What Is Motivational Interviewing?

Motivational interviewing is a person-centered counseling style that draws out a person's intrinsic motivation for change. It emphasizes autonomy, strengths, and a person's ideas about making positive change, while acknowledging conflicting feelings and challenges that come with change.

Motivational interviewing can be used on its own or in addition to other psychotherapy approaches. People are met with empathy, respect, genuine curiosity about their concerns, and are actively encouraged to explore what change means for them.

This article discusses how motivational interviewing works, key concepts, and effectiveness. 

How It Works

Motivational interviewing acknowledges that people inherently have what they need to create action and make positive changes in their lives. A person and mental health provider or therapist establish a trusting relationship built on partnership, empathy, and attention to the person’s goals.

Once a healthcare provider better understands your situation and experiences, they can begin to explore your needs, what they hope to achieve, and where to focus their energy.

In a motivational interviewing session, a person will describe what change might look like for them. This often presents an opportunity for the therapist to share information with the person about a condition, process, or resource to support them.

Motivational interviewing is well-studied and proven to be effective in many cases. It can be used to treat a variety of mental health conditions and assist with behavioral changes, such as:

• Problematic substance use or alcohol consumption
• Smoking cessation
• Gambling issues

It can also be applied in other settings such as health care, educational, and correctional settings.

The motivational interviewing approach is flexible and patient-centered, valuing the person's worth and input. In other words, we are the experts of our own lives. With guided listening and unconditional positive regard, we can tap into what we need to feel healthy.

Autonomy is central to motivational interviewing. Exploring a person's own ideas and reasons for change and how they might act on them can help them make and sustain changes.

Ambivalence

A concept of note within motivational interviewing is ambivalence.

Ambivalence involves the person's experience of simultaneously feeling two ways about changing behaviors. Listening for and reflecting "change talk," or language that indicates a person might be motivated, ready, or committed to making change, is a powerful skill within this approach that improves outcomes.

For example, imagine a person who drinks alcohol to unwind after work. On one hand, they enjoy socializing at happy hour with their colleagues. On the other hand, they may want to change their relationship with alcohol because it increases their anxiety and impacts their sleep. Ambivalence recognizes a person's reasons for maintaining the status quo vs. doing something different.

Key Concepts

The spirit of motivational interviewing aims to make the process collaborative, exploratory, compassionate, and accepting of each person's value, experiences, goals, and ideas.

There are four key processes in motivational interviewing: engaging, focusing, evoking, and planning.

Engaging

A supportive relationship is the cornerstone of motivational interviewing.

With engaging, a therapist takes time to listen deeply and understand their client, their priorities, challenges, and what they'd like to achieve.

The therapist uses active listening to demonstrate empathy and an accurate understanding of a person's situation in the process.

Focusing

The focusing process is like a funnel. It involves looking at the pressing issues affecting a person and leaning on their and the therapist's ideas about the best or most important place to start.

Evoking

Exploring reasons for and against change, or ambivalence, is an integral part of the behavior change process. Being able to draw out the patient's desire, ability, reasons, and need to change, a therapist can strengthen change talk and soften language that pushes against change.

Planning

Once you and your therapist have decided on a focus and strengthened your motivation for change, it's time to talk about how that change can occur. Then, you and your therapist will partner to create a plan rooted in your ideas and strengths.

Core Skills

The core skills of motivational interviewing include using open questions, affirmations, reflections, and summaries. These techniques are also known as OARS:

• Open questions go beyond seeking a "yes" or "no" answer from an individual. They invite a person to elaborate and share more details about their life. These questions typically start with "what" or "how."
• Affirmations are statements that highlight a person's strengths or efforts. This might look something like, "Despite the challenges you've faced, you are determined to make changes in your relationship with alcohol."
• Reflections are a way to demonstrate understanding by rephrasing or expanding on what a person has shared. These can be simple and repeat back what the person has said. Or, they can be complex and guess at a deeper feeling or meaning.
• Summaries are a great way to sum up key points exchanged between the person and therapist. It also gives the person a chance to address anything that feels important and might have been missed, or share additional thoughts
  

Uses

Mental health and healthcare providers use motivational interviewing to treat health-related concerns including, but not limited to:

• Alcohol and substance use disorders
• Behavioral addictions, like gambling
• Medication adherence
• Risky sexual behavior

Motivational interviewing can also be useful in helping to implement healthy lifestyle changes, like diet and exercise.

Effectiveness

Research shows that motivational interviewing is a powerful tool for helping people make healthy changes. 

A 2018 review examining studies that used motivational interviewing showed its usefulness in decreasing unhealthy substance use behaviors. Participants saw a reduction in binge drinking, the amount and frequency of drinking, smoking, and substance use.

A meta-analysis of 12 motivational interviewing studies demonstrated its effectiveness with a range of behavioral outcomes, including medication adherence, sexual behaviors, gambling, lifestyle changes like exercise and diet, and alcohol or other drug use.

Finding a Therapist

To find a mental health professional, you can seek a referral through:

• A primary healthcare provider
• Insurance company
• Employee Assistance Program
• Hotline providing local information

When selecting a therapist, ask about their education, training, experience, and use of motivational interviewing in their practice to decide if they are a good fit for you. If money is a concern, you can ask about a sliding fee scale, which can reduce the cost of treatment. 

Professionals outside of mental health providers, such as those who work in health care, may also incorporate motivational interviewing techniques into their practice. The best way to understand a provider's approach is to ask questions about their knowledge, training, and experience.  

Summary

Motivational interviewing is a counseling style that can help people get and stay motivated to make change. Mental health providers use motivational interviewing and active listening techniques to determine what a client wants to change, their goals and priorities, and how to start taking action.

Research shows that motivational interviewing is effective in treating substance use and addiction. For the best results, seek out a professional who has training and experience in this technique.

A Word From Verywell

Changing direction or setting out on a new path can be intimidating and even scary. You may not know where to start, or how you can accomplish your health and well-being goals. Working with a therapist who uses motivational interviewing can help you explore your concerns, values, goals, and create a manageable plan.