What Is Motivational Interviewing?
Motivational interviewing is a psychotherapeutic approach that attempts to move an individual away from a state of indecision or uncertainty and towards finding motivation to making positive decisions and accomplishing established goals.
Motivational interviewing was formed 30 years ago by William R. Miller and Stephen Rollnick as a way to push past the issue of low motivation to change.
When Is Motivational Interviewing Used?
Motivational interviewing was created with addiction in mind, but the principles are applied to a range of mental health and physical health issues like:
- Gambling problems.
- Prescription drug abuse.
- Illicit drug abuse.
- Pornography or sexual addictions.
Motivation is essential for progression in addiction treatment, while lack of motivation can serve as major hurdle. In the early 1980s, the prevailing thought was that lack of motivation needed to be addressed in therapy through confrontation. During this process, the therapist would list reasons why change was needed, state the negatives associated with lack of change, and pressure the person to change as means to gain motivation.
Miller and Rollnick’s motivational interviewing differs in that it utilizes a nonconfrontational, collaborative effort between therapist and client to spark motivation and initiate change. Rather than acting in an antagonistic or combative way, the therapist engages with the client to explore his feelings, including ambivalence about changing, and help the client find his own motivations. The therapist becomes a person of support, allowing the client to make their own choices and arrive at their own conclusions without feeling outside pressure to do so.
Motivational interviewing shares similarities to person-centered (or humanistic) therapy. This psychological theory and form of therapy was created by Carl Rogers in the 1950s and 1960s as an alternative to psychoanalytic and behaviorist views. Person-centered thought is based on the idea that people have innate goodness and value in them. It is the work of the therapist to permit the clients to create the best version of themselves.
Key Elements of Motivational Interviewing
In discussions about motivational interviewing, the phrase “the spirit of Motivational Interviewing” is commonly used to reference to the way this technique is employed, as opposed to technical procedures that are used. The “spirit” is comprised of three components. They are:
- Collaboration. Instead of being confrontational or argumentative with the client, the therapist will attempt to see the situation from the client’s point of view. Along these lines, the therapist is not the expert because no one has a better understanding of the client’s experience than the client. The goal here is for the therapist to act as a support rather than a persuader.
- Evocation. In other forms of therapy, like cognitive behavioral therapy, the client is given information by the therapist as encouragement to change their ways of thinking, beliefs, or behaviors. At times, this approach can trigger feelings of defensiveness in the client. Motivational interviewing has the goal of creating an internal desire for change from the client. The therapist listens more than talks and draws out the client’s own perceptions instead of imposing perceptions on him. This way, the client will be more interested in maintaining the change over a longer period.
- Autonomy. Motivational interviewing places all of the power on the client. The therapist shows respect for the client’s responsibility and decision-making ability.
Goals of the Therapist in Motivational Interviewing
The above items serve as an overall sense of the views of motivational interviewing. Inside the sessions, the therapist is tasked with certain principles and measures used to make the time more beneficial and productive. A therapist will:
- Principle 1: Express empathy. This is one of the core values of person-centered therapy that motivational interviewing incorporates. Here, the job of the therapist is to build an understanding of the client’s issues, struggles, and barriers of improvement. By doing this, the client becomes more open and free with accurate disclosure since there is a lack of judgment and criticism. A therapist might say, “I can understand why using drugs seems appealing in this situation.”
- Principle 2: Develop discrepancy. With the second principle, it becomes the job of the therapist to have the client point out the disparity between what they are doing and what their goals are. If the goal is to be happy and have a successful career, using heroin daily may get in the way of that. Of course, the therapist will use interventions that are not based in confrontation to produce this. The therapist will only ask a series of questions to lead the client to this natural conclusion.
- Principle 3: Roll with resistance. Motivational interviewing expects there to be some resistance and reluctance from the client during this process. Keeping in line with the nonconfrontational views, the therapist will not try to force or manipulate the client into acceptance. The therapist will work to understand the client’s point of view and avoid the desire to correct what may be viewed as flawed ways of thinking while offering alternative ways of thinking for the client to consider.
- Principle 4: Support self-efficacy (a belief in change). Many clients, especially those dealing with addiction, recovery, and relapse, have tried to maintain their sobriety with limited success. Because of this, they can become less hopeful for future success. The therapist will work to illustrate areas of strengths and compile a number of instances where the client was able to accomplish their goal.
A Session of Motivational Interviewing
The previous sections discussed the aims of motivational interviewing as a therapeutic style and the principles that a therapist works to uphold during the course of treatment. This section discusses what a typical session of motivational interviewing will include.
Open-ended questions. Some questions have a simple answer based on a number or a “yes or no.” Open-ended questions are different because they require increased length and detail. Therapists using motivational interviewing will employ these questions to engage the client in a discussion that encourages increased deliberation from the client to gain a better understanding of their thoughts, feelings, and beliefs. Open-ended questions give the client control of the session as the therapist follows their lead.
Affirmations. An affirmation is an assertion made by the therapist to support a decision or a behavior the client had. When done properly, the affirmation will be appropriate and valid. The therapist will not compliment clearly negative behaviors just to boost the confidence of the client. These statements from the therapist are essential in building the client’s sense of power and belief in his ability to change.
Reflections. Reflective listening is as important in motivational interviewing as it is in other types of therapy including person-centered, CBT, and Dialectical Behavior Therapy (DBT). A reflection involves the therapist listening to the client and reflecting on the information. This is not simply restating what the client says. It is a way to show the therapist understands the client’s experience. It builds the connection and helps to reduce ambivalence.
Summaries. To the untrained ear, summaries appear the same as reflections. Summaries differ because they summarize information to uncover themes and common issues. Summaries can help move towards change by exposing the discrepancies of the client.
Change talk. If the previous four components of the session are working well, change talk will occur. This act is completed by the client rather than the therapist. The client will make clear statements about change and the benefits of these changes. Change talk is divided into two categories. The first is preparatory, and it includes desire for change, acknowledgement of their ability to change, reason for the change, and the need for the change. Preparatory change talk is an encourage sign that real change is on the horizon. Even more encouraging is the second type of change talk: implementing. It includes statements of commitment to change, activation of preparedness and willingness, and taking steps to create the change.
Integrating Motivational Interviewing
Findings show that features of motivational interviewing help clients to engage in treatment and build their consistency.
Motivational interviewing stands apart from other schools of thought for its ability to be used in conjunction with other types of therapy. When used in combination with therapies like CBT, REBT, and other approaches, it can improve the efficacy of treatment. People seeking motivational interviewing services may also use medication management and 12-step supports to aid in their treatment.
Findings show that features of motivational interviewing help clients to engage in treatment and build their consistency. This is key for many in treatment but especially so for people seeking treatment for substance abuse.
Since motivational interviewing was built for addiction, the techniques lead to good results. People routinely move away from the ambivalence of addiction and towards the change of recovery.
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