Motivational Interviewing

What Is Motivational Interviewing?

Motivational Interviewing (MI) is a versatile therapeutic style that uses specific interviewing techniques to encourage intrinsic motivation in people who are unwilling or ambivalent to change.

As an empathetic and flexible approach to counseling, it emphasizes a client-centered method that works collaboratively to support individuals in the process of change. The approach utilizes strategies like change talk to evoke motivation and support self-efficacy, ensuring individuals feel empowered to make decisions that align with their values.

Healthcare professionals, including clinicians and psychotherapists, often employ Motivational Interviewing to address complex behavioral issues.

Practitioners aim to express empathy and acknowledge the individual’s unique circumstances using compassion (especially when working with adolescents or those dealing with mental health challenges), where fostering a supportive and understanding environment is essential.

Motivational Interviewing VS Other Approaches

MI’s approach differs from more traditional methods that may begin from a place of judgment or feature an expert or therapist acting with the authority to give advice or prescribe solutions.

As a counseling approach, Motivational Interviewing is set apart by focusing on respectful collaboration, support, and empathy with the individual while emphasizing and respecting their autonomy.

Dr. William R. Miller, the originator of Motivational Interviewing (MI), describes Motivational Interviewing as “a collaborative, person-centered form of guiding, to elicit and strengthen a person’s motivation for change.”

Goals of Motivational Interviewing

The first goal of Motivational Interviewing is for the therapist and individual to collaborate and address any mixed feelings or confusion in changing their behavior.

Resolving this is crucial before supporting and encouraging the person to find their own motivations and aspirations for making changes.

Next, collaboration can move into setting meaningful goals for change while building the individual’s confidence in overcoming obstacles as they take necessary steps towards realizing these goals.

Founded on core principles—Partnership, Acceptance, Compassion, and Evocation (PACE)—Motivational Interviewing may be helpful for individuals who have addictions or substance use disorders to build motivation and strengthen their resolve toward changing their behaviors.

Core Principles of Motivational Interviewing

There are four key principles to Motivational Interviewing, known by the acronym “PACE”:

• Partnership
• Acceptance
• Compassion
• Evocation

Following these four principles of Motivational Interviewing may result in successes like reduced use of substances, improved participation in treatment, making healthier choices, increased self-awareness, and a stronger willingness to continue to change.

Partnership

This refers to the importance of active collaboration. Through the partnership formed and the empathy shared, a person seeking to change their behavior guides the conversation with gentle encouragement from the therapist or expert.

Acceptance

Understanding and respecting a person’s point of view is crucial for the therapist or expert; demonstrating this by respecting the person’s situation and decisions shows acceptance.

This doesn’t mean that one must wholly agree with all of their decisions, but there should be an intention to view the issue or challenge from the person’s point of view.

As laid out in Miller’s seminal book, Motivational Interviewing: Helping People Change and Grow, there are four components to this principle of acceptance:

1. Absolute worth: Prizing the inherent worth and potential of the person.
2. Accurate empathy: An active interest in, and an effort to understand, a person’s internal perspective reflected by the therapist’s genuine curiosity and reflective listening.
3. Autonomy support: Honoring and respecting a person’s right to and capacity for self-direction.
4. Affirmation: Acknowledging the client’s values and strengths.

Compassion

This principle is relatively straightforward: It asks that the therapist or expert prioritize the individual’s needs and well-being (versus the therapist’s or expert’s own interests or expectations) during Motivational Interviewing.

Evocation

This is a fancy way of saying that the therapist should explore and discuss the person’s current motivations, values, and strengths.

Taking inventory of these positive tools clarifies one’s starting point. It also reminds the individual that these are internal and external resources that can be used to overcome challenges and make the desired behavioral changes.

These principles can be adapted depending on the individual’s needs, as they are fully based on their spoken desires, reasons, and obligations for change.

Motivational Interviewing in Addiction Treatment and Recovery

It’s helpful to think of Motivational Interviewing as an ally in addiction treatment and recovery. For both the therapist or expert and the individual, it’s all about empathy and support as they face the challenges of substance use and the obstacles to change.

Instead of pushing someone into sobriety, Motivational Interviewing means gently guiding them toward discovering their own reasons and ambitions for making changes.

Therapists and practitioners use empathy, deep listening, and thoughtful questions to help their clients explore their feelings about substance use and their wishes for their future while respecting their point of view and having compassion for their unique journey.

Building Motivation in the Early Stages of Recovery

Motivational Interviewing is particularly helpful when clients are in the Pre-contemplation and Contemplation stages of the Stages of Change (SOC), when readiness to change is low. However, it can also be useful throughout the change cycle.

In these early stages, Motivational Interviewing can help facilitate recovery by aiding in forming the foundational drive and reasoning for a person to change.

Open-ended questioning and a focus on reflection guide individuals to realize more than just their need for change but also the “why” change is important for themselves, their families, their community, and more.

A practitioner employing Motivational Interviewing may help individuals identify strengths, past successes, and potential resources, all of which empower them to take small steps toward recovery.

Why Motivational Interviewing Is Effective for Substance Use Disorders

Motivational Interviewing has many possible avenues of improvement for those dealing with addictions, but several aspects stand out:

• Overcoming ambivalence: Motivational Interviewing helps individuals explore their negative feelings and resistance to change in an accepting and supportive environment. It gives them the space and permission to weigh the pros and cons of their current behavior and consider the effects of making a change.
• Encouraging Engagement: Beginning from a place of acceptance and empathy while empowering individuals to assume the lead role in their recovery journey and work through what may be potential barriers or obstacles. As a result, Motivational Interviewing inspires them to take responsible action, which may improve participation and retention in addiction treatment programs.
• Development of Coping Skills: Focusing on reflective listening can gently guide individuals toward identifying and strengthening coping skills that support recovery and drive positive change. These may include stress management (without resorting to substance abuse or addictive behaviors), problem-solving, emotional regulation, and calming anxieties.
• Relapse Prevention: Motivational interviewing reduces the chances of relapsing by identifying triggers and planning strategies to combat them. It gives the individual the metaphorical tools to become more resilient.

Transforming Uncertainty Into Commitment to Addiction Recovery

Motivational Interviewing helps individuals understand their motivation and reasons for recovery by providing a safe and supportive space to explore their feelings and any perceived obstacles.

This is accomplished by first acknowledging the ambivalence; this is a normal reaction, as the road to recovery is not easy (and voicing this helps show empathy).

Throughout therapy that employs Motivational Interviewing, the practitioner may use reflective listening, work with the individual to list pros and cons, and encourage talk that allows the individual to think clearly and share their motivations, desires, and intentions.

By compassionately and nonjudgmentally addressing ambivalence, Motivational Interviewing helps individuals progress through uncertainty and resistance. Ultimately, this increases their desire to make positive changes and improves their readiness for recovery.

Combining Motivational Interviewing with Other Therapies

Combining Motivational Interviewing with other therapies can create a more well-rounded and effective approach to treating substance use disorders.

Using a blended approach for therapy, including Motivational Interviewing, may be beneficial for offering a more personalized and collaborative treatment. It may also remind the individual of their self-determination while strengthening their reasoning and drive to change their behavior.

Motivational Interviewing and Cognitive Behavioral Therapy (CBT)

Where Motivational Interviewing helps assess a person’s readiness for change while removing or lessening their ambivalence, CBT aims to provide practical skills and solid strategies for change.

Together, these two therapies may improve therapy engagement, aid in goal setting, support self-efficacy, and prevent relapse.

Motivational Interviewing and Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) combines medications with behavioral therapies to treat substance use disorders.

By integrating Motivational Interviewing with MAT, a practitioner can address an individual’s ambivalence about medication, increase their engagement in treatment, and help ensure medication adherence during and after treatment.

Motivational Interviewing and Group Therapy

The efficacy of group therapy sessions in addiction treatment programs may be enhanced in a few ways by Motivational Interviewing:

• OARS: The core counseling skills of Motivational Interviewing—Open questions, Affirming, Reflective listening, and Summarizing—can be used in group therapy to more deeply engage the group and underscore that it is a nonjudgmental space.
• Eliminating or reducing ambivalence: By encouraging open dialogue and reflection, group members may support each other in resolving their conflicting feelings and move forward with making positive behavioral changes.
• Peer influence: Group therapy means an opportunity to potentially derive inspiration from the treatment success of others, which may reinforce an individual’s resolve to bring about their own behavioral change and recovery.
• Accountability: Beyond inspiration from others’ successes in group therapy, an individual gains peer support as a resource, as members may hold each other accountable and further encourage progress for an individual working towards recovery.

Find Motivational Interviewing Therapists Near You

If you or someone you care about could benefit from Motivational Interviewing, several resources are available to help you find the right support. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers an online treatment locator and a 24/7 helpline at 1-800-662-4357 (HELP) for immediate assistance.

You can also connect with trained professionals through the Motivational Interviewing Network of Trainers (MINT), which provides a directory of therapists specializing in this approach.

For alcohol-related issues, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) treatment navigator offers guidance on finding trusted providers who use evidence-based methods like Motivational Interviewing.