Motivational Interviewing

Motivational Interviewing is an effective therapy option for substance use disorders (SUD), also known as addiction. This is because it works fast, is more affordable than other therapeutic approaches, and results in a longer commitment to treatment. Learn more here.
Evidence Based
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What is Motivational Interviewing?

Motivational Interviewing (MI) is a therapeutic approach used to treat substance use disorders (SUD). The goal is to help people make behavioral changes that are better for their health. A person should be an active participant in their recovery and be internally motivated to change.

Motivational Interviewing is based on five principles:

  • Expressing empathy 
  • Developing discrepancy
  • Avoid arguing
  • Rolling with resistance
  • Supporting self-efficacy 

Benefits of Motivational Interviewing for Drug Addiction

Motivational Interviewing is effective because it works fast, is more affordable than other therapeutic approaches, and results in a longer commitment to treatment.

For some, progress occurs after just two to four sessions. This is much faster than many other approaches. There is also evidence that MI reduces risky behavior in people and increases the likelihood of someone to stay in addiction treatment longer. This improves their odds of successful long-term recovery.

One of the reasons MI is effective is because it acknowledges how contradictory the mind can be. 

A person might want to change, but thoughts and actions prevent change from occurring. The MI approach helps a person get past mental and emotional roadblocks, as long as a person is ready to improve.

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When Is Treatment Necessary?

Motivational Interviewing is effective for people who need to find personal motivation to get sober. It helps with the struggle to overcome ambivalence regarding recovery. It is also used in conjunction with other therapeutic approaches to help people realize sobriety is necessary.

There are times Motivational Intervention is not effective. For instance, the inability to be present and clear headed during treatment interferes makes MI difficult.

MI is also not recommended when there are co-occurring disorders, such as bipolar disorder or depression. Co-occurring conditions make it difficult to reach the conclusions necessary for MI techniques to be effective.

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Techniques of Motivational Interviewing

Motivational Interviewing employs several techniques that a therapist can tailor to a specific individual. The goal is to find the best approach to motivate someone to want to recover. For example:

Battling Resistance

Based on the belief that people want to change, but they are resistant to doing so. The MI therapist is trained to recognize the resistance that ranges from direct to subtle and find a way to get around it, not with fighting, but with permissive questions and listening to the person’s point of view. Therapists invite people to think of new ways to solve problems without telling them they are wrong for anything they are doing.

Advice Offering

The best MI therapists can offer advice without it seeming as if they are telling someone what to do. They take a non-judgmental approach and offer advice casually. The process begins with careful listening, then a suggestion, then the request for feedback about advice. It’s inviting a person to take advice instead of telling that person what to do.

Therapeutic Paradox

If a person is struggling in treatment, a therapist might use the Therapeutic Paradox technique.

In this technique, the therapist uses a contradictory statement, such as “You’ve tried to stop drinking, but weren’t able to do so. Maybe it’s not something you really want to do.” From that point, the therapist and person working on sobriety can explore why not drinking is difficult.

Therapists using this approach might also Side with the Negative in order to adapt to client resistance. Doing so doesn’t present any ethical quandaries, nor is it “reverse psychology.” It’s simply becoming the negative voice in the discussion.

Self-Efficacy

To achieve sobriety, the person with substance use disorder needs the motivation to change. Improved self-esteem makes finding that motivation easier. Therapists using a self-efficacy approach encourage people, acknowledge progress, and provide positive feedback.

MI therapists must be empathetic. They need to put themselves in the other person’s shoes and be able to see things from an angle they might have never experienced personally. For MI to be successful, people need to feel understood and know that the person helping them realizes the work they’re doing isn’t easy.

Columbo Approach

The Columbo Approach is a technique based on an old television show called Columbo. It’s done in an effort to develop discrepancy. 

In the television series, Columbo, a detective, understood what likely occurred, but took a clumsy approach to the investigation and interrogation of suspects. He’d use a Socratic style and strategically pose questions in an effort to piece together what really occurred. This led to the suspect revealing the needed information to close the case. 

In therapy, this technique requires the therapist to rationalize discrepancies and help the person trying to overcome substance use disorder to question their mindset and reflect on their actions.  

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The "Stages of Change"

Change happens gradually and the length of time it takes varies from person to person. The stages of change include:

1. Pre-contemplation

A person is in this stage when he or she has no desire to change and does not recognize a problem.

2. Contemplation

A person enters this stage once he or she recognizes the problem, but does not yet have a realistic solution.

3. Preparation 

A person is in this stage when he or she is thinking about steps to change but still has pessimism or doubt.

4. Action

A person is in this stage when he or she begins taking steps to change, even if there is still skepticism.

5. Maintenance

This is the final stage and occurs when the new behaviors continue. If these new behaviors stop relapse is likely to occur.

6. Relapse

This is an additional stage that might occur for some people. It occurs when a person begins using drugs or alcohol again after recovery. It results in the need to return to a previous step and restart the recovery process.

Graphic of two people at a table to signify motivational therapy.

Example Questions 

There are several different types of questions and statements Motivational Interviewing therapists use. They include:

Open-ended Questions 

Questions that let a therapist learn more about someone’s perspective and build and strengthen the client-therapist relationship.

Specific open-ended questions that could be asked during Motivational Interviewing include:

  • What brought you here today?
  • How do you feel about being in rehab?
  • What do you gain from using drugs/alcohol?
  • Why do you think you have a problem with drugs/alcohol?
  • What worries you about your dependence/addiction?
  • Why do you think it’s important to change?
  • Tell me about your substance use
  • Tell me about how you felt when you used drugs
  • Tell me your thoughts on being in rehab
  • What would you like to talk about?
  • What do you like about using (drug of choice)?

Affirming Statements

Statements that recognize and comment on a person’s strengths. Affirming statements build rapport and validate emotions. These statements can be formed as complements or appreciation and understanding. 

Reflective Listening

Reflective listening is re-stating what a person says to build engagement and help a person who is upset calm down and feel understood. It’s also an opportunity to clarify points so there are no misunderstandings.

Summarizing

Finally, therapists summarize what a client has shared. This helps clients find the motivation to change within themselves because they can hear what they’ve said.

The whole point of this approach is to elicit self-driven change in people who want to achieve sobriety. It helps someone identify their desire to change, acknowledge their ability to do so, and to see the importance of that change. MI therapists recognize and emphasize the change talk they hear from their clients. When someone expresses an authentic desire to change (through commitment language), it’s an opportunity to move forward with treatment and an indication treatment will be effective. 

Graphic of head filled with gear

Treatment Combinations

Motivational Interviewing is used in combination with other treatment approaches. Many view it as a successful add-on approach to standard drug and alcohol addiction treatment.

It tends to not be as effective when a person has a long history of substance dependence or addiction that requires more intensive treatment. It is also not as effective for those undergoing detoxification but could be later in the recovery process.


Ready to Make a Change?

Resources

“Motivational Interviewing / SAMHSA-HRSA.” Samhsa.Gov, 2012, www.integration.samhsa.gov/clinical-practice/motivational-interviewing.

“Center of Excellence for Integrated Health Solutions.” Thenationalcouncil.Org, 2019, www.thenationalcouncil.org/integrated-health-coe/. Accessed 18 Dec. 2019.

“Principles and Techniques of Motivational Interviewing - AIPC Article Library.” AIPC Article Library, 12 Jan. 2015, www.aipc.net.au/articles/principles-and-techniques-of-motivational-interviewing/.

“17 Motivational Interviewing Questions and Skills.” PositivePsychology.Com, 5 Nov. 2019, positivepsychology.com/motivational-interviewing/.

National Center for Biotechnology Information. “Chapter 3—Motivational Interviewing as a Counseling Style.” Nih.Gov, Substance Abuse and Mental Health Services Administration (US), 2012, www.ncbi.nlm.nih.gov/books/NBK64964/.

 National Center for Biotechnology Information. “Chapter 3—Motivational Interviewing as a Counseling Style.” Nih.Gov, Substance Abuse and Mental Health Services Administration (US), 2012, www.ncbi.nlm.nih.gov/books/NBK64964/.

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Updated on: June 24, 2020
Author
Addiction Group Staff
About
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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