Motivational interviewing (MI)

Counselling to support behaviour change in domestic abuse offenders.
First published
Effect scale Quality of evidence
Effect Impact on crime Mechanism How it works Moderator Where it works Implementation How to do it Economic cost What it costs
Overall reduction

Strong

Strong

Moderate

Low

No information

Focus of the intervention

Motivational interviewing (MI) – also known as motivational enhancement therapy (MET) – is a non-judgemental, empathic and optimistic counselling style that has been used with offenders who have been ordered by a court to attend a standard domestic violence perpetrator programme.

MI is designed to overcome resistance, hostility or denial by the offender at the time of referral to these programmes.

It can be used when the offender is in custody or the community, while on bail or on probation.

MI is undertaken by the offender before another standard perpetrator intervention, such as cognitive behavioural therapy (CBT).

Underpinning the MI approach is a belief that the journey to permanent change in behaviour goes through several stages. These are:

  • the early stages of pre-contemplation and contemplation
  • preparation for change
  • readiness to take action
  • a maintenance stage

MI is designed to help domestic abuse offenders develop their own personal desire for change through use of a therapeutic style that is non-judgemental, empathic and optimistic.

This narrative is based on a systematic review of seven studies using victim-reported and official measures of reoffending, such as rearrests, as the outcome.

Effect – how effective is it?

Overall, the evidence suggests that MI has reduced rates of victim-reported reoffending.
 
The effect size within the review, from three studies, showed that lower levels of reoffending were reported by victims of offenders who received MI and attended a standard domestic violence perpetrator programme than by victims where the offender did not receive MI. The authors stated that while the effect size was small, it did show a significant reduction in victim reported reoffending.

The two studies that reported official measures of reoffending (such as rearrests and breaches of conditions) showed that MI had no significant effect on these measures. However, the control groups may not have been comparable as they measured different kinds of official reports, including those not related specifically to domestic violence.

How strong is the evidence?

The review was sufficiently systematic that many forms of bias that could influence the study conclusions can be ruled out. 

The search strategy for the review was well-designed and transparent, and the authors took care to use the correct statistical analyses within the statistical analysis.

However, differences in study design were not explored in the review and only one author coded the original studies, so calculating coder reliability was not possible.

Some biases were identified within the primary studies. Dropout rates (of both offenders and victims) were not always considered when analysing the results from these studies. The effect of different conditions of attendance and sanctions for non-attendance were also not taken into account by a number of the primary studies.

Mechanism – how does it work?

The review suggested a number of mechanisms by which MI might have an effect on crime.

MI draws on a theory of behaviour change that suggests domestic violence offenders may not be in a ready to change their behaviour when they are referred by the criminal justice system for treatment to standard perpetrator programmes.

Therefore, MI tries to move offenders from the earlier to later stages of change, which focus more on taking action and maintaining the new, non-violent behaviour. 

Studies within the review stated that an empathetic (rather than confrontational) therapist counselling style was more likely to be effective in helping perpetrators to recognise the impact of their actions and decide that their behaviour is a problem that needs to change.

Participants in a later stage of change were more likely to engage with and complete the standard domestic violence perpetrator programme.

Moderators – in which contexts does it work best?

The review identified a number of potential moderators, including offender characteristics such as age and gender, ethnicity and some psychological traits. These were not tested within the review, however.

One moderator analysis that was conducted found that MI was more effective for offenders who were defined as hostile or treatment-resistant and were at an earlier stage of change.

On average, offenders that were at a later stage of change and were delayed in seeking action by attending the MI did not benefit from the standard domestic violence perpetrator programme as much as those in the control group.

Programme completion was also highlighted as an important moderator. Four of the studies in the review found that participants who did not complete the programme were more likely to have further police involvement afterwards than those who did complete the programme.

Implementation – what can be said about implementing this initiative?

The delivery of MI follows a standard, manual-based approach. Key principles include:

  • expressing empathy with the offender
  • developing discrepancy (allowing offenders to realise the importance of change for themselves)
  • rolling with resistance (not arguing for change or challenging them)
  • supporting self-efficacy (belief in the possibility of change and a new positive identity)

The intervention can be delivered in brief sessions, single sessions or multiple sessions over a maximum of 26 weeks.

The person delivering the intervention varied between the studies, including therapists, psychology doctoral students and researchers.

The majority of the studies in this review described training of therapists, peer review and feedback as being necessary to ensure fidelity of treatment approach.

A clear link between MI to improved rates of the subsequent domestic violence programme completion could not be established due to large numbers of participants being transferred to other custodial facilities and being unable to pay for treatment (as is required in the US system).

Economic considerations – how much might it cost?

The review does not calculate the costs of implementing the programme, or conduct a cost-benefit analysis.

General considerations

  • MI asserts that the pathway to positive behaviour change is not necessarily a linear one – relapse and regression through previous stages is to be expected before lasting permanent change can be achieved and maintained. The review suggests that victims should be alerted to this process and to the potential for reoffending to occur.  
  • In the USA, offenders often have to pay for their own treatment, which affects dropout rates.

Summary

Overall, the evidence suggests that MI has reduced rates of victim-reported reoffending.

The intervention encourages perpetrators of domestic violence to change their behaviour.

Programmes with a more empathetic rather than confrontational approach appear to be more effective.

However, the review is only based on a small number of studies. More research is needed in order to understand the conditions under which the intervention works best.

Summary prepared by

This narrative was prepared by UCL Jill Dando Institute and was co-funded by the College of Policing and the Economic and Social Research Council (ESRC). ESRC grant title: 'University Consortium for Evidence-Based Crime Reduction'. Grant reference: ES/L007223/1.

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