Motivational Interviewing (A Complete Guide)

Motivational Interviewing is  a psychotherapeutic technique that helps people to make positive decisions and accomplish goals.

It helps them to move away from their state of ambiguity and uncertainty. 

We will discuss everything you need to know about motivational interviewing in this article.

What is Motivational Interviewing?

Miller and Rollnick defined Motivational Interviewing or MI as “a client-centered directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

It is strongly rooted in the client-centered therapy of Carl Roger’s (1951, 1959) in its stress on considering the client’s internal frame of reference and present concerns, and in discrepancies between behaviors and values.

Contrary to client-centered approach, Motivational Interviewing’s specific goals are to decrease ambivalence about change and to boost intrinsic motivation to change.

In this sense MI is both client-centered and directive.

When It’s Used

Motivational interviewing is mostly used for the problem of addiction and other physical conditions including diabetes, asthma, cardiovascular diseases.

It is a technique which motivates the client to change his behavior which is harmful for them and makes them continue an unhealthy lifestyle.

Motivational interviewing also helps a person to get prepared for further therapeutic interventions.

It is one of the best ways to treat people who have been unmotivated and unprepared for therapies or to bring a change in them.

It is also helpful for people who are angry or hostile because they are resistant to change while motivational interviewing will help them move past the emotional stage to the point where they can  see how change is necessary.

MI offers advantages in cross-cultural counseling particularly because of the therapist’s focus on understanding the client’s unique context and perspective.

Several large studies of MI treating drug abuse are also conducted. Clients given MI attended significantly more subsequent treatment sessions, compared with those receiving normal intake procedures.

Other studies have demonstrated significant clinical benefits of MI when delivered by frontline providers for problems including alcohol and drug abuse, hypertension and health promotion.

What to Expect

An interviewer will help the client in a supportive manner to talk about the need to change the client and also client’s need and wanting to change.

The interviewer will have to start a conversation about commitment and change.

Interviewers will also help the client after listening to his thoughts and reflecting back his thoughts so his motivations expressed can be listened and understood by the client.

Most of the time, motivational interviewing requires only a few sessions if it is used alone, but it can be used in combination with other therapies for a longer period of time.

How It Works

Motivational interviewing is mainly developed from client-centered or person-centered therapy by Carl Roger.

Client centered or person centered approach to counseling helps people to commit to a difficult process of change.

The procedure is twofold as the interviewer has to motivate the person to accept the change and second is to make the client committed to the process of change.

It has been seen to be more powerful for the clients to hear out loud about the need and commitment to change than simply stating it as a desire to change.

Motivational interviewing also increases the person’s ability to actually make changes. The main purpose of an interviewer is to listen and understand the views of the client rather than intervening.

MI is also combined with other therapies including cognitive behavior therapy and support groups.  

What to Look for in a Motivational Interviewer?

A good motivational interviewer will be a licensed mental health professional who is not only empathetic and supportive but he or she is also a good listener.

Try to find someone who is trained as well as an experienced mental health professional because it is a skill which improves with time, experience and formal training. 

Moreover, it is of grave importance that you are also comfortable with the interviewer and feel safe and at ease while discussing your problems with him or her.

You should also look for these basic skills in a motivational interviewer.

Miller and Rollnick have described a number of foundational skills for motivational interviewing

 Asks open-ended questions

In Motivational Interviewing, the client should be the one who does most of the talking, and open-ended questions are the way to do it.

     Listens Reflectively

Reflective listening is one of the most important skills in motivational interviewing.

Miller and Rollnick suggested that “the essence of a reflective listening response is that it makes a guess as to what the speaker means”

      Affirmation

In order to persuade and support the client all through the change process, the motivational interviewing therapist often affirms the client in the form of statements of admiration of understanding.

        Summarize

Summaries play an important role throughout motivational interviewing sessions.

Not only do they show that the therapist has been listening, but also they link material together and can help emphasize certain points.

Summaries are particularly used to collect and reinforce “change talk,” the client’s own statements of motivations for change.

         Elicit Change Talk

Change talk consists of statements reflecting desire, perceived ability, need, readiness, reasons, or commitment to change.

Amrhein, Miller, Yahne, Palmer, and Fulcher found that statements reflecting commitment to change were the strongest predictors of outcome in therapy for drug use.

Principles of Motivational Interviewing

Along with all the above mentioned skills, an interviewer must use these basic principles of motivational interviewing while dealing with a client.

These are commonly known as acronym of DEARS and stands for developing discrepancies, express empathy, amplify ambivalence, roll with resistance, support self-efficacy.

Develop Discrepancy

Motivation is a function of the discrepancy between the client’s positive behavior and values.

Awareness of these discrepancies can increase motivation to change.

The therapist differentially elicits and explores own arguments for change as a path out of ambivalence.

Express Empathy

Empathy involves a non-judgmental attitude in which the therapist tries to see the world through the client’s perspective.

It does not mean the therapist condones the behaviors, but neither does it mean that therapist disapproving or critical of the choices people make.

Amplify Ambivalence

The therapist wants the client to keep thinking about their contradictory behavior and realize that they have to make a choice.

Roll with resistance

In Motivational Interviewing, the therapist strives to understand and respect both sides of the ambivalence from the client’s perspective.

When arguments against change arise, they are met with empathy and acceptance.

It can be a profound experience for clients to talk about the advantages of having the problem and to find the therapist listening and responding compassionately without becoming an advocate for change.

Rolling with resistance tends to diffuse rather than amplify it.

Support Self-Efficacy

In MI, the therapist supports the client’s self-efficacy, the belief that he or she can carry out the necessary actions and succeed in changing.

Techniques of Motivational Interviewing

Motivational interviewing is a work of creativity and it can be specific to one client and one therapist.

However, there are a few techniques which remain specific for every motivational interviewing session.

Here are some techniques which are commonly used in MI sessions.

Combat Resistance

Human beings are the best example of walking contradictions. They would definitely want to change but they don’t want to work on it.

For example, someone would like to lose weight but he would not like to wake up early to get some exercise.

A trained therapist will be able to see beyond verbal and non-verbal cues. Resistance can be in the form of both verbal and non-formal cues, from outright saying NO to subtle hints in the client’s body language.

The therapist will have to work with a resistant client in an effective manner and not to fight him but asking permissive questions and hearing the client’s point of views.

Motivational Interviewing teaches the therapist to avoid declaring the client wrong and suggesting other ways to think about the possible solutions without being argumentative.

Advice Offering

One of the main things to do for a therapist is to offer advice during Motivational Interviewing without causing resistance and it can be tricky because clients can be defensive. 

There are a few effective ways to offer advice during MI and these can be highly effective if used properly.

Therapeutic Paradox

In therapeutic paradox, the therapist uses contradictory statements which can help the see what the therapist is saying.

For example, if a person is trying to quit smoking and have not been able to do so, the therapist can say that ‘perhaps it’s not time for you to quit smoking’.

In most cases, the client will be resistant to what the therapist is saying and then ask for advice to quit smoking.

Self-Efficacy

High self-esteem will help the client to change their ways early, so it is important to make the client self-efficient and the therapist will know how to make the client more motivated.

It can be done by praising their efforts during the therapy.

Empathy

Empathy can be one of the best methods for Motivational Interviewers. The therapist needs to put himself in the client’s position.

It will allow the therapist to see themselves from the client’s eyes, making it easier to understand the client’s perspective.

Columbo Approach

Columbo approach is inspired from TV series Columbo and it helps collect more information from the client about their perspective of changing behavior and not being able to do so.

FAQ’s about Motivational Interviewing

References

Hettema J, Steel, J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91-111.

Treatment Improvement Protocols. Enhancing Motivation for change in Substance Abuse Treatment. Chapter 3—Motivational Interviewing as a Counseling Style. SAMHSA. (1999, Rockville, MD)

SAMSA-HSRA Center for Integrated Health Solutions website. Motivational Interviewing.

Psychologytoday:Motivational Interviewing 

betterhelp.com/what-is-motivational-intervewing-techniques-and-how-they-are-used