People come to treatment under various circumstances. Some have realized their life has gotten off track, and they’re determined to make a change. Others come to treatment with reservations but willing to explore the options ahead of them. In some cases, people only go to treatment to appease loved ones or because they had to go because of a court order. Making a change is hard, and your attitude and belief that you can do it are major factors.
But mental and behavioral health issues are treatable, even when it comes to your motivations and readiness to change. Motivational interviewing is an approach to therapy that’s used to address people who are struggling to make a change in their life. It was developed to treat alcohol use problems, but it’s expanded to help people with various medical, psychological, and behavioral problems. Learn more about motivational interviewing, how it works, and what you might expect from it.
What is Motivational Interviewing?
Motivational interviewing (MI) is a form of talk therapy designed to help people who are going through a change or need to make a change in their lives. It’s often used in the treatment of substance use disorders, but it can also be used to treat other mental health and behavioral health issues.
Motivational interviewing is designed to strengthen a person’s motivation to make healthy changes by exploring their own goals and reasons for making a change. In addiction treatment, the change might be to seek or continue in a treatment program, to devote more attention to recovery, or to complete specific tasks in the recovery process.
Motivational interviewing seeks to honor and foster a person’s individual autonomy. Instead of using a confrontational approach or an approach where you just dump information onto another person, you engage with their own motivations. The therapist or counselor that uses MI would avoid giving direct advice or commands. Instead, they may seek to encourage a client to come up with their own arguments for change.
In the context of addiction recovery, MI would explore the reasons a person would like to achieve sobriety. Because it involves your deeper motivations, it may also increase treatment buy-in, which is a person’s willingness to participate in treatment and their expectations that it will be beneficial. Increased treatment buy-in may increase the likelihood of lasting change.
MI is an evidence-based treatment approach, which means it has been examined in scientific studies and found to be effective. This is as opposed to alternative treatment options that can be helpful for some but haven’t shown consistently effective results in research. Treatment programs may include some alternative therapies like yoga and art therapy, but they should only be supplemental to approaches like motivational interviewing and behavioral therapies.
What is Motivational Interviewing Used For?
Motivational interviewing was originally developed by clinical psychologist William R. Miller as a way to treat behavioral health issues like alcoholism in a paper he published in 1983. He partnered with fellow psychologist Stephen Rollnick to write a book that expanded the use of MI to include other aspects of health care.
MI is used in virtually any context in which a person’s motivation to seek and participate in treatment can improve treatment outcomes. MI is a mainstay in treatment for behavioral health issues like drug and alcohol addiction and gambling addiction.
Many people enter addiction treatment programs without fully committing to treatment and recovery. Some may enter a treatment program to appease family members or because of a court order. They may feel like their drug or alcohol use is under control. Others may be entering treatment after multiple attempts that lead to relapse and feel that they may never reach lasting sobriety. MI can help increase motivation, buy-in, and self-efficacy in people who are reluctant to go through treatment out of denial or a lack of self-confidence.
MI can also be used to treat other mental health issues like anxiety and mood disorders. It can also be used in the treatment of medical issues, especially in rehabilitation from injuries and disease. Physical and occupational therapy patients may benefit from motivational interviewing to increase buy-in and success of their treatment in a similar way to people going through behavioral therapies. In medicine, certain issues require a lifestyle change to effectively treat an issue. MI can help with issues like obesity, diabetes, smoking, and other medical issues that may come from bad habits.
MI can be used at any point during a treatment process, from intake to treatment progression. It can help people increase their motivation to begin treatment or to continue in treatment when things get difficult. MI may not be used if someone enters treatment with a positive attitude, ready to make a change. But in that same case, MI may be employed in treatment stalls or regresses.
What are the Five Principles of Motivational Interviewing?
Motivational interviewing has five principles at its core. If your therapist is trained in MI, they will keep these factors in mind while talking to you. These principles are designed to help create a productive and collaborative conversation that helps guide you toward a needed change.
Empathy is a big part of motivational interviewing. When you’re going through an MI session with a skilled counselor, you likely won’t feel judged or ridiculed. In a clinical context, empathy is a term used to describe an emphasis on understanding. Even though MI is designed to get you to change your behavior, it’s a collaborative process that’s built on understanding. Your therapist is trying to tap into your own motivations and what drives you. This will be extremely difficult without empathy.
MI was built on the “person-centered approach” that was developed by Carl Rogers in the 1950s. This approach requires therapists and counselors to respect and understand their clients as human beings. Rogers believed that people are unique and that they know their own situations better than anyone else. A collaborative, empathetic approach to therapy is the key to using a person’s own knowledge and will to create change.
Goal and Behavior Discrepancies
Ambivalence toward change is normal for human beings. We usually avoid change until our circumstances become so uncomfortable that a change is necessary. However, this can mean serious consequences in our lives before we make a change. In cases that involve addiction, even consequences may not be enough to spur change. In MI, your therapist will try to establish discrepancies between your goals and desires for your life and your current behavior.
For instance, if you want to repair your relationships with your family members, you may find and keep a job and improve your health. But if you’re still using the drug that jeopardized those things in the first place, your behavior doesn’t line up with your goals. If you want to achieve sobriety but you’re reluctant to participate in certain parts of your treatment plan, how can you make a lasting change?
Your therapist may try to raise your awareness of some of the consequences of your past and current behavior. This may be a painful process because it means coming to terms with the things you did that hurt yourself and others. But, again, your therapist will be practicing empathy to help you find a solution, not accusing you and making you feel ashamed. They may do this by separating you from your behaviors and looking at them more objectively.
Could anyone achieve your goals if they were engaging in some of your behaviors? Could someone achieve a healthy body without thinking about nutrition or exercise? Your therapist may not tell you what the solution is outright. Instead, they may ask for clarification. As you help them understand, you will begin to better understand the disparity between what you really want and the behaviors that are getting in the way.
While you go through MI, it’s unlikely that you would get into an argument with your therapist unless something has gone wrong. The urge to argue may be common. You may have a natural contention with your therapist, who is trying to get you to change your behavior, even if you feel like you don’t need to or aren’t ready to change.
However, since MI is a collaborative approach to therapy, your therapist will try to avoid direct confrontation. That doesn’t mean you and your therapist will never get frustrated, but arguments may lead to less progress. The goal of MI is to increase your own motivations. If a therapist tries to drag you into a change or impose their motivations onto you, you may feel more reluctance or ambivalence toward change.
According to the MI model, your therapist will probably try to follow the following principles to avoid direct confrontation:
- Arguments aren’t productive. Arguments can waste both the client’s and the therapist’s time since they usually produce limited results. Plus, they may do more harm than good, causing clients to resist what a therapist is trying to get them to do.
- Defending breeds defensiveness. If a therapist responds to contention by becoming defensive, it may just make their client more defensive.
- Resistance means it’s time to shift strategies. If a therapist finds that a client is unreceptive to certain thoughts or ideas, they shouldn’t try to break through. Media depictions of therapy often show a tense breakthrough moment, but that’s less likely in real life, especially in MI. Again, MI is collaborative, and your therapist would be better off exploring other topics or strategies that engage you.
- There’s no need to label. In the world of psychology, labeling is a description of a person that’s based on their behavior or mental illness. Examples include the addict, alcoholic, gambler, and more. While some organizations like AA embrace these terms, a MI therapy session may not be the place for them. Since labeling can carry a connotation of blame, you probably won’t see your therapist do it.
Adjusting to Resistance
Again, resistance or a sense of opposition in MI is a sign that something isn’t working. It may mean the interview has taken a direction that you’re uncomfortable with. There are various methods your therapist may use to adjust to resistance in MI. They may shift focus to a new, less contentious topic of conversation, they may reflect or mirror your statement to get you to explore it more deeply, or they might reframe a negative mindset in a positive way.
Your therapist may use your momentum as a way to move forward. If you’re frustrated in an interview, and you bring up something you’re bothered by, they may shift to talk about the issue you’ve brought up rather than anything they had in mind. This is part of the collaborative nature of MI. Adjusting to resistance may also come with reframing your perspective.
Shifting your perspective about change is a major part of motivational interviewing, and that may start when you express resistance or frustration about your life, treatment, or the issue that’s being addressed.
Self-efficacy is a concept in both motivational interviewing and behavioral therapies there refer to your own belief that you can take on challenges. Many people don’t resist change when there is a problem out of a sense of obstinacy. But they may resist change because they don’t believe they can make a lasting change. Making a long-lasting change is difficult, and many people try many times before succeeding. In the context of substance use problems, many people try to quit or cut back multiple times and continue to relapse.
Self-efficacy is an important part of making a behavioral change, and it’s something that can be developed over time. Your therapist may help to build up your self-efficacy by pointing out and celebrating your successes in treatment. They may draw your attention to others that have had success, even after experiencing many setbacks and relapses. Developing coping strategies that can help you avoid a relapse can also build your self-efficacy since they are tools in your toolbelt that can protect your change. Learning more about yourself, your problem, and your treatment options can also increase self-efficacy.
Belief in the possibility of change can be a powerful motivator, and lack of belief can be detrimental to lasting change. The thought that you couldn’t maintain change can quickly lead to relapse. It’s important for you to believe in your ability to change but it’s also important for your therapist or counselor to believe in you as well.
What are the Stages of Change?
A key concept in motivational interviewing is the Stages of Change model. Stages of change describe making a change as a continuum of six stages rather than a single moment. Motivational interviewing has a lot to do with helping you advance to the stages of change that lead to bettering your life. If you enter a treatment program, and you’re still in denial or hesitant about change, your therapist will use MI techniques to encourage you to examine your need for change and your own potential reasons for wanting to change. A counselor may use different techniques depending on the stage of change you’re moving to next. The six stages of change include the following:
- Precontemplation. This is the starting point for a lot of people who need treatment or to make some type of change in their life. You’re not thinking about making the change, and if someone brings it up, you feel like it’s unnecessary. Denial is common in this stage, but you may also be ignorant of your need to change until you’re confronted by consequences that are difficult to ignore.
- Contemplation. Contemplation sounds like an easy stage since all you’re doing is thinking about making a change, but it can be one of the most uncomfortable times in your journey to recovery. You may feel ambivalent, confused, and conflicted. You’re starting to see your need for a change but you may be hesitant to take steps toward it. You may be afraid of the barriers to change, or you may not feel able to give up the parts of your life that will be affected by the change.
- Preparation. During the preparation stage, you begin to make real steps toward change. You may experiment with small changes, make accountable commitments to change, or you may start collecting the information you need to make a change. In the context of addiction, this may be when you make arrangements to enter a treatment program and start preparing to go.
- Action. This is when you start to take direct actions that create change in your life, like attending and participating in treatment or therapy. There are several things you can do to maintain your motivation through this stage. It’s often helpful to seek social support and to reward success. In treatment, group therapy and contingency management can help in this stage.
- Maintenance. Maintenance is a crucial step to take after you’ve made a change. This will involve continued strategies to maintain your behavioral change and techniques to avoid falling into old habits. In the context of addiction treatment, this will be after formal treatment is complete. But maintaining sobriety often means continuing recovery after treatment through things like 12-step programs and regular meetings with mentors, sponsors, or counselors.
Relapse. Most people don’t like to think about relapse as part of your stages of change, but it’s a common part of making a behavioral change. You may slip back into old habits or addictions. It doesn’t mean treatment has failed, but it does mean that you have to recommit yourself to maintenance or action.
But what happens after a relapse? The Stages of Change model is often depicted as a wheel, but that doesn’t mean you will go through each stage in order every time you relapse. In fact, your response to a relapse can determine where you go next in the stages of change.
If you feel defeated and like you will never be able to make a lasting change, you can go all the way back to pre-contemplation. You may start making plans to take action again, which means you go to preparation. In some cases, you can take immediate action to make your change again.
Tips For Clients Going Through Motivational Interviewing
If you’ve entered a treatment program, and you’ve been placed in motivational interviewing, what can you do to make the most of your sessions? If you go through MI, you may be new to treatment, returning to treatment, you may be struggling to make progress in treatment, or you may need to build up self-efficacy. Either way, it’s important to approach new and different forms of therapy with an open mind, especially when they’re evidence-based. Here are some tips for your MI sessions.
Any meeting with a doctor or clinician will center on the information a medical professional can collect in order to help you. Therapists and counselors can’t run diagnostic medical tests to find problems; instead, they rely on what you tell them. Information that comes from you is even more important in MI because it’s an approach to therapy that assumes that you have the most insight into your day-to-day problems. Sharing information with your therapist can help them understand your situation better, which is important in developing empathy.
Bring Up Issues That Bother You
You may be hesitant to talk about things that are bothering you about therapy, people in your life, or other circumstances because it feels impolite. MI can help people who are obstinate or opposed to making a change, but it can also help people who are holding back for other reasons, like fear or discomfort. Talking about issues that are bothering you can help you and your therapist identify barriers that are between you and lasting change.
Know That You Won’t Be Judged
Many people struggle to trust therapists and counselors in the early days of treatment because they’re afraid they’ll be judged for behavioral or mental health problems. You may have felt judged by friends, coworkers, and family in the time that lead up to your treatment. No mental or behavioral health treatment professionals should make clients and patients feel judged, but MI is intended to specifically avoid judgment and labeling.