If you’ve ever tried to make an important change in your life, you know how difficult it can be. You may know in theory that making this change is important for your mental health, but that doesn’t mean you are able to actually make it happen. This is where a counseling approach called motivational interviewing therapy can help.
Motivational interviewing therapy is an evidenced-based approach to help people make positive changes in their lives, whether it be a health change, behavioral change, or freedom from addictive behaviors. It’s based on the idea that true change can’t come unless a person has an intrinsic motivation for change. Motivational interviewing helps you tap into that motivation and make a plan for implementing change.
What is Motivational Interviewing in Simple Terms?
So what is motivational interviewing, exactly? “In simple terms, motivational interviewing is the art of assessing and determining the level of willingness a client has for change and partnering with them to assist in holding them accountable to that change,” says Alan Deibel, a licensed clinical professional counselor at Grow Therapy.
Many people find motivational interviewing therapy affirming and empowering. “It helps clients move toward accepting that they have a problem and that they have the power to make changes to solve their problems,” describes Christy Barongan, a clinical psychologist at Grow Therapy.
Motivational interviewing therapy gives people the space to explore what is holding them back when it comes to making positive changes in life and explore any ambivalence they may have about changing. This counseling approach is non-judgmental in nature. Therapists and counselors don’t try to push an agenda on their patients, or inundate you with information. Instead, they help you look inside and find your inner motivation to change.
After all, a person can’t change unless they really want to, right?
History of Motivational Interviewing
The principles of motivational interviewing were introduced in 1983 by American clinical psychologist William Miller. Miller’s initial work centered on people with alcoholism and offered ways of changing alcoholic behavior. In 1989, Miller teamed up with UK psychologist Stephen Rollnick. Together, Miller and Rollnick published a book about the principles of motivational interviewing therapy. The fourth edition of their book, Motivational Interviewing: Helping People Change and Grow, was published by Guilford Press in 2023.
What is Motivational Interviewing Therapy Used For?
There are many different behavioral and health conditions that motivational interviewing can help you tackle. Here are a few:
- Substance use disorder
- Substance abuse
- Unsafe sex practices
- Risky behavioral reduction
- As an adjunct to CBT anxiety treatment, including generalized anxiety disorder, obsessive compulsive disorder, social anxiety disorder, PTSD, and anxiety caused by traumatic brain injuries
How Does Motivational Interviewing Work?
If you’re interested in trying motivational interviewing therapy, you likely have questions about what to expect during a typical session, and what motivational interviewing is generally like. In a nutshell, motivational interviewing therapy is a client-centered approach where therapists tend to ask open-ended questions and do a lot of deep listening and encouragement. You are in the driver’s seat during your therapy sessions.
During motivational interview therapy, therapists “express empathy, avoid arguing, and support self-efficacy,” Melissa Galica, a licensed professional counselor with Grow Therapy, says. “We don’t oppose change but draw out the patient’s motivation to change. It’s a counseling style that draws out the person’s intrinsic (own) motivations and reason to change.”
What are the Motivational Interviewing Techniques?
A main goal of motivational interviewing is to assess where in the “stage of change” a client is in, says Diebel. To that end, many therapists use Prochaska and DiClemente’s transtheoretical model “stages of change” theory to assess their clients.
The five stages of change, according to the transtheoretical model are:
- Precontemplation Stage
- Contemplation Stage
- Preparation Stage
- Action Stage
- Maintenance Stage
Once a client’s “stage of change” is determined, the clinician is able to decide where to put their energy in for the client, according to Diebel.
“For example, if the client is in the ‘pre-contemplative’ (not ready or willing to make change at this time) stage of change, the most effective intervention is to educate the client with facts and information and to empathize with their difficulty in making a decision to change,” he describes. “For someone in the contemplative stage (i.e. they want to change but don’t know how or aren’t ready), the main goal for the provider is to observe ambivalence and work with the client to clarify ambivalence.”
Similar to other therapy types, initial motivational interviewing sessions focus on building rapport through affirmations and empathetic, nonjudgmental listening, says Galica. “The therapist asks many open-ended questions to draw out the client’s perspectives without imposing their views,” she describes.
Prompts may include questions like:
“Tell me more”
“What does that mean to you?”
“How do you feel about that?”
Galica further explains, “as sessions continue, the questioning guides clients toward constructing their arguments for change and strengthening their readiness to change.” In motivational interviewing therapy, there is no set timeline, Galica emphasizes. “Some clients move quickly from building motivation to taking action, while others require more sessions to work through ambivalence.” Progress depends in large part on the client’s level of readiness.
We don't oppose change but draw out the patient's motivation to change. It's a counseling style that draws out the person's intrinsic (own) motivations and reason to change.
- Melissa Galica, LPC
Additionally, the spirit of motivational interviewing is person-centered, with therapists maintaining a gentle, collaborative tone throughout, allowing the client to voice their reasons and motivations for change rather than being directed.
“The therapist affirms strengths and autonomy,” Galica says. “Once committed to change, the client is supported in consolidating motivation and developing a change plan tailored to their insights and values.”
What are the 4 Principles of Motivational Interviewing?
Four main principles make up the spirit of motivational interviewing. They are:
- Partnership: A therapeutic collaboration between therapist and client, where the therapist doesn’t adopt an authoritative role
- Acceptance: Respecting the individual needs and autonomy of the patient
- Compassion: Respecting, promoting, and acknowledging the client’s needs and feelings
- Evocation: Allowing the client’s own motivation to be the driving force behind the change
In addition, motivational therapy involves four processes during therapy:
- Engagement: Empathetic, client-centered listening
- Focusing: Naming of a target goal for change
- Evoking: Supporting the client’s own intrinsic motivation
- Planning: Using a patient’s own knowledge and expertise to generate life changes
What are Some Benefits of Motivational Interviewing Therapy?
Does motivational interviewing work? A systematic review of reviews from 2018 looked at over 5,000 records, and over 100 reviews, including close to 40 meta-analyses, to gauge the effectiveness of motivational interviewing. The researchers found that motivational interviewing therapy is overall effective, but that there are certain things it’s most effective for.
For example, according to the researchers, motivational interviewing is most effective at managing and preventing behaviors like binge drinking, decreasing drinking frequency, smoking, and substance abuse. There is less evidence of effectiveness for people with gambling issues. In addition, motivational interviewing is overall less effective for people who don’t have much of a desire to change.
Deibel agrees that motivational interviewing therapy is highly effective for people who live with addiction. “Since addiction is a category that has a lot of shame and stigma associated with it, motivational interviewing provides a scaffolding that is free of bias and judgment and largely focuses on the goals the client is willing to put energy towards,” he says. “Motivational interviewing empowers the client to take charge of their recovery and their goals.”
Another benefit of motivational interviewing therapy is that it works well alongside other therapy types, according to Galica, including CBT, DBT, and exposure therapy. Motivational interviewing can enhance a person’s commitment to the work they are doing in therapy, and thereby make their treatment more successful.
“The motivational therapist resolves ambivalence and builds readiness to engage fully in the main therapeutic approach,” Galica says. “So motivational interviewing provides the fuel to prime the engine of change, while the other therapy provides the roadmap for the actual change process.”
The Bottom Line
Motivational interviewing therapy isn’t for everyone, but it can be a wonderful method for people who are ready, willing, and interested in making positive changes in their lives. The great thing about this method is that it can be used on its own or alongside other therapy types. Contacting a therapist who specializes in motivational interviewing therapy is a fantastic way to get started.
