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Book Review   |    
Lisa R. Fortuna
Psychiatric Services 2008; doi:
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edited by Hal Arkowitz, Henny A. Westra, William R. Miller, and Stephen Rollnick; New York, Guilford Press, 2008, 354 pages, $38

Dr. Fortuna is the director of child and adolescent multicultural health research at the University of Massachusetts Medical School, Worcester.

Since the publication of Miller and Rollnick's classic on motivational interviewing, this technique has become hugely popular as a tool for facilitating positive change in substance abuse and more recently in psychological and health behaviors. Motivational interviewing addresses a significant problem common to all therapies: resistance to change. The primary goal is to help clients increase their intrinsic motivation and resolve ambivalence in order to facilitate behavioral change.

Motivational Interviewing in the Treatment of Psychological Problems is a practical guide, edited by the leading experts and developers of this technique. It clearly moves motivational interviewing beyond the original arena of substance abuse to application with patients with diverse psychological challenges and toward their improved self-management and engagement in treatment. This is one of a series of highly accessible volumes by Miller and Rollnick that review the empirical evidence base and present easy-to-implement strategies, illuminating concrete examples, and clear-cut guidance on integrating motivational interviewing with other psychological interventions.

This volume includes chapters on the application of motivational interviewing to the treatment of persons with anxiety disorders, combat veterans with posttraumatic stress disorder (PTSD), patients with obsessive-compulsive disorder who refuse treatment, and persons with eating disorders. Motivational interviewing can be applied to several other areas: as a way to treat pathological gambling disorder, as a prelude to psychotherapy of depression, as an integrative framework for the treatment of depression, and as a way to improve medication adherence among individuals with schizophrenia. It can also be applied to dually diagnosed patients and patients in the criminal justice system. Each chapter demonstrates the application of motivational interviewing in the context of diverse patient populations that have all been traditionally understood as a challenge to engage in treatment.

I approached the text as a researcher interested in integrating motivational interviewing in the treatment of adolescents dually diagnosed with PTSD and substance abuse, a population hard to engage and motivate. What I found was an excellent step-by-step guide to motivational interviewing rich in clinical vignettes and therapist-patient dialogues illustrating how to manage various clinical scenarios with skill and sensitivity. The chapters also succinctly review motivational interviewing research for each type of problem under consideration, and also highlight areas where more research is needed. I found the chapters thought-provoking in generating my own research questions and methods for testing the application of motivational interviewing for improving engagement and outcomes for my patients. The authors provide a clear message that there are fundamental components of motivational interviewing that make it what it is, but it is not totally a one-size-fits-all approach. For example, the chapter on the application of motivational interviewing to individuals with schizophrenia spectrum disorders highlights suggestions for modifications to address problems that more often occur among individuals with these disorders such as the presence of negative symptoms, cognitive impairment, and medication side effects. Therapists and researchers who are seeking a positive, respectful, and collaborative approach for helping diverse patients make positive change and for improving psychological interventions—this book is for you.




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