Developing theory in motivational interviewing: academic and practitioner perspectives from MICBT integration

Motivational Interviewing (MI) and Cognitive Behaviour Therapy (CBT) are both evidence based psychosocial interventions. Motivational interviewing has not sought to develop its own comprehensive theory (Miller & Rollnick, 2012) although it has developed hypotheses on why MI works. This project has looks at what an integration of these two approaches can tell us about motivational interviewing’s theory, hypothesised mechanisms of action and efficacy. It has set out to examine and explore existing theory through qualitative research. This included Semi structured interviews with researchers and practitioners who are experts in the integration of MI and CBT (MICBT). Their views and existing literature were used develop understanding about MI efficacy. A critical realist philosophical framework and Theoretical Thematic analysis was used to explore and test MI theory. A number of themes around hypothesised mechanisms and MI theory emerged from both sets of participants. These included psychological safety, alliance, responding to resistance, acceptance, compassion and positive emotion. A relational rather than a technical practice was emphasised and the theory relating to that observed. Theory around Power, its negative and positive operation in people’s lives arose frequently; as did hypothesised mechanisms relating to power differentials and MI as a ‘power yielding’ approach. Building on insights from evolutionary theory, links were made to a more detailed consideration of the effects of social context on research, practice and the ability of individuals to make change. This project challenges a narrow-individualised approach to research and intervention, emphasising the need to take into account the effects of social inequality and individual social circumstances. The project has illustrated some of the reality of translating theory into real-world practice and suggests expanding MI theory so that it is more contextualised. The centrality of understanding power and power structures may be a useful addition to an understanding of why MI works. An increased awareness of social context and its impacts raise questions about how individual and societal level interventions could work together to improve health behaviour change. Finally, a number of suggestions for future research are made, including that individualised interventions need to be evaluated in real-world services, with direct consultation of and involvement of service users.