History, How it Works, & Effectiveness
What Is Motivational Interviewing?
Motivation is the process that initiates, guides, and maintains goal-oriented behaviors. It is what helps you quit smoking, for instance, or pushes you to reach out for help. In short, motivation causes you to act in a way that gets you closer to your goals.
In everyday usage, the term "motivation" is frequently used to describe why a person does something. It is the driving force behind human actions. Motivation includes the biological, emotional, social, and cognitive forces that activate human behavior.
In the field of behavioral health motivation may seem lacking or absent. At times an individual will appear motivated and goal seeking and within days or sometimes hours the same individual may appear stagnant or resistent. When an individual is struggling to change it may appear that they lack motivation. Sometimes this behavior will be classified as an unwillingness to change.
This is where Motivational Interviewing can be utilized; it is a counseling style that challenges people to develop the internal motivations necessary to counteract or change certain behaviors they consider problematic in their lives. This form of counseling can act as a precursor to other psychological interventions, work in adjunct to psychotherapy, or be a stand-alone technique to change a particular behavior.
“MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.” (Miller & Rollnick, 2013, p. 29)
Changing negative behaviors allows people to develop healthier choices, which, in turn, affects long-term physical and mental health outcomes. Motivational interviewing is helpful for individuals who have addictions or physical health issues and those who lack motivation, display hostility, or are unready to commit to change. The main goal is to elicit self-motivation by helping people see how tapping into motivation and generating lasting change are possible and accessible.
What Is the History of Motivational Interviewing?
Motivational interviewing was first developed in the 1980s by clinical psychologists William R. Miller and Stephen Rollnick to support patients with substance use disorders. Over time, other professionals have implemented motivational interviewing in public health, medical care, criminal justice systems, education, and familial systems.
As a counseling method, motivational interviewing has grown tremendously over the last few decades and is now an established, evidence-based practice. Its success is rooted in its view that the practitioner does not impose change; instead, practitioners who use this method cultivate and support self-directed change in their clients.
How Does Motivational Interviewing Work?
Motivational interviewing encourages clients to verbalize the changes they believe to be necessary and to explain their reasons for wanting change. The interviewer can be a psychologist, mental health counselor, social worker, or health care professional.
The interviewer’s job is to spark a conversation with a client about creating and committing to lasting change. Initially, interviewers will ask open-ended questions, listen reflectively, summarize and affirm the client’s points, and encourage self-motivational statements. This is a short-term type of counseling that lasts one or two sessions.
The Spirit of Motivational Interviewing
The spirit of motivational interviewing includes the following values:
MI is a collaborative process. The MI practitioner is an expert in helping people change; people are the experts of their own lives.
People have within themselves resources and skills needed for change. MI draws out the person’s priorities, values, and wisdom to explore reasons for change and support success.
The MI practitioner takes a nonjudgmental stance, seeks to understand the person’s perspectives and experiences, expresses empathy, highlights strengths, and respects a person’s right to make informed choices about changing or not changing.
The MI practitioner actively promotes and prioritizes clients’ welfare and wellbeing in a selfless manner.
Core Skills of Motivational Interviewing
Four core skills required by a therapist for successful motivational interviewing include:
Open questions draw out and explore the person’s experiences, perspectives, and ideas. Evocative questions guide the client to reflect on how change may be meaningful or possible. Information is often offered within a structure of open questions (Elicit-Provide-Elicit) that first explores what the person already knows, then seeks permission to offer what the practitioner knows and then explores the person’s response.
Affirmation of strengths, efforts, and past successes help to build the person’s hope and confidence in their ability to change.
Reflections are based on careful listening and trying to understand what the person is saying, by repeating, rephrasing or offering a deeper guess about what the person is trying to communicate. This is a foundational skill of MI and how we express empathy.
Summarizing ensures shared understanding and reinforces key points made by the client.
Attending to the language of change identifies what is being said against change (sustain talk) and in favor of change (change talk) and, where appropriate, encouraging a movement away from sustain talk toward change talk.
Exchange of information respects that both the clinician and client have expertise. Sharing information is considered a two way street and needs to be responsive to what the client is saying.
Four Main Techniques of the Motivational Interviewing Process
The four main steps for the motivational interviewing process are engaging, focusing, evoking, and planning.
Engaging: This is the foundation of MI. The goal is to establish a productive working relationship through careful listening to understand and accurately reflect the person’s experience and perspective while affirming strengths and supporting autonomy.
Focusing: In this process an agenda is negotiated that draws on both the client and practitioner expertise to agree on a shared purpose, which gives the clinician permission to move into a directional conversation about change.
Evoking: In this process the clinician gently explores and helps the person to build their own “why” of change through eliciting the client’s ideas and motivations. Ambivalence is normalized, explored without judgment and, as a result, may be resolved. This process requires skillful attention to the person’s talk about change.
Planning: Planning explores the “how” of change where the MI practitioner supports the person to consolidate commitment to change and develop a plan based on the person’s own insights and expertise. This process is optional and may not be required, but if it is the timing and readiness of the client for planning is important.
Effectiveness of Motivational Interviewing
Motivational interviewing is very effective in many ways. For example, in a 2011 study of meta-analyses of randomized control trials of people dependent on or abusing substances, researchers concluded that motivational interviewing could reduce substance abuse compared to no treatment.
A 2018 study found that motivational interviewing improved treatment outcomes (i.e., how well the therapy improves a client’s symptoms) for individuals with anxiety disorders when used as an adjunct to cognitive behavioral therapy for anxiety disorders.
In a 2017 study, a group of Australian psychological researchers found that two motivational interviewing sessions that lasted for as little as 15 minutes effectively enhanced clients’ attendance in mental health treatment.
Motivational interviewing may also improve health care management for adolescents with chronic illness and enhance group treatment engagement for adolescents with anxiety and mood disorders.
As an additive value, motivational interviewing helped improve symptoms of depression in clients in primary care settings.
Additionally, substantial evidence indicates that combining motivational interviewing with other existing treatments enhances overall treatment engagement. When an individual admits into residential treatment they will receive maximum benefits of Motivational Interviewing coupled with these other treatments.