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Types of Therapy > Motivational Interviewing

Motivational Interviewing
Reviewed by Psychology Today Staff

Motivational interviewing is a counseling method that helps

people resolve ambivalent feelings and insecurities to find
the internal motivation they need to change their behavior. It
is a practical, empathetic, and short-term process that takes
into consideration how difficult it is to make life changes.

Motivational interviewing evolved from Carl Roger’s person-

centered, or client-centered, approach to counseling and
therapy, as a method to help people commit to the difficult
process of change. It was introduced by psychologist William
R. Miller in 1983 and further developed by Miller and
psychologist Stephen Rollnick. “The more you try to insert
information and advice into others, the more they tend to
back off and resist. This was the original insight that
generated our search for a more satisfying and effective
approach,” Rollnick writes. “Put simply, this involves coming
alongside the person and helping them to say why and how
they might change for themselves.”

Contents
When It's Used
What to Expect
How It Works
 What to Look for in a Motivational Interviewer
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When It's Used

Motivational interviewing is often used to address addiction
and the management of physical health conditions such as
diabetes, heart disease, and asthma. This intervention helps
people become motivated to change the behaviors that are
preventing them from making healthier choices. It can also
prepare individuals for further, more specific types of
therapies. Research has shown that this intervention works
well with individuals who start off unmotivated or unprepared
for change. It is less useful for those who are already
motivated to change. Motivational interviewing is also
appropriate for people who are angry or hostile. They may
not be ready to commit to change, but motivational
interviewing can help them move through the emotional
stages of change necessary to find their motivation.

Research shows that motivational interviewing is effective in

many contexts, including:

Substance use disorder

Smoking

Weight loss

Medication adherence

Cancer care

Diabetes care

Health behaviors among children

What to Expect
In a supportive manner, a motivational interviewer
encourages clients to talk about their need for change and
their own reasons for wanting to change. The role of the
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interviewer is mainly to evoke a conversation about change
and commitment. The interviewer listens and reflects back
the client’s thoughts so that the client can hear their reasons
and motivations expressed back to them. Motivational
interviewing is generally short-term counseling that requires
just one or two sessions, though it can also be included as an
intervention along with other, longer-term therapies.

Motivational Interviewing is guided by four key principles.

These are:

1. Express Empathy

Empathy is a key component of motivational interviewing.

The therapist listens carefully to the patient and conveys that
they understand the patient’s feelings, beliefs, and
experiences.

2. Support Self-Efficacy

Motivational interviewing posits that clients possess the

strength and ability to grow and change—even if past
attempts at change have failed. The therapist supports the
patient’s belief in themselves that they can change. The
therapist may do this by calling attention to the patient’s
skills, strengths, or past successes.

3. Roll with Resistance

If the patient is struggling to change, they may resist potential

solutions or the therapist’s guidance. In motivational
interviewing, the therapist avoids becoming defensive or
argumentative if they encounter resistance. Instead, they
help the patient identify the problem and solution themself.
The therapist doesn’t impose their viewpoint on the patient
but helps the patient consider multiple viewpoints.

4. Develop Discrepancy
The therapist helps the patient identify discrepancies
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between their present circumstances and their future goals.
What thoughts and behaviors do they need to change to
achieve those goals? The therapist guides the patient in
spotting this discrepancy and solutions to reduce it.

Several skills help therapists employ these principles. Open-

ended questions encourage patients to think deeply or
differently about a given problem. Affirmations are
statements that recognize a client’s strengths, which can
instill confidence, or self-efficacy, in their ability to change.
Reflections involve listening to the patient and reflecting back
a response, which can demonstrate empathy as well as point
out discrepancies between their current behaviors and goals.
Summaries refer to recapping at the end of a session. (These
four skills may be referred to by the acronym OARS: open-
ended questions, affirmations, reflections, summaries.)
How It Works
The process is twofold. The first goal is to increase the
person’s motivation and the second is for the person to make
the commitment to change. As opposed to simply stating a
need or desire to change, hearing themselves express a
commitment out loud has been shown to help improve a
client’s ability to actually make those changes. The role of the
therapist is more about listening than intervening.
Motivational interviewing is often combined or followed up
with other interventions, such as cognitive therapy, support
groups, and stress management training.

What to Look for in a Motivational

Interviewer
Look for a licensed mental health professional who is
empathetic and supportive as well as a good listener. Since
motivational interviewing is a skill that improves with time,
look for an interviewer with both formal training and
experience. In addition to finding someone with the
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appropriate educational background and relevant
experience, look for a motivational interviewer with whom
you feel comfortable working.

References

Hettema J, Steel, J, Miller WR. Motivational interviewing. Annu Rev

Clin Psychol. 2005;1:91-111.

Treatment Improvement Protocols. Enhancing Motivation for

change in Substance Abuse Treatment. Chapter 3—Motivational
Interviewing as a Counseling Style. SAMHSA. (1999, Rockville, MD)

SAMSA-HSRA Center for Integrated Health Solutions

website. Motivational Interviewing.

Last updated: 06/06/2022

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Get Help
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Anger

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