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Motivational interviewing: definition, uses, techniques, and effectivity

Reading time: 15 mins
Motivational interviewing: definition, uses, techniques, and effectivity

Motivational interviewing (MI) is a counseling approach that assists individuals in finding the motivation to make beneficial changes in their behavior, especially when they have conflicting feelings about change. Motivational interviewing acknowledges the normality of ambivalence and seeks to address it by exploring the individual’s inner motivations and values. This method underscores a collaborative counselor-patient relationship, characterized by empathy and support, to foster a setting conducive to change.

Uses of motivational interviewing include treating addiction, particularly with alcohol and cigarette smokers. Additionally, its effectiveness has been demonstrated benefiting individuals with addiction to marijuana, and opioid use disorders (OUD). MI finds diverse applications in diabetes, pain management, and HIV risk reduction, among others. It complements cognitive behavioral therapy (CBT) for anxiety disorders and has shown success in treating post-traumatic stress disorder (PTSD).

Motivational interviewing techniques encompass open-ended questions, affirmations, reflective listening, summaries. In motivational interviewing, counselors help patients explore their feelings and motivations using these techniques. This approach is effective for resolving ambivalence and increasing motivation for change, with applications in various health behaviors and conditions.

Effectiveness of motivational interviewing extends across addiction treatment and mental health facilitating behavior change. It aids in exploring feelings, resolving ambivalence, and cultivating the motivation to change. It effectively treats addiction by empowering individuals to find their own motivation for change, building trust and collaboration. It boosts confidence by highlighting strengths and past successes, helps manage cravings and triggers, and equips patients with coping mechanisms for sustained recovery.

What is motivational interviewing?

An African American man having motivation interview session with a woman.

Motivational interviewing (MI) is a clinical strategy designed to help individuals with substance use disorders by enhancing a patient’s motivation for change. The chapter 2“Motivation and Intervention” from the book Enhancing Motivation for Change in Substance Abuse Treatment published by Substance Abuse and Mental Health Services Administration (SAMHSA) in 1999, explores various interventions that include counseling, patient assessment, multiple sessions, or a brief 30-minute intervention.

The goal of MI is to promote motivation for change among patients who are hesitant about making changes in their behavior. MI is a promising approach for supporting individuals in achieving long-lasting recovery.

MI is indeed a valuable approach for medical practice, as highlighted in the article titled “Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice” authored by Gallus Bischof et al. and published in the journal Deutsches Ärzteblatt International in 2021. MI has been shown to be effective in enhancing motivation for behavioral change among patients with a wide range of behaviorally influenced health issues. Additionally, it plays a crucial role in promoting treatment compliance, which is vital for achieving positive health outcomes.

Who created motivational interviewing?

Motivational interviewing (MI) was created by clinical psychologists William R. Miller and Stephen Rollnick to facilitate behavior change by helping individuals explore and resolve their ambivalence towards change. In the past, addiction treatment focused on fixing people with addiction. MI takes a different approach, inspired by Carl Rogers’ person-centered therapy, emphasizing the scientific study of therapeutic processes. MI prioritizes understanding and empathy to help individuals find their own path to recovery.

As an empirical approach, MI began by observing clinical practice to understand what promotes change. It bridges the gap between evidence-based practice and the importance of the therapeutic relationship. This approach holds that individuals find their own solutions and make positive changes when given the right support.

When was motivational interviewing developed?

Motivational interviewing was developed in the 1980s by William R. Miller based on his observations while working with individuals with alcohol use disorders (AUD). Although trained in traditional behavioral therapies, Miller discovered that therapist empathy had a greater impact on patient outcomes than specific techniques. This insight led him to explore more patient-centered approaches. In his 2023 article “The Evolution of Motivational Interviewing” published in the journal Behavioural and Cognitive Psychotherapy, Miller reflects on his experiences with individuals with AUD.

Further refinement of his approach occurred during a sabbatical leave in Norway, where discussions with therapists provided valuable insights. These efforts culminated in the first published description of MI in 1983.

What is motivational interviewing used for?

A man smiling after motivational interview.

Motivational interviewing (MI) is used for addiction, particularly with alcohol and cigarette smokers. The Chapter 2 “Motivation and Intervention” from the book Enhancing Motivation for Change in Substance Abuse Treatment published by Substance Abuse and Mental Health Services Administration (SAMHSA) in 1999, explores the expanded applications of MI in treating substance abuse. The effectiveness of MI has been demonstrated in multiple countries, benefiting individuals with addiction of alcohol, smoking, marijuana, and opiate use disorders (OUD).

The article further discusses the diverse applications of MI in areas like diabetes, pain management, coronary heart disease rehabilitation, HIV risk reduction, smoking and obesity prevention, and with various populations like sex offenders, pregnant women with alcohol issues, and veterans with alcohol problems.

MI isn’t limited to addiction treatment. It works alongside another powerful therapy approach i.e., cognitive behavioral therapy (CBT) to address anxiety disorders. This combined approach has been successful in treating generalized anxiety disorder, social anxiety disorder, and even post-traumatic stress disorder (PTSD).

MI has been widely applied across various cultures, addiction problems, and treatment settings, showing successful outcomes like increased treatment referrals, reduced substance use, and improved compliance with specialized treatment.

What is the process of motivational interviewing?

A woman smiling while a motivational interview session.

The process of motivational interviewing (MI) involves four steps that include engaging, focusing, evoking, and planning. In Chapter 3 titled, “Motivational Interviewing as a Counseling Style” in the book Enhancing Motivation for Change in Substance Use Disorder Treatment published by Substance Abuse and Mental Health Services Administration (SAMHSA) updated in 2019, MI is depicted as a counseling style that embraces the dynamic nature of behavior change. Rather than adhering to a rigid, linear progression through distinct stages or processes, MI acknowledges the fluidity of a patient’s journey toward change.

Engaging is the cornerstone of MI, involving building a trusting relationship between the practitioner and the individual seeking care. This process, characterized by empathy, respect for autonomy, and acceptance, establishes a collaborative partnership where the individual feels understood and valued. Through techniques like open questions, affirmations, reflective listening, and summary reflections (OARS), the practitioner respects the patient’s expertise and autonomy, laying the groundwork for effective conversations about change.

Focusing stage involves building an agreement between the patient and the practitioner, where the practitioner guides the patients’ to identify a specific target behavior to change while acknowledging any ambivalence. Establishing clear goals is essential for maintaining a focused and effective discussion, fostering a strong partnership between the counselor and the patient, thus ensuring that the patient feels understood and valued.

Evoking in MI is about getting patients to talk about why they want to change. Practitioners listen carefully to understand what drives patients to change and help them find their own reasons. This process helps patients see the importance of change and feel more confident about making positive changes.

Planning in MI isn’t always necessary if evoking is successful, as patients often make their own plans. Practitioners trust patient’s expertise in their own lives, though they offer guidance. Planning involves asking key questions like, “What’s your next step?” and addressing potential barriers to success. It’s about helping patients apply their motivations and insights to practical, manageable steps forward.

What are the techniques used in motivational interviewing?

The techniques used in motivational interviewing (MI) are listed below.

  • Open-ended questions: Open-ended questions let people freely share their thoughts and emotions. They’re not just “yes” or “no” questions. They help patients talk more about their thoughts and feelings. It is beneficial to employ open-ended questions extensively while ensuring attentive listening to the responses. For example, “How was your relationship with your parents?“, this question invites the patient to describe their relationship with their parents in their own words, without suggesting whether it was good or bad. It allows for a more detailed and personal response, giving the person the opportunity to share their thoughts, feelings, and experiences openly.
  • Affirmations: Affirmations are positive statements or gestures that acknowledge and reinforce a person’s strengths, efforts, or positive qualities. In MI, affirmations are used to build confidence and motivation for change. It recognizes a patient’s small efforts towards recovery, reflecting on their progress and positive qualities. They focus on highlighting past successes or qualities that help the patient overcome challenges and make positive changes in their life.
  • Reflective listening: Reflective listening involves rephrasing a patient’s statement to grasp the underlying meaning and emotion. It captures the implicit meaning and feeling of their statement, promoting self-exploration and understanding of motivations. Additionally, it amplifies the desire for change. Reflection acknowledges both sides of a statement, guiding the conversation positively. Reflective listening is a multi-level approach that impacts the depth and intimacy of conversations. This technique involves repeating or rephrasing the speaker’s words closely, using synonyms or echoing phrases. Paraphrasing is another level where the listener restates the speaker’s message to convey its intended meaning. The deepest level is the reflection of feeling, where the listener focuses on the emotional content of what was said, showing empathy and understanding. Each level of reflective listening deepens the connection between individuals and enhances the overall quality of communication.
  • Summaries: Summarizing, though seemingly simple, is a powerful technique in active listening. It involves pulling together the key points of what someone has said and presenting them back in a concise manner. This not only shows understanding but leads to new insights for the speaker. Summaries serve several purposes, including linking discussions and ensuring mutual understanding, highlighting discrepancies between the current situation and future goals, and demonstrating empathy. They are particularly useful at transition points in a conversation, such as after discussing a topic or personal experience, or as the conversation near its end. Overall, summarizing promotes clear communication and acts as a catalyst for change.

What are the principles of motivational interviewing?

A woman in glasses having MI online.

The principles of motivational interviewing (MI) are listed below.

  • Express empathy: Empathy in MI involves understanding the patient’s perspective by seeing the world through their eyes, thinking as they do, and feeling as they feel. This approach allows patients to feel heard and understood, encouraging them to share their experiences more openly. Expressing empathy in MI involves careful listening and nonjudgmental curiosity about the patient’s situation, different from other therapies that focus more on verbal expressions of empathy. In MI, clinicians help patients explore both sides of their ambivalence, including the side that others consider “unhealthy,” without judgment. Empathy is important in building rapport, reducing resistance, and increasing a patient’s readiness to change. It involves reflecting the patient’s perspective accurately and respectfully, fostering an open and honest dialogue.

  • Roll with resistance: From an MI perspective, resistance in treatment occurs when the patient feels a conflict between their own view of the problem or solution and that of the clinician, or when they feel their freedom or autonomy is being infringed upon. This often stems from the patient’s ambivalence about change. In MI, counselors avoid eliciting resistance by not confronting the patient directly. When resistance does occur, they work to de-escalate and avoid a negative interaction, opting instead to “roll with it.” This means actions and statements demonstrating resistance remain unchallenged, especially early in the counseling relationship. By “rolling with resistance,” counselors disrupt any potential struggle and prevent the session from becoming argumentative. This approach aligns with MI’s emphasis on having the patient define the problem and develop their own solutions, leaving little room for the patient to resist. Counselors in MI use empathetic listening to invite patients to explore new perspectives without imposing their own. Resisting the urge to impose solutions or persuade the patient is crucial in MI, as it allows the patient to voice their own reasons for change, which is more effective in motivating change.

  • Develop discrepancy: Developing discrepancy is a key strategy in MI to enhance motivation for change. It involves helping patients recognize the mismatch between their current behaviors and their values or goals. By highlighting this discrepancy, patients are more likely to feel motivated to make significant life changes. However, it’s important for counselors using MI to develop discrepancy gradually and in alignment with other principles, ensuring that patients become aware of how their current behaviors lead them away from their goals. This approach emphasizes the importance of patients recognizing for themselves the need for change, rather than being persuaded by the clinician. Through careful questioning and active listening, clinicians help patients explore their values and goals, ultimately increasing their motivation for change.

  • Support self-efficacy: MI adopts a strengths-based approach, emphasizing patients’ inherent capacity to enact successful change. Central to this is fostering self-efficacy, or the belief in one’s ability to effect change. MI counselors bolster self-efficacy by highlighting past successes and existing strengths, empowering patients to take an active role in their treatment. In MI, clinicians view patients as consultants on their own lives, fostering collaboration to develop personalized solutions. This approach not only acknowledges patients’ expertise but cultivates optimism and resilience, crucial factors in facilitating meaningful change. By affirming a patient’s efforts and recognizing their intrinsic capabilities, MI therapists create a supportive environment conducive to growth and transformation.

What is the main goal of motivational interviewing?

A white man with a long beard in MI session.

The main goal of motivational interviewing (MI) is to enhance motivation of patients for behavior change by addressing ambivalence or uncertainty. This approach attempts to increase a person’s intrinsic motivation, encouraging change that originates from inside as opposed to being driven from outside, contributing to more self-driven and sustainable development.

The article“Applying Motivational Interviewing Strategies to Enhance Organizational Readiness and Facilitate Implementation Efforts” by Melissa R. Arbuckle et al., published in the journal Quality Management in Health Care in 2021, discusses how MI operates on the premise of personal autonomy, acknowledging that individuals ultimately make their own decisions. Clinicians want to help people find their own reasons to change by encouraging them to talk about why they want to change and how they do it. This is called “change talk.” At times, patients talk about why they want things to stay the same, which is called “sustain talk.” Both types of talks are normal, and conversations with clinicians help patients decide what changes they want to make.

What are the elements of motivational interviewing?

The elements of motivational interviewing (MI) are listed below.

  • Partnership: MI emphasizes a partnership between the therapist and the patient, where the therapist seeks to understand the patient’s perspective and experiences. This contrasts with approaches that are more hierarchical, with the therapist assuming an “expert” role and imposing their perspective. Collaboration builds rapport and trust, even if the therapist and patient see things differently. The aim for the therapist is to provide support rather than persuasion.
  • Autonomy : MI recognizes that the true power for change lies within the patient. The therapist demonstrates regard for the patient’s autonomy and responsibility to make decisions and take actions. Patients are encouraged to develop a list of options for how to achieve the desired change, reinforcing that there is no single right way to change.
  • Compassion: Compassion means actively promoting the patient’s welfare and prioritizing their needs. It involves dedicating oneself to advancing and supporting the patient’s well-being by focusing on their needs.
  • Evocation: In MI, the therapist focuses on listening more than speaking and encourages the patient to share their own perceptions instead of imposing any. This approach aims to increase the patient’s interest in maintaining the change for a longer period. This is because motivation and commitment to change are most powerful and lasting when they come from the patient themselves. The therapist’s role is to elicit the patient’s motivations and skills for change, not to dictate what they do.

How does motivational interviewing work in addiction treatment?

Motivational interviewing (MI) works in addiction treatment by helping individuals explore and resolve their ambivalence about changing addictive behaviors. MI therapists use a collaborative, empathetic approach to help patients identify their reasons for change and increase their motivation to make positive changes. This is done through open-ended questions, reflective listening, and affirmations, which encourage patients to talk about their feelings and beliefs regarding their addiction. By focusing on the individual’s intrinsic motivation and strengths, MI helps build confidence in their ability to change and increases the likelihood of successful outcomes in addiction treatment.

What are the benefits of motivational interviewing in addiction recovery?

The benefits of motivational interviewing (MI) in addiction recovery are listed below.

  • Improved medication adherence: Enhancing medication adherence poses a challenge, particularly among minority and vulnerable populations at increased risk of non-adherence. A study by Ana Palacio et al., titled “Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis,” published in the Journal of General Internal Medicine in 2016, highlights that MI enhances medication adherence, especially among minority populations. MI has been proven to be effective in improving how well people stick to their prescribed medications for chronic conditions. Whether someone participates in MI for a short or long period, the improvement in medication adherence is consistently seen in both self-reported and objective measurements.
  • Reduced cravings: Cravings pose a significant hurdle in addiction recovery, but MI offers strategies to combat them. By pinpointing triggers, building coping mechanisms, and boosting self-efficacy, MI empowers individuals to resist cravings and uphold their recovery. A study “Listen to Yourself: How Motivational Interviewing Shifts Food Choices and Craving-Related Brain Responses to Healthier Options” authored by Belina Rodrigues et al. and published by Cold Spring Harbor Laboratory in 2023, supports this notion. MI fosters changes in dietary decisions while influencing brain circuits associated with decision-making and craving. These findings deepen understanding of the neurocognitive mechanisms involved in communication-based behavior change strategies, potentially informing future interventions to promote healthier eating habits.
  • Enhanced self-efficacy: MI enhances self-efficacy by highlighting past successes and strengths, aligning behavior change goals with personal values, and breaking down goals into manageable steps. A study titled “Motivational interviewing for smoking cessation” by Douglas Tc Lai et al., published in the journal of The Cochrane Database of Systematic Reviews in 2010, showed MI’s promise in aiding smoking cessation, with a significant rise in quitting rates of smoking.
  • Reduced relapse risks: MI reduces relapse risk by boosting motivation, improving problem-solving skills, increasing awareness of triggers, and fostering a supportive environment. These elements empower individuals to manage challenges effectively, align goals with values, and maintain behavior change, reducing the likelihood of relapse. In the study titled “Psychoeducation and Motivational Interviewing to Reduce Relapses and Increase Patients’ Involvement in Antipsychotic Treatment: Interventional Study” authored by Gabriella Bröms et al. published in the journal of BJ Psychiatric Bulletin in 2020, it was discovered that a single session of psychoeducation and MI combined promotes patients’ involvement in treatment choices and leads to a reduction in relapse frequency.

Who performs motivational interviewing for addiction treatment?

A qualified mental health professional with a woman and a man.

Motivational interviewing (MI) for addiction treatment is performed by qualified mental health professionals in addiction treatment settings. These professionals include licensed therapists, who hold a master’s or doctoral degree in fields like social work, psychology, or counseling and have undergone specific MI training.

Addiction counselors, with certifications from bodies like the National Certification Commission for Addiction Professionals (NCC AP), receive MI training as part of their professional development. Licensed nurses, depending on state regulations and training, incorporate MI techniques into their practice in addiction treatment settings. While psychiatrists mainly focus on medication management, they use MI skills to support their patient’s overall addiction treatment plan.

What are some examples of questions used in motivational interviewing for treating addiction?

Motivational interviewing (MI) relies on open-ended questions, reflections, affirmations, and summaries to guide a person towards their own motivation for change.

Some examples of questions used in motivational interviewing for treating addiction are listed below.

  • What is it that brings you here today?
  • What motivates you to consider this change?
  • What are your goals for our work together?
  • What negative effects of drinking or drug use are concerning you?
  • How would you approach quitting drinking if you chose to do so?
  • What aspects of your behavior do you think are changeable?
  • What strategies do you have in mind for making this change?
  • Can we discuss your (specific behavior) for a moment?
  • What will happen if you don’t change?
  • How can I assist you in overcoming the challenges you’re facing?
  • What positive aspects do you associate with your (specific behavior)?
  • I admire your courage in discussing your drinking with me today.
  • You’ve shown great resourcefulness in dealing with these challenges over the past few years.
  • Thank you for sticking with me; I understand this isn’t easy for you to hear.
  • While alcohol eases stress and social anxiety, are recent health concerns and your partner’s input making you question its positive impact?
  • Summarizing your drinking concerns: health issues, partner’s dissatisfaction, past attempts to quit is that accurate?

Is motivational interviewing effective for addiction treatment?

A man sitting with a mental health expert.

Yes, motivational interviewing (MI) is effective for addiction treatment by enhancing motivation for change, reducing substance use, and improving treatment outcomes. It complements interventions like cognitive-behavioral therapy (CBT) and pharmacotherapy, aiding in resolving ambivalence and adopting positive behavioral changes in substance use disorder treatment.

In the study titled “Motivational Interviewing to Enhance Treatment Engagement and Outcome in Individuals Seeking Treatment for Substance Abuse” authored by Kathleen M. Carroll et al. published in the journal Drug and Alcohol Dependence in 2005, researchers observed significant reductions in the frequency of substance use over time. Additionally, they discovered that MI was associated with improved retention rates.

What makes motivational interviewing effective for treating addiction?

Motivational interviewing (MI) proves effective for treating addiction by fostering a patient-centered approach that empowers individuals to find their own motivation for change. Unlike traditional directive methods, MI focuses on understanding a patient’s ambivalence and exploring their reasons for wanting to quit. This builds trust and collaboration, increasing the chance of long-term success.

MI strengthens a patient’s belief in their ability to change by highlighting their strengths and past successes. This newfound confidence is significant for overcoming cravings, managing triggers, and staying committed to recovery. By equipping individuals with healthy coping mechanisms and fostering a desire for a better life, MI significantly reduces the risk of relapse and paves the way for sustained recovery.

What are the cons of motivational interviewing for addiction treatment?

The cons of motivational interviewing (MI) for addiction treatment are listed below.

  • Staff level barriers: These are factors related to the counselors themselves that make it difficult to implement MI. They include lack of time, resistance to change, lack of confidence, limited competency in MI, apprehension about using MI, and lack of buy-in to MI. Counselors face busy schedules with limited time for each patient, making it challenging to build rapport and engage in reflective listening required for MI. Resistance to adopting new methods, preferring familiar techniques, hinders MI integration. Lack of confidence and limited competency in MI skills, such as active listening and empathy, result from inadequate training. Apprehension about MI’s effectiveness or ability to use it properly prevents full commitment.

  • Management level barriers: Management-level barriers like leaders’ time, staffing issues, financial resources, external contractual constraints and limited support, hinder the implementation of MI. These challenges affect leaders’ ability to follow up on training, manage staffing, comply with contracts, receive support, allocate funds, and cope with turnover. Addressing these issues is important for successful implementation.

  • Resistance from patients: Patients’ resistance is a significant barrier to MI, occurs when patients refuse to acknowledge their issues and resist change. This challenge is prominent in patients directed to therapy by family or court orders.

  • Varied effectiveness: While MI works for many, it does not suit everyone, as responses to treatment approaches differ. This variability underscores the need to consider alternative approaches when MI does not achieve desired outcomes.

  • Time constraint: High caseloads hinder therapists from fully embracing the empathetic, collaborative approach of MI. Time constraints lead to a more directive approach focused on efficiency, potentially limiting the exploration of patients’ motivations for change.

  • Limited effectiveness for highly motivated individuals: MI thrives on building motivation for change. If a patient is already highly motivated and committed to quitting, other therapeutic approaches are more suitable to address the underlying causes of addiction or develop specific coping mechanisms.

Is motivational interviewing a form of cognitive behavioral treatment (CBT)?

A woman and a man going through MI's session.

No, motivational interviewing (MI) is not a form of cognitive behavioral treatment (CBT), but rather a distinct approach that complements CBT. Both MI and CBT are evidence-based methods for behavior change, each with its own focus and methodology. MI, a collaborative conversational style, aims to bolster intrinsic motivation and commitment to change, particularly effective in areas like substance abuse and mental health.

In contrast, CBT targets maladaptive thoughts and behaviors to alleviate symptoms, widely used across various diagnoses. Integrating MI with CBT enhances motivation for change, improving response rates and the maintenance of change post-treatment, as discussed in the chapter “Integrating Motivational Interviewing and Cognitive‑Behavioral Therapy RATIONALE, APPROACH, AND EVIDENCE” authored by Sylvie Naar and Steven A. Safren, published in the book Motivational Interviewing and CBT: Combining Strategies for Maximum Effectiveness in 2017.

What is the difference between motivational interviewing and cognitive behavioral therapy (CBT) in addiction treatment?

The difference between motivational interviewing (MI) and cognitive behavioral therapy (CBT) in addiction treatment lies primarily in their approaches and goals. MI is a patient-centered approach that aims to explore and resolve ambivalence to change, enhancing intrinsic motivation. It focuses on empathy, collaboration, and evocation to elicit the individual’s motivations for change. In contrast, CBT is a structured, goal-oriented therapy that targets dysfunctional thoughts, beliefs, and behaviors related to substance use. It teaches coping skills, addresses cognitive distortions, and promotes behavior change through various strategies. While MI aims to enhance motivation for change, CBT focuses on modifying cognitive and behavioral patterns underlying addiction.

MI utilizes strategies such as open-ended questions, reflective listening, and affirmations to establish a connection and delve into a patient’s emotions and experiences. On the other hand, CBT employs methods such as cognitive restructuring, exposure therapy, and teaching behavioral skills to challenge negative thoughts and patterns and to cultivate coping strategies.

In MI, the therapist plays a supportive role, guiding the patient to explore their own motivations and reasons for change. The focus is on eliciting the patient’s thoughts and feelings. Conversely, in CBT, the therapist takes a more direct approach, teaching the patient specific skills and strategies to address negative thought patterns and behaviors. The therapist in CBT is more instructive and provides structured exercises to help the patient learn and apply new skills.