Motivational Interviewing

Motivational Interviewing is a style of counseling that focuses on change. In this model of therapy, a counselor interacts with a client in a way that helps the client explore their own desires for change. As a result of engaging in Motivational Interviewing, the client will better understand their own motivation for and commitment to a specific goal.

In Motivational Interviewing, the counselor is seen as a partner, not a guide or teacher. The counselor will ask questions of the client but refrain from directing or advising the individual. Because of this, the therapist must be dedicated to this model and very self-aware. He or she must believe in the agency of his or her client and seek to draw that out.

This method of therapy is often used to treat those who have substance abuse disorders, but it can be used for people in other situations as well. This type of therapy is most useful for people who find themselves in the following situations:

• Situations where change is an option, but a person is not sure how they feel about that change.
• A person is not sure that they will be able to change.
• A person is not sure that they even want to make a change.
• The benefits and drawbacks of a certain change are unclear.
• Working with a therapist trained in motivational interviewing can help clients work through their thoughts, feelings, and goals for the possibility of change.

Because MI is seen as a partnership, collaboration between the client and therapist is key. There are four elements that make up the spirit of motivational interviewing, according to Miller and Rollnick, who developed the model.[1]

• Partnership: the client and therapist need to work together. The therapist is there to draw out the client’s thoughts and feelings, not direct the client. Clients are experts on their own lives.
• Acceptance: the therapist seeks to understand the client’s viewpoint. In doing this, the therapist:
• Believes in the absolute worth of the client.
• Displays empathy through active listening.
• Gives support to the client’s autonomy; the client directs the conversation and gets to decide how and when he or she does or does not change.
• Affirms the client’s strengths.
• Compassion: the therapist prioritizes the client’s needs and well-being.
• Evocation: the client has resources within themselves. The therapist draws out a client’s motivation, values, and wisdom.

Motivational Interviewing is a therapy model that was developed by William R. Miller and Stephen Rollnick in 1991 to support those with substance abuse disorders. According to Sune Rubak et al., it has since been used to treat many other issues, such as “alcohol abuse, drug addiction, smoking cessation, weight loss, adherence to treatment and follow-up, increasing physical activity, and in the treatment of asthma and diabetes.”[2]

Sune Rubak and colleagues undertook a meta-analysis of motivational interviewing in 2005, and they found that “motivational interviewing…effectively helps clients change their behaviour and that it outperforms traditional advice giving in approximately 80% of the studies.”[3]  They found that even a brief encounter with motivational interviewing (of just 15 minutes) improved outcomes.

Motivational Interviewing has been shown by Westra, Constantino, and Antony (2016) to have greater patient engagement than other therapy techniques like Cognitive Behavioral Therapy.[4] It also builds self-confidence and increases intrinsic motivation.

There are four core processes that direct the conversations in motivational interviewing sessions. Client and therapist may move between the processes as needed.

• Engaging: True engagement is the goal of MI. Therapists listen carefully to understand what the client is expressing. Therapists will reflect back to the client what they hear them saying.
• Focusing: The client and therapist will work together to agree on a goal for the session and for the overall partnership.
• Evoking: The therapist helps the client explore their feelings about change. The therapist will help the client understand their own ambivalence toward change, which is a normal attitude. However, ambivalence (feeling two ways at once) can often be a roadblock for change. Without judgment, the therapist will pay attention to how the client talks about change and respond in a way to maintain rapport and encourage the client.
• Planning: The therapist will support the client as they make a plan for change. This may not happen during every session.

The therapist is committed to using OARS: asking open questions, affirming the client, reflective listening, and summarizing. Patients can expect to have time to explore their thoughts in a non-judgmental zone.