Motivational interviewing is a directive, client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship. This article seeks to define motivational interviewing and to characterize its essential nature, differentiating it from other approaches with which it may be confused. A brief update is also provided regarding (1) evidence for its efficacy and (2) new problem areas and populations to which it is being applied.

This paper aims to contribute to the discussion of the ethical issues in motivational interventions which have recently been raised by Miller (1994). Motivational interviewing is typically used when a therapist perceives a need for behaviour change in someone who is ambivalent about such change. Motivational interviewing aims to evoke motivation by making salient the inconsistency of continuing with a problem behaviour and other longer term or wider life goals. Miller (1994) discussed what was manipulative about this approach and considered both a descriptive and evaluative component. The ethics of motivational interviewing are considered here, within the context of psychological therapy in a general sense, and questions whether the ethical issues relevant to motivational interviewing are different from other psychological interventions. A distinction between the goals and the means of obtaining therapeutic goals is suggested as useful.

In an earlier edition of this journal (vol. 22, 111–123) William R. Miller persuasively defends his motivational interviewing approach (Miller, 1983) against the claim that it is “manipulative”, at least in the pejorative sense of that term. This critique of Miller's methods and his response to it is explored as a new manifestation of a longstanding conflict between (cognitive) behaviourism and psychoanalysis, a conflict that seems to lie at the very heart of psychological science, restricting the professional development of us all. It is argued that our own discipline could benefit from some form of motivational intervention to enable cognitive-behaviourists and psychodynamicists to communicate genuinely and more fully with each other. Some suggestions for steps in this direction are provided.

In two separate commentaries, Withers and Seager offer constructive critiques of “The Ethics of Motivational Intervention.” It is difficult to render ethical judgments regarding a method apart from the goals and contexts within which it is to be applied. A clearer and transtheoretical understanding of the mechanisms underlying the efficacy of motivational interviewing may better inform future discussions of these ethical concerns that pertain to psychotherapy more generally.

Frequent checkers with obsessive-compulsive disorder (OCD; n=24), high checking controls (n=24) and low checking controls (n=48) were instructed to learn action phrases such as “to open the book” by performing the action themselves with imaginary objects (motor encoding), by imagining how one performs the action oneself (motor-imaginal encoding), by imagining seeing somebody else performing the action (visual-imaginal encoding) and by subvocal rehearsal. Compared to low checking controls, OCD checkers showed poorer free recall of motorically encoded actions and poorer reality monitoring, i.e. they confused motor and motor-imaginal encoding more frequently. The results are consistent with a specific motor memory deficit in OCD checkers. Moreover, memory performance of OCD checkers differed from that of high checking controls.

This paper describes two interventions used to treat patients suffering with chronic depression. In the first (Study 1), a group of five sufferers from depression of more than one year's duration who had been unresponsive to, or declined drugs were given cognitive therapy for depression in a group format and followed up for a year afterwards. They were compared with a wait-list group with a similar natural history. The treatment group showed greater improvement than the wait list group and maintained most of their gains at follow-up. In the second (Study 2) four patients also suffering from chronic depression who scored highly on the Hollon Severity Index were treated in a cognitive therapy group over a more extended period (28 weeks) using the approach designed to treat personality disorder. Modest gains were made by some patients. The findings are discussed and suggestions for improvement are made.

The limited effectiveness of cognitive behavioural marital therapy (CBMT) for some couples may be due to a failure to achieve generalized changes in behavioural, cognitive or physiological responses during marital interaction. In the present study an intra-subject replication design across five maritally distressed couples assessed changes associated with CMBT in behaviour, cognitions, and physiological arousal during marital communication. These response domains were assessed weekly in both clinic and home settings. Introduction of CBMT was associated with clear reductions in behavioural negativity in both settings for all couples, some variable cognitive changes across couples and settings, but no consistent change in physiological arousal across couples or settings. Physiological responding was asynchronous with behaviour and cognition. Further research is needed on the significance of physiological arousal in marital distress, and the importance of changes in physiological responding during marital interaction to marital therapy outcome.

Recent research has revealed that relapse in manic depressive psychosis and schizophrenia is preceded by specific prodromal signs and symptoms that include dysphoria, other non-psychotic symptoms and features unique to individual patients. Treatment studies in schizophrenia have shown that early pharmacological intervention during a prodromal phase of psychotic relapse may be effective in the prevention of hospitalization. This paper describes the procedure of prodromal signs identification in manic depressive psychosis and the negotiation of an appropriate plan of action with the mental health services in order to abort the relapse or reduce its severity through early pharmacological intervention. A case example is presented to demonstrate this approach.