Our objectives were as follows: 1) to survey the literature on motivational interviewing (MI), “a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence” and a well-established method of brief intervention, especially in the field of addictions treatment; 2) to review hypotheses about its mode of action; and 3) to discuss its possible impact on clinical psychiatry, in particular, on teaching communications skills.
Method:
Literature reviews and metaanalyses of numerous clinical trials of MI for addictions treatment have already been published and are briefly summarized. So far, no literature survey exists for MI applied to psychiatric patients. This review is limited to a synthesis of the articles relevant to psychiatry and to comments based on our team's experiences with MI.
Results:
There is no evidence that MI achieves better results than other established techniques for treating addictions; it may simply work faster. The explanation for the method's rapid effectiveness remains speculative. Outcomes concerning the application of MI to psychiatric patients, although preliminary, are promising. Methods of assessing the integrity of MI treatment are more developed than in most psychotherapies, which permits the learning progress of trainees to be measured.
Conclusions:
MI offers a complement to usual psychiatric procedures. It may be worthwhile to teach it, not only for addictions but also for other broad treatment issues, such as enhancing patients' medication compliance and professionals' communication skills. Questions remain concerning MI's feasibility in psychiatry settings.
MillerWRRollnickS.Facilitating change. In: MillerWRRollnickS.Motivational interviewing: Preparing people for change. 2nd ed.New York: Guilford Press; 2002: P 20–9.
2.
Project MATCH Research Group. Matching alcoholism treatment to client heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud Alcohol1997;58:7–29.
3.
Project MATCH Research Group. Matching alcoholism treatment to client heterogeneity: Project MATCH three-year drinking outcomes. Alcoholism: Clinical and Experimental Research1998;23:1300–11.
4.
DrakeREMercer-McFaddenCMueserKTMcHugoGJBondGR. Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophr Bull1998;24:589–608.
5.
RachBeiselJScottJDixonL.Co-occurring severe mental illness and substance use disorders: A review of recent research. Psychiatr Serv1999;50:1427–34.
6.
MillerWRRollnickS.Motivational interviewing: Preparing people for change. 2nd ed.New York: Guilford Press; 2002.
7.
RogersCR. Client-centered therapy: Its current practice, implications, and theory. Boston (MA): Houghton Mifflin; 1951.
8.
ProchaskaJODiclementeCC. Stages of change in the modification of problem behaviors. Prog Behav Modif1992;28:183–218.
9.
ProchaskaJODiclementeCCNorcrossJC. In search of how people change. Applications to addictive behaviors. Am Psychol1992;47:1102–14.
10.
MillerWRBenefieldRGToniganJS. Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. J Consult Clin Psychol1993;61:455–61.
11.
StephensRSRoffmanRACurtinL.Comparison of extended versus brief treatments for marijuana use. J Consult Clin Psychol2000;68:898–908.
12.
BakerAHeatherNWodakADixonJHoltP.Evaluation of a cognitive-behavioural intervention for HIV prevention among injecting drug users. AIDS1993;72:247–56.
13.
BakerAKochanNDixonJHeatherNWodakA.Controlled evaluation of a brief intervention for HIV prevention among injecting drug users not in treatment. AIDS Care1994;6:559–70.
14.
ButlerCCRollnickSCohenDRusselIBachmannMSN. Motivational consulting versus brief advice for smokers in general practice: A randomised trial. Br J Gen Pract1999;49:611–6.
15.
ColbySMMontiPMBarnettNPRohsenowDJWeissmanKSpiritoA, and others. Brief motivational interviewing in a hospital setting for adolescent smoking: A preliminary study. J Consult Clin Psychol1998;66:574–8.
16.
BurkeBLArkowitzHMencholaM.The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. J Consult Clin Psychol2003;71:843–61.
17.
LipseyMWWilsonDB. The efficacy of psychological, educational, and behavioral treatment. Confirmation from meta-analysis. Am Psychol1993;48:1181–209.
18.
CorriganPWMcCrackenSGHolmesEP. Motivational interviews as goal assessment for persons with psychiatric disability. Community Ment Health J2001;37:113–22.
19.
SwansonAJPantalonMVCohenKR. Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients. J Nerv Ment Dis1999;187:630–5.
20.
BakerALewinTReichlerHClancyRCarrVGarrettR, and others. Motivational interviewing among psychiatric in-patients with substance use disorders. Acta Psychiatr Scand2002;106:233–40.
21.
WalitzerKSDermenKHConnorsGJ. Strategies for preparing clients for treatment. A review. Behav Modif1999;23:129–51.
22.
ZiedonisDMTrudeauK.Motivation to quit using substances among individuals with schizophrenia: Implications for a motivation-based treatment model. Schizophr Bull1997;23:229–38.
23.
WylieKHouseAStorerDRaistrickDHendersonM.Deliberate self-harm and substance dependence: The management of patients seen in the general hospital. J Ment Health Adm1996;23:246–52.
24.
GraeberDAMoyersTBGriffithGGuajardoEToniganS.A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders. Community Ment Health J2003;39:189–202.
25.
BakerALewinTReichlerHClancyRCarrVGarrettR, and others. Evaluation of a motivational interview for substance use within psychiatric in-patient services. Addiction2002;97:1329–37.
26.
BrownRARamseySEStrongDRMyersMGKahlerCWLejuezCW, and others. Effects of motivational interviewing on smoking cessation in adolescents with psychiatric disorders. Tob Control2003;12 (Suppl 4):IV3–IV10.
27.
HulseGKTaitRJ. Five-year outcomes of a brief alcohol intervention for adult in-patients with psychiatric disorders. Addiction2003;98:1061–8.
28.
CareyKBPurnineDMMaistoSACareyMP. Enhancing readiness-to-change substance abuse in persons with schizophrenia. A four-session motivation-based intervention. Behav Modif2001;25:331–84.
29.
CareyKBCareyMPMaistoSAPurnineDM. The feasibility of enhancing psychiatric outpatients' readiness to change their substance use. Psychiatr Serv2002;53:602–8.
30.
ZygmuntAOlfsonMBoyerCAMechanicD.Interventions to improve medication adherence in schizophrenia. Am J Psychiatry2002;159:1653–64.
31.
CoffeyM.Psychosis and medication: Strategies for improving adherence. Br J Nurs1999;8:225–30.
32.
GrayRRobsonDBressingtonD.Medication management for people with a diagnosis of schizophrenia. Nurs Times2002;98:38–40.
33.
CorriganPWLibermanRPEngelJD. From noncompliance to collaboration in the treatment of schizophrenia. Hosp Community Psychiatry1990;41:1203–11.
34.
KempRHaywardPApplewhaiteGEverittBDavidA.Compliance therapy in psychotic patients: Randomised controlled trial. BMJ1996;312:345–9.
BarrowcloughCHaddockGTarrierNLewisSWMoringJO'BrienR, and others. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry2001;158:1706–13.
37.
BellackASDiclementeCC. Treating substance abuse among patients with schizophrenia. Psychiatr Serv1999;50:75–80.
38.
PantalonMVSwansonAJ. Use of the University of Rhode Island Change Assessment to measure motivational readiness to change in psychiatric and dually diagnosed individuals. Psychol Addict Behav2003;17:91–7.
39.
Van HornDHBuxDA. A pilot test of motivational interviewing groups for dually diagnosed inpatients. J Subst Abuse Treat2001;20:191–5.
40.
MartinoSCarrollKMO'MalleySSRounsavilleBJ. Motivational interviewing with psychiatrically ill substance abusing patients. Am J Addict2000;9:88–91.
41.
MartinoSCarrollKKostasDPerkinsJRounsavilleB.Dual diagnosis motivational interviewing: A modification of motivational interviewing for substance-abusing patients with psychotic disorders. J Subst Abuse Treat2002;23:297–308.
42.
RuschNCorriganPW. Motivational interviewing to improve insight and treatment adherence in schizophrenia. Psychiatr Rehabil J2002;26(1):23–32.
43.
FrankJ.Persuasion and healing: A comparative study of psychotherapy. Baltimore (MD): Johns Hopkins University Press; 1961.
44.
MillerWR. Toward a theory of motivational interviewing. Motivational Interviewing Newsletter: Updates, Education and Training (MINUET)1999;6(3),2–4. Available: http://motivationalinterview.org/mint/Mint6_3.PDF. Accessed 2005 June 17.
45.
MillerWR. Transcendent moments. Motivational Interviewing Newsletter: Updates, Education and Training (MINUET)2004;11(1):1–2. Available: http://motivationalinterview.org/mint/MINT11_1.pdf. Accessed 2005 17 June.
46.
BinswangerL.Being-in-the-world; selected papers of Ludwig Binswanger. New-York: Basic Books; 1963.
47.
EyH.Consciousness: A phenomenological study on being conscious and becoming conscious. Flodstrom JH, translator. Bloomington (IN): Indiana Univ Press; 1978.
48.
JaspersK.General psychopathology. Chicago (IL): University of Chicago Press; 1963. Republished Baltimore (MD): Johns Hopkins University; 1997.
49.
NaudinJGros-AzorinCMisharaAWigginsOPSchwartzMAAzorinJM. The use of the husserlian reduction as a method of investigation in psychiatry. Journal of Consciousness Studies1999;6:155–71.
50.
KafkaF.A country doctor. The penal colony. Stories and short pieces. New York: Shocker Books; 1917.
51.
MillerWRMoyersTErnstDAmrheinP.Manual for the Motivational Interviewing Skill Code. Version 2.0. Center on Alcoholism, Substance Abuse, And Addictions2003. Available: http://casaa.unm.edu/download/misc.pdf. Accessed 2005 June 27.
52.
MillerWRMountKA. A small study of training in motivational interviewing. Does one workshop change clinician and client behavior? Behavioural and Cognitive Psychotherapy2004;29:457–71.
53.
MoyersTMartinTCatleyDHarrisKJAhluwaliaJS. Assessing the integrity of motivational interviewing interventions: Reliability of the Motivational Interviewing Skills Code. Behavioural and Cognitive Psychotherapy2003;31:177–84.
54.
MoyersTMartinTManuelJKMillerWR. Motivational Interviewing Treatment Integrity (MITI) Code: Version 2.0. Center on Alcoholism, Substance Abuse, And Addictions2003. Available: http://casaa.unm.edu/download/miti.pdf. Accessed 2005 June 27.
55.
ChanutFBrownTGDongierM.A simple tool for the evaluation of the quality of motivational interviewing. Paper presented at the Canadian Psychiatric Association Annual Meeting; 2004 October 14–17; Montreal (QC).
56.
MillerWRYahneCEMoyersTBMartinezJPirritanoM.A randomized trial of methods to help clinicians learn motivational interviewing. J Consult Clin Psychol. 2004;6:1050–62.
57.
MueserKTNoordsyDLDrakeREFoxL.Integrated treatment for dual disorders: A guide to effective practice. New York, London (UK): Guilford Press; 2003.
58.
MartinLSapersonKMaddiganB.Residency training: Challenges and opportunities in preparing trainees for the 21st century. Can J Psychiatry2003;48:225–31.
59.
McCambridgeJPlattsSWhooleyDStrangJ.Encouraging GP alcohol intervention: Pilot study of change-orientated reflective listening (CORL). Alcohol Alcohol2004;39:146–9.
60.
RollnickSButlerCCStottN.Helping smokers make decisions: The enhancement of brief intervention for general medical practice. Patient Educ Couns1997;31:191–203.
61.
StrangJMcCambridgeJPlattsSGrovesP.Engaging the reluctant GP in care of the opiate misuser: Pilot study of change-orientated reflective listening (CORL). Fam Pract2004;21:150–4.
62.
Goodyear-SmithFWhitehornMMcCormickR.General practitioners' perceptions of continuing medical education's role in changing behaviour. Educ Health (Abingdon)2003;16:328–38.
63.
BeichAGannikDMalterudK.Screening and brief intervention for excessive alcohol use: Qualitative interview study of the experiences of general practitioners. BMJ2002;325:870.
64.
KanerEFWutzkeSSaundersJBPowellAMorawskiJBouixJC. Impact of alcohol education and training on general practitioners' diagnostic and management skills: Findings from a World Health Organization collaborative study. J Stud Alcohol2001;62:621–7.
65.
WHO Brief Intervention Study Group. A cross-national trial of brief interventions with heavy drinkers. Am J Public Health1996;86:948–55.
66.
IvanetsNNLukomskayaMI. Evaluation of early intervention strategies used in primary health care: A report on the World Health Organization (WHO) project on Identification and Treatment of Persons with Harmful Alcohol Consumption. Alcohol AlcoholSuppl1991;1:489–91.
67.
PoirierMKClarkMMCerhanJHPruthiSGedaYEDaleLC. Teaching motivational interviewing to first-year medical students to improve counseling skills in health behavior change. Mayo Clin Proc2004;79:327–31.
68.
KoerberACrawfordJO'ConnellK.The effects of teaching dental students brief motivational interviewing for smoking-cessation counseling: A pilot study. J Dent Educ2003;67:439–47.
69.
BarskyAColemanH.Evaluating skill acquisition in motivational interviewing: The development of an instrument to measure practice skills. J Drug Educ2001;31(1):69–82.
70.
ArthurD.Assessing nursing students' basic communication and interviewing skills: The development and testing of a rating scale. J Adv Nurs1999;29:658–65.
71.
BrownRLOrielK.Teaching motivational interviewing to first-year students. Acad Med1998;73:589–90.
