Motivational Interviewing: A Game-Changer for Changing Your Life

We can all think of things we want to change about ourselves or our behavior. So what keeps us from taking the necessary steps to move toward those goals? In a word, motivation. When you have the right motivation, changing your behavior for the better is no longer matter of "if" but of "how."

This is the essence of Motivational Interviewing (MI), a popular psychotherapy technique that "motivates" you to make positive changes to improve your health, relationships and quality of life.

Here are answers to frequently asked questions about how and why Motivational Interviewing is such a behavioral game-changer. 

What is Motivational Interviewing?

Motivational Interviewing is a person-centered, non-confrontational counseling technique that prompts behavior change. Behavioral and Cognitive Psychotherapy defines MI as "a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence." 

With Motivational Interviewing, there's no judgment. There's no confrontation. There's no arguing or ultimatums. Just as the name implies, MI helps you find the motivation to change your behavior. This motivational approach guides you in the process of deciding for yourself how to live your best life.

Although Motivational Interviewing was originally designed to address alcohol or other drug addiction, clinical psychologists Stephen Rollnick and William R. Miller identified further applications for the behavior change approach in their book on the process, Motivational Interviewing: Preparing People for Change (a second edition to the popular Motivational Interviewing: Preparing People to Change Addictive Behavior). In this manual for clinicians, Rollnick and Miller explain how Motivational Interviewing can be used in many different scenarios and settings—health care, mental health, corrections, social work, schools—where people may feel ambivalent about making positive behavioral changes. The counseling approach is now also widely used by therapists and health care providers to help patients address eating disorders, thoughts of suicide, smoking, gambling, hoarding, substance use disorder, co-occurring disorders and other chronic medical conditions such as diabetes, cardiovascular conditions and asthma.

How does Motivational Interviewing work? 

Using techniques that explore the individual's readiness to change, the therapist asks open-ended questions, listens in a supportive manner, provides affirmations, offers feedback, acknowledges struggle/pain, shows empathy, and helps to clarify and set goals.

Why does Motivational Interviewing work?

When you are able to see how your own problematic or negative behaviors are at odds with your goals, values or desired outcomes, you are better prepared to make a real commitment to changing your life.

What does the expression "the spirit of Motivational Interviewing" mean? 

The spirit of MI refers to the clinician or therapist's frame of mind. By showing respect, empathy and compassion, working in collaboration (instead of authority) with you, and helping you express your ideas—instead of imposing ideas—the clinician fosters a supportive therapeutic relationship with you.

What are the core therapeutic methods involved in Motivational Interviewing?

Clinicians use four main techniques to help patients consider their readiness for behavior change (contemplation) and explore their motivation to change:

• Express and show empathy through reflective listening
• Amplify discrepancies between the patient's goals and their current behavior
• Support self-efficacy and optimism
• Roll with resistance 

What does it mean to "roll with resistance"? 

The phrase refers to the Motivational Interviewing technique of validating the individual's thoughts and feelings of ambivalence or resistance to change rather than attempting to dissuade, argue with or be confrontational. The idea is that we are more likely to change our behavior when we become self-motivated to do so rather than feel threatened or pressured to do so.

What makes us resistant to change? 

An individual might feel "stuck" in what's called the contemplation stage of change, or lack insight about available resources and/or coping strategies, or feel unnecessarily pressured by others or be fearful about how difficult the change process could be. Additionally, some mental health conditions could be a factor in fueling resistance to change.

Especially in addiction treatment, therapists and clinicians use Motivational Interviewing techniques in combination with the Stages of Change process to elicit behavior change. The Stages of Change model provides a behavioral framework for determining an individual's readiness to change, resolving any ambivalence and reinforcing motivation. The five stages of behavioral change are:

• Precontemplation stage
• Contemplation stage
• Preparation stage
• Action stage
• Maintenance stage

When you understand which behavioral stage you're in—as well as your hesitancy or readiness to change your behavior—you are better positioned to not only find the motivation to change but to maintain that motivation.

What are some typical open-ended questions used in MI?

The most effective questions invite self-reflection and self-direction, such as:

• What is important to you?
• How do these behaviors conflict with your values?
• How would you go about making this change?
• How does substance use conflict with your goals?
• What does change look like for you?
• Why is it important for you to make this change?
• What would your life look like if you didn't have this problem/current behavior?

Do you use MI therapy in conjunction with other therapies? 

Motivational Interviewing is an effective modality for both individualized counseling and group therapy, and elements of Cognitive Behavioral Therapy, Gestalt Therapy, Solution-Focused Therapy or Mindfulness-Based Cognitive Therapy are often combined with this counseling approach.

What are the limitations to Motivational Interviewing? 

• Insurance companies often require mental health interventions to be conducted swiftly, which doesn't always allow for the time needed with this approach. 
• A counselor or mental health professional who is not equipped to "roll with resistance" may grapple with this approach. 
• Motivational Interviewing may not work well in treatment for trauma or depression.
• The patient needs to be ambivalent about changing their behavior, habits or lifestyle; MI doesn't work well if you're already highly motivated to make a change—or on the flip side, if you absolutely don't believe you have a problem.
• Time constraints could prevent a therapist from fully adopting the "spirit of MI" if they're managing a high caseload.

Are there patients who shouldn't try this clinical approach?

MI should not be the primary clinical approach for people with mental health disorders such as bipolar disorder, schizophrenia and others. Interventions such as psychiatry, medication management and other specific treatments should be explored first, and then elements of MI can be used in conjunction with other interventions, depending on the individual patient's circumstances and needs.

What are some patient-centered counseling strategies? 

Patient-centered counseling strategies guide the individual in identifying goals they would like to work on (instead of the therapist imposing goals) as well as collaboration with the patient about their action plan or addiction treatment plan.

Motivational Interviewing can help counselors as well as patients. By learning to "roll with resistance," clinicians eliminate the possibility of power struggle scenarios that can arise in the therapeutic setting. This becomes an important long-term skill to acquire, not just to help patients, but also for self-care as a helping professional.