Motivational interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. It is a practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes.
Motivational interviewing evolved from Carl Roger’s person-centered, or client-centered, approach to counseling and therapy, as a method to help people commit to the difficult process of change. It was introduced by psychologist William R. Miller in 1983 and further developed by Miller and psychologist Stephen Rollnick. “The more you try to insert information and advice into others, the more they tend to back off and resist. This was the original insight that generated our search for a more satisfying and effective approach,” Rollnick writes. “Put simply, this involves coming alongside the person and helping them to say why and how they might change for themselves.”
When It's Used
Motivational interviewing is often used to address addiction and the management of physical health conditions such as diabetes, heart disease, and asthma. This intervention helps people become motivated to change the behaviors that are preventing them from making healthier choices. It can also prepare individuals for further, more specific types of therapies. 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. Motivational interviewing 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.
Research shows that motivational interviewing is effective in many contexts, including:
Substance use disorder
Smoking
Weight loss
Medication adherence
Cancer care
Diabetes care
Health behaviors among children
What to Expect
In a supportive manner, a motivational interviewer encourages clients to talk about their need for change and their own reasons for wanting to change. The role of the interviewer is mainly to evoke a conversation about change and commitment. The interviewer listens and reflects back the client’s thoughts so that the client can hear their reasons and motivations expressed back to them. Motivational interviewing is generally short-term counseling that requires just one or two sessions, though it can also be included as an intervention along with other, longer-term therapies.
Motivational Interviewing is guided by four key principles. These are:
1. Express Empathy
Empathy is a key component of motivational interviewing. The therapist listens carefully to the patient and conveys that they understand the patient’s feelings, beliefs, and experiences.
2. Support Self-Efficacy
Motivational interviewing posits that clients possess the strength and ability to grow and change—even if past attempts at change have failed. The therapist supports the patient’s belief in themselves that they can change. The therapist may do this by calling attention to the patient’s skills, strengths, or past successes.
3. Roll with Resistance
If the patient is struggling to change, they may resist potential solutions or the therapist’s guidance. In motivational interviewing, the therapist avoids becoming defensive or argumentative if they encounter resistance. Instead, they help the patient identify the problem and solution themself. The therapist doesn’t impose their viewpoint on the patient but helps the patient consider multiple viewpoints.
4. Develop Discrepancy
The therapist helps the patient identify discrepancies between their present circumstances and their future goals. What thoughts and behaviors do they need to change to achieve those goals? The therapist guides the patient in spotting this discrepancy and solutions to reduce it.
Several skills help therapists employ these principles. Open-ended questions encourage patients to think deeply or differently about a given problem. Affirmations are statements that recognize a client’s strengths, which can instill confidence, or self-efficacy, in their ability to change. Reflections involve listening to the patient and reflecting back a response, which can demonstrate empathy as well as point out discrepancies between their current behaviors and goals. Summaries refer to recapping at the end of a session. (These four skills may be referred to by the acronym OARS: open-ended questions, affirmations, reflections, summaries.)
How It Works
The process is twofold. The first goal is to increase the person’s motivation and the second is for the person to make the commitment to change. As opposed to simply stating a need or desire to change, hearing themselves express a commitment out loud has been shown to help improve a client’s ability to actually make those changes. The role of the therapist is more about listening than intervening. Motivational interviewing is often combined or followed up with other interventions, such as cognitive therapy, support groups, and stress management training.
