Incoherences in motivational interviewing practice

Abstract

The interest, training and practice of motivational interviewing in the field of addictions have experienced a spectacular development in recent decades. This impulse, undoubtedly positive, coexists, nevertheless, with some concepts which are inconsistent. On the one hand, with  the vision of addictive behaviours as irrational or pathological (more or less in line with the Brain Disease Model of Addiction); on the other, with the vision of motivation as an internal state of cognitive nature that precedes action and is strongly linked to the popular model of Stages of Change. Faced with this approach, the strategy of validation, as the central and defining element of the motivational interview, requires assuming the rationality of the addictive behaviour and the resistance to its abandonment, as well as the contextual and non-internalism nature of the willingness to change.

In particular, the Stages of Change model is questioned and a vision of attitudes towards change is defended not as prior or causal to the action but as a result of the relation between actions and its results, highlighting its implications for clinical practice.