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What are the Benefits of Motivational Interviewing?

Motivational interviewing is a therapeutic approach widely used in the treatment of substance abuse that focuses on resolving a person’s ambivalence to change a particular behavior. It is made up of a set of principles and techniques that aim to establish a collaborative relationship between the therapist and the patient and elicit the patient’s own motivation to quit using drugs or alcohol.

The therapist expresses empathy and understanding for the patient and honors their freedom to develop their own reasons and goals for change.

What is Motivational Interviewing?

Motivational interviewing is a form of counseling that strengthens a person’s motivation and commitment to change some behavior. It helps people overcome their resistance or ambivalence to participating in treatment.1

Motivational interviewing gained prominence as an alternative to the more confrontational and guided styles of substance abuse therapy in the 1980s. Several of its principles and interventions are based on the patient-centered therapy approach promoted by the therapist Carl Rogers. However, MI is considered more goal-driven than this approach.9

One of the major misconceptions about MI is that it is a way for the therapist to “trick” the person into getting them to do what the therapist wants them to do. In fact, motivational interviewing operates under the assumption that the patient should make their own choices, not go along with the choices of the therapist. The desire for change is something that cannot be manufactured externally—it must be inherent.3

Another misunderstanding about MI is that it is based on the popular transtheoretical model of change. This model assumes that people move through 5 distinct stages in the recovery process. According to the creators of MI, William Miller and Stephen Rollnick, motivational interviewing helps people build motivation for change, while the transtheoretical model demonstrates how and why people change. There is a close relationship between the two, but there is no need for the therapist to explain the stages of change when working with a patient; they need only to help the patient build their motivation to recover.3

What is Motivational Interviewing Used for?

Motivational interviewing (MI) is primarily used with people suffering from addiction or other mental health disorders. But it has also been used to help people with various issues, including:2

  • chronic health illnesses (e.g., diabetes and heart conditions).
  • adherence to regimens to improve their health.
  • increase motivation for good behaviors.

Does Motivational Interviewing Work for Substance Use Disorders?

Over the years, motivational interviewing for substance abuse has established itself as an evidence-based treatment.1 This means that its usefulness is supported by research.4

MI is very popular in the field of addiction treatment, and many studies have examined its effectiveness:

  • One study found that motivational interviewing outperformed traditional counseling techniques in 75% of studies. In these studies, the interventions targeted alcohol abuse, psychiatric diagnoses, and other types of addiction.5
  • Another study found that MI was able to improve recovery outcomes when used in combination with other treatment approaches.6
  • Yet another study that looked at 4 meta-analyses found that MI was much more effective (10-20%) than no treatment at all and equal to other forms of substance abuse rehabilitation in helping people stop engaging in risky behaviors and participate in treatment.7
  • A review of 11 clinical trials found that in 9 of the studies, motivational interviewing produced better outcomes than no treatment, typical care, long-term treatment, or being on a waiting list. In the other 2 studies, researchers believe that the treatment providers may not have effectively followed the “spirit of motivational interviewing”,10 (explained below).

MI for substance abuse has been found to be effective for many addictive behaviors, as well as the management of chronic illnesses.6

While it helps individuals alter their behavior and become more motivated to embrace positive lifestyle choice, motivational interviewing for addiction does not address the underlying reasons for the substance misuse and abuse. It also does not address any co-occurring disorders that may be present, including mental health disorders like depression, bipolar disorder, or schizophrenia. Depending on the co-occurring disorder, it may be more problematic to use motivational interviewing. That is why it is important that motivational interviewing be used in combination with other forms of therapies and treatment.

The Spirit of Motivational Interviewing

Although motivational interviewing uses a set of interventions, it is grounded in a “spirit” or “way of being” that forms the foundation of the therapist’s work with the patient.1

The spirit is comprised of 3 elements:

  • Collaboration. The MI approach sees the therapist and the patient as partners, as opposed to other therapeutic styles in which the therapist is the “expert” who takes a more confrontational approach.1 In MI, the patient is the expert on their addiction and other issues, and the therapist creates an environment that is conducive to change, as opposed to coercive.8
  • Evoking. Under an MI approach, the patient possesses the resources and motivation to change, and the therapist tries to evoke or draw out this motivation.8 The person is more likely to quit drinking or using drugs if they discover their own reasons and express their commitment to doing it.1
  • Autonomy. The patient takes responsibility for change and making it happen. The therapist does not believe there is one “right way” to change and lets the patient create their own path to recovery. The patient is also responsible for coming up with various options for how to change.1 The therapist respects the patient’ right and ability to lead their own life.8

Central Therapeutic Principles of Motivational Interviewing

Motivational interviewing therapists adopt several underlying principles that they use when working with patients. These include:1,8

  • Expressing empathy. The therapist tries to see the world through the patient’s eyes, which helps the patient feel heard. It also helps build rapport and makes it more likely that the patient will open up and share their thoughts and feelings.
  • Developing discrepancy. According to MI, people are more likely to want to change if there is a gap between where they are and where they want to be. The therapist helps the patient to identify the discrepancy between the way they are currently living and their values and goals. One way the therapist may do this is to have the person list the pros and cons of their drug-using behavior.
  • Rolling with resistance. MI therapists view arguments as both counterproductive and potentially damaging in that they may push the person further away from wanting to change. When a conflict occurs, the therapist tries to dampen it and “roll with it.” They don’t challenge any statements or actions the patient makes that show resistance to treatment.
  • Supporting self-efficacy. MI puts faith in the patient’s ability to change. This is significant because many patients have relapsed and doubt their ability to regain and maintain their sobriety. The therapist focuses on times when the patient succeeded and emphasizes their skills and strengths.

The Therapist’s Approach to Motivational Interviewing

Typical skills that therapists use in motivational interviewing include the following, which are sometimes represented by the acronym OARS:

  • Open-ended questions. Instead of questions that can be answered with a simple “yes” or “no,” MI therapists use questions that require the patient to put more thought into their response, such as “how do you think your drug use hurts you?” They help the therapist better understand the patient’s point of view and provide them with more information about the patient’s thoughts and feelings. They also help build momentum in communication.1,10
  • Affirmations. A therapist uses statements such as “I hear” or “I understand” to acknowledge the difficulties the patient is going through. They validate the person’s viewpoint and help them feel more confident about change.10
  • Reflective listening. The therapist makes an assumption as to what the patient tried to say and expresses this in a statement, instead of a question. It demonstrates that the therapist has accurately heard and understood the patient. Reflective statements prompt the patient to keep talking, show respect, help strengthen the therapist and patient’s relationship, and clarify what the patient meant.10
  • Summarizing. The therapist summarizes to the patient what was discussed in the session. Again, this technique shows that the therapist has properly understood the patient. The therapist can focus on important aspects of the discussion and highlight the patient’s ambivalence or encourage discrepancy by selecting which information to include in the summary.1

The Importance of Change Talk for Addiction Recovery

Change talk refers to statements the patient makes that indicate that they are either considering change, motivated to change, or committed to change. Research has shown a link between change talk and real behavior change. The more change talk a patient engages in, the more likely they are to take action.1

Different types of change talk have been defined and are usually explained using the acronym DARN-CAT. The first 4 letters indicate that the person is preparing to change, and the last 3 indicate that they are committed and taking actions. These statements are promising, but they don’t guarantee change.1 The DARN acronym stands for:

  • Desire. The person says that they want something, such as, “I want to stop using marijuana.” Wanting to change is helpful for but not essential to actually changing, as people can still make a change even if they don’t want to.11
  • Ability. The person says things such as, “I can” or “I’m able to” that indicate they believe they can change. A person won’t change if they don’t think it’s possible, and these types of statements suggest they have at least some degree of confidence in their ability to make a shift.11
  • Reasons. The person gives reasons why they should change. However, even though the person may have good reasons why they want to change, they still may feel as though they aren’t able to succeed.11
  • Need. The patient expresses their need to change, which also does not necessarily mean they have a desire or ability to change. They may, for example, have been told by a friend or an authority figure that they need to make a change.11

The following types of change talk show a strong movement toward change and may better predict future success:1,11

  • Commitment. The patient says things such as, “I will” or “I promise.” These statements make it more likely the person will do something.
  • Activation. The patient makes statements that signal they are ready, willing, and prepared to make a change; however, they may not yet be fully committed.
  • Taking steps. The person says something to the therapist that indicates they have taken a step toward change, for example attending an AA meeting or checking into rehab.

Change talk is the opposite of “sustain talk,” or statements the patient makes in defense of their current behavior. A patient using sustain talk may bring up the advantages of continuing to use drugs, reasons not to quit, and why change is not possible.11

Make a Change

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