BOOK REVIEW
Handbook of Motivational Counseling: Concepts, Approaches and Assessment. Edited by W. Miles Cox and Eric Klinger. John Wiley & Sons Ltd, Chichester, 2003. £75. 538pgs. ISBN 0-470-84517-1.
Amid the worldwide popularity of ‘motivational interviewing’ in both treatment and scientific circles over the last decade or more, there is another approach to motivational intervention in substance use disorders that has gone relatively unnoticed. This is the Systematic Motivational Counseling (SMC) approach developed by Miles Cox and Eric Klinger in the late 1980s. This book updates the theory, research and practice of SMC, and persuades that it should have received far more attention that it has in the past and should receive far more in future.The handbook is divided into six parts. The first part is concerned with basic concepts and theories wherein the editors present their ‘theory of current concerns’ in Chapter 1 and round off the section in Chapter 6 by describing their motivational model of alcohol use. The chapters in between are from a variety of theoretical perspectives, including basic learning theory and behavioural economics, which succeed admirably in directly relating their contents to Cox and Klinger's own thinking. One assumes that this was done at the explicit request of the editors and it gives the handbook a much more integrated feel than is often found in works of this kind. A theme running throughout this theoretical discourse is that any successful treatment or counselling for alcohol dependence or other addictions must focus on creating incentives in the client for non-drug rewards.
The second part is devoted to the measurement of motivation, introducing and discussing the Motivational Structure Questionnaire and its briefer, more recent companion, the Personal Concerns Inventory. This is followed in Part III by an introduction to SMC in action and a further five chapters on its application in various settings. Part V considers other motivational approaches to behavioural change, ranging from existential analysis and logotherapy to the community reinforcement approach. Three of the chapters in this section deal with motivational interviewing (MI) in various forms. Finally, the editors round off the book succinctly by ‘taking stock and looking ahead’ with respect to the theory, research and applications of SMC.
Relationships between SMC and motivational interviewing are considered in passing by Resnicow and colleagues in Chapter 24. One obvious difference is that, while MI is rooted in the counselling tradition developed by Carl Rogers and his students, SMC is much more firmly based in the main currents of behavioural and cognitive theory and research over the past 50 years. SMC is clearly a much more structured and elaborate approach to motivational counselling than MI and in one sense this is its main advantage. It may also be a disadvantage, however, because it may be less applicable to the very brief interventions in generalized settings whose implementation is now steadily increasing and also because it would obviously take more effort from practitioners to become competent to practice it. But that effort, in this reviewer's opinion, would be very worthwhile.
If determined to be critical, one would have to say that this book is somewhat uneven in quality. The best chapters include the six chapters which the editors themselves have written and these form a continuous thread through the book; while several of the remaining chapters are very good, some are of less interest and quality. On the whole, however, this is an important and excellent volume, highly recommended for anyone who wishes to learn more about a carefully developed and consistent approach to treatment and counselling with strong empirical support and clear foundations in the theory of human motivation.
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