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Eight Stages in Learning Motivational Interviewing

William R. Miller a; Theresa B. Moyers a
a
University of New Mexico, Albuquerque, NM

Online Publication Date: 25 April 2007

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 RESEARCH ARTICLES

Eight Stages in Learning Motivational

Interviewing
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William R. Miller, PhD

Theresa B. Moyers, PhD

ABSTRACT. Motivational interviewing (MI) is a clinical method for

helping people to resolve ambivalence about change by evoking intrin-
sic motivation and commitment. Based on our research and experience
in providing training on MI, practitioners acquire expertise in this
method through a sequence of eight stages: (1) openness to collaboration
with clients’ own expertise, (2) proficiency in client-centered counsel-
ing, including accurate empathy, (3) recognition of key aspects of client
speech that guide the practice of MI, (4) eliciting and strengthening cli-
ent change talk, (5) rolling with resistance, (6) negotiating change plans,
(7) consolidating client commitment, and (8) switching flexibly between
MI and other intervention styles. These key skills are acquired roughly

William R. Miller and Theresa B. Moyers are affiliated with the University of New
Mexico, Albuquerque, NM.
Address correspondence to: Theresa B. Moyers, Department of Psychology (MSC03-
2220), University of New Mexico, Albuquerque, NM 87131-0001 (E-mail: tmoyers@
unm.edu).
Preparation of this article was supported in part by grants K05-AA00133 and R01-
AA13696 from the National Institute on Alcohol Abuse and Alcoholism, and DAMD
17-01-1-0681 from the U.S. Department of the Army.
Journal of Teaching in the Addictions, Vol. 5(1) 2006
Available online at http://jtadd.haworthpress.com
© 2006 by The Haworth Press, Inc. All rights reserved.
doi:10.1300/J188v05n01_02 3
 4 JOURNAL OF TEACHING IN THE ADDICTIONS

in order, with earlier steps representing logical prerequisites for later

stages of skill acquisition. doi:10.1300/J188v05n01_02 [Article copies
available for a fee from The Haworth Document Delivery Service: 1-800-
HAWORTH. E-mail address: <[email protected]> Website:
<http://www.HaworthPress.com> © 2006 by The Haworth Press, Inc. All rights
reserved.]

KEYWORDS. Motivational interviewing, client-centered therapy, coun-

selor training, client commitment
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Motivational interviewing (MI) is a client-centered, yet goal-directed

counseling method for helping people to resolve ambivalence about
health behavior change by building intrinsic motivation and strengthen-
ing commitment (Miller & Rollnick, 2002). More than 80 randomized
clinical trials of MI have been published, generally supporting its effi-
cacy in promoting health behavior change, particularly reduction in al-
cohol and other drug use (Burke, Arkowitz, & Menchola, 2003; Dunn,
Deroo, & Rivara, 2001; Hettema, Steele, & Miller, in press; Miller,
2004). Adoption of this clinical approach has been increasing, with the
number of publications on MI doubling every 2-3 years over the past
two decades. Despite its widespread dissemination, relatively little is
known about optimal strategies for teaching and supervising this com-
plex clinical method. Are there particular learning stages or methods
that facilitate competence in MI?
Miller and Mount (2001) found that a familiar method of continuing
professional education–a 2-day clinical workshop–did not significantly
increase counselors’ proficiency in MI. Comparing audiotaped samples
of trainees’ counseling sessions before and after training, they observed
some statistically significant increases in MI-consistent behaviors, but
not large enough to make a difference in clients’ outcomes. The coun-
selors’ basic style, which often included methods antithetical to MI,
remained unchanged, as did their clients’ responses.
This led us to explore other approaches for helping practitioners learn
the clinical style of MI. We revised our training approach to place em-
phasis on the underlying assumptions and spirit of MI (Miller & Rollnick,
2002; Rollnick & Miller, 1995) and focused on how to learn MI from
one’s clients, rather than assuming that skills would be acquired during
the workshop. An evaluation of this revised learning-to-learn approach
showed much better acquisition of MI expertise after a 2-day practi-
tioner workshop, with practice proficiency maintained or increasing
over the year after training. Audiotaped samples of trainees’ substance
 William R. Miller and Theresa B. Moyers 5

abuse counseling sessions also showed substantial changes in clients’

responses during treatment, a pattern predictive of long-term behavior
change (Amrhein, Miller, Yahne, Palmer, & Fulcher, 2003). Individual
coaching and/or performance feedback further improved clinicians’ skill-
fulness in MI (Miller, Yahne, Moyers, Martinez, & Pirritano, 2004).
In the course of revising our training approach, we clarified a set of
eight logical steps required to develop expertise in the clinical method
of MI. These also represent eight points at which counselors get stuck in
learning MI. Each of these skills is a prerequisite to acquiring the next.
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In this way, these eight stages of proficiency can be used to structure the
course of training for MI and the evaluation of interviewer expertise.
They provide guidelines for assessing each trainee’s current level of
skill development and determining the next steps on which to focus fur-
ther training and supervision. This article provides the first description
of these eight hypothesized stages of skill acquisition.

STAGE 1:
THE SPIRIT OF MOTIVATIONAL INTERVIEWING

Miller and Rollnick have described an underlying spirit that epitomizes

the clinical method of MI, characterizing it as a clinical approach that
is collaborative, evocative, and respectful of client autonomy (Miller &
Rollnick, 2002; Rollnick & Miller, 1995). At a deeper level, it shares
with client-centered counseling (Rogers, 1980) and positive psychol-
ogy (Snyder & Lopez, 2002) a set of assumptions about human nature:
that people possess substantial personal expertise and wisdom regarding
themselves and tend to develop in a positive direction if given proper
conditions of support. Our own process research indicates that the thera-
pist’s ability to convey this spirit is a powerful predictor of using other
behaviors central to MI as well as a predictor of increased client respon-
siveness during MI sessions (Moyers, Miller, & Hendrickson, in press).
We do not regard attainment or even endorsement of this underlying
spirit to be a prerequisite for the beginning MI therapist. Indeed, we
have found that this spirit is less a precondition than a result of practic-
ing MI. What does seem to be important as a starting point in learning
MI is an openness to this way of thinking about clients and consultation,
at least a willing suspension of disbelief and active curiosity about the
client’s perspective. We have found that the extent to which therapists
practice such a perspective is a good indicator of how readily they will
acquire expertise when learning MI.
 6 JOURNAL OF TEACHING IN THE ADDICTIONS

This point is best illustrated, perhaps, by the difficulty of learning or

practicing MI if one is guided by conceptually opposite assumptions.
When clients are viewed primarily from a deficit perspective (e.g., be-
ing in denial; lacking insight, knowledge, and skills), it makes little sense
to spend time eliciting their own wisdom. Instead, the counselor would
be inclined to confront denial, explain reality, provide information, and
teach skills. Within this perspective, consultation is clinician-centered,
and it revolves around the counselor providing what the client lacks:
“I have what you need.” It can be quite a cognitive jump from this expert
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stance to MI, wherein the counselor instead communicates a respect for

the client’s own perspectives and autonomy. The MI counselor seeks to
evoke the client’s own motivations for change (“You have what you
need”) rather than installing them. A willingness to entertain this client-
centered perspective is a starting point in learning MI.

STAGE 2:
OARS–CLIENT-CENTERED COUNSELING SKILLS

The second stage of skill development is not unique to MI. It involves

acquiring proficiency in the use of classic client-centered counseling
skills (Egan, 2002; Truax & Carkhuff, 1967). Particularly crucial, we
believe, is the skill of accurate empathy, which is sometimes misunder-
stood or caricatured as simply repeating what clients say. In fact, accu-
rate empathy is quite a complex clinical skill that can be continually
strengthened and deepened across decades of practice. Skillful em-
pathic listening includes accurate reflection of what a client has said as
well as what the client is experiencing but has not yet verbalized (Truax &
Carkhuff, 1967). Furthermore, reflections can promote any of the foun-
dational principles of MI. For example, a single reflection might not
only express empathy but also serve the purpose of enhancing client
confidence for change or pointing out a discrepancy that increases the
felt need for change. Ideally, clients surprise themselves by things they
say and think when counselor reflections are accurate and complex.
Along with reflective listening, three other counseling micro-skills
are particularly emphasized in MI, using the mnemonic acronym OARS:
asking open questions (O), affirming (A), reflecting (R), and summariz-
ing (S). These skills in client-centered counseling form a foundation for
the next steps in MI (Miller & Rollnick, 2002).
 William R. Miller and Theresa B. Moyers 7

STAGE 3:
RECOGNIZING AND REINFORCING CHANGE TALK

MI departs from client-centered counseling in being consciously and

strategically goal-directed. Originally developed to help people change
addictive behaviors (Miller, 1983; Miller & Rollnick, 1991) MI is di-
rected toward particular behavior change goals. A key process is to help
clients resolve ambivalence by evoking their own intrinsic motivations
for change. When MI is done well, therefore, it is the client rather than
the counselor who voices the arguments for change. Particular attention
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is given to client “change talk,” verbalizations that signal desire, ability,

reasons, need, or commitment to change (Amrhein et al., 2003; Miller &
Rollnick, 2002). From an operant perspective, the MI counselor re-
sponds to client speech in a way that differentially reinforces change
talk and minimizes verbal commitment to status quo while minimizing
resistance that may block the opportunity for change talk to occur. The
first two decades of MI research have generated reasonable support for
attending to client language as a mediator of client outcome. With ran-
dom assignment to treatment approaches, MI substantially increases
change talk and reduces resistance, relative to other approaches (Miller,
Benefield, & Tonigan, 1993), a finding consistent with prior psychother-
apy process findings (Patterson & Forgatch, 1985). The level of client
resistance during an MI session, in turn, is inversely related to subsequent
behavior change (Miller Benefield, & Tonigan, 1993). More recently,
psycholinguistic analyses of MI session transcripts have emphasized
the importance of client change talk and its relationship to behavior
change (Amrhein et al., 2003). Amrhein differentiated motivational
speech into natural language components of desire, ability, reasons, need,
and commitment to change. Of these five forms of self-motivational
speech, only one predicted behavior change. Abstinence from illicit drugs
was predicted by the strength of client commitment language during a
single MI session. More specifically, client abstinence was predicted by
a pattern of increasing strength of commitment to abstinence across the
course of the MI session. This converges with cognitive psychology
findings that the verbalization of specific implementation intentions
predicts subsequent behavior change (Chiasson, Park, & Schwarz, 2001;
Gollwitzer, 1999).
However, the remaining four categories were not irrelevant. All four
of them (desire, ability, reasons, and need) predicted the emergence of
commitment language which, in turn, presaged behavior change (Amrhein
et al., 2003). In other words, clients who will eventually be successful in
 8 JOURNAL OF TEACHING IN THE ADDICTIONS

changing their behavior first speak about their desire to change, need for
change, their ability and/or reasons to change. This change talk is asso-
ciated with an increasing strength of commitment language. Amrhein’s
data suggest that behavior change occurs if and only if change talk (de-
sire, ability, reasons, need) is followed by expressed commitment.
This empirically derived pattern of natural language during MI ses-
sions converges with the original conceptualization of MI as occurring
in two phases (Miller & Rollnick, 1991): in Phase 1, the counselor fo-
cuses on enhancing motivation for change by evoking the client’s own
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intrinsic motives (e.g., desire, ability, reasons, need); then in Phase 2, the
counselor shifts to strengthen and consolidate commitment to change. All
of this indicates a need for the MI counselor to be able to accurately
identify and differentiate change talk as it naturally occurs in the context
of the client’s ambivalence. If unable to recognize change talk when it
occurs, the counselor cannot reinforce and shape it toward commitment.
Similarly, without being able to recognize commitment language and
differentiate it from change talk, the counselor is missing key cues of
readiness for change.

STAGE 4:
ELICITING AND STRENGTHENING CHANGE TALK

Once able to recognize change talk, the counselor is then in a position

to learn how to elicit and reinforce it. This intentional effort to elicit cli-
ent change talk, rather than simply waiting for it to occur, is a strategic
skill that differentiates MI from other therapeutic approaches. It is our
experience that counselors first learn to recognize and reinforce natu-
rally occurring change talk, and then develop skill in eliciting it.
Miller and Rollnick (1991, 2002) described a variety of strategies for
evoking client change talk, and for responding in a way that strengthens
it once it has been elicited. For example, the MI counselor asks open
questions the answer to which is change talk (e.g., “In what ways might
this change be a good thing?”), and is cautious with questions the an-
swer to which is resistance (e.g., “Why haven’t you changed?”). When
change talk occurs, the counselor may reflect it, affirm it, or ask for elabo-
ration or examples–all of which are likely to elicit more change talk.
Knowing how and when to ask such questions so that change talk will
occur requires complex decisions and purposiveness on the part of the
counselor. In our process research with MI, we have been unable to
code reliably the counselor responses that would evoke change talk.
 William R. Miller and Theresa B. Moyers 9

There are many different ways to do it and the crucial (but unobserv-
able) characteristic is the therapist’s intent, making it particularly diffi-
cult for raters to reach a consensus about observable behavior. What can
be coded reliably, however, is the occurrence (pattern, strength) of cli-
ent change talk, and that becomes the clinical criterion for whether the
counselor is “doing it right.” In essence, once the counselor can recognize
change talk and commitment language, the client’s language shapes the
therapist’s behavior, and becomes a principal source of immediate per-
formance feedback in increasing MI skillfulness. With attention to cli-
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ent language, MI counselors have a proximal indicator of their success

in practicing this method, as well as an empirical predictor of subse-
quent client change (Amrhein et al., 2003).

STAGE 5:
ROLLING WITH RESISTANCE

It is one thing to evoke and reinforce change talk, but how does one
respond when resistance emerges? Miller and Rollnick described the
MI response as “rolling with” resistance rather than opposing it. Direct
refutation of clients’ arguments against change tends to reinforce them.
In this case, the counselor and client are acting out the client’s internal
ambivalence, with the counselor taking the pro-change side and the cli-
ent arguing against change. This is counter-therapeutic, in that client
verbalization of counter-change arguments (“resistance”) decreases the
likelihood of behavior change. Here is a point of departure of MI from
forms of cognitive therapy that rely upon verbal refutation of clients’
“irrational” beliefs.
Various strategies have been described as MI-consistent ways for
rolling with resistance (Miller & Rollnick, 2002). Most common of
these are simple, amplified, or double-sided reflection of the client’s
resistance.
Client: Well, I overdo it sometimes, but I don’t have a problem
with drinking.
Simple reflection: You don’t think of yourself as a problem drinker.
Amplified reflection: Your drinking has never really caused any
problems or unpleasant effects in your life.
Double-sided reflection: You think you drink too much at times,
and also you don’t think of yourself as a problem drinker.
 10 JOURNAL OF TEACHING IN THE ADDICTIONS

Other strategies include emphasizing the client’s personal choice and

control, reframing, and joining with the resistance (“coming alongside”).
Some strategies may involve introspection on the part of the therapist
regarding the meaning of client resistance and the consequences if it is
not confronted directly (Moyers & Yahne, 1998). In essence, the key is
not to oppose, and thereby inadvertently reinforce resistance. Learning
how to avoid provoking resistance and how to defuse and diffuse it
when it occurs is a fifth stage in the acquisition of MI proficiency.
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STAGE 6:
DEVELOPING A CHANGE PLAN

As Phase 1 of MI proceeds, most clients verbalize progressively

stronger statements of their desire, ability, reasons, and need for change,
which in turn increases the likelihood that commitment language will
emerge (Amrhein et al., 2003). Miller and Rollnick described therapeu-
tic skillfulness in timing, in knowing when to move on to the develop-
ment of a change plan. The usual procedure is to offer a transitional
summary of change talk (desire, ability, reasons, need) that the client
has offered for making a change, and then to ask a key open question,
the essence of which is “What next?” If the counselor times this cor-
rectly, the client proceeds to discuss how (not just why) change will oc-
cur. If the transition has been attempted prematurely, the client signals
with resistance and the counselor returns to Phase 1 strategies to further
enhance motivation for change.
Part of the skill here, then, is knowing when to attempt the transition
from Phase 1 to Phase 2. Once a client is ready to discuss change, it can
be counter-productive to continue exploring motivation for change. It is
now time to be curious about how the client envisions change happen-
ing, and what unique contributions the client can make to that change. A
key component of Stage 6 skill is proficiency in developing a specific
change plan (not necessarily treatment plan) without evoking resis-
tance. Clients often need some time to prepare for change without com-
mitting to it (Prochaska, 1994). There is a temptation for the counselor
to take over the process at this point, but in MI one maintains a client-
centered focus. It is the client who decides what is needed, and when
and how to proceed. The counselor, of course, does offer expertise at
this stage when asked, or with the client’s permission. It is worth noting,
though, that a successful change plan may emerge with very little sub-
stantive input from the counselor.
 William R. Miller and Theresa B. Moyers 11

STAGE 7:
CONSOLIDATING CLIENT COMMITMENT

Once a change plan has been developed, a crucial step remains,

which is for the client to commit to it. Amrhein’s psycholinguistic find-
ings (Amrhein et al., 2003) as well as studies of verbalized implementa-
tion intentions indicate that behavior change is unlikely to occur unless
and until the client expresses commitment to change. This is not a reason
to push immediately for commitment, because doing so prematurely
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can undermine behavior change. It is unlikely that having a client chant,

“I will change, I will change” would make much difference. In one
clinical trial, we apparently undermined change in ambivalent clients by
pressing too soon for a change plan (Amrhein et al., 2003; Miller, Yahne,
& Tonigan, 2003). Skills for Stage 7 are very much like those of Stage 4
in that the counselor is listening and pulling for a specific pattern of
speech from the client. This time, however, the specific type of speech
is not change talk but commitment language, a naturally occurring set
of speech acts that are present when, for example, people enter into a
verbal agreement (“I will . . .”). Public commitment language is re-
quired when witnesses taking the stand during a trial are asked if they
will tell the truth, the whole truth, and nothing but the truth. Similarly,
when exchanging wedding vows a bride and groom ideally respond
with commitment language (“I do”) rather than just change talk (“I hope
so,” “I could,” “I have good reason to,” or “I need to”). It this type of
emphatic language implying a decision or contract that we call commit-
ment language and attempt to strengthen once a plan has been made.
Learning to consolidate commitment language in the service of a spe-
cific change plan is a seventh stage of developing clinical skillfulness
in MI.

STAGE 8:
SWITCHING BETWEEN MI
AND OTHER COUNSELING METHODS

Finally, MI was never meant to be the only tool in a clinician’s reper-

toire. It was developed primarily to help clients through motivational
obstacles to change. Within the language of the transtheoretical stages
of change (Prochaska & DiClemente, 1984), MI was originally concep-
tualized for helping people move from precontemplation and contem-
plation, through preparation and on to action. Clients who are truly
 12 JOURNAL OF TEACHING IN THE ADDICTIONS

ready for action when they present for treatment are unlikely to need
MI. Indeed, it can be frustrating or countertherapeutic for a client who is
ready for change to meet with a counselor whose focus is on contem-
plating change (Waldron, Miller, & Tonigan, 2001). This can be as much
a mismatch as the ambivalent client whose therapist is pressing for im-
mediate action.
There appears to be a synergistic effect when MI is joined to other
evidence-based counseling methods (Burke, Arkowitz, & Menchola,
2003). For example, clients randomly assigned to receive MI at the out-
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set of treatment have shown significantly better retention in substance

abuse and dual diagnosis treatment and a doubling of abstinence rates
after outpatient- (Aubrey, 1998; Bien, Miller, & Boroughs, 1993) or
inpatient-treatment (Brown & Miller, 1993). The synergistic effects of
adding MI to other treatment also seem to endure for at least a year after
treatment (Hettema et al., in press).
When MI is done successfully, an initially ambivalent client ad-
vances in motivational readiness, develops a change plan, and commits
to it. At this point, if treatment is to continue, the counselor would nor-
mally shift to a style that facilitates action (Miller, 2004). This, too, can
be a challenge. We have observed therapists who provide highly com-
petent MI while the client is preparing for change, but then have diffi-
culty shifting into a more directive and action-oriented style. Some
counselors who are successful using MI come to view it as the only ther-
apeutic method needed, a view that we do not share. The eighth stage of
learning MI involves knowing how to combine it flexibly with other
methods or even put it away entirely to use another approach.
This is not to say that one must discontinue the collaborative, em-
pathic, respectful counseling style of MI in order to deliver an interven-
tion such as cognitive-behavior therapy or twelve-step facilitation. In an
ongoing multisite clinical trial, MI has been used as the underlying
counseling style throughout a largely cognitive-behavioral outpatient
treatment program (Miller, 2004). An empathic counseling style rich in
reflective listening has been found to differentiate highly effective from
less effective substance abuse counselors delivering traditional (Valle,
1981) or behavioral treatment (Miller & Baca, 1983; Miller, Taylor, &
West, 1980), whereas an authoritarian confrontive counseling approach
is strongly linked to poorer treatment outcomes (Miller Benefield, &
Tonigan, 1993; Miller & Wilbourne, 2002; Najavits & Weiss, 1994). The
client-centered style of MI may therefore be a good foundation for other
interventions.
 William R. Miller and Theresa B. Moyers 13

Nevertheless, the delivery of other substance abuse treatment meth-

ods generally involves a shift in style from pure MI. Within Project
MATCH, a multisite trial of treatments for alcohol dependence, the
therapeutic style of MI was highly discriminable from that of cognitive-
behavioral or twelve-step facilitation therapies (Carroll et al., 1998). In
order to deliver other evidence-supported interventions such as the com-
munity reinforcement approach (Meyers & Smith, 1995), social skills
training (Monti, Abrams, Kadden, & Cooney, 1989), or twelve-step
facilitation (Nowinski, Baker, & Carroll, 1992), one necessarily moves
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beyond MI. Furthermore, as every clinician knows, motivational obsta-

cles often continue to arise in the course of cognitive-behavioral, twelve-
step, or any other treatment approach. Client ambivalence or resistance
can serve as a signal to switch back into an MI style until the obstacle is
resolved and counseling can move forward again. Thus, effective prac-
tice may be facilitated by flexible shifting between clinical styles.

DISCUSSION

MI is an evidence-based and theory-grounded method of psychother-

apy that overlaps significantly with client-centered counseling. It is not
a behavior therapy in the usual sense. It involves no behavioral skill
training, no shaping of successive approximations of behavioral re-
sponse, no systematic desensitization or counterconditioning. It does
overlap with radical behaviorism, however, in the conscious use of op-
erant principles applied to speech, and in its strong emphasis on accep-
tance and commitment as interpersonal transactions (Hayes, Jacobson,
Follette, & Dougher, 1994). MI also shares with behavior therapy an
historical grounding in testable theory and a commitment to empirically
supported intervention approaches. MI has received reasonable empiri-
cal support both from efficacy trials and from process research testing
its hypothesized mechanisms of action. There is also sound evidence
that clinicians can develop strong proficiency in MI through combina-
tions of training experiences (Miller et al., 2004; Moyers et al., in press).
Although our proposed developmental sequence of MI skills is logical,
it arises from our experience in teaching MI, and remains to be validated
empirically. It would be useful to develop reliable measures of each of
the eight skills, and to demonstrate that they can be differentiated among
clinicians in training. For some of the skills (e.g., accurate empathy)
there are already well-developed and tested measures. Others, such as eli-
citing change talk, have proved elusive when defined in terms of coun-
 14 JOURNAL OF TEACHING IN THE ADDICTIONS

selor behaviors, and thus far can only be inferred from their impact on
client speech. For still others, there has been very little progress toward
skill-specific measures.
Also testable is our assertion that the eight skills emerge in a manner
that approximates a Guttman scale wherein each step is a prerequisite
for the next, so that achievement of expertise in a specific stage of skills
is dependent upon the establishment of at least reasonable proficiency
in all of the skills that precede it within the model. For some pairs this
seems highly likely. For example, it would be difficult to evoke and re-
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spond differentially to change talk (Stage 4) unless one can first recog-
nize change talk and differentiate it from other client responses (Stage
3). Similarly, one must first develop reasonable proficiency in reflective
listening (Stage 2) before being able to use reflections directively as dif-
ferential reinforcement (Stage 4). On the other hand, the recognition of
change talk (stage 3) does not logically require prior proficiency in client-
centered counseling. Indeed, we have trained student coders to reliably
recognize and categorize the occurrence of change talk from MI session
tape recordings, without first teaching them clinical skillfulness in cli-
ent-centered methods. Similarly, it may be possible to learn how to roll
with resistance (Stage 5) based primarily on client-centered counseling
skills (Stage 2) before developing skill in eliciting change talk (Stage 4).
If these stages of learning MI can be empirically supported, it would
be useful to know what counselor characteristics might be associated
with ease of learning for each of them. Are there particular experiences
or attributes of counselors that make reflective listening easier or harder
to acquire? Is there an ideal learning trajectory for these stages? Can we
identify predictable detours or trouble spots for counselors and perhaps
methods for overcoming them to facilitate efficiency in training? An-
swering these and similar questions could clarify the processes of ac-
quiring therapeutic expertise in motivational interviewing, and perhaps
have more general applications in the training of counselors.

REFERENCES

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commitment language during motivational interviewing predicts drug use out-
comes. Journal of Consulting and Clinical Psychology, 71, 862-878.
Aubrey, L. L. (1998). Motivational interviewing with adolescents presenting for out-
patient substance abuse treatment. Unpublished Doctoral dissertation, University
of New Mexico, Albuquerque.
 William R. Miller and Theresa B. Moyers 15

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