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Motivational Interviewing

What is Motivational Interviewing?

Motivational interviewing is a counseling 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.

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Techniques

In motivational interviewing, counselors 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 do you think about that?"

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.

Benefits

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.

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.

Effectiveness

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.