Motivational interviewing is a treatment modality that is designed to help clients accept the necessity for making important changes. It plays an important role in both addiction recovery and mental health treatment. Even many other therapeutic techniques utilize the strategies and principles of motivational interviewing.
Even healthy people often find it difficult to change their behavior. In the course of everyday life, it is always necessary to make small behavioral adjustments — and sometimes major ones. If a person wants to lose excess weight, start taking medications, or abstain from drugs or alcohol, then they have a goal that requires them to change how they live their lives. Making these changes is difficult for anyone, but it can be especially difficult for someone suffering from addiction or mental illness. Motivational interviewing is a technique that offers an empathetic, nonjudgmental, and safe method for helping patients recognize and resolve their own inner doubts.
What Is Motivational Interviewing?
Motivational interviewing is a specific technique that clinicians and therapists can use while working with a client. The term refers to a set of counseling techniques that can be used to help clients change their own behavior.
This counseling style was developed on the foundation of several assumptions. Motivational interviewing is based on the following principles:
- It is normal for clients to have mixed feelings about change. These mixed feelings can be overcome.
- Clients can overcome their mixed feelings by developing their feelings of motivation.
- Therapists are most effective when they work together with their clients. When clients and therapists operate as partners, they can both provide expertise and insight.
- Direction, support, and empathy are the three most important ingredients for fostering behavioral change.
What Makes Motivational Interviewing Effective?
Motivational interviewing is not a strict procedure. There is no beginning, middle, and end to motivational interviewing. Rather, motivational interviewing refers to a specific approach to clinical treatment. It is a specific style. A clinician who practices motivational interviewing will generally allow their client to determine the goal of therapy. After all, the client generally has a strong sense of what they want to achieve. The therapist’s job is to help the client navigate toward their destination.
During motivational interviewing, clients will discuss the aspects of their lives that they’d like to change. Clients who suffer from substance use disorders might discuss a desire to quit drinking alcohol or smoking marijuana, for instance. Clients with depression or anxiety might express a desire to live their lives more healthily. A clinician using a motivational interviewing style will act without giving advice, judging, or arguing. Their job is to listen, offer feedback when appropriate, and help clients recognize when they seem conflicted about their own desire.
Motivational interviewing is highly effective for addiction treatment. This is because motivational interviewing is designed to help people feel less conflicted, and addiction is generally characterized by extreme inner conflict. People suffering from addiction often feel like they have two different voices in their heads: one voice screaming for more drugs and alcohol, and another voice begging to be done with substances. While the first voice is often louder and more pressing, the second voice is older and wiser. Deep down inside, most people want to listen to the second voice, but it is often quite difficult without support.
During the interviewing stage of motivational interviewing, the therapist will provide direction and support to the client. The client will work out what their goal is, and the therapist will aim to understand this goal as clearly as possible without passing judgment. Ultimately, the client is in control — since they are the ones with the power to make the change. The therapist’s purpose is merely to help them distinguish between their competing motivations and engage in behavior that matches the goal they’ve chosen.
What Does Motivational Interviewing Sound Like?
Client: I really do want to stop smoking marijuana. I try to stop, and sometimes I can quit for a week or two. But eventually, I return to smoking marijuana. I don’t know why!
Therapist: That’s perfectly normal. It sounds like you’re telling me you’re frustrated with your current relationship with marijuana. What do you picture when you think of your life without marijuana?
Client: I think I would struggle to relax at night… I wouldn’t be able to enjoy movies or video games. I think a lot of my friends would stop hanging out with me. When I think about those consequences, it seems absurd to quit marijuana…
Therapist: I see. It sounds like you want to quit but you feel pretty conflicted about it. You believe marijuana is helping you feel relaxed and have a social life.
Client: Yes, I guess so. I know that sounds crazy… I feel addicted to it, and it’s having a horrible effect on my career and my health. I’ve even had some legal problems from my smoking. But I can’t imagine life without it!
Therapist: You don’t sound crazy. Do you think you’d say that marijuana has harmed you in several ways but that it has helped you in other ways?
Client: Yeah, that’s probably a good way to put it. I wish my girlfriend would see it that way. She just tells me I need to quit my addiction.
Therapist: Maybe we can work on a way of discussing the issue of your marijuana consumption with her in a way that feels more accurate and helpful.
Client: Yes, I think that would be a good idea.
Therapist: Let’s begin by brainstorming a list of the harms that marijuana has led to — and another list of the ways that you believe marijuana adds to your life.
Stages of Motivational Interviewing
Motivational interviewing is a relational style that can take many forms. However, in most cases, it is a relatively straightforward process. As a goal-directed therapeutic modality, motivational interviewing rarely continues indefinitely. Instead, it is most frequently conducted in a small number of sessions. The stages of motivational interviewing are as follows:
- Engaging: Clients discuss their hopes, concerns, and issues. Clinicians aim to establish a trusting and collaborative partnership with the client.
- Focusing: The clinician and the client both aim to narrow the topics of conversation. They work to get to the heart of the matter and establish exactly which habits and behavioral patterns the client hopes to alter.
- Evoking: During the evoking stage, the therapist helps the client elicit motivation for change. They do so by helping the client recognize the importance of making the change and the benefits that they will get from making it. They also strive to build the client’s confidence in their ability to make the change.
- Planning. During the planning stage, the clinician works with the client to outline a set of pragmatic steps that can be taken to implement the change.
What To Expect During Motivational Interviewing
Since motivational interviewing is not a specific predefined procedure, there are many styles of motivational interviewing. When a client begins seeing a clinician who practices motivational interviewing, they should be prepared to discuss:
- How they feel about their current state
- What their experiences have been like trying to change their behavior thus far
- Aspects of their life that they do not want to change
- Aspects of their life that they do want to change
- What they believe is preventing them from making changes
- Their level of confidence about making changes
- Their level of motivation to make changes
Principles Behind Motivational Interviewing
Motivational interviewing is a relational strategy practiced by many different types of therapists and clinicians. People who practice motivational interviewing generally try to abide by four primary motivational interviewing principles. These principles of motivational interviewing include:
- Develop Discrepancy: Therapists work to build clients’ motivations to change their behavior by helping them recognize the differences between their current behavior and their goals behavior.
- Utilize Empathy: The therapist should strive to listen to the client without passing judgment. Instead, they should practice nonjudgmental acceptance and reflective listening. Making decisions is the client’s job.
- Deal with Resistance: It is normal for clients to resist behavioral change. It is ironic, of course, that a client would resist making changes — since the client is really just resisting their own goals. They may resist by blaming others, minimizing the issue, denying it, rationalizing, or lashing out. The therapist’s job is to support the client while helping them recognize and confront their resistance.
- Build Self-Efficacy: It is important for clients to actually believe in themselves to make changes. As such, therapists aim to help clients develop a stronger sense of their own autonomy and self-efficacy. To that end, they support the client’s sense of optimism, feasibility, and hope. They also make sure that clients pursue goals that are reasonable, attainable, and specific.
Strategies of Motivational Interviewing
When therapists work with clients in a rehab or health care setting, they may utilize several different techniques and strategies. The strategies of motivational interviewing are designed to help clients refine their goals and develop more nuanced understandings of their own relationships with drugs and alcohol. Clinicians build an alliance with their clients and work with them as partners to help them make critical behavioral changes. Strategies that clinicians utilize during motivational interviewing include:
- Reflective Listening: Reflective listening is sometimes known as “active listening.” It means listening intently to what the client is saying. More importantly, it means demonstrating that one has understood. After listening, the therapist will use their own words to paraphrase what the client was trying to communicate. This not only ensures that the therapist understands accurately but also guarantees that the client will feel accepted and understood.
- Affirmations: Affirmations are not compliments or flattery. They are simply statements of fact. When a therapist affirms their client, they help the client feel understood and recognized. An example of an affirmation is when a therapist tells their client that they understand that enrolling in rehab was a big step and that it took a lot of courage.
- Open-Ended Questions: Open-ended questions are the exact opposite of yes-or-no questions. It is impossible to answer an open-ended question with a single word. By asking these questions, therapists can ensure that their clients can express information that actually matters to them. It also helps ensure that the client will be the one in control of the therapeutic process.
- Summarize: A therapist summarizes by periodically providing a quick overview of the discussion. They can also solicit feedback from clients at this time. This helps clients stay on track and get much-needed perspective throughout a discussion. It also helps clients continue to feel accepted and understood.
Purpose of Motivational Interviewing
During the course of motivational interviewing, the therapist’s main goals are to help the client commit to making a behavioral change and support them as they develop strategies to that end. In the process of doing so, clinicians pursue several smaller goals. These goals include:
- Providing clients with a safe, supportive, and trigger-free environment where they can explore their ambivalence and mixed feelings without fear of judgment
- Building a partnership with the client and facilitating a sense of collaboration
- Recognizing problem areas that a client might want to change now or down the line
- Using motivational interviewing strategies to overcome resistance and develop both autonomy and self-efficacy
- Help clients explore their feelings regarding changing a behavior
History of Motivational Interviewing
Motivational interviewing was developed by clinical psychologists Stephen Rollnick and William R. Miller. Initial development of motivational interviewing as a technique began in1983. At this time, William R. Miller was writing about new ways of helping individuals who suffered from alcohol addiction. His work centered on the experiences of clients who felt ambivalent about whether they wanted to stop drinking or not.
By the late 1980s, William R. Miller had partnered with the clinical psychologist Stephen Rollnick. Earlier in his career, Stephen Rollnick had actually worked as a nurse at an addiction treatment center. His experiences made him strongly desire a new set of methods of helping people who suffer from addiction change their behavioral patterns.
Together, Miller and Rollnick developed new ideas regarding the behavioral change. They were heavily influenced by the theories of Carl Rogers, who had pioneered a type of client-centered therapy. Unlike Rogers’ non-directive therapeutic exploration, however, Miller and Rollnick’s therapy involved the use of direction. By helping direct clients, clinicians could engage in focused and goal-directed therapy that could help clients stay sober and make critical life changes.
In 1991, influenced by both Carl Rogers and the Stages of Change model pioneered by Prochaska and DiClemente, Drs. Miller and Rollnick published the book, “Motivational Interviewing: Helping People Change.” This book brought motivational interviewing into the mainstream. It has become an important part of both medical and therapeutic training.
Today, motivational interviewing addiction is highly effective at reducing substance abuse and relapse rates. It can help individuals who are working to recover from substance use disorders implement other important changes as well, which ultimately allows them to live fulfilling and joyful lives in sobriety.
Who Benefits from Motivational Interviewing?
Motivational interviewing is beneficial for anyone who has clear behaviors that require changing. Since motivational interviewing is a pragmatic and goal-directed form of therapy, it is helpful for mental health conditions like substance use disorder. Treating a substance use disorder involves withdrawing from drugs and alcohol, which can be an arduous process. However, in many cases, it is far more difficult for people to stay off of drugs and alcohol than it is to quit. This is because they may be far more ambivalent about sobriety than they realize. Motivational interviewing helps people in recovery address their lack of motivation by changing their behavior and thought patterns.
Motivational interviewing is often recommended to people who have not gotten results from cognitive-behavioral therapy (CBT). Cognitive-behavioral therapy can help clients develop healthy coping strategies, but it is often not effective at helping people develop inner motivation. Without inner motivation, clients may be unwilling to even begin utilizing these healthy coping strategies.
Research shows that motivational interviewing is particularly effective with clients who have a history of relapse. Individuals who have attempted to get clean and sober and failed repeatedly generally have an issue with ambivalence. They may want to get sober but struggle to follow through because drugs and alcohol continue to benefit them in certain areas of their lives. Motivational interviewing helps these chronic relapsers develop stronger motivation to get sober. During the course of therapy, clients also work to come up with alternative ways of meeting the needs that drugs and alcohol once met.
Motivational interviewing is helpful not only for substance addiction but other kinds of behavioral issues too, including mental illness and other types of addiction. It is often recommended for people who suffer from low self-esteem, eating disorders, gambling addiction, and sex addiction.
Motivational Interviewing at NuView Treatment Center
Motivational interviewing is one of many evidence-based therapies offered by NuView Treatment Center. NuView Treatment Center is the preeminent outpatient rehab located in West Los Angeles. At our modern facility, clients can take part in a range of evidence-based treatment programs. NuView Treatment Center offers every level of outpatient care, including partial hospitalization programs, intensive outpatient programs, outpatient programs, and aftercare planning. More importantly, clients can benefit from addiction and mental health treatment without breaking the bank. NuView Treatment Center is covered by the vast majority of health insurance policies and a wide range of other health insurance plans.
It is our philosophy that addiction recovery involves more than just quitting drugs and alcohol. Clients in our outpatient addiction treatment programs work daily to rebuild their lives from the ground up, creating a lasting foundation for mental health and long-term sobriety. Staff members at NuView Treatment Center are highly trained and professional, but they emphasize compassion above all. We believe that addiction treatment cannot be one-size-fits-all. As such, our individualized treatment plans are holistic and comprehensive. We work with clients to help them address underlying issues, rebuild their lives in recovery, and learn new coping techniques for mitigating the potential for relapse.
If you are ready to put down your substance of choice and begin a new life, reach out to NuView Treatment Center today.