Motivational Interviewing Techniques

One of the best ways to change something, be it about you or something else, is motivation. If you don't have the motivation, you'll have a hard time making the commitment to change anything. You either won't feel like it or put it off for another day. Motivational Interviewing (MI) helps people find the drive to change; it is short-term and focuses on empathy. Many of us know how difficult it is to "do it" when a person tells you, “Just do it."

What is motivational interviewing?

Developed by Stephen Rollnick and William Miller, the Australian Family Physician Journal describes motivational interviewing (MI) as an effective counseling method that promotes behavior change by encouraging the patient’s motivation rather than approaching sessions with an authoritative style. The model proposed by Miller and Rollnick is a change model and practice similar to motivational therapy that evolved from Carl Rogers’ values and takes a person-centered approach. The book, “Motivational Interviewing: Helping People Change”(Rollnick, S; Miller, W.R., published by Guilford Press) details the motivational interview process at length.

Meta-analysis studies have shown the motivational interviewing techniques developed by Miller and Rollnick to be highly effective, even in comparison to another popular counseling method, cognitive behavioral therapy. It uses elements of cognitive psychotherapy such as focusing on thought processes and behaviors to impact your current situation and mental health positively. 

Impact of motivational interviewing

In order to grasp the importance of motivational interviewing, you should understand how behavior change happens. Helping people change would be impossible without knowing their starting point and the typical stages of change. The Transtheoretical Model, or Stages of Change Model, breaks down what a patient goes through before real change occurs:

1. Precontemplation: There may be a simple reflection of the pros and cons of change, but the patient is not ready to change. They might be in denial about the importance of particular changes, and not feel they are capable of it. Their concerns may outweigh the benefits in their mind.
2. Contemplation: The patient is beginning to weigh out the pros and cons of change realistically. The decisional balance is starting to skew towards the positive aspects of change. They are still discussing it as a future option, but not unattainable.
3. Preparation: They are starting to use change talk and understand the importance of change. They may begin to see it as something that will happen soon and steps are being formulated for it to occur. The motivation for change may begin to arise in this stage.
4. Action: The patient is taking real steps and making smaller changes to see the differences they want in their life. Their values are changing and they make decisions to prioritize their mental and physical health.
5. Maintenance: The changed behaviors have become a regular, sustained practice; there may now be a commitment to change.
6. Termination: The behaviors have now become habitual and the patient no longer wants to return to their old ways. The person values their new mindset and health.

Useful cases for motivational interviewing

Addiction

Many people have tried to end an addiction or substance use disorder. If you’re addicted to something such as cigarettes, you know smoking cessation does not come easily. It doesn't have to be drugs, but instead food, social media, or any other addictive habit that is bad for our health. However, the addiction to the habit can be stronger than the motivation to recover. MI can give you the motivation needed to succeed and reduce substance use or substance abuse. Motivational interviewing techniques can be used in addiction medicine practice to treat adult or adolescent substance use disorders as well.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Managing diseases

Some people lose all motivation to manage their health, particularly challenging diseases. If one has diabetes, they may not have the motivation to check their blood sugar often. Maybe they feel jaded about having diabetes, or maybe it's something deeper that’s keeping them from successful diabetes management. Perhaps is smoking cessation. MI can also help get to the bottom of it. Treatment adherence is crucial to managing any disease and your overall health, but sometimes lacking a sense of control or motivation can hinder this process. Motivational interviewing uses techniques to understand what is keeping patients in their current situation and how to change this behavior. When interviewing, motivational strategies often result in helping people change by teaching them applicable skills and methods to shift their mindsets.

Preparing for change

Many people don't like life changes or to alter their status quo. Be it a divorce, a new job, a new location, or anything else, hating change can make people lose their desire to adapt. This can slow their life progress and make them not want to succeed. Some motivational interviewing strategies can be useful for preparing people learn to embrace change and see it as a challenge rather than an obstacle. Interviewing techniques can help the patient address concerns and develop a stronger ability to change. Preparing people to process the upcoming change can help them build confidence.

Emotional health

Motivational interviewing is good for people who are too emotional to be motivated. Sometimes, emotional health may cloud a patient’s strength and motivation. Anger, sadness, or apathy are reasons why someone may not be motivated. By addressing these and beginning to process them, the patient can be ready for a change.

Motivational interviewing techniques and principles

Like cognitive psychotherapy, MI strives to solve problems in a patient’s life. The MI approach uses many techniques to help the patient change by using motivation as the driving force. The counselor knows how people work, and will try everything they can to get the client motivated. Here are some motivational interviewing techniques and principles.

Battling resistance with motivational interviewing techniques

People are contradictory. They have mixed feelings like wanting to change, but showing resistance to do so. A therapist is prepared to handle resistance in many ways. From people outright saying no to subtle hints, such as their body language or how they say certain words. A good therapist will learn how to get around the resistance, not by fighting it, but instead by asking permissive questions and using reflective listening. MI teaches that the therapist should avoid telling the client that they are wrong. Instead, the therapist should invite the client to think about new ways of solving a problem or tell the client to change their thinking around. It's a friendly form of therapy that doesn't want to be argumentative.

In a therapeutic relationship, a good counselor honors client autonomy and knows that motivation to change must come from within. Oftentimes, when people are pushed, their resistance grows stronger. Readiness for change is a gradual process that must happen with time.

Advice offering

How does a therapist offer advice while not causing resistance? It's a tricky rope to walk, yet MI therapists are good at what they do. They know that people don't like being told to do something, but instead, they like to have a choice. A patient’s autonomy is at the forefront of motivational interviewing. The choices MI brings are not delivered in a judgmental manner, but instead in a casual way through conversation.

This is performed in many ways, including:

• The therapist always asks before giving advice. People don't like the advice they didn't ask for, and by asking, they are more open to listening.
• Then, the advice is given. It's given not in a way that demands change, however. You'll hear language such as, "You should consider doing this," rather than "do this." Telling someone they should consider their options makes the client feel like they're not being rushed. A therapist may also say "It's your choice," to give the client more freedom of thought.
• The therapist then asks for feedback about the advice they gave. Then, they give confidence in their advice. They are not only confident about their advice, but also about the chances of the client taking it.

Therapeutic paradox

Another technique for clients who have made little progress is the therapeutic paradox. What is this? They are statements made by the therapist that seem contradictory.

For example, say a client is having a hard time quitting smoking. The therapist may say, "You've tried to quit, yet I see you're still smoking. Maybe it's not time for you to quit right now."

The client will be resistant to the therapist's words. They may say that they want to quit smoking, and then the therapist can figure out why they have had such a hard time quitting.

It's a riskier technique, but it can be effective for clients who refuse to change.

Self-efficacy

In the end, the client needs the confidence and motivation to change their ways. Having high self-esteem can make them self-efficient, and the therapist knows how to make the client more motivated. Ultimately, the patient is striving to identify their future goals and build confidence in their ability to achieve them. Telling them that they have a good plan, that they have made progress, or emphasizing the patient’s strengths can give them the extra boost they need to keep going.

Empathy

One of the biggest techniques used by motivational interviewing therapists is empathy. The therapist can put themselves in the client's perspective, and this can allow them to see it through their eyes. Many clients come to feel like no one understands them, and by having a therapist who is good at understanding, the therapist is more likely to succeed in the patient’s change process. The therapist acknowledges that change is difficult and that they know how they feel.

Columbo approach

One of the motivational interviewing techniques used is the Columbo approach. For those who have never seen the TV series Columbo, the titular protagonist used skills to try to rationalize discrepancies. The motivational interviewing therapist may ask open-ended questions about the client’s behavior that sound like a curious question. It's not meant to be judgmental, but instead, a question that wants more information.

When they find contradictory information in motivational interviewing, the therapist will present it in a way that is not judgmental but instead makes the client think about their mindset. They will end their questioning with a simple reflection on their actions.

A good example is a client who is trying to quit smoking. The client may say earlier they have a desire to live a long life, but they are continuing to smoke. The therapist may ask the client, "How can your smoking make you live a long life," and this lets the client think about their actions quite well.

Another example might be a patient striving for weight loss. A patient might express that they want to invest in their health and have an active lifestyle, but they don’t feel extremely confident exercising. A therapist might respond with “What would help you build that confidence?” The weight itself is holding them back, but the weight loss could be the patient’s motivation.

DEARS

Motivational interviewing therapists have five principles, and many put them into an acronym known as DEARS. Develop discrepancy, express empathy, amplify ambivalence, roll with resistance, and support self-efficacy.

• Develop discrepancy. The therapist wants the client to realize that their beliefs are contradictory, and they are not compatible with one another. Their problematic behaviors are not in tune with their goals.
• Express empathy. The therapist will then be understanding of the client's struggle. They can put themselves in the shoes of the person on the chair, and this opens the client to hearing advice.
• Amplify ambivalence. The therapist wants the client to pay particular attention to their contradictory behavior and realize that they have to make a choice. The Guilford Press has shown motivational interviewing techniques to be effective in resolving ambivalence. Breaking down this decision-making barrier helps clients take real action. However, the Guilford Press study acknowledges that the methodology is complex and the exact reason why it works is not entirely known.
• Support self-efficacy. Finally, the therapist wants the client to be confident with all the progress they have made. In MI, the patient’s autonomy is one of the tenets principles or change. The motivational interviewing techniques used are meant to empower the patient to make changes on their own in the future. By showing off the progress the client has made, the client can be able to find the motivation to carry on. And that is the goal of MI, to increase motivation.

Effectiveness of motivational interviewing

Motivational interviewing techniques are quite effective in practice, as they know how the human psyche works. The method involves enhancing our predisposed tendencies towards motivation and change. Humans have a mind that is quite a puzzle. We want to change, but contradictory thoughts and actions prevent us from doing so. Be it a byproduct of evolution, or another underlying reason, many of us don't have the motivation to change.

Cognitive psychotherapy can help us understand our current behaviors. Furthermore, motivational interviewing techniques can help use these realizations to get past all the roadblocks that make humanity resistant to change. For example, it's not confrontational or judgmental. No one likes to hear judgmental comments about themselves, and motivational interviewing helps deliver the changes in a way that does not feel condescending or judgmental.

Of course, in addition to establishing a therapeutic relationship with the counselor, it is extremely important that the client be the one who ultimately makes the decision and begins the change process. MI is good at battling resistance to change, but the client needs to be the one to take the path that will lead them to improvement. Change talk is used to describe language used by patients that signifies they are ready to make a behavior change. The motivational interviewing counselor may elicit change talk in the patients by using reflective listening and drawing from the client’s ideas. Essentially, MI techniques give the client the map and compass they need, and the client will be the one who uses it.