Motivational interviewing is a counseling approach that helps individuals develop their intrinsic motivation to modify harmful behaviors, such as substance use, by resolving their ambivalence about change. It’s an effective and widely available treatment for substance and behavioral addictions and other negative health behaviors, from eating disorders to smoking.
- Motivational interviewing (MI) was developed in the 1980s by psychologist William R. Miller based on his experiences treating problem drinkers and further elaborated in collaboration with Stephen Rollnick in the 1990s.
- MI holds that people are impeded in changing their habits, even to meet their goals, by ambivalence—a conflict between two courses of action.
- MI is based on the client’s resolution of their ambivalence about change. This ambivalence is particularly evident in addiction, where people often express concern about the impact of substance abuse on their health, relationships, and career while continuing to use.
What is motivational interviewing?
Motivational interviewing (MI) is a collaborative and goal-oriented style of therapy that helps the client develop motivation to change their problematic behavior.[1]
Through open-ended questions, affirmations, reflective listening, and summarising (a set of skills known as OARS), the therapist helps the patient understand how these negative behaviors, such as drug and alcohol use, are preventing them from reaching their goals. They’re guided to explore and challenge their ambivalence about leaving these behaviors behind.
MI was developed in the 1980s by psychologist William R. Miller based on his experiences treating problem drinkers and further elaborated in collaboration with Stephen Rollnick in the 1990s.[2]
How does motivational interviewing work?
MI is a directive counseling style, meaning it’s led by the therapist rather than the client and is focused and goal-directed.
The goal is to motivate the patient to change their behavior. This motivation isn’t externally imposed, such as through coercion or persuasion, but rather developed from within.
MI holds that people are impeded in changing their habits, even to meet their goals, by ambivalence—a conflict between two courses of action. The therapist guides the client to articulate and confront their particular ambivalence. For example, the ambivalence might be: “If I stop drinking, I’ll be healthier, but I can’t have fun without alcohol and I’ll lose some of my friendships.”
The therapist then helps them understand both sides of the impasse and work toward an acceptable resolution that will trigger change. This resolution might be: “I can stop drinking if I develop an alternative social life that doesn’t revolve around alcohol and find new ways to have fun.”
Motivational interviewing holds that a client’s willingness to change isn’t an intrinsic trait but rather a fluctuating product of the interpersonal interaction between the client and therapist. So clients who currently appear resistant to change or in denial about their negative behavior won’t always be so and just need to be motivated through different strategies.[2]
Motivational interviewing techniques
Therapists delivering MI use four basic techniques, sometimes abbreviated as OARS:
- Open-ended questions: help the individual explore their own thinking and arrive at self-motivating statements, which are more helpful than external advice. Eg. “I understand you have concerns about your drinking. Can you tell me about them?”
- Affirmations: help the individual acknowledges their positive behaviors and strengths and build self-confidence. Eg. “You handled yourself really well in that situation.”
- Reflective listening: echoes what the individual said back to them, so they know they’re being heard and gain a deeper understanding of their thoughts
- Summarising: checks in with the patient, confirms mutual understanding of the conversation, and highlights gaps between their current situation and future goals. Eg. “Let me check I understand everything that we’ve discussed so far…”[3]
Motivational interviewing components
There are four fundamental processes in a motivational interviewing conversation:
- Engaging: The therapist seeks to understand the client and what’s happening in their life, using empathy and active listening. The therapist can discuss change with the client but the main focus during this stage is to develop a good working relationship with the client, create an environment that is comfortable for them to consider change, and reduce their ambivalence about counseling itself.
- Focusing: During this stage, the therapist helps the client hone in on the area in which they are struggling to make a change. In the context of addiction treatment, the target for change will be the continuation of substance use or a behavior like gambling or gaming. The therapist then guides them to explore any barriers to making this change, including their ambivalence, and to see the gap between their goals and their current habits.
- Evoking: Now, the therapist draws out the client’s internal motivation for change by guiding them to identify their reasons and how much importance they ascribe to change. For example, the therapist might ask: “What makes this change important to you?” or “What makes you confident you can achieve this?” The therapist identifies, positively reinforces, and summarises statements the client makes about changing.
- Planning: During this phase of treatment, the therapist helps the client solidify their commitment to change and formulate a specific plan of action to make it happen. They may ask, “What are some next steps you can take?” or “What support can you lean on as you make this change?“ Often, the therapist will present the client with a menu of options for their next steps drawn from the ideas, resources, and support networks the client has identified.[4][5]
What conditions are motivational interviewing used to treat?
Motivational interviewing was developed as a treatment for alcoholism. Today it’s still widely used to treat substance use disorders.
MI is also used as an interventional strategy to address other conditions and health behaviors, including[2][6]
- Smoking
- Behavioral addictions such as gambling
- Eating disorders
- Weight management
- Diabetes management
- Cancer care
- Heart disease rehabilitation
- Pain management
- Medication adherence and compliance with medical advice
- Risky sexual behavior
MI has also been used to supplement cognitive behavioral therapy (CBT) in the treatment of anxiety disorders.[7]
Motivational interviewing for addiction treatment
Addiction treatment was the initial application of motivational interviewing and has helped people overcome substance abuse for nearly forty years.
MI is based on the client’s resolution of their ambivalence about change. This ambivalence is particularly evident in addiction, where people often express concern about the impact of substance abuse on their health, relationships, and career while continuing to use.[3]
MI helps the individual resolve this impasse between their conflicting desires to quit and use, by helping them identify the advantages and disadvantages of substance use, lay out their values, priorities, and goals while helping them understand how they conflict with their current actions.
With motivational interviewing, the individual doesn’t feel forced or bribed into changing their harmful behaviors. Rather, the motivation for change comes internally and is merely drawn out and cultivated by the therapist. The client also decides what change looks like and how they will achieve it. This can lead to more self-sufficient and sustainable recovery.
Effectiveness of motivational interviewing for addiction treatment
Motivational interviewing has been scientifically validated as an effective treatment for substance use disorders. A meta-review of 59 randomized trials, covering more than 13,000 patients, found that, compared to no treatment, motivational interviewing led to a reduction in substance use after treatment and for up to 12 months.[8]
Motivational interviewing has been found to be effective in treating substance use in adolescents and college students and in helping people quit smoking.
Motivational interviewing typically delivers its benefits in one to four sessions, but more sessions are associated with greater efficacy.[9]
Less research has been conducted into the use of motivational interviewing for behavioral addictions but studies that have been completed are promising. A meta-review of eight randomized controlled trials found that in patients with gambling addictions, motivational interviewing was associated with a significant reduction in gambling frequency for up to a year after treatment. It also reduced gambling expenditure for up to one to three months post-treatment.[10]
Where to find motivational interviewing treatment
With proper training, therapists, counselors, physicians, and other clinicians can effectively deliver motivational interviewing.[9]
Motivational interviewing is a common treatment modality offered in inpatient and outpatient rehab programs. You can also find motivational interviewing from individual therapists.
Will my insurance cover motivational interviewing?
Under the Affordable Care Act, all health insurance policies must require at least part of the treatment of substance use disorders. Motivational interviewing may be covered as part of a rehab program accepted by your insurance.
It may be more difficult to secure coverage for motivational interviewing when it’s not part of a formal rehab program. You should speak to your health insurer about their coverage of addiction and mental health treatments.
