Motivational interviewing: An empirical-phenomenological study of the interpersonal process and client experience of a counseling style

Motivational Interviewing (MI) is an explicitly described, increasingly prevalent counseling style that has been shown, by the standards of quantitative outcome research, to be reliably followed by change in problematic behavior. However, a clear and convincing theoretical account as to why MI is effective, and an empirically grounded functional account of how MI exerts its effects, have yet to be articulated. This study undertook a systematic, qualitative investigation of the interpersonal process and client experience of MI. Three subjects, who received a protocol-guided adaptation of MI in a randomized controlled trial of HIV risk reduction among men who have sex with men, provided informed consent to participate. An audiotape recording of their MI session was played for subjects by an interviewer, who employed an empathic-reflective style of inquiry to help them articulate their experience of the session. The combined transcripts of the MI session and research interview were analyzed according to principles consistent with an empirical-phenomenological method, producing narrative structures of the process and content of each session, which were synthesized into a general structure of the MI session. The results of these analyses allowed for identification of essential constituents of "good" motivational interviewing and meaningful deviations from good practice, as well as essential constituents of clients' experience of MI. Establishment of psychological safety was revealed as foundational, articulation of clients' central dilemma was revealed as transformative, and feedback was revealed as supplemental and of ambiguous impact. Clients experienced a sense of healing validation, a broadening of perspectives to include appropriation of that which had been lived but not known, and enhanced self-acceptance associated with a greater sense of potential for change in the central dilemma. These results were elaborated upon and brought into dialogue with the elements of MI praxis as described by its developers, the theoretical frameworks offered by them to account for its effects, and relevant accounts in the empirical-phenomenological literature. The place of human freedom in these accounts and in understanding the nature and value of MI was emphasized, and limitations of the study as well as suggestions for future research were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)