Motivational interviewing is a counselling approach designed to help people find the motivation to make a positive behavior change. This client-centered approach is particularly effective for people who have mixed feelings about changing their behavior. It’s possible to experience to have conflicting desires, such as wanting to change your behavior, but also thinking that you’re not ready to change your behavior. The motivational interviewing approach holds that resolving this ambivalence can increase a person’s motivation to change.
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 honours client autonomy.1
In order for motivational interviewing to be effective, the therapist must maintain this overall “spirit.”
Collaboration Instead of Confrontation
Collaboration is a partnership formed between the counsellor and the client. In motivational interviewing, this relationship is based on the point of view and experiences of the client.
This approach contrasts with some other therapeutic approaches, specifically those in which the counsellor is confrontational and imposes their own point of view about their client’s behavior.
Collaboration builds rapport between the therapist and the client. It allows the client to develop a trusting relationship with their counsellor, something that is difficult to do in a more confrontational environment.
Evocation Rather Than Education
The notion of the counsellor 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 counsellor.
No matter how much the counsellor might want a person to change their behavior, it will only happen if the individual also wants to change. So, it is the counsellor’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.
Principles Behind Motivational Interviewing
Although each person’s journey is different, counsellors 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, counsellors focus on understanding the situation from their client’s point of view. This is known as empathy.
A counsellor doesn’t have to agree with their client to show empathy. Empathy is about surrendering your own opinions in order to understand someone else. This practice creates a safe space where clients feel comfortable being themselves and sharing their concerns. Autonomy Over Authority
Unlike treatment models that emphasize the counsellor as an authority figure, motivational interviewing recognizes that the true power for making changes rests within the client. The counsellor 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.
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 counsellor’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 counsellor’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 counsellor 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.2 A counsellor 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, counsellors help people explore their feelings and find their own motivations. They do this using four basic techniques.
Therapists gather information by asking open-ended questions, show support and respect using affirmations, express empathy through reflections, and use summaries to group information.
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.
Reflection is a foundational skill of motivational interviewing and how therapists’ express empathy.
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 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 control
Diet
Obesity prevention
Physical activity
Sexual behavior
Smoking
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 themselves
Helping clients take responsibility for themselves and their actions
Lowering the chance of future relapse
Preparing clients to become more receptive to treatment
Showing clients that they have the power to change their lives themselves
Teaching 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.
Motivational interviewing can effectively treat a variety of conditions. But keep in mind that there is no one form of therapy that is appropriate for everyone and works in every instance.
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
