Motivational interviewing (MI) is a counseling approach developed by William Miller and Stephen Rollnick in the 1980s. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. The approach is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.
MI is used in various settings, including healthcare, substance abuse treatment, and criminal justice, to help individuals make positive changes in their lives, such as quitting smoking, reducing drinking, and increasing physical activity.
History of MI
Motivational Interviewing (MI) was first developed by William R. Miller and Stephen Rollnick in the 1980s as a method for addressing the problem of ambivalence in individuals seeking help for addictive behaviors, such as alcohol and drug abuse. The original model was heavily influenced by the work of Carl Rogers and his concept of “client-centered therapy.”
Miller and Rollnick recognized that many individuals who seek help for addictive behaviors are not yet fully committed to change, and that simply providing them with information and advice was unlikely to be effective. Instead, they developed MI as a way to help these individuals explore and resolve their ambivalence, and to increase their motivation and commitment to change.
The principles of MI have been expanded and applied to a wide range of other areas since then, including healthcare, mental health, and criminal justice. Over the years, it is been recognized as an evidence-based practice, and has been researched and tested in various fields and populations.
The approach is based on the idea that people have their own reasons and motivations for making a change, and that these motivations can be strengthened through a process of exploring and discussing the pros and cons of change. As a result, MI is often described as a “collaborative and evocative” approach, as it seeks to collaborate with individuals and help them to evoke their own motivations for change.
Basic Principles of MI
The basic principles of Motivational Interviewing (MI) include:
- Express Empathy: MI practitioners aim to establish a therapeutic relationship with their clients by actively listening and trying to understand the client’s perspective. This helps to build trust and creates a sense of safety for the client to express their thoughts and feelings.
- Develop Discrepancy: MI practitioners aim to help clients recognize the discrepancy between their current behavior and their goals, values, and aspirations. By highlighting the negative consequences of the current behavior and the positive benefits of change, the client may become more motivated to make changes.
- Roll with Resistance: MI practitioners view resistance as an opportunity for change rather than an obstacle. They do not argue or confront the client, instead, they try to understand the client’s perspective and to help them work through any concerns or ambivalence they may have about change.
- Support Self-Efficacy: MI practitioners aim to help clients develop a sense of confidence in their ability to change. They do this by highlighting the client’s past successes, providing information, and by offering strategies and resources to help the client reach their goals.
- Engage: MI practitioners help the client to create a plan and take action to reach their goals by identifying specific, measurable and achievable goals, with their clients and working on the steps needed to achieve them.
These principles are implemented using specific MI techniques such as reflective listening, open-ended questions, affirmations, and summaries, which helps the client to explore their own motivations for change and to commit to specific action plans.
Motivational Interviewing for Addiction
Motivational Interviewing (MI) is an evidence-based approach that has been shown to be effective in helping individuals with addiction issues to reduce or quit their substance use. The approach is based on the understanding that addiction is a complex problem that is often characterized by ambivalence about change. People with addiction issues may be aware of the negative consequences of their behavior but may also feel that the benefits of substance use outweigh the costs.
MI is designed to help individuals explore and resolve their ambivalence about change by helping them to identify the reasons for and against change, and to strengthen their motivation and commitment to change.
In the context of addiction, MI practitioners use a variety of techniques to help clients explore their motivations for change, including open-ended questions, reflective listening, and summarizing. They also help clients to identify the specific goals they want to achieve and to develop a plan for reaching those goals.
MI has been shown to be effective in reducing substance use in a variety of populations, including those with alcohol use disorder, opioid use disorder, and tobacco use disorder. It has also been found to be effective in reducing other problem behaviors such as risky sexual behavior and non-adherence to medication regimes.
In summary, MI is a client-centered approach that helps individuals with addiction to explore and resolve their ambivalence about change and increase motivation for change. It is an evidence-based approach and has been shown to be effective in treating different kinds of addiction, by helping individuals set goals and achieve them.
What is an MI Session Like?
A Motivational Interviewing (MI) session is typically structured to be a conversation between the practitioner and the client. The practitioner acts as a guide and facilitator, helping the client to explore their thoughts and feelings about their behavior and the potential for change.
The session usually begins with the practitioner building rapport with the client, which is done by expressing empathy, active listening, and understanding the client’s perspective.
During the session, the practitioner uses open-ended questions, reflective listening, and summarizing to help the client to explore their motivations for change. The practitioner may also use techniques such as “scaling” or “decisional balance” to help the client to recognize the discrepancy between their current behavior and their goals, values, and aspirations.
As the session progresses, the practitioner helps the client to identify specific, measurable and achievable goals and to develop a plan for reaching those goals. The practitioner also helps to increase the client’s sense of confidence in their ability to change by highlighting past successes and by providing information, strategies and resources to support change.
Towards the end of the session, the practitioner encourages the client to take action and may schedule follow-up sessions to check progress. The session typically lasts between 30-60 minutes, but it can also extend based on the client’s needs.
It’s important to note that MI is not a one-size-fits-all solution and the practitioner should tailor the approach to each client’s unique circumstances and motivations, with the understanding that the process of change is ongoing, the MI practitioner should be supportive and understanding of the client’s progress.
MI as Part of Residential or IOP Treatment
Motivational Interviewing is often used as part of a comprehensive treatment program for individuals with addiction or other behavioral health issues. When used in the context of residential or Intensive Outpatient Programs (IOP), MI can help individuals to explore and resolve their ambivalence about change and increase their motivation for change.
In a residential or similar setting, MI sessions can be integrated into the individual’s treatment plan, along with other therapies such as cognitive-behavioral therapy, group therapy, and 12-step programs. The sessions can be held one-on-one with a therapist, or in a group setting. The frequency and duration of the sessions will depend on the individual’s needs and the treatment plan, but it’s often used as a daily or weekly session.
In an IOP setting, MI sessions are typically held in a group setting, alongside other evidence-based therapies, such as cognitive-behavioral therapy, and family therapy. The sessions are typically held 3 times a week, with each session lasting between 90 minutes to 2 hours. The sessions are led by a therapist who is trained in MI and focus on different topics and goals, such as goal-setting, coping skills, and relapse prevention.
In both residential and IOP setting, the use of MI as part of a comprehensive treatment program can be effective in helping individuals with addiction to:
- Increase their motivation for change
- Recognize the discrepancy between their current behavior and their goals, values, and aspirations
- Develop a sense of confidence in their ability to change
- Create a plan for reaching their goals and take action
- Reduce or quit their substance use
It’s worth noting that MI should be used as part of a comprehensive treatment program, and it’s not intended to be a standalone therapy, MI works best when used in combination with other evidence-based approaches. To learn more about mental health and substance use treatment, contact us.