Journal of Social Work

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DOI: 10.1177/1468017305051365

2005 5: 45Journal of Social Work

StÉphanie Wahab

Motivational Interviewing and Social Work Practice

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Motivational Interviewing

and Social Work Practice

STÉPHANIE WAHAB

University of Utah, Salt Lake City, USA

Abstract

• Summary: Motivational interviewing was proposed as an alternative

model to direct persuasion for facilitating behavior change. Social work

behavior change interventions have traditionally focused on increasing

skills and reducing barriers. More recent recommendations tend to

encourage practitioners to explore a broad range of issues, including but

not limited to skills and barriers. The article deﬁnes and explains

motivational interviewing by presenting its essential spirit and

techniques, and provides a brief case example within a domestic

violence context.

• Findings: This article proposes motivational interviewing as an

intervention appropriate for social work practice concerned with

behavior change by arguing that motivational interviewing is an exciting

intervention model for numerous social work settings due to its

consistency with core social work values, ethics, resources, and

evidence-based practice.

• Applications: Social workers may strive to practice and test motivational

interviewing in addictions settings, as well as within other critical social

work arenas including but not limited to health, domestic violence,

batterer treatment, gambling, HIV/AIDS prevention, dual disorders,

eating disorders, and child welfare.

Keywords ambivalence intrinsic motivation motivational

interviewing practice resistance

Introduction

Of the ‘four forces’ of social work (psychodynamic, cognitive-behavioral, exis-

tential-humanistic and transpersonal (Derezotes, 2000)), cognitive behavioral

therapy (CBT) has signiﬁcantly informed numerous social work interventions

concerned with behavior change both with individuals and with groups.

Traditionally, behavior change interventions have speciﬁcally focused on

Journal of Social Work

5(1): 45–60

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DOI: 10.1177/1468017305051365

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increasing skills and reducing barriers. Practice knowledge now indicates that

simply telling people what to do, or how to do it, is rarely effective in support-

ing people to change their desired behaviors. More recent recommendations

tend to encourage practitioners to explore a broad range of issues. In fact,

leading theoretical approaches such as the information-motivation-behavioral

skills model (Fisher and Fisher, 1992), the transtheoretical model (Prochaska

and DiClemente, 1984), and the health belief model (Rosenstock et al., 1994)

highlight motivational constructs as key elements of the behavior change

process. Also reﬂected in the behavior change literature is a signiﬁcant ﬁnding

that the way (the spirit) in which clinicians interact with clients has a signiﬁcant

effect on clients’ motivation and resistance to change (Miller et al., 1988; Brown

and Miller, 1993).

What is Motivational Interviewing?

Motivational interviewing (MI) was proposed as an alternative model to direct

persuasion for facilitating behavior change by Miller in the early 1980s (Miller,

1983, 1985). The original conceptualization of MI evolved from Miller’s work

in the treatment of problem drinkers and was elaborated and developed more

fully with the assistance of his colleague Dr Stephen Rollnick in 1991 (Miller

and Rollnick, 1991). Miller and Rollnick (2002) deﬁne MI as ‘a client centered,

directive method for enhancing intrinsic motivation to change by exploring and

resolving ambivalence’ (p. 25).

Although several models such as the drinker’s check-up (DCU) (Miller and

Sovereign, 1989), motivational enhancement therapy (MET) (Project Match

Research Group, 1993), brief motivational interviewing (Rollnick et al., 1992)

and brief interventions (Holder et al., 1991) were derived from and are similar

to MI, MI is distinct from these methods in its time, intensity and structure.

MI is grounded in the transtheoretical model (TM) (Prochaska and

DiClemente, 1982) and informed by seven distinct theories: conﬂict and

ambivalence (Orford, 1985), decisional balance (Janis and Mann, 1977), health

beliefs (Rogers, 1975), reactance (Brehm and Brehm, 1981), self-perception

theory (Bem, 1967), self-regulation theory (Kanfer, 1987), and Rokeach’s value

theory (Rokeach, 1973). Brieﬂy, the transtheoretical model conceptualizes

behavior change as a process with various stages. Change is understood as a

series of stages of change. The stages represent distinct categories along a

continuum of motivational readiness. These categories include precontempla-

tion, contemplation, preparation, action, maintenance and relapse. According

to Prochaska and DiClemente (1982) precontemplation is the state in which an

individual is not yet considering the possibility of change. Contemplation is the

stage deﬁned by ambivalence about changing or initiating a behavior. Prep-

aration is a state characterized by an intention to change in the immediate

future, usually within the next month. Action is the stage where the individual

takes action in order to achieve a behavior change. Maintenance is the stage

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where the individual strives to maintain and integrate a behavior that has been

successfully started or changed. Relapse is the stage when an individual re-

engages the undesired behavior and/or stops the desired behavior. While the

TM informs MI, we must be cautious not to mistake one for the other. Even

though current literature (Miller and Rollnick, 2002) and training by the MI

leaders (Miller and Rollnick) no longer stress the signiﬁcance of the TM for MI

as much as they used to (because it does not necessarily capture the many

nuances of the individual change process), they continue to agree that the TM

can provide a helpful heuristic for helping clinicians understand the need to

tailor what they do to the client’s readiness proﬁle.

The overall intention of MI is to support people to move along a continuum

of behavior change by creating a supportive, non-judgmental, directive environ-

ment to facilitate the exploration of one’s motivations, readiness and conﬁ-

dence levels for change, as well as ambivalence to change (Miller and Rollnick,

2002). The intention behind assessing motivation, readiness and conﬁdence

levels for change is to tailor the intervention accurately to the client’s stage of

change at any given moment. A client who is considered a ‘precontemplator’

(Prochaska and DiClemente, 1982) would be unlikely to be responsive to an

action-oriented intervention. Similarly, someone who is ready to act or change

their behavior(s) may not be supported and encouraged by an intervention that

focuses on getting ready for change. In addition, an individual who is ready and

motivated to change their behavior, and does not feel conﬁdent that they can

carry out the change, will require different supports and resources than if their

barrier resides in their motivation level. More speciﬁcally, it is possible to be

motivated and ready to change yet not conﬁdent about one’s ability to success-

fully carry out the change.

The Spirit of Motivational Interviewing

What is referred to as the MI spirit is the style, the way, the intention and the

gestalt of the practitioner’s disposition with the client. The spirit is different

from the technique in that it transcends the mechanisms of the practice by

supporting and providing the foundation for the skills and techniques. While

the skills and techniques can be taught, the spirit is more elusive and comes

from within the clinician. MI trainers often aim to elicit and evoke the MI spirit

within trainees by modeling it themselves. Rollnick and Miller (1995) point to

seven particular elements of the MI spirit:

1. Motivation to change is elicited from the client, and not imposed from

without.

2. It is the client’s task, not the counselor’s, to articulate and resolve his or

her ambivalence.

3. Direct persuasion is not an effective method for resolving ambivalence.

4. The counseling style is generally a quiet and eliciting one.

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5. The counselor is directive in helping the client to examine and resolve

ambivalence.

6. Readiness to change is not a client trait, but a ﬂuctuating product of inter-

personal interaction.

7. The therapeutic relationship is more like a partnership or companionship

than expert/recipient roles.

The spirit of MI involves an availability and willingness to be present

enough with a client to glimpse their inner world. Consequently, empathic and

reﬂective listening are foundational skills to this practice. It has been said that

one never masters the art of reﬂective listening, but rather, develops and

nurtures the ability though a lifetime. Without the ability to engage in reﬂec-

tive listening, it is impossible to practice MI (Miller and Rollnick, 2002).

While MI draws from CBT models, it also embodies elements and inﬂuence

from the third (existential-humanistic) and fourth (transpersonal) forces. The

client-centered approach to MI supports the third force’s focus on uncondi-

tional positive regard (Rogers, 1957, 1959), acceptance, and the here and now.

It has been argued (Miller and Rollnick, 2002) that the spirit and techniques of

MI are grounded in the Rogerian (1957, 1959) concepts of ‘acceptance’ and

‘unconditional positive regard’. Rogers surmised that by creating an accepting,

non-judgmental, empathic relationship setting, the therapist constructs the

circumstances that facilitate change. Miller (2000), who has spent a signiﬁcant

portion of his career researching ‘what triggers change’, postulates that love,

referenced as agape, might be the key ingredient that facilitates behavior

change. In fact, in a study of individuals who had experienced sudden trans-

formational change, Miller and C’de Baca (1994) reported that a majority of

the participants in the study mentioned that they had felt completely loved and

accepted during their transformational experiences. While not all clients choose

to explore the spiritual elements of their behaviors, the client-centered

approach coupled with the spirit of MI create a space for transpersonal and

existential experiences and exploration to take place within the context of

behavior change interventions.

MI ﬁdelity tools such as the motivational interviewing skills code (MISC)

(Miller et al., 2003) and the motivational interviewing integrity manual (MITI)

(Moyers et al., in press) allow practitioners and researchers to evaluate the

integrity of the spirit of MI. They may also serve as tools for self-evaluation by

clinicians learning MI, and as feedback mechanisms to improve MI competence

in training. While clinicians, program and grant funders may be drawn to CBTs

because of the clarity and ease associated with measuring the respective

outcome variables, clinicians may be encouraged to move beyond simply task-

centered approaches now that MI tools have been developed to evaluate third

and fourth force constructs such as empathy and understanding. Both the MISC

and MITI have been evaluated and tested (see above-referenced studies for

reliability estimates).

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Motivational Interviewing Skills and Techniques

Unlike confrontive techniques, MI aims to support the client to generate

reasons, plans, and motivations for change. Within MI, practitioners do not

impose diagnostic labels, engage clients in a punitive or coercive fashion, argue

that the client has a problem, attempt to convince or force the client to change,

or create change plans for the client, nor does the practitioner do most of the

talking. Rather, the MI clinician facilitates a process where clients convince

themselves to consider and engage in behavior change. They do so speciﬁcally

by engaging the four basic principles of MI: 1) express empathy; 2) develop

discrepancy; 3) roll with resistance; and 4) support self-efﬁcacy (Miller and

Rollnick, 2002). The principles are operationalized by assessing motivation,

conﬁdence and readiness; exploring ambivalence; enhancing client motivation;

rolling with resistance; supporting self-efﬁcacy; and strengthening commitment.

A Good Fit with Social Work

Evidence-based Practice

Currently, there are more than 73 publications of international clinical trials

that have evaluated MI (Miller, personal communication, 28 October, 2004)

and its effectiveness in a variety of settings (see www.motivationalinterview.org

for a listing of these studies). Contemporary MI practices occur on ﬁve conti-

nents and demonstrate the feasibility of adapting MI to a variety of risk behav-

iors and populations (Dunn et al., 2001). Studies have been conducted in the

US, Canada, England, Norway, Switzerland, Italy, Zambia and South Africa

among other countries. In addition, MI has been used and tested with adoles-

cents and adults in settings and problem areas that include but are not limited

to problem drinkers (Miller et al., 1993; Senft et al., 1995; Bosari and Carey,

2000; Murphy et al., 2004),

drug users (Saunders et al., 1995; Longshore and

Grills, 2000; Stotts, et al., 2001; Babor, 2004), smokers (Butler et al., 1999;

Cigrang et al., 2002; Stotts et al., 2002), psychiatric patients (Kemp et al., 1996;

Swanson et al., 1999), gamblers (Hodgins et al., 2001), batterers (Kennerley,

2000; Kistenmacher, 2000), HIV risk reduction (Carey et al., 1997; Picciano et

al., 2001; Koblin et al., 2004), nutrition and minority populations (Longshore

and Grills, 2000; Resnicow et al., 2001), in probation settings (Harper and

Hardy, 2002).

Dunn et al. carried out the most comprehensive and systematic review of

the effects of MI. They focused on four particular practice domains in which

MI was utilized: substance abuse, HIV risk, smoking and diet/exercise. They

found that:

there was substantial evidence that MI is an effective substance abuse intervention

method when used by clinicians who are non-specialists in substance abuse treatment,

particularly when enhancing entry to and engagement in more intensive substance

abuse treatment. (2001: 1)

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Dunn et al. (2001) were unable to judge the effectiveness of MI in the other

three domains due to ‘inadequate data’, and note that the reason for the

cumulative evidence for the effectiveness of MI in the substance abuse domain

is due to the large number of studies on the topic.

MI in Social Work

Social workers have quickly joined the ranks of practitioners who are both

utilizing and evaluating MI interventions. Smyth (1996) considers the use of MI

to help engage and motivate clients to make the changes necessary for recovery

from dual disorders. Hohman (1998) suggests MI for child welfare workers who

work with substance abusers, as a useful intervention technique, by applying it

to a case study. Rutledge et al. (2001) describe the principles of MI and discuss

its application, with case examples drawn from a pilot trial of motivational

enhancement therapy (MET), for HIV risk reduction among ‘men who have

sex with men’ (MSM). Finally, Harper and Hardy (2002) tested the use of MI

as a method to improve ‘effective practice with offenders who had a

drug/alcohol problem’ (p. 394). Sixteen probation ofﬁcers were trained in MI.

Probation ofﬁcers recruited offenders (n = 65) who they knew had drug and

alcohol problems. Offenders were administered the CRIME-PICS II (Frude et

al., 1994), before and after the MI training for ofﬁcers. The ﬁndings indicate

that offenders who were supervised by MI-trained ofﬁcers, demonstrated more

signiﬁcant attitudinal changes (measured by the CRIME-PICS) than offenders

not supervised by MI-trained ofﬁcers. While offenders in the control group also

demonstrated signiﬁcant changes, changes occurred across two scales, rather

than four scales (as they did for the intervention group). In addition, they found

a signiﬁcant decrease in the score for drinking and drugs on a probation inven-

tory, amongst offenders in the intervention group, which was not affected in the

control group. Although the application of MI has yet to be systematically used

and tested within the social work profession, it is clear by their participation in

MI training that social workers are increasingly interested in the intervention.

Additional rigorous research on the use of MI within various social work

settings could signiﬁcantly contribute to the growing body of literature on the

effectiveness of MI, particularly since social workers tend to bring unique and

empowerment-based approaches to multi-disciplinary practice settings.

While there has been and continues to be extensive speculation on why and

how MI works, researchers and practitioners, including Miller and Rollnick,

remain speculative about what exactly makes MI effective when it is effective

(Rollnick and Miller, 1995; Noonan and Moyers, 1997). Speculations about why

MI works have thus far revolved around constructs such as empathy, self-

efﬁcacy, cognitive dissonance, motivation, love, and change talk.

Social Work Codes of Ethics

While we do not yet know exactly why or how MI works when it does work

(Miller and Rollnick, 2002), MI researchers and practitioners alike claim that

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the therapeutic relationship is a key component to its efﬁcacy. Empathy, one of

the four basic MI principles, appears to have particular signiﬁcance for behavior

outcome measures (Miller et al., 1980). MI’s emphasis on, and valuing of, the

therapeutic relationship is consistent with the value social work places on

human relationships. The four basic MI principles (mentioned earlier) under-

score and support the value social work places on the dignity and worth of the

person (NASW, 1996) also supported by the Australian Association of Social

Workers, L’Association Nationale des Assistants de Service Social, and the

British Association of Social Workers, as well as the International Federation

of Social Workers.

Respect for Self-determination and Autonomy

MI’s client-centered approach to behavior change supports the social work

ethical standards of self-determination by allowing and encouraging clients to

set the agenda and pace for change. Although directive, the client-centered

nature of MI requires that practitioners respect and accept clients’ choices

regarding their behaviors; including the choice not to change.

Brief Intervention

Another beneﬁt (and interest) to social work practice is the ‘brief intervention’

model of MI. The literature on brief interventions supports both its cost-effec-

tiveness (Holder et al., 1991; Langenbucher, 1994) and effectiveness in addic-

tions treatment (Oliansky et al., 1997). Miller and Rollnick (1991) note that

research teams in numerous countries have found that brief interventions,

lasting one to three sessions, are ‘comparable in impact to more extensive treat-

ments for alcohol problems’ (p. 31). Similarly, the WHO Brief Intervention

Study Group (1996) concluded that brief interventions in alcohol treatment ‘are

remarkably robust and should generalize to a variety of different health care

settings and sociocultural groups’ (p. 954). While Dunn et al.(2001) note that

more research is needed to evaluate the cost-effectiveness of MI, the time-

limited nature of brief interventions, such as MI, holds the potential to respond

to client needs, demands for treatment, and agency resource limitations simul-

taneously. In a time where funding and budget cut-backs are the norm,

providers and third party payers are hungry for time- and resource-effective

interventions.

Diverse Populations

As social workers continue to reﬁne their attention to cross-cultural issues and

practice competencies, MI may prove to support those endeavors. Two studies

have tested the use of MI with minority populations and found positive results.

Resnicow et al. (2001) incorporated MI in their multi-component intervention

to increase fruit and vegetable consumption among African-Americans. At

baseline, 1011 participants were recruited from 14 different churches. Partici-

pants were randomly assigned to three treatment conditions, one of which

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included three counseling calls that were informed by MI. Their results showed

that fruit and vegetable intake was signiﬁcantly greater in the MI group than in

the comparison and self-help groups. Although the MI intervention was not

‘classic’ MI (Resnicow et al., 2001: 7), their ﬁndings provide cause to believe

that MI may hold potential to be effective with diverse racial and ethnic groups.

The second study, by Longshore and Grills (2000), tested MI in conjunction

with didactic counseling in a ‘culturally congruent’ setting (p. 1231), to promote

recovery from illegal drug use among African-Americans. Two hundred and

twenty-two drug users were randomly assigned to a control condition or a

‘culturally congruent’ setting where they received didactic counseling and MI.

Their ﬁndings showed that participants assigned to the intervention group

reported more favorable change in their motivation to seek help. In addition,

they were signiﬁcantly more involved in the experience, were more self-disclos-

ing, and participated more actively. Because MI was used in conjunction with

didactic counseling and a culturally congruent setting, it is difﬁcult to know

which elements facilitated the positive outcomes. Like the Resnicow et al.

(2001) project, this study provides social work practitioners and researchers

with questions and additional reason to consider the use of MI.

Example of the Use of Motivational Interviewing in a

Domestic Violence Context

As case examples for the use of MI in substance abuse settings are already

provided in the literature (for example, Hohman, 1998), what follows is a case

example of the use of MI within a domestic violence context. The following case

example takes place with an MI-trained counselor in a battered women’s

shelter. The skills utilized in this example represent some of the techniques

practiced in Phase I of MI (Miller and Rollnick, 2002).

Delores is a 36-year-old woman, originally from Ixtapa, Mexico. She

currently lives in Salt Lake City, Utah, with her husband. She has three children

with her husband; the children currently live with her parents in Mexico. She

entered a conﬁdential battered women’s shelter due to emotional and physical

violence she had been experiencing from her husband. She feared for her safety

as well as her life. The most recent incident of abuse occurred the day prior to

entering the shelter. Her husband beat her severely with a gun and left her for

dead. A neighbor heard her screams and called 911. By the time the police and

ambulance arrived, the husband was gone and Delores was unconscious. She

was taken to the hospital, treated and released 24 hours later. She did not want

to return home at that time. With the assistance of a hospital social worker she

gained entry into a conﬁdential battered women’s shelter.

Upon reviewing the intake notes of Delores’ initial interview prior to

entering the shelter, the counselor discovered that this was not the ﬁrst time

that Delores had been severely beaten by her husband. She had already been

sent to the emergency room three times within that same year due to her

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husband’s violence. She had left him on two prior occasions for extended visits

with friends and family in order to recover and attain safety for a short while.

She had never stayed in a battered women’s shelter in the past, nor had she ever

pressed charges against her husband. She feared deportation and did not want

to return to live in Mexico.

Social worker (SW): I’m glad to see you found your way to a safe place. I imagine

that you may have many mixed feelings about being here. Could I spend some

time exploring your situation with you? [Ask Permission. Wait for response.]

What incident brought you to the shelter? [Appreciation. Open-ended

question.]

Dolores (DE): Well, my husband hit me. I made him angry by disobeying him. I

didn’t have dinner ready on time. He had made plans with his friends to go out

and told me that dinner had to be ready by 5 p.m. I had been at the neighbor’s

house helping her with her children when I realized that it was 5:15 p.m. and I

hadn’t started dinner. I ran home and he was waiting for me when I ran in the

door. I could tell he was very upset.

SW: You were nervous about being late. What happened next? [Reﬂection. Open-

ended question. Explore.]

DE: He just came up to me and started hitting me and beating me. I fell to the

ground and was begging for him to stop. He pulled me by the hair across the

room and kicked me. I realized that the more I cried, the more he hit. I tried

not to make too much noise because I didn’t want him to get more angry and

I was afraid the police would come. I didn’t want them to take him to jail. I

think I blacked out because I don’t remember anything else. Next thing I knew

I was in the hospital. [She begins to cry.]

SW: Even though he was hurting you, you were worried and concerned about what

would happen to him. [Reﬂecting emotion.]

DE: Yes, I didn’t want him to get in trouble. I love him. The police don’t like

Mexicans in Utah and I was afraid that they would do something bad to him.

I was afraid for the both of us.

SW: It sounds like you were worried that things would be worse if the police inter-

vened. [Paraphrase.]

DE: Yes, I’m so glad that he didn’t get arrested. That would have been bad! I don’t

even know how long I will stay here. I just want my face and bruises to heal. I

want time to think, and I want him to cool off a bit. I’ll go back when I’m good

and ready.

The worker did not react to Delores’ comment about going back to her

husband. She continued to explore Delores’ history of abuse with her husband,

as well as the help that she had sought from friends and family through the

years. Delores never used the word abuse to refer to her husband’s violence.

Consequently, the worker mirrored her language and did not use words such

as violence or abuse when referring to what happened. The worker continued

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to explore Delores’ feelings about her husband, as well as her thoughts about

what she wants for herself.

SW: So, it sounds like even though your husband has hit you on numerous

occasions, you still have strong feelings for him. You love him. [Summarize.

Paraphrase. Reﬂect emotion.]

DE: He is a great man. It may not seem like it sometimes, but he loves me and is a

good friend. He is good to the children. We’ve been together a long time.

SW: You have a complicated history and despite the violence he has some qualities

that are important to you. [Pause.] You mentioned that once you heal and he

has time to cool off you are going to be ready to return to him. Tell me a little

bit about the advantages of going back to him. [Ampliﬁed reﬂection followed

by a paraphrase. Begin to explore ambivalence.]

DE: For starters, things will be really good for a while when I go back, they always

are for a while. Second, I won’t have to worry about how I’m going to send

money back to my parents for the kids. I’ll be able to see my friends, and I

won’t have to start from scratch like I would if I didn’t go back. Most of all, I

won’t have to worry about having to go back to Mexico right away.

SW: So when you return, a honeymoon phase, ﬁnancial security, your friends and

being able to stay in the US are the positive aspects of going back. What other

reasons? [Rephrase followed by an open-ended question.]

DE: No, I think that is about all.

SW: You have mentioned some of the advantages, what would you say are some of

the disadvantages to going back to your husband? [Explore ambivalence.]

DE: Well, I have one friend who will be very mad and she may not want to talk to

me if I go back to him. Also, chances are I will piss him off again at some point

and he might hit me. Next time it might even be worse. It seems to get worse

every time. I wouldn’t be surprised if he kills me one day.

SW: So, the concern for your safety and life are some of the negatives. [Ampliﬁed

reﬂection.] You have expressed important reasons to go back and important

reasons not to go back. [Summary reﬂection.]

DE: Yes, I think the positives outweigh the negatives. That may seem crazy to you,

but it makes sense to me.

SW: On the one hand, ﬁnancial, social, and immigration issues are taken care of if

you go back. On the other hand, if you go back, he may kill you someday.

[Double-sided reﬂection.] Right now you are willing to take the risk of losing

your life because the positives outweigh the negatives. [Ampliﬁed reﬂection.

Develop discrepancy.]

SW: Where does this leave you now? [Support self-determination. Develop discrep-

ancy. Elicit self-motivational statements.]

DE: I don’t know really? I guess I just need time to think.

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The worker does not press Delores to make a decision, nor does she suggest

that she not go back. Instead, she supports Delores’ expression of need for time

and allows her to sit with the positives and negatives of going back.

SW: This is a difﬁcult time for you. You love your husband and don’t want him to

get in trouble. You feel like there are advantages and disadvantages to going

back. Right now, you want time to think and heal before you decide what to

do next. Whatever you decide to do is your choice. I’m conﬁdent that you will

make the best choice for yourself. I believe that you are the expert on your life

and current situation. I/we will be here to support you in your process. [Express

empathy. Summarize. Support self-determination and choice. Express conﬁ-

dence and support.]

In the following session, instead of focusing on Delores’ expression of intent

to return to her husband, the worker explores, in more depth, what Delores

wants for herself and her family. She never gives advice or unsolicited feedback.

Instead, she uses a lot of reﬂective listening and summarizing to act as a mirror

for Delores. It is only if and when Delores feels safe, accepted and supported

for who she is, that she will be able to consider doing something different. Since

‘going back’ does not seem like a pressing issue for Delores, the worker asks

Delores what she would like to focus on and seek assistance for while she is in

the shelter. She allows Delores to set the plan for work and supports her

choices, without (positive or negative) judgment.

Central to the MI client-centered spirit and techniques is the consistent

emphasis on client autonomy and self-determination. The client has the

freedom and responsibility to contemplate and engage in change. When a client

is motivated and already engaged in behavior change, the MI practitioner

works to support and encourage the client’s commitment to change. When an

individual is motivated, conﬁdent and ready for change, a practitioner engages

MI Phase II techniques (Miller and Rollnick, 2002) that include working with

a menu of options, reﬂecting change talk, supporting self-efﬁcacy, negotiating

a change plan, and strengthening commitment.

Conclusion

In conclusion, the literature both within and outside the social work profession

suggests that MI may be an intervention worthy of additional social work atten-

tion and exploration. As the use of MI within the alcohol and drug addictions

ﬁelds has been widely tested, social workers may both strive to incorporate MI

in such practice settings, and add to the body of literature by using and testing

MI within other critical social work areas including but not limited to health,

domestic violence, batterer treatment, gambling, HIV prevention, dual

disorders, eating disorders, adolescents, the homeless, and child welfare.

The potential beneﬁts of incorporating MI in social work practice settings

that have been explored in this paper include its consistency with certain social

work values (client-centered, right to self-determination, respect for diversity

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and respect for the inherent worth of the individual) and ethics (importance of

human relationships, respect, and practice-based interventions), its brief inter-

vention structure, and the empirical support for its use with certain populations.

In addition, the fact that MI is already being used and tested in a number of

practice settings both across and within social work speak to its ﬂexibility and

practicality for social workers who work with individuals who present with

varying levels of motivation to change a variety of different behaviors. The

potential to utilize MI within multi-cultural settings is promising for social

work, as well as supporting our profession’s commitment to working with and

across difference with respect, sensitivity and efﬁciency. Finally, a search of the

Computer Retrieval of Information on Scientiﬁc Projects (CRISP) database

(http://crisp.cit.nih.gov) indicates that some 68 research projects using and

testing MI have received federal funding, a promising statistic for MI prac-

titioners and researchers.

Despite all the perceived beneﬁts to adopting MI in social work settings,

social workers may also encounter some challenge. Although MI trainers are

widely available in North America and Europe, agencies and organizations may

not always have the ﬁnancial resources to provide appropriate training and

supervision. In addition, because MI is much more than a set of skills and tech-

niques – rather, a way of being with individuals – practitioners and agencies

must be able and willing to embrace, live and support the MI spirit (Miller,

2000). Teaching and practicing with the MI spirit may be challenging for those

who do not embrace epistemologies that regard human beings as experts on

their own lives, entitled to self-determination, respect and acceptance. Finally,

although directive in its practice, MI counselors engage in minimal problem

solving, action planning and advice giving, activities that are often central to

social work practices and interventions. Learning to allow clients to make their

own choices, even in the face of their attachment to their potentially life-

threatening behaviors (substance use, violence, etc.), frequently proves

challenging for those who wish to help.

Note

1. See Noonan and Moyers (1997) for a review of the evidence supporting the efﬁcacy

of MI with problem drinkers.

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STÉPHANIE WAHAB, PHD has been an Assistant Professor at the University of

Utah’s College of Social Work since 2000. Her areas of specialization are

qualitative research, commercial sex work, motivational interviewing, diversity and

social justice, and domestic violence. Recent publications have appeared in Afﬁlia,

Journal of Sociology and Social Welfare, International Journal in Psychiatry in

Medicine, Cancer Control Journal (Cancer, Culture and Literacy Supplement),

Qualitative Inquiry and Qualitative Social Work. She has been a motivational

interviewing trainer since 1999 and belongs to the international Motivational

Interviewing Network of Trainers. Address: University of Utah, College of Social

Work, 395 S. 1500 E, Salt Lake City, Utah 84112–0260, USA.

[email: [email protected]]

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