In this introductory video, Dr Stephen Rollnick explains the core principles of motivational interviewing (MI), as well as its wide applicability for both everyday difficulties and more severe mental health issues. As Dr Rollnick puts it, motivational interviewing is a conversation that focuses on the client’s own ideas and feelings about the prospect of behavior change.
Unlike more directive or instructive therapy interventions that seek to change patients’ cognitions through challenging or teaching, MI focuses on genuine collaboration, guided by the client’s own level of readiness and ideas about change.
How MI Works
MI is a style of communication, rather than a structured framework, making it highly flexible and applicable across a variety of contexts by therapists and other health professionals. MI operates on the understanding that ambivalence about change is a normal feature of human psychology. When clients feel pushed towards change, they tend to push back, aligning with reasons why they can’t, won’t or shouldn’t change, and inducing the paradoxical effect of consolidating their ambivalence rather than resolving it.
The recognition of this tendency as a natural response to pressure, rather than a sign of client resistance or deficit, is a significant conceptual shift for many clinicians and a defining characteristic of motivational interviewing. While the goal of motivational interviewing is ultimately to support change and healthy behavior, the clinician maintains an explicit respect for the client’s agency, the complexities of their circumstances, and ultimately, their right to make choices to change or not.
Most clients who are stuck are not lacking information or willpower; rather, they are simply holding competing motivations. What they need is an opportunity to examine them with some support, at their own pace. The MI clinician invites the client to discuss their feelings about a particular behavior, attending to the client’s use of language reflecting ambivalence, desire, priorities and the importance of the issue. The clinician is careful to follow the client, while looking for opportunities to evoke or amplify the client’s own desire and wisdom regarding the importance of change. They only offer direction or guidance in response to expressions of readiness and desire from the client.
William Miller and Stephen Rollnick explain more in Understanding Motivational Interviewing.
Why Therapists Like Using MI
Most clinicians are trained to be helpful in an active, directive sense - to assess, advise, explain, and persuade. Training in MI offers a different orientation for the clinician, one that allows the client's own motivations to surface, rather than aiming to substitute the clinician's reasoning for the client's own. This orientation frees the clinician to walk alongside the client, attending to their present state of mind and the realities of their situation, rather than operating from a sense of pressure to push the client in a certain direction.
This genuine stance offers an experience of congruence that is beneficial not just for patients, but for clinicians too. Therapists using the framework report greater satisfaction in their work, reduced burnout, more rewarding interactions with clients, and more efficient use of appointment time (Hershberger et al., 2024).
Who MI Is For
Motivational Interviewing (MI) was first used by psychologist William Miller for the purposes of addiction treatment. It was subsequently developed into a comprehensive clinical method in collaboration with Dr Rollnick, and is now used across mental health, healthcare, social care, and criminal justice settings worldwide. MI targets the underlying process of motivation rather than a specific diagnosis or disorder, making it applicable across a wide range of clinical contexts. It is particularly useful when clients are ambivalent, disengaged, or have previously struggled to act on advice.
MI integrates well with other modalities, with many clinicians finding MI to be a useful engagement framework in the early phases of CBT, DBT, or health coaching, before more directive interventions are introduced. It can also be used to address ambivalence about engaging in therapy itself.
MI is also a practical fit for clinicians working outside formal therapy contexts: nurses, case managers, peer workers, doctors, and others who have brief, high-stakes conversations about behavior change and need something that works in constrained time.
The Evidence Base
MI is among the most extensively researched clinical interventions in existence. There are now over 1,000 controlled trials and several dozen meta-analyses examining its efficacy across a wide range of presenting problems (e.g. Frost et al., 2018; Lundahl et al., 2010).
What the research consistently shows is that when clients are given space to talk purposefully about change on their own terms, rather than be actively coached or coaxed, both outcomes and patient satisfaction improve. This holds across addiction, chronic disease management, mental health, medication and dental hygiene adherence, diet, exercise, and a growing list of other behavioral domains.
Learning MI Directly from the Experts Who Created It
Training in MI offers a practical, easy-to-apply addition to almost any clinician’s toolbelt. Psychwire's Motivational Interviewing Foundational course offers a six-week introduction to the basic principles of MI, taught by both founder William Miller and co-developer Stephen Rollnick, alongside leading MI researcher and trainer Theresa Moyers. The course covers the theory required to integrate MI into clinical practice, as well as direct access to the trainers via a live discussion forum. For those who work in Healthcare, Motivational Interviewing for Healthcare provides foundational MI concepts in the context of healthcare settings. For more specialized training, Psychwire’s expert faculty also offers Motivational Interviewing for Addiction.
