What Is Motivational Interviewing?

Many people have aspects of their lives they hope to change, such as a career path, strained relationship, or a tendency to order takeout instead of cooking a home meal. Whatever the circumstance, it can take energy and motivation to make healthy changes and influence mental health.

When attempting to create a behavior change on your own you may have mixed feelings about how to proceed, it may be beneficial to have a supportive network of friends, family, and professionals to support you, such as a counselor who can provide motivational therapy to help keep you on track. Some counselors devote their careers to studying how people commit to making healthy life changes. Psychologists trained in motivational interviewing (MI) may be able to help by facilitating behavior change through resolution of the client’s ambivalence. They tend to pay particular attention to finding intrinsic motivators for making behavioral changes. 

Changes can occur, whether ambitious, minor, or somewhere in between. If you're in a season of personal development, motivational interviewing might inspire you to make healthier changes in the present and transform your future.  

What is motivational interviewing in behavioral and cognitive psychotherapy?

Motivational interviewing was a process initially developed by clinical psychologist William R. Miller and later expanded on with Stephen Rollnick as an option in clinical practice for those experiencing a substance use disorder. The process itself is based on the humanistic values of Carl Rogers in which patients are treated with empathy and unconditional positive regard. Miller and Rollnick developed a guide printed by Guilfold Press that serves as a foundation for helping patients change behavior using MI principles. The theory and practice of MI in clinical psychology have evolved over subsequent decades, and it's now used in behavioral and cognitive psychotherapy for various conditions. 

Counselors may use MI as an evidence-based approach to help clients find the internal motivation to make beneficial changes. This could help clients cease smoking, abstain from substance use, adhere to medications, maintain healthy eating practices, or improve physical health conditions. 

In an MI session, the therapist often engages a person in a candid discussion to assess whether they’re genuinely interested in change. Client autonomy is typically a key component of motivational interviewing. Motivational behaviors can differ greatly—and people change for many reasons. The motivation to change may originate in the patient, not the therapist, which makes it important to consider a client’s ideas in the process. Through extensive discussion or "interviewing" about a person's own reasons for change, during this collaborative process, clients can move away from ambivalence and establish a clear, personal argument for change to start achieving their goals. If a person engages in more “change talk,” they may be prepared to make meaningful changes. 

Who can benefit from motivational interviewing?

MI may be effective for many mental illnesses and symptoms and can be applied in a broad range of settings, including healthcare, education, and human services. Therapists often employ MI to treat substance use disorders, but MI strategies might also be used to support the following objectives: 

• Healthy nutrition and physical activity levels
• Abstinence from smoking, gambling, unsafe sex, or other behaviors
• Stress management
• Engagement in management programs for diabetes, cardiovascular health, or other health concerns

The American Psychological Association (APA) notes that MI benefits people with low intrinsic motivation to change. By discussing a client's goals, values, and strengths at length, MI may make it easier for people to verbalize and visualize reasons for change that they may not discover on their own. 

Core principles of motivational interviewing and the therapeutic relationship

The success of the MI counseling method and treatment adherence may depend on three components of motivation, which can be summarized by the phrase "ready, willing, and able." These three components are:

1. Willingness: How open a client is to change 
2. Ability: The confidence a client has to change
3. Readiness: Whether the change is an immediate priority

Clients may not feel motivated enough to begin working toward change without addressing these three components. Assuming the client is ready, willing, and has the ability to change, a therapist can use MI to assist them in altering their thought patterns and health behaviors. This therapeutic process is rooted in the following evidence-based guiding principles, as outlined by the Royal Australian College of General Practitioners:

1. Listen with empathy: As a foundational skill, Therapists trained in MI learn to take an active interest in a client's internal perspective and express empathy by showing genuine curiosity and using reflective listening.
2. Understand the client's motivations: If the client isn't motivated, change may not occur, regardless of how much a therapist cares for the client's well-being. Instead, the therapist honors client autonomy and strives to support their client’s self-efficacy by reflecting on the their strengths and past successes and restoring confidence in their capacity for change.
3. Resist the righting reflex: Counselors may feel inclined to prescribe the "right path" for healthy change, but this can defeat the purpose of MI, as clients may resist change when therapists propose a strict plan of action. A well-trained MI counselor may roll with resistance and emphasize a client's decision to make changes independently, using reflective phrases.
4. Empower the patient: Research shows that when clients are primary and active collaborators in their healthcare, the treatment outcomes tend to improve. In MI, empowerment may look like collaboration that boosts a client’s ability to change. 

If you're a client, your counselor might prompt you to explore your ideas about making change, discuss your personal history of change, and identify discrepancies between your current situation and where you'd like to be.

Common strategies used in motivational interviewing

To build a client's motivation, counselors use several research-backed strategies to give clients confidence in their ability. There are many therapeutic techniques that may promote change and support a healthy client-therapist relationship and productive conversation in Motivational Interviewing. Motivational strategies include:

Open-ended questions

A therapist may ask evocative questions that may require more than a "yes" or "no" answer. The client in MI often does most of the talking, allowing the counselor to learn more about a client's values, goals, and uncertainties about changing a specific behavior. The line of questioning may begin to develop a discrepancy between what a client is doing currently and the change that they hope to make. This is the first step to helping people identify behaviors they’d like to change.

Affirmations

Sincere affirmations can build strong therapeutic relationships between counselors and clients. Using compliments or statements of appreciation and understanding, therapists can direct focus toward a client's strengths, past successes, and current efforts to create change.

Reflective listening and phrasing to express empathy

In MI, a counselor may repeat the patient's verbalized vital points, which can clarify and deepen their understanding of the client's thoughts and feelings. This practice can also amplify or reinforce a patient's stated commitment to change.

A collaborative "change plan" 

Rather than a set of techniques to "use on" people, MI offers common sense strategies for counselors to use in collaboration with their clients that can build skills. After establishing a strong therapeutic rapport, clients and therapists may create a "change plan" together. This planning process can be shaped by essential questions, which might include:

• Where do we go from here?
• What do you want to do at this point?
• After reviewing this plan, what's the next step for you?

The client is the change leader in this plan (and in all MI strategies). Their therapist can be a collaborative, trusting professional who recognizes their strengths, autonomy, and vision for the future. 

The benefits of online motivational interviewing 

On online platforms like BetterHelp, there may be many providers specializing in motivational interviewing for substance abuse treatment, weight loss, and many others. They can ask thought-provoking, open-ended questions, offer affirmations, and collaborate with you to create a change plan through your preferred session method. You can choose between phone, video, or live chat sessions once you have signed up. 

Online therapy can be as effective in treating a broad range of mental health conditions as in-person therapy. In 2017, a comparison of in-person and online MI found that online therapy was equally effective, based on the outcomes of adults in a health management program. In addition to positive treatment outcomes, online therapy is often a more affordable option for clients interested in MI. Many practitioners of behavioral and cognitive psychotherapy offer their services both in a general practice setting and online. If you don’t feel comfortable with in-person therapy at this time, you might consider talking to a therapist who practices MI online.  

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