Motivational interviewing (MI) is a technique that has been used for 30 years to help people process feelings around changes they want or need to make. By asking questions and allowing the individual to talk freely and without judgment, a practitioner can increase their internal motivation toward a specific goal. MI should feel conversational and driven by the person who is considering a change.
Components of MI
MI is a type of counseling developed to help resolve contradictory and/or mixed feelings. It helps people find needed motivation so they can make changes.
How Is MI Different?
MI is collaborative in nature and “autonomy” is often used to describe this part of the process. This means that the clinician is not given special status as an “expert”, but rather, utilizes the expertise of the patient as the person most knowledgeable about their own life. The practitioner and client are equal partners in the therapeutic process.
According to Psychology Today, unlike other therapies, MI “is also appropriate for people who are angry or hostile. They may not be ready to commit to change, but motivational interviewing can help them move through the emotional stages of change necessary to find their motivation.”
MI tends to elicit fewer defensive responses because the practitioner is not telling the person what they need to do, but rather getting them to use their own beliefs and values to decide what to do.
Empathy is crucial to the successful utilization of MI. The practitioner must be able to recognize that a person can have conflicting needs, values, and beliefs. In addiction recovery, this may mean empathizing with the conflicting desires to immediately satiate cravings by using and also to stay abstinent from using.
Resistance Is Normal
Motivational interviewing is based on the idea that it is okay for people to be resistant to change, but that resistance can be overcome. Motivationalinterview.net explains, “The resistance is a normal reaction here. It is hard to change the way we think, act, and what we do with our feelings. The counselors’ job is not to shush or kill any raised alarms and questions client has, but to explore motives behind the resistance, to address it, and to help both get a better understanding of it.”
How and Where Is MI Used?
Doctors, nurses and other healthcare practitioners use MI to address a variety of issues. The American Academy of Pediatrics (AAP) reports, “Numerous studies have illustrated the efficacy of MI as a promising strategy to encourage positive health behavior change around substance abuse, oral health, and diet and exercise.”
Heart disease, diabetes, asthma, and other chronic physical health conditions can be helped by motivational interviewing. It can also prepare individuals for more specific types of therapies. According to Psychology Today, “Research has shown that this intervention works well with individuals who start off unmotivated or unprepared for change. It is less useful for those who are already motivated to change.”
MI is also sometimes used in mental health therapy and substance abuse counseling. Because lack of internal motivation can be a barrier to recovery, MI is an ideal method to help people move forward in essential changes they need to make in order to live a drug-free lifestyle.
Before MI was developed, the methods used to support people in recovery could feel coercive and judgmental. This technique, which allows for collaboration between the practitioner and the individual who is being treated, is more supportive and empathetic.
Why Practitioners Like MI
MI has been found effective in both adults and children, so skilled practitioners can use it to assist people of any age.
Besides the fact that MI has shown to be an effective intervention, the AAP article says MI, “Can reduce (the practitioner’s) own stress and frustration by removing the burden of having to problem solve and come up with all the answers on your own. By involving your patients in the problem-solving process, you are actually increasing the odds that they will find a solution that works for them.”
This also makes it inherently more culturally sensitive, as it allows the individual to define what is or is not important to them.
Motivational interviewing seeks to use the individual’s own knowledge and beliefs to help them find a solution to their issue. This is accomplished through:
- “How did you make that decision?”
- “How did you feel when that happened?”
- “What was the result of that choice?”
- “I hear you saying…is that accurate?”
- “It seems like you’re feeling…is that right?”
Shared agenda setting
- Allowing the person to help set a timeline and specific goals around the change.
Pros and cons of change
- “What good things could happen if you do this?”
- “What will you have to give up by making this choice?”
- “What do you gain if you don’t make the change?”
- “What will you lose by remaining where you are?”
The elicit-provide-elicit technique for exchanging information
- Getting permission from the person to discuss the matter, giving them information, and then getting their feedback before moving forward with more information.
Inquiring about the importance and confidence of making a change
- Determining if the person already sees the value in making a change and if they believe change is possible. This can be done using a rating scale of 1-10. Research shows that if a person believes they are capable of altering their behavior, they are both more likely to try and more likely to succeed in making the desired change.
Summarizing the conversation
- Repeating back to the person what has been discussed, what they have agreed to do, and how support will be provided.