Motivational interviewing (MI) is an evidence-based therapeutic approach that helps ambivalent people make changes. When used appropriately, MI can help people decide how they want to proceed moving forward- even if they experience fear or resistance.
MI is inherently client-centered and has roots in Carl Jung’s person-centered care approach. In this model, therapists act in collaborative roles alongside their clients. The overarching goal is to help people develop insight and motivation to change.
Basic Principles of Motivational Interviewing
Motivational interviewing can occur in both individual and group therapy formats. It’s a common model used in substance abuse treatment, but many clinicians integrate MI techniques within their practice. Here are some of the core tenants of this model:
Collaboration Between Therapist and Client
In motivational interviewing, the therapist aims to work with the client rather than act as an expert or coach. This mentality assumes that the client is the expert in their life. Therefore, the therapist does not impose personal beliefs or dole out advice.
Emphasis on Autonomy
Motivational interviewing focuses on enhancing a client’s independence. In other words, clients must dig into themselves to decide how they want to make a choice. This happens on their terms and without pressure or expectations from the therapist.
This focus shifts attention away from the therapist’s influence. The client must hold themselves responsible for making changes in their lives. With that, therapists strive to help clients recognize their own strengths and capabilities.
Roll With Resistance
In motivational interviewing, resistance isn’t scary or a sign of failure. It’s an expected part of the process. Change, after all, is incredibly challenging.
Therapists who practice motivational interviewing understand that it’s normal for clients to oscillate between feeling excited, scared, or apathetic when moving forward. With that in mind, they aim to highlight patterns in the client’s behavior. They don’t judge the resistance. They simply become curious about it.
Therapists work to help clients recognize potential discrepancies in their lives. For example, a client may insist that spending time with family and friends is the most important part of their life. Yet, they continuously take every overtime shift available to them, only to come home exhausted.
Discrepancies focus on the space between how a client wants to live versus how they’re actually living. Raising awareness of this issue can help a client pinpoint where they want to make a change.
Understanding the Stages of Change Model
Therapists who use motivational interviewing techniques often work within the stages of change model. This framework provides a step-by-step action plan (although it’s not uncommon for clients to move in different and non-linear directions).
Precontemplation: At this point, the client may be thinking about making a change. However, they have taken no further action to move forward. They may lack resources or awareness about what to do next. Therapists often provide psychoeducation about behavioral choices and may offer harm-reduction strategies during this time. Some clients enter this stage without any desire to make a change.
Contemplation: This is when the client starts preparing to make a change. In therapy, it’s common to explore the pros and cons during this time. If the client lacks confidence in believing they can make the change, the therapist will offer specific interventions based on increasing self-esteem.
Preparation: Also known as the getting ready stage, this is when goal-setting begins. The therapist and client work together to make a feasible plan for making the necessary changes.
Action: This is when the momentum starts rolling. The client believes they can change their behavior and is taking the initiative to do the necessary work.
Maintenance: This is the “work” of keeping up with a change. There are numerous ups and downs during this time, as the client is implementing new skills and coping with relevant stressors. Discussing relapse prevention strategies is key at this time.
Relapse: Sometimes this stage is added. Reframed as the learning phase, this is a point where the therapist and client review the function of old behavior while also normalizing its role. The therapist provides support for moving forward.
Understanding the OARS Model In Motivational Interviewing
MI practitioners adhere to the four following concepts in their practice.
For example, say someone enters therapy because they’re concerned about their relationship with alcohol. On the one hand, they express an interest in reducing or quitting. On the other hand, they haven’t made any real attempt to change. They’ve tried abstaining from alcohol in the past, and it never worked.
Here is how clinicians may intervene using the MI OARS model:
Open-ended questions require detailed answers that extend beyond just a basic “yes” or “no.” In therapy, these questions open the conversation for deeper exploration.
Open-ended questions may sound like this:
- What are the benefits of you continuing to drink?
- What other methods have you tried that didn’t work?
- How do you feel when you think about drinking for the rest of your life?
- Who does your drinking hurt?
Therapists highlight strengths, assets, and motivations as the client answers the open-ended questions. These affirmations are essential for building rapport and validating the client’s internal experiences.
Affirmations may sound like this:
- I commend you for trying therapy again after so many disappointing times in the past. That must have been hard.
- It sounds like you’ve been doing your best to cope with stress lately.
- Thank you so much for sharing this with me.
Reflective listening refers to an active and intentional style of listening. Therapists listen in this way to connect and support their clients. Reflective listening may include paraphrasing important statements, asking clarifying questions, and sharing empathy.
Reflecting listening can sound like this:
- What I hear is that ____. Does that sound about right?
- Let me make sure I understand what you’re saying. It sounds like you ___
- Now I understand the situation better.
Summaries happen as the session concludes. These summaries highlight that the client is “doing the work” and can continue moving forward.
Other Motivational Interviewing Interventions
Along with reviewing the stages of change and engaging in OARS, therapists using MI may also use the following exercises:
Pros/cons lists: Reviewing the risks and benefits of a certain behavior can help clients make a more informed decision about making change.
Values inventories: Therapists may work with clients to explore their core values. The client is then instructed to review how their current lives (and choices) align with their most important values. This insight can help motivate someone to make important changes.
Agenda mapping: This refers to making a specific agenda to structure each therapy session. This mapping keeps things on track, so both therapist and client are on the same page.
SMART goals: SMART is an acronym that stands for specific, measurable, action-oriented, realistic, and time-sensitive. These goals are highly-structured, which increases the likelihood of someone following through with them. For example, instead of a client wanting to feel less anxious, they might commit to meditating for five minutes a day for 30 days using a meditation app.
Asking permission: Therapists might ask permission to review certain information or bring up certain topics. This might sound like, I notice that you talk a lot about your frustration at work. Can we talk about that some more?
Normalizing: Clients often feel alone in their struggles, and they may worry about being judged for their behavior. Normalizing offers a sense of validation. A therapist saying, Many people struggle with this exact issue, can go a long way in helping someone feel understood.
Change talk: Change talk is typically oriented in the future. What will be the best thing that happens should you make this change? What might happen if you don’t change? How would your husband react if this improved? Visualizing this can help increase a client’s level of motivation.
Who Benefits From Motivational Interviewing?
MI can be used as a standalone treatment, but it also complements many other therapeutic approaches. It is helpful for clients experiencing issues like:
- Substance use
- Eating disorders
- Compulsive behaviors
- Relationship problems
- Complacency or boredom
- Career stressors
- Medication noncompliance
- Stress management
MI is generally not appropriate for the following issues:
- Complex trauma
- Psychosis or thought disorders
- Personality disorders
- Suicidal ideation or other imminent crisis issues
Motivational interviewing isn’t just used within counseling settings. Teachers, doctors, nurses, managers, and business leaders can all use MI techniques with their employees or clients. Similarly, parents can employ some of these strategies when trying to support their child’s well-being.
Effectiveness of Motivational Interviewing
A large meta-analysis on MI found that this therapy model outperformed traditional advice-giving interventions in approximately 80% of the measured studies. Even just 15 minutes of MI-concentrated discussion showed significant effects on desire to change. While all therapies pose some risk, there are no specifically-listed downsides to this model.
Enhanced treatment compliance MI can be highly beneficial within treatment-resistant settings (inpatient care facilities, prisons, and among mandated clients). The client may be more invested in their therapy when they feel a sense of autonomy over their behavioral choices.
Self-reliance and self-sufficiency: MI puts the ball in the client’s court when it comes to making a change. It is not the therapist’s responsibility to do anything on their behalf. This provides a sense of empowerment.
Honors the difficulty of change: Some therapies move quickly and seemingly disregard all the emotional stress associated with making a big change. MI honors that change takes time, resistance is common, and relapse may be a part of the process.
Motivational interviewing is a powerful therapeutic approach that can help people who feel stuck or resentful in their lives. It can quickly increase insight and foster desirable changes. If you feel ambivalent about making an important decision in your life, consider meeting with a therapist specializing in MI work.