, with the explicit goal of enhancing readiness for change by helping clients explore and resolve ambivalence toward behavioral problems (Miller & Rollnick, 2002). MI can be understood as an evolution of Rogers's person-centered counseling approach (Rogers, 1961), because it elicits the client's own intrinsic motivations for change; it is a supportive, empathetic, reflective, and collaborative counseling style that honors client autonomy (Hettema, Steele, & Miller, 2005). Typically MI is differentiated from Rogers's style in that MI is directive, attending to and reinforcing selective change talk regarding the presenting behavioral problem. However, this distinction of nondirective versus directive counseling approaches may not be as clear as is commonly understood. For example, Truax's (1966) empirical research asserted that Rogerian psychotherapy was actually just as directive as it was nondirective. In Truax's detailed analyses of Rogers's therapy tapes, he indicated significant reinforcement effects (directive counseling) in the client-centered therapy, thereby bringing into question the complete nondirective nature of Rogerian therapy. This type of clinical behavior, such as reinforcing and encouraging positive statements, represents a style of clinical communication that is very similar to MI's more directive, albeit client-centered, counseling. Notwithstanding, MI uses many, if not all, of the core ingredients that Rogers set forth in his work. A recent variation of MI that has been manualized and examined through clinical trials is called Motivational Enhancement Therapy (MET). MET is a four-session adaptation of MI. It was developed specifically as one of three treatments tested in Project MATCH (Project MATCH Research Group, 1993), a multisite clinical trial of treatments for alcohol abuse and dependence. However, the MI approach is the predominant style used by counselors throughout MET.

Addressing ambivalence is a critical focus for MI. Clients are at various stages of awareness of their ambivalence toward their problematic behaviors. They may know the reasons why they should stop a behavior, yet there are benefits and costs associated with not changing as well as with keeping things the same. If a counselor were to begin to argue or to take the side for change, the client often would take the other side, arguing against the need for change, thereby resulting in increased resistance and decreased likelihood for behavioral change. The counselor can help in assisting the client to identify, articulate, and clarify his or her own intrinsic motivation for change. The initial identification leads to a values clarification exercise in which the client examines his or her current behavior in light of his or her broader goals and core values. This component is called "developing discrepancy" and has been referred to by Miller and Rollnick (2002) as the "active ingredient" that accounts for MI's efficacy. In essence, the client begins to articulate within the session the incompatibility of the current behavior with those most valued and important things in his or her life, thereby providing the discrepancy and clinical focus for the counselor. This sensitive work is done most effectively when the client experiences acceptance and value from the counseling encounter. Effective acceptance and value are operational terms for Rogers's (1961) "accurate empathy" thereby further establishing the connection between MI and Rogers's work and the constituted nature of the core MI treatment principles within the client-centered approach.

The label MI may be misleading in that one may conclude only motivated clients are appropriate for counseling or motivation is given to or provided for clients by the counselor. Contrary to these assertions, MI evokes the clients' own motivation based on confidence in the innate desire...

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