Motivational Interviewing (MI) is a directive, patient-centred counselling style that aims to help patients explore and resolve their ambivalence about behaviour change. It combines elements of style, such as warmth and empathy, with technique, for instance, focused reflective listening and the skilful development of discrepancy. A core tenet of the technique is that a patient's motivation to change is enhanced if there is a gentle process of negotiation in which the patient, rather than the practitioner, articulates the benefits and costs involved. A strong principle of this approach is that conflict is unhelpful and that a collaborative relationship between therapist and patient in which they tackle the problem together is essential. The four central principles of MI are shown in Box 1.

Reflective listening is a core skill whereby the therapist encourages patients to explore their thoughts and beliefs by using short summarizing statements which attempt to encapsulate (a) the overt content of the patient's utterance (simple reflection) or (b) the underlying and possibly covert emotional content (complex reflection). Rollnick and Miller (1995) were able to define specific and trainable therapist behaviours that they felt led to a better therapeutic alliance and better outcome. These skills are summarized in Box 2.

The first four items in Box 2 explore the factors that sustain the behaviour and aim to help the patient shift the decisional balance of pros and cons into the direction of change. The last two items cover the interpersonal aspects of the relationship.