Someone hoping to manage a substance use or mental health disorder should pursue a variety of treatment styles and techniques to improve their state. While therapy options like cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT) and contingency management are proven to help reduce symptoms, other techniques are also available.
Another helpful therapy available is called motivational interviewing. Although the style of treatment is relatively newer, it has a strong reputation for aiding people, especially individuals with substance use problems.
Motivational Interviewing Definition
Motivational interviewing is a therapeutic style that can be used to shift people away from a place of indecision and inaction toward a more decisive, goal-driven perspective. A therapist trained in motivational interviewing will employ the therapy during individual, family or group sessions to help people achieve and maintain recovery.
Motivational interviewing therapy was created in a time when more alcohol and other drug treatment was focused on using confrontation and threats as a motivation for change. Motivational interviewing strives to create a relationship between therapist and client based on:
- Collaboration: In other forms of therapy, the therapist is the expert, but in motivational interviewing, the client’s experience and perspective are essential in forming a collaborative team approach.
- Evocation: Rather than the therapist setting goals for the client, in motivational interviewing, the therapist pulls out the client’s needs, wants and level of motivation through evocation.
- Autonomy: In motivational interviewing sessions, the clients are independent and hold all the power for the direction and speed of their sessions.
These aspects help create the “spirit of motivational interviewing” that sets it apart from the other therapy styles that have come before and since the technique’s development in the mid-1980s.
Motivational Interviewing Techniques
The motivational interviewing techniques continue on in the same spirit as the collaboration, evocation and autonomy that sets motivational interviewing apart from other therapeutic styles. As a therapist receives motivational interviewing training, they can begin to utilize motivational interviewing strategies with clients to build the desire needed to produce the wanted results.
The client may not notice the specific interventions and techniques used during a session of motivational interviewing. Nonetheless, these techniques can still help clients accomplish their treatment goals. Another benefit of motivational interviewing techniques is their ability to be integrated into other treatment styles. A therapist using CBT or person-centered therapy approaches can easily add facets of motivational interviewing into treatment to enhance the effects.
While other therapies may have a strict collection of techniques and ways to put them to use, motivational interviewing offers a looser set of motivational interviewing principles.
The five principles of motivational interviewing are:
Helpful in most styles of therapy, empathy is the therapist’s ability to accurately understand a client’s thoughts and feelings in the moment. While empathy is often confused with sympathy, empathy involves feeling what another person is going through, instead of merely caring about and understanding their experience. Therapists commonly use motivational interviewing reflective listening to establish empathy.
An essential component of motivational interviewing, developing discrepancy is when a therapist works to illustrate the difference between what the client says they want and what they are doing to achieve it. If a client says they want to remain sober but is continuously going to bars, a therapist may point out the ways this behavior is incompatible with their goal.
There is no room for arguments and confrontation in motivational interviewing, so the therapist will do their best to maintain a comfortable and relaxed relationship with the client. The therapist will stick to reflecting and practicing empathy during the session.
Resistance is a natural side effect of change. Although addiction and mental health issues are problematic, changing to a new way of life is scary. The therapist will not push back against the client’s resistance, but they will use motivational interviewing techniques to make a note of the resistance and discuss it with the client.
Self-efficacy is a client’s belief in their ability to change and improve their situation. Without self-efficacy, motivation will be low, so therapists practicing motivational interviewing will promote the power and control of the client while reminding them of past accomplishments to bolster their confidence.
Steps of Change
The aim of motivational interviewing is helping people change, but change does not come all at once. Lasting changes usually come in a slow progression that requires time and energy as the therapist and client move through motivational interviewing steps.
It may be challenging for the client to see the motivational interviewing steps of change, but the process tends to be similar for many people moving from where they are to where they’d like to be. The five steps of change are:
- Precontemplation. At this stage of change, the person sees the benefit of changing, but they are not quite ready to do what it will take to create change. In most situations, the individual thinks the change is not really possible or that it will take too long.
- Contemplation. Here, the person is thinking about changing and imagines that the change could happen soon. A major feature of the contemplation stage is a lack of urgency and genuine motivation to move forward, so change does not take place yet.
- Preparation. As someone shifts into preparation, they begin to see change as a possibility in the near future. The person starts thinking about choices and obstacles standing in their way.
- Action. With the information gathered from the preparation stage, the person is now ready to take action to achieve the goal. The action can be behavioral changes or changes in thinking styles, so the action may not always be obvious.
- Maintenance. Making changes is hard, and maintaining the change is even more challenging. During the maintenance stage, the person works to continue building on changes made in the action phase.
Motivational Interviewing for Mental Health Disorders
Motivational interviewing is an extremely useful tool for mental health disorders and substance use disorders. Research shows that motivational interviewing can be effective in managing a variety of behavioral health issues, including substance abuse, smoking cessation, depression and eating disorders.
People with substance use disorders often find developing the motivation to change very difficult. On the one hand, they can see the ways drugs and alcohol damage their health and well-being. On the other hand, the substances they use produce feelings of happiness that they fear cannot be achieved through other means.
Motivational interviewing does not try to minimize or avoid this conflict. Instead, treatment focuses on exploring the client’s view on this specific subject so they can weigh the pros and cons of continued use. Motivational interviewing for substance abuse utilizes empathy and support to develop discrepancy and strengthen the desire for recovery and sobriety in the individual.
Motivational interviewing for smoking cessation works in a very similar way as motivational interviewing for substance abuse. Tobacco, like other drugs, make someone feel good and encourages them to maintain the altered brain chemistry caused by nicotine dependence.
Deciding to stop smoking is difficult since many people view quitting smoking as an uncomfortable and risk-ridden process. A person may know that the benefits of stopping smoking are numerous while still fearing drawbacks like stress, weight gain and boredom.
Motivational interviewing therapy can be used to examine ambivalence on the subject while encouraging the person to believe in their own capacity for change and growth. Motivational interviewing treatment may involve the use of nicotine replacement therapies like gum or patches to aid in the process.
It may seem like motivational interviewing for depression would be much different than motivational interviewing for substance abuse or smoking, but the process is very similar. Like addiction, depression is a mental health condition that affects the thoughts, feelings and behaviors of the individual, so motivational interviewing will target these aspects.
Someone with depression may engage in negative coping skills to manage the symptoms of their condition, including sex, self-injury and frivolous money spending. Motivational interviewing helps clients identify the discrepancy between these behaviors and the goal of happiness. The client will see that the path to recovery involves healthy, positive coping skills, rather than these negative behaviors.
Motivational interviewing for depression may also investigate problematic thought patterns a person has about themselves and the outside world that may be making them feel worse. The therapist’s empathy and attention to self-efficacy can help break this dangerous cycle of negative self-regard and pessimism.
Eating disorders are complex conditions that can pose significant dangers to an individual’s physical and mental health. Fortunately, motivational interviewing for eating disorders can help aid in treatment and recovery.
Motivational interviewing can start by looking at the behaviors associated with the eating disorder like binge eating, food restrictions and purging. Even though these actions are completed in the hopes of being happier and better looking, motivational interviewing can be used to illustrate how these behaviors don’t help the individual work toward achieving those goals.
In motivational interviewing, the client works with their therapist to establish new, healthier goals and identify what behaviors will help them meet those goals. Along the way, motivational interviewing will target the person’s flawed ways of thinking that underlie and motivate their eating disorder to reverse these thoughts and create a more appropriate self-image.
Effectiveness of Motivational Interviewing
Studying motivational interviewing effectiveness or the effectiveness of any mental health or substance abuse treatment is a challenging task. A variety of characteristics will influence the data, such as:
- Whether the therapy is delivered in individual, group or family therapy in an inpatient or outpatient setting
- The duration of each session and how many sessions were completed
- The skills of the individual therapist administering motivational interviewing
Even with all of these variables, one analysis of several motivational interviewing research studies found the treatment to be effective in creating wanted change with:
- Substance use
- Tobacco use
- Cardiovascular health status
- Chronic pain
- Dental hygiene
- Diabetes management
- Eating disorders
- Various mental health conditions
All of this motivational interviewing evidence-based information demonstrates how versatile and helpful the treatment can be in physical health and mental health settings. Another beneficial aspect of motivational interviewing is the lack of risk linked to treatment. There seems to be very little chance of the therapy style causing any unwanted side effects, so people can feel free to experiment with motivational interviewing techniques with a low chance of harm.
Find Treatment Near You
Motivational interviewing is a widely-recognized and widely-used therapeutic approach across the country. Many therapists know about the therapy orientation and have been trained by experts in motivational interviewing.
If you are interested in starting the motivational interviewing treatment process for yourself or a loved one in your life, there are many avenues to pursue. You can:
- Make an appointment with your primary care physician to go over your symptoms and plan a course of treatment
- Schedule an intake with a local mental health or substance abuse center to determine your need for services
- Call your insurance company to learn about their recommendations for your next steps
If you or a loved one lives with addiction, considering reaching out to The Recovery Village Palm Beach at Baptist Health to enroll in a substance use treatment program. When you call The Recovery Village Palm Beach at Baptist Health, you will be connected to a representative who can provide information about helpful services to address your addiction and any co-occurring mental health conditions, including motivational interviewing.
Center for Substance Abuse Treatment. “Treatment Improvement Protocol Series, No. 35. Chapter 2 — Motivation and Intervention.” 1999. Accessed July 13, 2019.
Massachusetts Behavioral Health Partnership. “Motivational Interviewing — Stages of Change.” Accessed July 13, 2019.
Motivationalinterviewing.com. “Systematic and Meta-Analyses of Research on Motivational Interviewing.” July 12, 2017. Accessed July 13, 2019.University of Massachusetts. “A Definition of Motivational Interviewing.” Accessed July 13, 2019.