What Is Motivational Interviewing?

Introduction

It is common to experience conflicting desires, such as a desire to change behaviour coupled with a feeling of unreadiness to do so. Motivational interviewing posits that resolving this ambivalence can enhance an individual's motivation for change.

Overview

Motivational interviewing (MI) is a counselling method aimed at assisting individuals in discovering the motivation necessary to enact positive behaviour changes. Motivational interviewing stands out for its emphasis on empowering individuals to take ownership of their recovery journey.¹

This method emerged as an extension of Carl Roger's person-centred counselling approach, aiming to support individuals in embracing challenging transformations. Psychologist William R. Miller introduced this method in 1983, refining it alongside psychologist Stephen Rollnick.

Rollnick articulates, "Our pursuit for a more fulfilling and impactful approach stemmed from recognizing that pushing information and advice often leads to resistance.” This approach proves particularly effective for individuals grappling with mixed feelings about altering their behaviour.

Key principles

MI operates on four key principles that guide counsellors in fostering trust and progress in the therapeutic journey. These principles are fundamental in nurturing a supportive therapeutic alliance.¹

1. Express empathy: counsellors employing motivational interviewing prioritise understanding their clients' perspectives without passing judgment. Rather than imposing personal opinions, they aim to empathise with clients' experiences, creating a non-judgmental environment conducive to open dialogue and self-expression.

2. Develop discrepancy: central to motivational interviewing is the concept that individuals are more inclined to change when they recognize discrepancies between their current situation and their desired goals. Counsellors assist clients in identifying their values and aspirations, fostering a collaborative environment where clients can explore their motivations and establish personalised objectives.

3. Roll with resistance: recognizing that ambivalence and resistance are common in the change process, motivational interviewing encourages counsellors to navigate these challenges with empathy and flexibility. Rather than confronting resistance directly, counsellors seek to understand clients' perspectives and offer alternative interpretations or perspectives, fostering internal motivation for change.

4. Supports self-efficacy: Motivational interviewing emphasises the importance of clients' belief in their ability to enact change.² Counsellors bolster clients' self-efficacy by acknowledging their strengths, guiding them through the change process, and providing positive reinforcement for their progress. Over time, clients develop confidence in their capacity to effect meaningful change in their lives.

How does it work?

MI sessions may fluctuate between phases based on the patient's requirements. What is crucial is that each phase is incorporated into the process.

Engagement: initially, clinicians aim to establish rapport with their adolescent patients, emphasising confidentiality and creating a safe environment for expression. This phase focuses on allowing teenagers to voice their feelings and uncertainties regarding change without immediately seeking solutions. Clinicians prioritise meeting patients where they are and adapting to resistance rather than confronting it directly.

Focusing: once a solid therapeutic alliance is formed, patient and clinician collaboratively determine the treatment focus. Despite patients often being uncertain about their recovery direction, clinicians ensure that decision-making remains a shared endeavour. Beginning each session with agenda items allows patients autonomy in directing sessions, while also enabling clinicians to align their goals with those of their patients. This process unfolds gradually over multiple sessions as clinicians assist patients in identifying specific behaviours for change, drawing upon values established during engagement.

Evoking: adolescents may struggle with goal-setting, often displaying resistance. Clinicians initiate "change talk" to encourage positive statements supporting change. For example, if a patient acknowledges the need to stop substance abuse but expresses doubt, the clinician prompts exploration of reasons behind this realisation. Through open-ended questions and affirmations, therapists guide patients in envisioning the benefits of change and believing in its possibility, fostering optimism and support throughout the process of behavioural change.

Planning: the concluding stage of MI is planning, which although optional, becomes essential when patients require further assistance in delineating the steps necessary for behaviour change. During this phase, patients explore obstacles to their goals and strategize ways to overcome them. Clinicians collaborate with patients to develop a "change plan," which breaks down objectives into manageable steps. Additionally, discussions revolve around potential strategies for handling setbacks should they occur.

What are the areas in which motivational interviewing can help with?

Motivational interviewing initially focused on treating substance use disorders by preparing individuals to change addiction-related behaviours. However, it has since been recognized as a valuable intervention for addressing various health behaviours and conditions, including:

• Diabetes management
• Dietary habits
• Obesity prevention
• Physical activity
• Sexual behaviour
• Smoking cessation

Additionally, motivational interviewing can complement cognitive behavioural therapy (CBT) in the treatment of anxiety disorders such as generalised anxiety disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD). This approach has also been utilised to reduce the fear of childbirth.³

Advantages of motivational interviewing

The utilisation of motivational interviewing as a prevalent approach in mental health therapy can be attributed to several advantages, including:

• Cultivating self-confidence and self-trust within clients
• Guiding clients towards assuming accountability for their actions and decisions
• Reducing the likelihood of future relapse
• Preparing clients for enhanced receptivity towards treatment
• Demonstrating clients' innate capacity to initiate life changes
• Instilling self-responsibility in clients
• Particularly advantageous for individuals initially resistant to commencing treatment or unready to undertake essential life adjustments

Effectiveness

Since its inception in the 1980s, motivational interviewing has demonstrated effectiveness in addressing various psychological and physical health issues.

A meta-analysis of 72 clinical trials highlighted its success in promoting smoking cessation, weight loss, and managing cholesterol levels.⁴ Moreover, research indicates its efficacy in addiction treatment, with a review of 39 studies showing that two-thirds observed significant reductions in adolescent substance use.⁵

Additionally, motivational interviewing has been found to be effective in reducing binge drinking, as well as decreasing both the frequency and quantity of alcohol consumed, as demonstrated in another review.⁶

Summary 

Overall motivational interviewing is a counselling method that helps individuals find the motivation to make positive behaviour changes. It evolved from Carl Roger's person-centred approach and prioritises empowering individuals to take charge of their recovery journey.

MI operates on four key principles: expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. MI sessions fluctuate between phases, including engagement, focusing, evoking, and planning, with each phase crucial to the process.

Additionally, motivational interviewing can address various health behaviours and conditions such as substance use disorders, diabetes management, dietary habits, obesity prevention, physical activity, sexual behaviour, and smoking cessation. It can also complement CBT in treating anxiety disorders and fear of childbirth.

Advantages of motivational interviewing include cultivating self-confidence, accountability, reducing relapse, and preparing clients for treatment. It is particularly beneficial for individuals resistant to treatment or hesitant to make life changes. MI has proven effective in numerous clinical trials, showing success in promoting smoking cessation, weight loss, managing cholesterol levels, and reducing adolescent substance use and binge drinking.