Exploring the effectiveness of motivational interviewing

What Is Motivational Interviewing?

As previously stated, motivational interviewing (MI) is a form of therapy that seeks to identify individual factors unique to each client that promote a change in behaviors. Motivational interviewing is considered to be an evidence-based approach, which refers to a process that seeks to ensure that an approach is safe, effective, and does what it says it will do. 

Motivational interviewing was developed by psychologists William R. Miller and Stephen Rollnick. It was originally designed to treat substance use disorders; however, it is now used in many healthcare settings where behavior modification is needed.

It differs from traditional forms of therapy, working to mitigate one’s ambivalence by talking through the individual’s own objectives, values, or reasons for change and using them to achieve goals. It is very person-centered, as it wholly relies on finding ways to make one motivate oneself, rather than relying on the therapist or counselor to do the motivating. 

What Are Motivational Interviewing’s Applications in Therapy and Counseling?

The overarching objective of motivational interviewing is to cultivate motivation for change in the individuals being treated. This approach has largely been used to treat substance use disorder, exploring one’s intrinsic motivation to stop using or abusing substances. However, it can also be used to inspire motivation in other areas of behavioral change, such as weight management.

Motivational interviewing works to align one’s behavior with their values so their objectives and reasoning behind them are clear.

How Does Motivational Interviewing Work? Understanding Motivational Interviewing

Motivational interviewing helps clients overcome their ambivalence and fear, focus on their goals, develop confidence in their ability to meet those goals, and confront challenges in an effective manner. The therapist’s role is to gently guide them through this process by listening to and reflecting their change talk (i.e., practice reflective listening). 

The motivational interviewing counseling approach begins with assessing the client’s readiness to change, then gearing interventions toward that stage. At certain points, a client may open up about what they want to change and why. Therapists stimulate this commitment language in a way that reinforces the client’s desire to change. 

Talking about change is so effective because it helps clients figure out what to do and how they should move forward on their own, rather than being told. The lack of emotional pressure allows individuals to relax and calm their minds. This space can cause an individual to initiate talking about what’s on their mind, facilitating a collaborative conversation about solutions to their issues.

Motivational interviewing builds on collaboration and functions off of curiosity, compassion, and acceptance. It does this by employing open-ended questions about motivation, barriers to motivation, and the change process, thereby helping clients tap into their own desires and circumvent their fears. Clients feel challenged in a positive, non-threatening way. Therapists are on their side, helping them realize that they already know what to do.

Motivational interviewing can be woven throughout the therapy process, depending on how receptive a client is and what stage of change they’re in. MI can also help prepare clients for the therapy process itself. It can be incorporated into other evidence-based interventions, such as cognitive behavioral therapy (CBT). 

What Are Common Motivational Interviewing Questions?

Below are common types of questions used in motivational interviewing:

• Eliciting “change-talk”: Talking through open-ended questions can invite a change. This can include questions that reflect a client’s desire, ability, reason, and need, allowing them to see their concerns more clearly and think through possible solutions.
• Importance ruler: This refers to scaled questions that allow the client to state their level of motivation from 1-10. Upon identifying their number, the clinician may ask why a lower number was not selected, prompting the individual to provide reasons why they have motivation for changing behavior.
• Querying extremes: These questions refer to the outcomes that can occur in the best and worst situations. For example: “If you were to lose weight, what is the best thing that could occur?” Discussing these scenarios allows the clients and therapist to work through the negative possibilities and can help make the benefits of change more real.
• Looking forward/looking back: These questions center perspectives in the past or future that help motivate change. Questions could include, “What things were you able to do in life before x happened?” or “If you don’t change, what could your future be like?”
• Decisional balance: This refers to an approach to increase an individual’s awareness of the issue before making a choice, allowing them to see the whole truth of the behavior. Questions can explore the benefits and disadvantages of the current behaviors, such as, “How do you benefit from this behavior?”
• Goals and values: By asking a person to create a meaningful goal that is specific, measurable, attainable, realistic, and time-limited (SMART goals), one can better position themselves for success. Then, combining values with goals can help one better align their behaviors to what is important to them.

Each of these types of questions is meant to help make individuals curious about outcomes in their life, inspiring them to believe in themselves and the goals they are trying to reach.

What Is an Example of Motivational Interviewing?

Motivational interviewing uses many interventions to help individuals; one example of a motivational interviewing technique is asking clients to make a personal list of the benefits of changing their behavior. Making a personal list ensures that each of these benefits is meaningful to that individual, which gives them personal inspiration to change rather than generalized reasons. 

By having them articulate each of the benefits of reaching their goal and talking them through together, this intervention helps empower people by allowing them to hope and visualize what their life would be like if they made their desired change.

What Are the Real-World Applications of Motivational Interviewing?

Motivational interviewing can be applied to a variety of situations that people face in their daily lives. Below are some areas that MI can be applied:

• Educational applications: This can apply to areas where a student has the resources but lacks the motivation to perform to their potential and is vulnerable to receiving negative or unfair evaluations of their intelligence that can have lasting consequences.
• Parenting applications: This can apply to areas where a child is displaying behaviors that are likely to result in harm to the child, such as disordered eating or aggression toward others. Principles of MI promote more meaningful one-on-one time between parents and child.
• Social applications: MI can be used to change behaviors that have social implications, such as using substances to create social comfort, or perhaps negative body image causing social discomfort. 
• Financial applications: This can apply to compulsive behaviors that are likely to result in significant monetary loss, such as gambling. Sometimes, being clear about one’s long-term financial plans and aware of the counterproductive impact of losing large amounts of money is enough to facilitate change. 

If motivation is lacking in any area of your life, therapists can utilize motivational interviewing to help you feel inspired again.

Motivational Interviewing in Addiction Treatment

When used to treat addiction or substance use disorder, MI is much like person-centered therapy in that therapists try to work with clients to find what would make them want to change themselves. The approach is used to try to elicit change rather than demanding or requesting it, which is helpful in preventing cycles of shame that are more hurtful than helpful. 

In order for motivational interviewing to work effectively, therapists need to facilitate a solid and empathetic therapeutic relationship in order to gain the trust of the client. This doesn’t mean that therapists can’t still have a clear agenda of facilitating behavioral change in their clients, but an empathetic and trusting relationship is much better for cultivating lasting change than force and demands.

What Are the 5 Principles of Motivational Interviewing? ​​The Core Principles

The five principles of motivational interviewing (MI) that therapists use to negotiate change include: 

1. Expressing empathy: Empathy refers to understanding another person’s perspective. Expressing empathy to clients helps them feel understood, allowing them to develop trust in their therapist.
2. Supporting self-efficacy: Self-efficacy refers to an individual’s assessment of their capabilities or ability to achieve something in certain situations. Therapists will support the client’s self-efficacy by promoting the idea that change is possible through recalling examples in the client’s life or noting their strengths.
3. Rolling with resistance: To “roll with resistance” is not so much about what a therapist does, but what they don’t do. To roll with resistance, the therapist avoids the impulse to “right” behaviors through confrontation. Instead, they try to dance delicately through conversations, inviting the client to explore helpful ways of thinking on their own but avoiding conflict or imposing their own values.
4. Avoiding arguments: The therapist avoids arguing with the client by not enforcing their wishes upon their client despite their expressed disagreement. To persist in arguing can potentially impair the trust in the therapeutic relationship and mitigate any progress made.
5. Developing discrepancy: Therapists will work to develop discrepancy by encouraging the client to be more aware of how their current behavior does not align with their future goals, allowing them to see the discrepancy between their goals and their actions.

These pieces each build on each other in motivational interviewing, working to inspire trusting relationships between client and therapist in order to facilitate real and lasting change.

What Is a Motivational Interviewing Technique?

Here are some specific motivational interviewing techniques that may help therapists (and their clients) be successful:

1. The therapist uses open strategies. This means creating a safe, comfortable, judgment-free environment for their client. They should also ask open questions, which encourage the client to share and explore how they’re feeling.
2. The therapist utilizes the four basic principles of motivational interviewing. According to Stephen Rollnick and William R. Miller, these are expressing empathy, developing discrepancy (making the client aware of the difference between their values and their behaviors), rolling with resistance, and supporting self-efficacy. 
3. The therapist supports and maintains a strong working alliance—or what is often called the therapeutic relationship.
4. The therapist educates their clients about self-talk and assists them in adopting more positive self-talk that will support their progress. Through this practice, the client can talk about the problem at hand, recognize their need or desire to change, assert their ability to make the change, and then commit to taking the necessary steps toward change.
5. The therapist respects the client’s pace and encourages inner reflection. The client should be allowed to take the necessary time to process their emotions and understand the progress that they’re making in therapy. Contemplation tends to precede preparation and action. 

Motivational interviewing works because it makes the client the effective agent of change. But MI still requires an insightful therapist to help build this self-efficacy.

The motivational interviewing counseling approach is meant to be empathetic and supportive. This means that the client’s autonomy is respected. Their motivation must come from within. An experienced counselor must be able to sense client resistance and shift approaches as needed.

What Are 3 Key Elements of Motivational Interviewing?

Three key elements of motivational interviewing (MI) include

1. Style: MI takes a guiding approach rather than an instructional one. It is described as almost a middle ground between active listening (following a client) and providing advice (directing a client).
2. Evocation: MI seeks to empower change in individuals by identifying their potential for change as well as what is important to them. In turn, these factors help evoke client-led change.
3. Respect: MI encourages therapists to honor the autonomy of another person by using respect and curiosity when attempting to facilitate change.

What Are the 4 Main Processes of Motivational Interviewing?

Motivational interviewing (MI) has four fundamental processes commonly referred to as the “flow,” including engaging, focusing, evoking, and planning.

• Engaging refers to the formation of a therapeutic relationship between the clinician and the client. The therapist will attempt to facilitate engagement from the client through emphasizing partnership, active listening, respect, and autonomy. During this process, the therapist will attempt to identify the client’s strengths and reflect their perspective.
• Focusing refers to the part of the process where goals are determined. The therapist will attempt to do so by helping the client identify what they should focus on, exploring those goals, and forming an agreed-upon agenda to target the goal.
• Evoking refers to bringing out a client’s own motivation for changing their behavior. The therapist will attempt to use partnership, acceptance, compassion, and the belief that the client can change to attempt to bring about that change. At this stage, “change talk” is the goal, and it is promoted and honed in on by the therapist. 
• Planning refers to preparations for the change in behavior. This step is optional in therapy because the client may be able to do this on their own in a way that works best for them. The therapist will attempt to work with the client to identify how to put a plan in action based on their respective expertise. This can include resources such as goal creation (i.e. SMART goals) or revisiting previous processes.

By combining these processes in an effective way that is unique to each client, therapists can work collaboratively with their clients to increase their motivation. It’s important to have specific and achievable goals, otherwise too much motivational energy can be wasted on irrelevant or misdirected tasks. Having specified goals also helps clients see a clear path to what they want and the benefits of getting there.

Practical Tips for Motivational Interviewing

Motivational interviewing is a goal-oriented, short-term form of therapy. Unlike other therapies, it isn’t so much of a technique as it is a “spirit” or approach with which a clinician relates to their client. 

It uses specific tactics to help people realize their goals. These include:

• Collaboration: This process is a collaboration of two experts — the therapist being the expert in helping individuals change and the client being an expert on their life and experiences.
• Evocation: This works to seek and identify reasons for change. It is assumed that the client has the resources and skills but needs to identify motivating factors to promote change. 
• Acceptance: A receptive and non-judgmental attitude needs to be held by both parties, especially the therapist. During this process, therapists should show a favorable stance toward the client’s ideas, experiences, and decisions.
• Compassion: It’s important to maintain sympathy for a client’s misfortune. The therapist’s words and actions would be consistent with that of a person who experiences compassion and a strong urge to help the person.

Each of these are important facets of making motivational interviewing effective. 

Benefits of Motivational Interviewing

The benefits of MI begin with the type of therapy itself. MI has flexibility in its ability to be used in various settings, such as doctor’s offices or schools, as well as its ability to treat diverse conditions, from substance abuse disorders to diet or behavior changes.

Some of the practical benefits of using MI may include:

• Decrease in the likelihood of relapse or making lifestyle choices that tend to have adverse consequences
• Increase in treatment participation 
• Improved medical compliance (when applicable) 
• Self-understanding 
• Accountability
• Self-confidence

For those who struggle with motivation, self-doubt, substance abuse, behavioral issues, or any number of other concerns, motivational interviewing can be an excellent tool for inspiring lasting change. Motivational interviewing focuses on drawing out motivation from within — a resource that already exists within all of us, but isn’t always easy to access. This means that anyone is capable of motivating themselves and paving the way for lasting change.

Motivational Interviewing at Thriveworks: Find the Right Provider for You

The expert therapists and clinicians at Thriveworks can help you with whatever you’re going through. They will offer you qualified and compassionate guidance, tailoring care to your unique concerns and working with you to establish a treatment plan that works for you. 

Thriveworks makes it easy to schedule: just call to speak to one of our helpful booking specialists or use our online booking tool to make an appointment. We also make our resources accessible by offering both online and in-person sessions and accepting 575+ insurance plans, covering 1 in 2 insured Americans across the country. Thriveworks also offers self-pay options for those out-of-network.

You have to wait to make a change. Book a session with Thriveworks and get the support and guidance you need to change your life today.