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Motivational Interviewing: A Useful Therapy Technique for Addiction?

Motivational interviewing is a therapeutic approach that helps people resolve ambivalent feelings or insecurities regarding behavioral change through therapy. The process helps someone who otherwise may not feel that they need help to find internal motivation to focus on therapy sessions or mutual support groups and begin the work of changing patterns and behaviors.

The point of motivational interviewing is to encourage a person to understand that they can get treatment for conditions they struggle with, including addiction or mental illness. This happens with a small number of sessions over a short time.

Although motivational interviewing is considered a counseling technique, it is not the sole approach to therapy for most people. For example, if someone drinks too much but does not think they meet the criteria for alcohol use disorder (AUD), one session with a social worker after the person is arrested for driving under the influence can encourage the individual to enter detox and rehabilitation.

Motivational interviewing sessions can be conducted in a range of environments, but they must be empathetic and practical. Many people benefit from motivational interviewing as a way to understand more about what they struggle with and to find the resources to get help. 

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How Does Motivational Interviewing Work? 

This technique is most often used to address addiction, and it also works to address symptoms of chronic health problems like diabetes, asthma, or heart disease. While all four of these conditions are considered chronic illnesses, they each have a component of lifestyle change, such as changing diet. Motivational interviewing can help the person learn more and feel more motivated to make important lifesaving changes.

This approach to treatment was developed from Carl Roger’s client-centered approach to talk therapy. The original focus of MI, developed in 1983, was to help people who struggled with problem drinking, including heavy drinking, binge drinking, and AUD. The technique works well for those who struggle with addiction.

There are two goals in motivational interviewing: 

  1. Increase the individual’s motivation to get help
  2. Make a commitment to change

Motivational interviewing encourages the client to state aloud their commitment to change rather than simply expressing the need or desire to change their behavior, like their behavior around drugs or alcohol. Hearing themselves make the statement of commitment to change has been shown to help clients focus on making those changes.
The therapist’s role is more to listen and less to intervene. To that end, there are three key elements to motivational interviewing: 

  1. Collaboration: Some approaches to talk therapy or cognitive behavioral therapy rely on confronting the client about their behavioral patterns, thoughts, or feelings. MI relies on collaborating with the client to encourage them and offer them support.
  2. Evocation: Motivational interviewers draw out the client’s thoughts and ideas on their behaviors, the harm these have done, and their thoughts on changing. Most people who struggle with addiction have thought about quitting, realize that their addiction has harmed their lives, or have even tried to quit a few times before. However, they may have relapsed, or they may worry about what will happen if they quit. This step helps them solidify that they do want to change, and they can commit to the process.
  3. Autonomy: Many treatment models focus on the clinician as the authority figure, but MI focuses on the client as self-driven; the power to change rests with them. This focus helps the interviewer empower the client without telling them explicitly that they need to change or that there is a “right way” to change.

Typically, only one or two sessions are needed. It is possible for you to return to motivational interviewing sessions if you need reminders of why you want to make positive changes, like staying in addiction treatment.

During these sessions, a motivational interviewer will

  • Express empathy. Acceptance helps the client build self-esteem and facilitate change. The client has a positive self-image reflected by another person, so they may feel more worthy of feeling good.
  • Support self-sufficiency. Once the client understands that they are worthy of change, they begin to understand that they have the power to make these changes.
  • Roll with resistance. There will be several moments in which the client resists the idea of change; however, motivational interviewers will not argue with the client. Instead, they will offer new perspectives and not impose their personal beliefs.
  • Demonstrate discrepancy. This helps the client see that there is a difference between where they are now in their life compared to where they wish to be. Understanding this difference can help the client see that there are steps to take to make positive changes, like quitting drugs or alcohol.

In some cases, motivational interviewing can be incorporated into long-term counseling, like talk therapy or cognitive behavioral therapy, to encourage you to remain invested in making positive changes for yourself.
During the appointments, the motivational interviewer will encourage you, as the client, to talk about your need for change and what your own needs might be for making changes. The interviewer will listen and then reflect your thoughts back. This helps you hear your reasons and motivations expressed back to you.
Motivational interviewing works best when combined with other forms of therapy.

Who Benefits From Motivational Interviewing?

Anyone who struggles with a chronic condition like addiction, and also feels unmotivated to change, is in denial that they have a problem that can be solved. Or perhaps they feel overwhelmed and do not want to change. These individuals will benefit from motivational interviewing. This type of short-term therapy can also prepare someone to enter long-term treatment or to find more specific types of therapies, like inpatient detox and rehabilitation.

This type of counseling works well for people who are hostile or struggle with anger management problems. While someone with these struggles may be ready to change or overcome substance abuse, motivational interviewing can help them move through the emotional stages of change that are necessary to find their motivation.

While motivational interviewing is a powerful tool to encourage almost anyone to make positive changes and stick with the long process of taking care of their health, not everyone benefits from motivational interviewing.

Two people talking to each other sitting side by side on a couch

People who are already motivated to make changes, by going to regular doctors’ appointments, taking any needed medications as prescribed, and participating in counseling or behavioral therapy, do not need motivational interviewing. 

What to Look for in a Motivational Interviewer

If you start looking for a professional who specializes in motivational interviewing, especially for a loved one, it is beneficial to find someone who is empathetic, a good listener and can offer encouragement and support. Seek out someone who has been working in the field for at least a few years and who has specific training and certifications in motivational interviewing.

That person does not have to be a counselor or therapist. They can be a social worker, doctor, nurse, religious leader, or another individual with training as a motivational interviewer.

The approach is focused more on the interpersonal relationship between client and interviewer. Since motivational interviewing works for many people who need to make specific changes to their behaviors or lifestyle, this counseling method can be found in many different settings.

Sources

Motivational Interviewing. Psychology Today. Retrieved April 2019 from https://www.psychologytoday.com/us/therapy-types/motivational-interviewing

(January 2019) Treatment Approaches for Drug Addiction. National Institute on Drug Abuse (NIDA). Retrieved April 2019 from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

All About Motivational Interviewing. Motivational Interview. Retrieved April 2019 from http://www.motivationalinterview.net/clinical/whatismi.html

A MI Definition: Principles and Approach. University of Massachusetts, Amherst. Retrieved April 2019 from https://www.umass.edu/studentlife/sites/default/files/documents/pdf/Motivational_Interviewing_Definition_Principles_Approach.pdf

Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency. Blending Initiative: NIDA and SAMHSA. Retrieved April 2019 from https://www.drugabuse.gov/sites/default/files/files/MIA-STEP_Factsheet.pdf

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