William R. Miller, PhD, and Stephen Rollnick, PhD: William R. Miller, PhD, is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico. He introduced motiva- tional interviewing (MI) in a 1983 article and in the first edition of Motiva- tional Interviewing (1991), coauthored with Stephen Rollnick. Dr. Miller’s research has focused particularly on the treatment and prevention of addic- tions and more broadly on the psychology of change. He is a recipient of two career achievement awards from the American Psychological Associa- tion, the international Jellinek Memorial Award, and an Innovators Award from the Robert Wood Johnson Foundation, among many other honors. His publications include 65 books and over 400 articles and chapters. His website is https://williamrmiller.net. Stephen Rollnick, PhD, is Honorary Distinguished Professor in the School of Medicine at Cardiff University, Wales, United Kingdom.
He is cofounder of MI, with a career in clinical psychology and academia that focused on how to improve conversations about change, and helped to create the Motivational Interviewing Network of Trainers (http:// motivationalinterviewing.org). He has worked in diverse fields, with spe- cial interests in mental health and long-term health conditions such as dia- betes, heart disease, and HIV/AIDS. Dr. Rollnick has published widely in scientific journals and has written many books on helping people to change behavior. He has traveled worldwide to train practitioners in many settings and cultures, and he now works as a trainer and consultant in health care and sports. His website is www.stephenrollnick.com.
As we finish writing this fourth edition of Motivational Interviewing, we have each devoted half a century to understanding how and why people change and how to help them do so. For each edition, including this one, we have almost completely rewritten the book, benefiting from what has been learned in the decade since the prior edition. Psychological methods tend over time to become ever more technical and complex. The textbooks grow larger.
Practitioners and instructors seek advanced training and certificates of proficiency in the brand-name method, which in turn can lead toward restricting practice to those so qual- ified. There are some understandable reasons for this progression, and early in the development of motivational interviewing (MI) we were advised by respected colleagues to trademark and copyright the name and to license its practice: “You’ll be sorry if you don’t.” We declined to do so, and MI has followed a very different course. Our conscious reason was our disinclination to become MI police, occupied with preventing bad practice, if indeed that is even possible.
Instead we and the MI Network of Trainers (http://motivationalinterviewing.org) have chosen to focus on understanding and promoting better practice, freely sharing what we have learned along the way. MI is like open-source soft- ware, available for those who want to learn and practice it, which may be one reason for the surprisingly rapid and wide dissemination of MI. Still, many ideas that are freely available do not spread so readily. There seems to be something more to why MI has been adopted across so many different settings, professions, cultures, and languages and why it has been applied to such a wide range of change challenges.
It is as though helpers seem to recognize MI when they meet it, like something they had already known. It viii Preface to the Fourth Edition is not a totally new or strange approach. To some it feels more like a friend they had known long ago and perhaps lost touch with for a while. Writing this fourth edition has posed many interesting challenges for us. For readers new to the method, this book serves as their introduction to MI. Some have heard of MI, perhaps learned a bit about it in presenta- tions or readings, and are interested in understanding how to practice it. At the same time, this has also been the authoritative book on MI to which people turn for scientific documentation and a more advanced understanding.
Some readers are teachers and trainers who help others to develop skillfulness. How could we write for all these audiences? The first three editions of Motivational Interviewing did grow in size and complexity. Each time, hundreds of new studies had appeared to clarify the promise, processes, and limitations of MI. We could now write a still larger and more complicated fourth edition, but we are drawn instead toward simplicity.
When understanding something more deeply, it may become possible to explain it more clearly and with less jargon. U.S. Supreme Court Justice Oliver Wendell Holmes Jr. opined: “I would not give a fig for the simplicity this side of complexity, but I would give my life for the simplicity on the other side of complexity.” In this fourth edition we pursue the challenge of conveying simplicity on the far side of complexity in hopes that what we have learned over the decades may be of use to a still broader range of professional helpers.
We are conscious, too, that many readers of this edition are specialists in behavioral health fields—practitioners, counselors, and psychotherapists who treat psychological problems. For this reason, we have included a new feature, special “For Therapists” sections that offer more advanced material within the context and terminology of psychotherapy. Using these sections allows us to fill in some specialist pieces without assuming that all readers will be interested in treatment issues or will be familiar with psychotherapy jargon. For those already familiar with MI, we have introduced some changes from prior editions. Writing for helpers more broadly, we have sought to move away from specialist jargon toward more everyday language.
Whereas early editions focused on preparing people for change, we now understand MI as a way of accompanying people throughout the journey of change and growth. Within the spirit of MI we have retained the constructs of partner- ship, acceptance, and compassion, but we have broadened “evocation” to “empowerment,” affirming clients’ own strengths, motivations, resource- fulness, and autonomy. We describe the four processes of MI (engaging, focusing, evoking, and planning) more simply as component “tasks” of MI. Informed by ongoing discussions about praise versus affirmation, we adopted the distinction between simple and complex affirmations intro- duced by Miller and Moyers in their 2021 book, Effective Psychothera- pists.
Our prior term, righting reflex, has been changed to the clearer fixing reflex. A technical procedure that we had inaptly termed running head start is now called a pendulum technique. We give greater attention to the strategic use of directional questions and reflections that are chosen inten- tionally to invite and strengthen change talk. With increased remote delivery of services via telephone and digital technology, this edition addresses issues in providing MI beyond in-person contexts.