Bruce Berger practiced pharmacy before returning to graduate school to earn a PhD in social and behavioral pharmacy that focused on health psychology and health communication. While practicing pharmacy Bruce noticed that the way health care professionals talked to patients affected whether patients were willing to consider and discuss their medications and their illnesses. Bruce was struck by how critical it is in patient care to build rapport with patients. In fact, this observation led him back to graduate school at The Ohio State University College of Pharmacy. Since then Bruce’s research has continued to focus on 1) how health care professionals talk to patients, and 2) how their talk impacts patient outcomes such as treatment adherence. Health care professionals never stop having influence on their patients. With motivational interviewing we increase the probability that the influence will be positive.
In the late 1980s and early 1990s, Bruce’s research on improving treatment adherence led him to Miller and Rollnick’s work on motivational interviewing. He knew immediately that this caring, compassionate and genuine way of being with the patient would improve adherence and treatment outcomes. It was then that he brought motivational interviewing into health care and began to teach it as a faculty member at the Auburn University Harrison School of Pharmacy. MI is now a required part of the core curriculum at Auburn’s University Harrison School of Pharmacy.
Bill Villaume was a Lutheran minister who went to graduate school at The Ohio State University and received a PhD in speech communication. Bill has always been fascinated by how people use language in their talk to build relationships and to have influence on each other. His studies in communication theory, linguistics, discourse/conversation analysis and interaction analysis gave him a breadth of theoretical perspectives and research methodologies to apply in studying how MI works in professional-patient interaction. Fortuitously, Bill was a graduate teaching assistant in a PhD level course in human communication theory at Ohio State that Bruce was taking as a student. It was there that they met. Shortly after Bruce arrived at Auburn University to take a faculty position in the Harrison School of Pharmacy (1982), he looked for faculty members to collaborate with in psychology and communication. Lo and behold, there was a faculty member in the Department of Speech Communication named William Villaume … how many could there be? They made contact and have worked together ever since.
Our ongoing collaboration has produced a tremendous synergy that has spurred the development of our own theoretical description of MI. As a team we are deeply committed to the proposition that the optimal use of MI can facilitate major health behavior change by patients.
Bill has used his background in communication theory to contribute several major concepts to our theoretical description of MI. First, he identified how losing face for the patient triggered resistance by the patient. Then, the classical distinction between the content and relational dimensions of messages led to his identification of two types of resistance in patients: issue resistance (“I don’t like taking medicine because I am worried about side effects”; “I’m under too much stress to quit smoking now”) and relational resistance (“Look, I told you … I am just not ready to quit! Stop nagging me!”). Finally, the theory of practical reasoning led to an understanding of how to address the patient’s issue resistance without creating more relational resistance. These concepts are important both theoretically and practically because integrating the management of both types of resistance is critical to optimizing the power of MI in facilitating the patient’s consideration of health behavior change.
Bruce brought a distinctive psychodynamic approach to our conception of MI. Bill often notes that Bruce is uncanny in understanding the nature and essence of emotions experienced by both patients and professionals during their interaction. Bruce has also provided deep insight into how empathy with the patient allows for the patient’s issues to be addressed in a nonthreatening manner. Finally, Bruce’s insight into the nature and impact of emotions has allowed Bruce to identify the nature of several major impasses experienced by health care professionals as they learn MI.
We have taught motivational interviewing to thousands of physicians, nurses, pharmacists, social workers, dietitians, and psychologists who work in various health settings. We have taught thousands of students at the Auburn University Harrison School of Pharmacy. We have studied hundreds of hours of videotapes of our “students” interacting with standardized patients in order to better understand how to more effectively teach MI. We have also listened to countless hours of audiotapes of health care professionals with patients (de-identified to meet HIPPA requirements) to better understand where and why success is occurring and where and why problems are consistently occurring. Ultimately our study of these successes and problems led to our own theoretical description of MI that subsequently improved our teaching of MI. HCPs seemed to grasp the heart of MI more quickly and were more successful at laying aside their controlling patterns of talk to listen to the patient and to address the patient’s core concerns. Our new book and this website are a response to their request that we write up our approach to MI in ways that they could use as a resource.