Motivational Interviewing: Preparing People for Change, 2nd Edition, by William R. Miller and Stephen Rollnick, Guilford Publications, New York, NY, 2002, 428 pp, $40.00.
Health care professionals have long struggled to help patients and their families make behavioral changes that are necessary to improve health outcomes. Now there is an empirically based intervention that specifically aims to help providers enhance motivation to change. Motivational Interviewing is a "client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" to change (p. 25). Originally targeted to the addictions field, Motivational Interviewing has gained empirical support in various areas of health behavior change (i.e., treatment adherence and participation, diet and physical activity) and has been embraced by professionals (psychologists, physicians, counselors, and health care providers) as a method of communicating with patients to make important changes in their lives.
This Second Edition of Motivational Interviewing (MI) provides an expanded and updated review of the advances in the field from both a conceptual and empirical basis. It is not a handbook nor treatment manual, but rather a graduate level guide for implementing principles and skills into daily practice that includes clinical examples and empirical support. The reader will gain knowledge and skills, but clinical competence will likely not be obtained from perusing the text (additional training and clinical feedback is recommended). The book begins with an overview of the development of MI and covers the central concepts of change and ambivalence from an interpersonal context. The second section centers on practice, emphasizing the fundamental "spirit" of MI while addressing issues of resistance, change talk, confidence and commitment to change. Specific MI concepts and skills are introduced and multiple clinical examples are provided. A chapter on ethics is included that highlights the ethical complexities in discussing change and values clarification with patients that may or may not be ready to make a change. Moreover, this chapter provides guidelines that illuminate the complexity of using MI from a provider perspective (i.e., dissonance in aspirations and values with patients, personal investment, and coercive power). The third section reviews the process of learning and facilitating MI and maintains an active, learner-centered approach. The best way to learn MI, the authors posit, is from patients, "there are no better teachers." The final section of the book covers diverse applications of MI, with chapters contributed by experts in the field. Included topics range from MI and the Stages of Change model; a comprehensive review of the efficacy of MI; and adaptations to specific areas of interest and populations. Chapters of most interest to JDBP readers would also include MI in Medical and Public Health Settings; MI and Treatment Adherence; and MI with Adolescents and Young Adults.
Miller and Rollnick's Motivational Interviewing is an internationally recognized, emerging and empirically based method of communicating with patients about behavior change, yet the application of MI to Developmental and Behavioral Pediatrics has yet to be explored in any detail. While MI has a robust empirical basis for populations ages 16 and older, the literature on pediatric populations below this age range is sparse. However, from this author's perspective the application of MI to pediatric settings has much promise. Specifically, issues of patient motivation, resistance of and commitment to change are areas that are imperative to any successful clinical intervention targeting behavioral modifications. Medical and psychosocial issues where MI may show clinical utility include examples such as: (a) communicating with parents about compliance with stimulant and other medications, (b) behavioral charting, (c) toileting issues, and (d) feeding disorders. Additional areas of interest are beyond the scope of this review, but it is clear from the empirical support of MI with adult populations that it has the potential to positively impact pediatric practices and work with teenagers.
Additionally, the incorporation of MI into teaching curricula would be a novel approach to training. For example, MI could be integrated into communication skills courses in graduate and medical school, as well as residency and fellowship training. Although the above applications are hypothetical, the incorporation of MI into Developmental and Behavioral Pediatrics is worthy of further research and has the potential to positively impact clinical practices.
In sum, Miller and Rollnick's Motivational Interviewing, Second Edition, is a highly recommended, reader friendly text that is appropriate for medical students and graduate level therapy courses, as well as for JDBP readers interested in expanding their knowledge and repertoire of skills for understanding how people change, and more importantly, why they don't.
Mariann Suarez, Ph.D.
Case Western Reserve University
Medical School and MetroHealth