What is the history of Motivational Interviewing (MI)?

History of Motivational Interviewing

Motivational Interviewing (MI) was developed in the early 1980s, with its first formal description published in 1983, initially as a method to treat alcohol addiction before evolving into a widely-used patient-centered counseling approach across multiple healthcare disciplines. 1

Origins and Early Development

• MI emerged from happenstance beginnings in the treatment of substance use disorders, representing an evolution of Carl Rogers's person-centered counseling approach 2, 1
• The foundational description was published in Behavioural and Cognitive Psychotherapy in 1983, marking the formal introduction of this counseling method 1
• Originally developed to treat alcohol abuse and addictions, MI was designed to manage resistance and increase readiness to change in patients experiencing defensiveness, ambivalence, guilt, and shame 3, 4

Theoretical Foundation

• MI built upon Rogers's person-centered therapeutic principles while adding a more directive element to enhance intrinsic motivation for behavior change 5, 2
• The approach was conceptualized as a method to help clients explore and resolve ambivalence about behavior change by examining discrepancies between current behaviors and broader life goals and values 5, 6
• The theoretical framework emphasizes patient autonomy support while providing guidance about potential mechanisms of change, distinguishing it from purely non-directive counseling 7, 8

Evolution and Expansion

• From its origins in addiction treatment, MI rapidly expanded to diverse healthcare settings including primary care, public health, pediatrics, and dental care 3, 5
• By 2005, MI had demonstrated efficacy across a range of target problems, with a meta-analysis of 72 clinical trials showing an average short-term between-group effect size of 0.77 2
• The method gained particular traction in adolescent health, with increasing evidence by 2014 showing effectiveness for contraceptive counseling and sexual health topics using this patient-centered approach 3

Formalization of Core Components

• The "MI Spirit" was formalized as the foundational attitude consisting of collaboration, evocation, and respect for client autonomy 4, 6
• Core clinical strategies were systematized, including reflective listening, eliciting change talk, rolling with resistance, and developing discrepancy 3, 6
• The OARS framework (Open-ended questions, Affirmations, Reflections, and Summaries) emerged as the structural foundation for MI conversations 4, 7

Contemporary Applications and Adaptations

• MI is now practiced in many professions, nations, and languages, with efficacy documented in hundreds of controlled clinical trials 1
• Technology-delivered adaptations of MI (TAMIs) have been developed since the 1990s to increase accessibility, with 34 studies by 2022 demonstrating feasibility across text messaging, web-based platforms, and mobile applications 3, 7
• The most common contemporary use is in combination with other treatment methods such as cognitive behavioral therapies, with MI offering an evidence-based therapeutic style for delivering other treatments more effectively 1

Evidence Base Development

• Extensive process research has elucidated why and how MI works, with parallels identified between MI core processes and characteristics distinguishing more effective therapists across 70 years of psychotherapy research 1
• Brief MI sessions of less than 20 minutes have demonstrated efficacy, making the approach feasible for busy clinical settings 4
• MI by primary care physicians appears somewhat more successful than by counselors, though both delivery methods are effective 4