Meeting in the middle: motivational interviewing and self-determination theory
- PDF / 99,252 Bytes
- 2 Pages / 595.28 x 793.7 pts Page_size
- 58 Downloads / 215 Views
COMMENTARY
Open Access
Meeting in the middle: motivational interviewing and self-determination theory William R Miller1 and Stephen Rollnick2* Motivational interviewing (MI) is indeed a “bottom-up” model that emerged from practical experience in the field of alcohol treatment. The original description of MI [1] suggested some links to social psychological theories, but focused on an intuitive approach in treating alcohol problems for which there was at the time no empirical support. Our subsequent volumes [2,3] have similarly focused on clinical applications without proposing an underlying theory of treatment or change. In part this reflects our own temperaments, preferring intuitive to rational-deductive ways of knowing [4,5], with a focus on the “real” world of clinical practice. We are “bottom-up” people. Much of what we have done in our careers has sprung from efforts to deal with practical problems that clinicians encounter in their daily work [6]. The world of academia, in contrast, tends to place a high premium on starting from coherent theory and rationally deriving hypotheses that will be tested to either confirm or revise the theory. This has simply never been a forte or primary scientific interest for either of us, to the dismay of some of our mentors and colleagues. We have preferred instead to move between the context of discovery and the context of justification [7] - deriving intuitive hypotheses from clinical experience, submitting them to the verification of scientific method, and then going back to the drawing board to try again. Over time, this approach may lead to the development of a higherorder theory as a byproduct [8]. The rigor of scientific method is equally important in both approaches. They differ in the source of hypotheses: intuitive experience versus rational deduction from a pre-existing theory. Both approaches have value and a long tradition in the history of science. Whether either one is in some sense superior to the other is a value judgment that we do not wish to make. The history of MI, however, does suggest potential value in beginning from clinical intuition. A large * Correspondence: [email protected] 2 School of Medicine, Cardiff University, Wales, UK Full list of author information is available at the end of the article
evidence base comprising more than 200 randomized clinical trials has emerged, showing positive effects (albeit inconsistent) across many health problem areas. Well before this evidence base accumulated, however, MI disseminated readily and rapidly by word of mouth among clinicians, who are drawn to it not just from the clinical trials but because, for the lack of a better term, they seem to “recognize” it. It feels intuitively sound based on their own experience. This kind of practice-based evidence is also important, and needs to be compared, tested and refined with clinical trials. Hall [9] suggested a similar two-way street in psychotherapy research with cultural minorities. Evidence-based treatments are worth trying in populations where they have not
Data Loading...
