Q&A with Dr. William Miller - NSHC

Q&A with Dr. William Miller - NSHC

Dr. William Miller, originator of Motivational Interviewing and co-author of Motivational Interviewing in Health Care: Helping Patients Change Behavior responds to our questions:

Huffman: "How did you arrive at the use of the term Motivational Interviewing?"

Dr. Miller: "The first word was easy, because the goal of the interaction is to increase personal motivation for change. I liked "interviewing" because in English it is a neutral term in regard to power. A supervisor might interview a prospective employee, but also a student or reporter can interview an expert. A good interview is like a conversation. If I had called it anything else, it might have been motivational conversation."

Huffman: "Healthcare professionals more often use the term health coaching as opposed to motivational interviewing. Does this concern you? If yes, please explain."

Dr. Miller: "Health coaching is a broader term, and can involve a variety of different approaches. Sometimes a coach is very directive, telling the person what to do. Sometimes the coach is a good listener, following what the person has to say. Both are legitimate types of communication sometimes. In between is the communication style of guiding, which is a collaborative partnership. The coach uses his or her own expertise, but also draws on the wisdom of the person being coached, because no one knows more about that person. It's more like negotiation, recognizing that each person has the right to choose their own course. When health behavior change is what is needed, that middle ground of guiding is usually the best place to be. Motivational interviewing is a particular, refined form of guiding that calls forth the person's own health motivations. In other words, motivational interviewing is just one tool that can be used in health coaching. It's not the whole tool box."

Huffman: "MI is certainly a paradigm shift from teaching do's and don'ts "at the patient" to guiding the patient to set his/her own goals for health behavior change and to help the individual discover his/her own ambivalence to change. What feedback have you received from healthcare providers about both the ease and difficulty they have experienced as they make this transition to the use of MI?"

Dr. Miller: "Well, there is a lot of variability. Some providers take to it naturally, and tell us that we have clarified and systematized for them something that they were already trying to do. They recognize this approach when they see it, and it feels natural to them. That doesn't make it easy to learn, necessarily, but it feels right to them. Others really prefer the directing role of telling people what to do, or believe that their patients need and want that kind of expert direction. Some patients do, but for the most part, people respond much better to collaborative, respectful listening and guiding than to being told what to do when it comes to their own behavior. Once healthcare providers get into practicing MI, though, they often report that it feels like a burden has been lifted off of them. They don't have to MAKE change happen, to coerce or cajole or persuade or scare people into changing. In fact, you can't make someone else change, so to have that as your mental map is a somewhat self-defeating approach. You go home at the end of the day feeling discouraged or frustrated. A nice thing about MI, it seems, is that even a little bit of it can go a long way. You get positive feedback and results pretty early in the process of learning it."

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