Motivational interviewing (MI), developed by psychologist William R. Miller and further improved by Miller and Stephen Rollnick, is a short-term, empathetic counseling technique designed to assist individuals in overcoming ambivalent feelings and insecurities to uncover their inner motivation for behavior change. This practical approach acknowledges the challenge of making life changes and draws on Carl Roger’s person-centered therapy method.

Originally developed to address challenges like addiction, diabetes or cancer care, and weight loss, motivational interviewing is now used in a variety of contexts. MI is one of the therapeutic techniques incorporated into our intensive outpatient program at Bespoke Treatment, in addition to many other therapies such as CBT, psychoeducation, EMDR, and ketamine-assisted psychotherapy.

According to Miller and Rollnick, the implementation of motivational interviewing should embody a specific approach, referred to as the “spirit,” which is characterized by being collaborative, evocative, and respectful of the client’s autonomy.

The “Spirit” of Motivational Interviewing

One of the most important values in MI is collaboration over confrontation. In motivational interviewing, collaboration is established as a partnership between the therapist and the client, with a focus on the client’s perspective and experiences. This collaborative approach fosters a strong rapport between the therapist and the client, creating a trusting relationship that is difficult to achieve in a confrontational setting.

Another key concept is evoking change from within the patient rather than educating them. The concept of the therapist eliciting a client’s thoughts rather than imposing their own is rooted in the belief that the drive for change must come from within. As a result, it cannot be instilled by the therapist. For change to occur, the individual must possess a desire for it. Thus, it is the therapist’s role to “elicit” the client’s genuine reasons for change. Once these motivators are discovered, the client can utilize them to simplify the change process or to sustain their progress even during difficult moments.

Going along with this, motivational interviewing devalues authority in the client-therapist relationship, and instead prioritizes accountability. In contrast to treatment models that view the therapist as an authoritative figure, motivational interviewing recognizes that the ultimate power to bring about change lies within the client. The therapist cannot mandate change. In other words, it is the responsibility of the client to take the necessary steps towards behavior change. The individual must exert effort and exert control. This not only empowers the client, but also assigns them personal accountability for their actions.

Key Values of MI

There are four key principles that are upheld by the therapist throughout motivational interviewing:

1. Express Empathy

Many individuals may be hesitant to seek therapy due to fear of being criticized by the therapist. Some may even feel guilty about their negative behavior, perceiving this criticism as validation. However, this is not the focus of motivational interviewing.

Rather than passing judgment, therapists concentrate on comprehending the situation from the client’s perspective. This approach is known as empathy.

2. Develop Discrepancy

The principle of fostering discrepancy is rooted in the idea that an individual becomes more motivated to change when they recognize the discrepancy between their current state and their desired state.

It is the responsibility of the therapist to assist clients in identifying their core values and defining their personal objectives. These objectives and actions are established in a trusting, collaborative environment, free from any pressure. This creates a setting that is centered on the client’s needs, desires, goals, values, and strengths.

3. Roll with Resistance

Motivational interviewing recognizes that change is not always a straightforward process, and that it’s natural for individuals to have fluctuating thoughts about wanting to change their behavior and what that change entails.

Instead of criticizing, opposing, or challenging clients, it is the therapist’s duty to help clients gain a new self-awareness and understanding of their behavior. This can be achieved by offering alternative perspectives, or reframing certain situations. This shift in perspective can increase a person’s motivation to change, as it is based on their own goals and values.

For instance, if a client confides that they started drinking as a coping mechanism for their partner’s infidelity, the therapist may help reframe the situation. Instead of blaming themselves, the client may begin to see that their partner’s infidelity stems from their own issues.

4. Support Self-Efficacy

Self-efficacy refers to an individual’s belief or confidence in their capability to carry out a desired behavior. A counselor utilizing the motivational interviewing approach strengthens their client’s self-efficacy by highlighting their ability to bring about the changes they desire. The therapist guides the client through the behavior change process, acknowledges the positive changes made, and provides encouragement along the way.

Initially, the therapist may possess more confidence in the client than the client has in themselves. However, this can change as the client receives continued support. Eventually, the client begins to acknowledge their own strengths and their capacity to change their behavior for the better.

In following these principles, motivational interviewing can be a highly beneficial form of talk therapy. With these key values instilled, clients see an increase in self-confidence, are encouraged to take personal responsibility, become more open to treatment, and demonstrate that they have the power to change their own lives. This approach is especially beneficial for individuals who are initially resistant to starting a treatment program or who are unprepared to make the necessary life changes. By teaching clients to take responsibility for themselves, motivational interviewing empowers them to make positive changes in their lives.

Therapeutic Techniques

There are a number of techniques therapists use to help achieve the key principles listed above in counseling sessions:

• Asking open-ended questions that encourage clients to think deeply about an issue.
• Giving positive affirmations that acknowledge the client’s strengths and help them build confidence in their ability to change.
• Practicing reflective listening to let the client know that the therapist understands their point of view.
• Giving summaries in a conversation is a good way to confirm the therapist’s understanding with the client, make associations between two parts of the conversation, and transition to a new topic.