Motivational Interviewing

Motivational interviewing often focuses on understanding and resolving ambivalence when helping people move forward—the conflicted feelings or thoughts that can hinder an individual's progress toward desired change. Whereas traditional therapeutic approaches may adopt a directive stance, motivational interviewing is intended to be more collaborative and client-centered. It seeks to determine people's motivations and skills for change rather than prescribing solutions. In addition, the therapist can express empathy and use open-ended questions to connect more profoundly with the client to prompt behavior change. 

Understanding motivational interviewing

The process typically begins with active listening. The MI therapist listens intently to a client's thoughts, feelings, and reservations about change. The therapist helps the client recognize their motivations by reflecting on what the individual talks about. 

This reflection might highlight discrepancies between the client's current behaviors and broader life goals or values. For instance, if a person desires to be around for their child's future but continues with habits that may threaten their longevity, the therapist might gently highlight this inconsistency, guiding the client to recognize it themselves.

One component of motivational interviewing is the evocation of "change talk." Change talk is when clients voice their desires, abilities, reasons, and needs for change, as well as their trust in their ability to change. The therapist helps recognize and encourage this change talk, amplifying the client's arguments for transformation and asking open-ended questions as they discuss. 

The motivational interviewing process

Throughout this process, the therapist maintains an empathetic, nonjudgmental stance. As a result, the client’s resistance is acknowledged and explored instead of being met with similar resistance. This respect for client autonomy—the acknowledgment that every decision to change (or not) rests with the client—can help ensure a genuine, collaborative partnership. People change, and therapy can be a tool in this part of life. 

Over time, with the MI therapist's guidance, a subtle shift may occur. Ambivalence makes way for clarity, and apprehension can transform into motivation. Having articulated and analyzed their reasons for and against change, the client may be more equipped and motivated to embark on their transformation journey.

Motivational interviewing relies on distinct principles that guide the therapist's approach and the therapeutic process.

Motivational interviewing techniques

These principles may ensure that the interaction is productive, respectful, and conducive to eliciting genuine motivation from the client.

• Expressing empathy: The first principle of MI emphasizes the importance of genuine empathetic understanding. The therapist engages in reflective listening to understand the client's perspective without judging or criticizing. This approach helps create an environment where the client feels heard and understood, fostering trust and openness. By showing empathy, the therapist validates the client's feelings and struggles, acknowledging their inherent worth and capacity for change.
• Acknowledging discrepancy: Focusing on the contradictions between clients' current behavior and their broader life goals or values is often a central element of MI. The client is guided to see the disparity independently using a delicate and collaborative approach. Recognizing this discrepancy can act as a powerful catalyst for change, as the client becomes more aware of the benefits of modifying their behavior to align more closely with their deeper values and desires.
• Managing resistance: Instead of confronting or challenging resistance directly, MI often approaches resistance as a natural part of the change process, not as defiance or denial. If a client expresses reservations, the therapist may work to explore and understand its sentiment. This step might involve examining the client's fears or looking at things differently. The goal is to decrease defensiveness and encourage open dialogue about the ambivalence surrounding change.
• Supporting self-efficacy: Belief in one's ability to change can help the change occur. In MI, therapists continually emphasize the client's autonomy and capability to make positive choices. They celebrate small victories and remind the client of past successes, bolstering their confidence. Therapists can cultivate an environment of optimism and possibility by reinforcing that clients are the principal agents of change and possess the tools to achieve their goals.

Several skills help MI therapists apply the above principles. They include asking open-ended questions, affirming the client, reflecting on what the client discussed, and summarizing what was discussed in the session once it’s complete. 

These principles foster a therapeutic setting where clients feel respected, understood, and empowered. Instead of dictating the path of change, motivational interviewing ensures clients find their way, fortified with genuine motivation and self-belief.

Motivational interviewing is a versatile therapeutic approach that can be applied in numerous settings and for diverse concerns. One of the main objectives of motivational interviewing is to assist individuals in harnessing their intrinsic motivation to bring about behavioral changes that align with their values and goals.

• Substance use or addiction: MI has its roots in treating alcoholism and has been used for various substance use disorders.¹ When individuals are challenged by addiction, ambivalence about quitting or reducing intake is common. MI can help navigate this, amplify the individual's reasons for change, and bolster their confidence in their ability to achieve it.
• Health behavior change: Beyond substance use, MI is employed in medical care settings to aid patients in adopting healthier habits. Whether adherence to medication regimens, making dietary changes, increasing physical activity, or quitting smoking, MI can be a pivotal tool. MI can be valuable when the required behavioral change is challenging or previous attempts have been unsuccessful.
• Mental health: While MI is primarily known for addressing behaviors, it can also be beneficial in mental health concerns. For individuals facing disorders such as depression² or anxiety,³ initiating and sticking with treatment can be a hurdle. MI can boost motivation to attend therapy, practice coping skills, or pursue lifestyle changes.
• Youth and adolescents: Young individuals often stand at the crossroads of significant life choices concerning education, career, relationships, and substance use. MI has proven effective in school and community settings in helping youth make decisions that reflect their long-term goals. MI can steer young people toward more constructive paths by emphasizing their autonomy and helping them envision the benefits of positive choices.

Given its client-centered, empathetic, and non-confrontational nature, motivational interviewing is adaptable to diverse populations and cultural contexts. Whether used as a standalone intervention or integrated into other therapeutic frameworks, motivational interviewing can be beneficial when change is the objective, but motivation is wavering.

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

Motivational interviewing can offer an effective approach to therapy grounded in respect for the client's autonomy and a genuine belief in their capacity for change. This approach's benefits span various domains and can profoundly impact the therapeutic process. 

• Strengthens client/therapist relationship: MI emphasizes the therapeutic relationship, encouraging an open atmosphere of collaboration and trust. This connection can be helpful for long-term treatment success, as clients are more likely to stay engaged with therapy if they feel respected.
• Promotes client autonomy: Unlike more directive forms of therapy, there is no external pressure to change. Clients are regarded as experts in their own lives, and MI assists them in uncovering and amplifying their internal motivations for transformation. Autonomy enhances self-reliance and ownership over the change process, facilitating lasting behavioral modifications.
• Addresses ambivalence: Often, when considering an unwelcome behavior modification, there is an underlying ambivalence. Rather than trying to suppress this uncertainty, MI acknowledges and works through it. Clients can explore their reservations and reframe them more productively.
• Enhances self-efficacy: The goals of MI are behavioral and psychological. Helping the client improve their self-belief has far-reaching implications. Clients become more receptive to treatment, allowing them to ultimately realize their goals and make meaningful changes in their lives. 
• Versatility: Whether managing a chronic disease or helping individuals navigate life transitions, MI can be universally relevant. The principles of MI can be adapted and applied to countless scenarios, making it a powerful tool for therapists in various settings.
• Client-centered and non-judgmental: One advantage of MI is its non-judgmental and client-centered approach. By creating a supportive and understanding environment, MI can be especially beneficial for individuals with past traumatic experiences in therapy. 
• Reduces resistance: Another aspect of MI is its ability to address and reduce client resistance. Instead of challenging or confronting resistance directly, MI transforms potential obstacles into stepping stones, encouraging clients to view their ambivalence as a sign of readiness for change rather than a roadblock.

Transformation potential from motivational interviewing

Motivational interviewing can facilitate transformation at both the individual and systemic levels. As an empowering process emphasizing self-efficacy and autonomy, it provides a safe container for change and allows individuals to take charge of their lives. Through compassionate coaching, motivational interviewing uncovers a client's capacity for resilience and strength, empowering them to create lasting progress. In this way, meaningful growth and transformation can occur.

Over the past few decades, motivational interviewing has been the subject of extensive research, underscoring its efficacy and adaptability across various settings and populations. Two particularly noteworthy areas of recent research illuminate MI's adaptability and potency.

Recent studies have delved deep into the intricate connection between substance use and criminal behavior, with an additional focus on polydrug use. Findings indicate that individuals involved in polydrug use were more prone to engage in criminal activities. The studies identified childhood trauma and familial factors as precursors leading to both substance use and criminality. 

Motivational interviewing studies

Recognizing these intertwined pathways, the therapeutic community began to explore targeted interventions. As a non-confrontational, empathetic approach, motivational interviewing is well-suited to address the complex emotions and challenges faced by this demographic. Furthermore, integrating motivational interviewing within multidisciplinary treatment modules, which can include aspects of social work, counseling, and medical care, has proven to be especially effective.

Another avenue where MI's potential may help is by assisting youth transitioning out of the foster care system. This group often faces unique challenges, from establishing independence to managing potential trauma or abandonment issues. The research underscores the need for support mechanisms that bolster these young individuals' self-worth, resilience, and self-efficacy. 

The client-centered approach

With its client-centered approach, MI is particularly adept at fostering these characteristics. Motivational interviewing may reinforce their intrinsic motivation by facilitating a space where youth can vocalize their fears, aspirations, and goals. Youth can benefit from interventions that guide them toward stability while empowering them to envision and work for a brighter future.

These emerging research areas underscore MI's versatility and emphasize its pivotal role in addressing complex, intertwined challenges in diverse populations. As more studies are conducted, it becomes evident that motivational interviewing's principles hold promise for various societal issues, providing hope and direction for practitioners and those they serve.