The Role of Motivational Interviewing Toward Lasting Change

You may recognize Los Angeles for Hollywood and the glamor that comes with it, but beneath this facade, there lingers a long, dark shadow of substance use and mental health struggles. Despite this, the decision to heal is not evident right away. Think about it - many wish to quit substance use and make healthier choices, but endless demands and expectations put recovery on the back burner. This is why motivational interviewing (MI) becomes a very powerful tool in discovering your own inner motivations toward sustainable changes and recovery.

If you are at a stage where you want to change but feel stuck or conflicted with a behavior or condition, then MI meets you where you are. In this article, we will break down what motivational interviewing is and where you can find it in Los Angeles.

Motivational interviewing (MI), or motivational enhancement therapy (MET), is a therapeutic technique that explores a person’s inner motivations to change a certain behavior. It is a client-centered approach that was developed by William Miller and Stephen Rollnick in the 1980s.

Linda Whiteside, the Clinical Supervisor at the NuView Treatment Center, says, “Many times, there is a certain nonchalance toward change. Take someone who drinks, for example - they may fully understand the risks to their health, yet feel conflicted between wanting to quit and wanting to keep drinking. This is where MI makes them look inward to understand the ambivalence and move toward healthier choices.”

At its core, motivational interviewing is a goal-oriented interviewing technique that draws attention to communicating change. It is widely used in Los Angeles and U.S.-based behavioral health programs for the following reasons:

• MI is a guiding therapeutic technique, which becomes the in-between of listening and giving advice.
• MI acknowledges resistance to change in a non-confrontational way, as it recognizes these fears and reasons as valid.
• MI facilitates change by touching on one’s own meaning, interpretation, and ability to change.

The spirit of MI, OARS, and the four fundamental processes are the core concepts of motivational interviewing. We will look at each of them in detail below.

The Spirit of MI

The practice of MI is always in the spirit of:

• Partnership: MI is a collaboration between the client and therapist. The client is considered to be an expert on their life, while the therapist is an expert in enabling change.
• Evocation: MI draws upon one’s own knowledge, principles, reasons, and skills to change. It does not impose change, but rather evokes change from within.
• Acceptance: The therapist creates a non-judgmental environment, where they respect the client’s reasons to change or not to change and make informed decisions.
• Compassion: The therapist selflessly prioritizes the client’s safety and well-being.

The OARS (Open-Ended Questions, Affirmation, Reflections, and Summarizing) Technique

The OARS technique becomes the core of MI, and this is how it is implemented:

• Open-Ended Questions: Using open-ended questions to create a safe environment helps the client explore their experiences, perspectives, and ideas of ambivalence and change. For instance, “How has substance use affected your career and relationships?”
• Affirmation: Directs attention toward strengths, efforts, and past success to affirm the client’s ability to change. For instance, “You have already taken a step forward by coming here today.”
• Reflections: By listening to what the client is saying and reflecting it back to them, the therapist communicates empathy and gains a deeper insight into what they are trying to communicate. For instance, “From what you are saying - it seems like you understand the risks that come with drinking, but you enjoy the company of your friends who drink, and you fear being left out otherwise.”
• Summarizing: By summarizing what the client is saying, it makes them feel heard and understood. For instance, “You understand that cannabis is bad for your health, but you like how it relaxes you when you are stressed out. So, let us explore other ways you can manage your stress without smoking cannabis?”

The OARS technique identifies the reasons for and against change and encourages steps toward change by keeping communication a two-way street between the therapist and the client.

The Four Fundamental Processes

As MI is a communicative therapy, the four fundamental processes describe the flow of conversation between the therapist and the client:

• Engaging: MI needs to be an engaging experience, as only then will it pave the way toward an active, intentional change.
• Focusing: The therapist drives a directional conversation toward change, as both the therapist and client agree on this shared purpose, with the therapist being an expert on change.
• Evoking: MI probes the client to explore their own “why” for change, rather than pushing for change or offering advice.
• Planning: Based on the readiness of the client, MI thinks ahead as to how to plan for change while fostering the commitment to change.

Motivational interviewing is highly effective in treating substance use disorders, psychological conditions, and chronic illnesses.

Studies have specifically indicated how MI can be beneficial in substance use recovery, in that it enhances recovery outcomes and reduces the chances of relapse, which are exceptionally high with substance use - especially in major metropolises like Los Angeles, given the stressors of a fast-paced, glamorous lifestyle.

In the context of substance use recovery, MI is central to the Matrix Model, which also uses cognitive behavioral therapy or CBT, a behavioral technique called contingency management, and the 12-Step facilitation model.

Meta-analysis studies have also shown that MI is effective with the following:

• Willingness to change behavior
• Increasing treatment adherence
• Promoting physical activity
• Maintaining a healthy body weight
• Following dental hygiene

Linda Whiteside says, “In Los Angeles County, MI has wide applicability in the field of behavioral health. But it even extends beyond this to education, human services, and correctional facilities. The reason why it is so popular and effective is that it is based on the simple fact - something that you might have even heard outside of it - the power to change is within you.”

In Los Angeles, an estimated 1,482,000 residents are struggling with a substance use disorder as we speak. Moreover, 46.1% residents in California struggle with a mental health condition. 33% of the time, these struggles tend to intersect.

These numbers indicate a great need for therapeutic modalities that can cultivate a positive mindset toward healing. You will see that many delay recovery owing to stigma, prejudice, or losing out on jobs/livelihoods. MI acknowledges these fears, but it also tries to cut through them by imploring you to look within and identify your reasons for change.

When used with other cognitive and behavioral techniques, it can lay the groundwork for a lasting recovery.

If you or a loved one is feeling stuck between the desire to change and the fear of change that comes with substance use and mental health struggles, we understand how it feels.

At NuView, our therapists create a safe, engaging experience using motivational interviewing techniques, where you can explore your own reasons for change and commit to a healthier tomorrow.

We see you, and we want to hear from you. Please call us at (323) 307-7997 to connect with our MI experts today!

1. What is motivational interviewing?

Motivational interviewing, or motivational enhancement therapy, uses structured interviews to explore inner motivations toward change and recovery.

2. Who benefits from motivational interviewing?

Anyone who wants to change a behavior or condition, but is feeling conflicted or stuck, can benefit from motivational interviewing. For instance, someone who wants to quit substance use, but enjoys the pleasing feelings substances lead to.

3. Is motivational interviewing only for substance use disorders?

No, motivational interviewing can also be used to treat mental health conditions and promote treatment adherence in the case of chronic illnesses.

4. How long does motivational interviewing typically last?

The length of motivational interviewing typically varies. While some may find their motivation in 2-3 sessions, some may need a few more weeks.

5. Will motivational interviewing surely lead to change?

Motivational interviewing will increase the likelihood of change by tapping into your inner motivations and confidence.

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• https://motivationalinterviewing.org/understanding-motivational-interviewing
• https://pmc.ncbi.nlm.nih.gov/articles/PMC8939890/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC2871705/
• https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
• https://pmc.ncbi.nlm.nih.gov/articles/PMC8200683/
• https://www.recoverla.org/sud_101/substance-use-in-la-county/
• https://www.nami.org/wp-content/uploads/2023/07/CaliforniaStateFactSheet.pdf
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