Originally developed by William Miller and Stephen Rollnick to treat alcohol addiction, motivational interviewing is unique in the way it empowers people to take responsibility for their own recovery.
The Spirit of Motivational Interviewing
Motivational interviewing should always be implemented with a particular “spirit.” According to Miller and Rollnick, the “spirit” is collaborative, evocative, and honors client autonomy.
Collaboration Instead of Confrontation
Collaboration is a partnership formed between the counselor and the client. In motivational interviewing, this relationship is based on the point of view and experiences of the client. Collaboration builds rapport between the therapist and the client. It allows the client to develop a trusting relationship with their counselor, something that is difficult to do in a more confrontational environment.
Evocation Rather Than Education
The notion of the counselor drawing out a client’s ideas rather than imposing their own opinions is based on the belief that motivation to change comes from within. As such, it cannot come from the counselor. No matter how much the counselor might want a person to change their behavior, it will only happen if the individual also wants to change. So, it is the counselor’s job to “draw out” their client’s true motivations for this change. Once these motivators are identified, the client can use them to make the recovery process easier or to help them keep going when they want to give up.
Autonomy Over Authority
Unlike treatment models that emphasize the counselor as an authority figure, motivational interviewing recognizes that the true power for making changes rests within the client. The counselor cannot demand this change. Put another way, it is up to the client to take the actions necessary to change their behavior. They must put in the work. This is self-empowering to the individual, but also gives them personal responsibility over their actions.
Principles Behind Motivational Interviewing
Although each person’s journey is different, counselors who use motivational interviewing hold true to four principles throughout the recovery process. These principles are vital to establishing trust within the therapeutic relationship.
Express Empathy
People may initially be reluctant to go to therapy for fear of being judged by their therapist. Some may even feel guilty about their negative behavior, making that judgment valid in their eyes. But judgment is not what motivational interviewing is about. Instead of judging, counselors focus on understanding the situation from their client’s point of view. This is known as empathy.
Develop Discrepancy
Developing discrepancy is based on the belief that a person becomes more motivated to change once they see the mismatch between where they are and where they want to be. It is a counselor’s job to help clients identify their core values and clarify their personal goals. Goals and actions are developed in a trusting, collaborative atmosphere free from pressure. This offers an environment that is based on the person’s needs, wishes, goals, values, and strengths.
Roll With Resistance
Motivational interviewing understands that change doesn’t always happen just because you want it. It’s natural to change your mind many times about whether you want to change your behavior and what that process or new lifestyle looks like. Rather than challenging, opposing, or criticizing clients, it’s a counselor’s job to help them reach a new understanding of themselves and their behaviors. One way they do this is by reframing or offering different interpretations of certain situations. This changing viewpoint increases the person’s motivation to change. It is based on their own goals and values. For example, if a client reveals that they started drinking to cope with a partner’s infidelity, the counselor might help them reframe the situation. Instead of the client blaming themselves, they may begin to see that the person cheated because of their own issues.
Support Self-Efficacy
Self-efficacy is a person’s belief or confidence in their ability to perform a target behavior. A counselor following the motivational interviewing approach supports their client’s self-efficacy by reinforcing their power to make the changes they want. They guide them through the behavior change process, recognize the positive changes clients make, and offer encouragement along the way. In the beginning, the therapist may have more confidence in the individual than they have in themselves, but this can change with ongoing support. Soon, the client starts to recognize their strengths and ability to change their behavior for the better.
Techniques
In motivational interviewing, counselors help people explore their feelings and find their own motivations. They do this using four basic techniques.
Open-Ended Questions
Open-ended questions are questions you can’t answer with a simple “yes” or “no.” These types of questions encourage you to think more deeply about an issue. Such questions often start with words like “how” or “what,” and they give your therapist the opportunity to learn more about you. Examples of open-ended questions include:
“How would you like things to be different?““What have you tried before to make a change?““What can you tell me about your relationship with your parents?”
Affirmations
Affirmations are statements that recognize a person’s strengths and acknowledge their positive behaviors. Done right, affirmations can help build a person’s confidence in their ability to change. Examples of affirming responses include:
“You’re clearly a very resourceful person.““You handled yourself really well in that situation.““I’m so glad you came into the clinic today. I know it isn’t always easy to seek help.““I appreciate that it took a lot of courage for you to discuss this with me today.”
Reflective Listening
Reflection or reflective listening is perhaps the most crucial skill therapists use. Reflection lets a client know that their therapist is listening and trying to understand their point of view. It also gives the client the opportunity to correct any misunderstandings and to elaborate on their feelings.
Summaries
Summaries are a special type of reflection. They show that the therapist has been listening and understand what the client has been saying. Therapists can use summaries throughout a conversation. Some examples of summarizing techniques include:
Collecting: Collecting reinforces what the client has said. For example, a therapist might say, “Let me see if I understand what you have said thus far.“Linking: Linking entails making associations between two parts of the discussion. For example, a therapist might say, “A minute ago you said you wanted to talk to… Maybe now we can talk about how you might try…” Transitioning: Transitioning wraps up the end of a session or moving on to another topic. For instance, a therapist might say, “A minute ago you said… But the last time we met, it seemed like… What do you think about that?”
What Motivational Interviewing Can Help With
Originally, motivational interviewing was focused more on treating substance use disorders by preparing people to change addition-related behavior. Over time, however, motivational interviewing has been found to be a useful intervention strategy in addressing other health behaviors and conditions such as:
Diabetes controlDietObesity preventionPhysical activitySexual behaviorSmoking
Motivational interviewing can also be used as a supplement to cognitive behavioral therapy (CBT) for anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD). This approach has even been used to reduce the fear of childbirth.
Benefits of Motivational Interviewing
There are several reasons why motivational interviewing is a widely used form of mental health therapy, including:
Building the client’s self-confidence and trust in themselvesHelping clients take responsibility for themselves and their actionsLowering the chance of future relapsePreparing clients to become more receptive to treatmentShowing clients that they have the power to change their lives themselvesTeaching clients to take responsibility for themselves
Motivational interviewing is especially beneficial to people who are initially resistant to starting a treatment program or who are unprepared to make the necessary life changes.
Effectiveness
Since motivational interviewing was first introduced in the 1980s, studies have shown that it can effectively treat a range of psychological and physical health conditions. One meta-analysis of 72 clinical trials found that motivational interviewing led to smoking cessation, weight loss, and cholesterol level control. Research also reveals that motivational interviewing can aid in addiction treatment. Another review showed that, of the 39 studies reviewed, two-thirds found that motivational interviewing was associated with significant reductions in adolescent substance use. Yet another review indicates that motivational interviewing can effectively reduce binge drinking as well as the frequency and quantity of alcohol consumed.
Things to Consider
Although motivational interviewing has helped many people find the motivation to make both small and major behavior changes, it’s not the ideal course of treatment for everyone. Motivational interviewing works best for people who have mixed feelings about changing their behavior. If you have absolutely no desire to change your behavior, or are already highly motivated to change, you may not reap the benefits of this approach.
How to Get Started
If you feel that you or someone you love might benefit from this counseling approach, consider the following first steps:
Find a trained counselor. Your primary care physician may be able to refer you to an in-person or online counselor who has been trained in motivational interviewing approach. If you have health insurance, you can call your insurance company or use their online search tool to find a trained counselor in your area. Check with your health insurance. In some cases, insurance may pay at least part of the costs for this type of counseling. If this is the case, you’ll want to find a therapist that your insurance company will work with. Prepare for the first session. The first session is usually a clinical assessment. You’ll be asked to complete intake paperwork, similar to what you complete for a medical appointment. The counselor will likely also ask what changes you’re hoping to make and your concerns and your overall priorities.
