All right, welcome back to the podcast. I am joined today with Dr. William Miller. He is the founder of Motivational Interviewing along with Stephen Rolnek.

He has been doing this for 40 years. He has countless articles that he's written on this countless books. Probably most of interest is his fourth edition of Motivational Interviewing.

This was actually a book that I read back in medical school. I think it was the first psychotherapy-esque book that I read as a third-year medical student and it's what initially sparks some interest in psychiatry.

Today, we will be talking about Motivational Interviewing. We will be talking about Change. We will be talking about ambivalence. Welcome to the podcast.

Thank you so much.

I'm super excited to have you here. I feel like I know you a lot more than you know me at this point, just because of your work, which is monumental to the field.

I wonder if we could talk about the why of why this episode and why talking about Change is so important.

I was reading this article, it was a 2009 article called Adding Motivational Interviewing Pre-Treatment to Cognitive Behavioral Therapy for generalized anxiety disorder, a preliminary randomized controlled trial by Wester et al.

And was impressed that they found that in the most anxious group, starting with a few sessions of Motivational Interviewing, I think it was four, 50 minute sessions, really improved CBT outcomes.

And there was a bunch of studies that kind of had a similar thrust. And I'm wondering why you think Motivational Interviewing supercharged CBT in this study and others like it?

Well, it makes sense, particularly with severe anxiety disorders here, especially if you're going to be doing some exposure based treatment, you're asking people to do something they really don't want to do.

Something that is quite difficult and even frightening for them. And so they'd better trust you, you'd better have a good relationship with them to start.

And I think that's one piece of it, just establishing a working alliance. I wrote another book with Terry Moyers in 2021, in which we went back through 70 years of psychotherapy research.

Looking for why is it that some therapists just get better outcomes than others do, even using the same manual in a highly controlled setting.

You still get differences, even when you try to squash them as much as possible, you still get differences among therapists. And one of the better predictors of how a patient does is who treated them.

So we finished that book and we came up with eight characteristics of therapists that over these 70 years have been found to be related to the better outcomes.

And then I looked at the list after we finished the book and said, this looks awfully familiar.

At least seven of the eight are things that have been characteristics and motivational interviewing from the very beginning.

And so it just got me to thinking, is this what we've been studying for 40 years, what makes helpers more effective.

So that that piece at least of of establishing a good working alliance, then the other piece of course is mobilizing the person's own motivation for change and their own resources.

And that that's a feature of motivational interviewing as well of evoking from people their own desire and ideas about change. So I think both of those things happening before you charge into an exposure based treatment for anxiety disorders, it makes sense that that would that would help without comes.

Yeah, I was thinking about so this is kind of like still in the vein of the why why this episode why thinking about change behavior why this is relevant.

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