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Motivational Interviewing: A Collaborative Treatment

Silver Ridge

Motivational interviewing is a substance abuse treatment approach that is defined as “a collaborative conversation style for strengthening a person’s own motivation and commitment to change“. This therapy approach to substance abuse treatment involves talk therapy to help a person find their own personal motivations to quit abusing drugs or alcohol. The approach is an empowering style of rehabilitation treatment that some people may respond to.

Sometimes a person who struggles with addiction may know they need to quit abusing drugs or alcohol, but they aren’t sure where to begin. They also may not feel motivated to make the kinds of changes and commitments it will take to truly make changes. This is where motivational interviewing can come in. The process involves working with a therapist who will ask open-ended questions and provide feedback to a person to help them identify areas in their life where they can make a change. Ideally, at the conclusion of motivational interviewing sessions, a person will commit to change and find themselves ready to quit abusing drugs and alcohol for good.

The University of Massachusetts-Amherst provides the following acronym to describe the overall process of motivational interviewing: OARS. This stands for Open-ended questions, Affirmations, Reflections, and Summaries. In this way, motivational interviewing is a conversation that helps a person find those elements inside them that give them the power to make a real and lasting change.

History of Motivational Interviewing

When considering available therapy techniques, motivational interviewing is a fairly new approach to substance abuse treatment that emerged in the 1980s. However, the therapy has its roots in the concept of “person-centered therapy,” which was pioneered by Dr. Carl Rogers in the 1940s and 1950s.

American clinical psychologist Dr. William L. Miller is credited with developing the motivational interviewing technique. Dr. Miller worked with those who struggled with alcohol addiction and noticed that denial about drinking problems and how a person’s drinking was affecting their life was often ignored or overlooked. Traditional techniques involve confronting a person who struggled with alcohol or even shaming the person regarding their alcohol abuse. Instead, Dr. Miller established a way to talk to people about their drug or alcohol problems by helping them find their own personal motivations and reasons for wanting to get sober. In 1991, Dr. Miller collaborated with another psychologist, Stephen Rollnick, to write the book “Motivational Interviewing: Preparing People to Change Addictive Behavior”. This book described the initial theories and strategies of motivational interviewing. Since this time, the authors have released several editions and updates of the book. According to an excerpt in the book’s third edition, “Motivational interviewing is done for or with someone, not on or to them”.

How Does Motivational Interviewing Work?

According to Miller and Rollnick, who wrote the seminal book on motivational interviewing, there are four key elements of motivational interviewing as a treatment: acceptance, compassion, evocation, and partnership. Each of these aspects has an integral role in the process, including:

  • Acceptance: The therapist acts in a non-judgmental manner to help find the good aspects of a person’s life and positive interpersonal qualities.
  • Compassion: The therapist understands that the person is struggling and that quitting their substance abuse problem is not an easy task. The therapist also commits to acting in the person’s best interests when providing care.
  • Evocation: This is the concept of listening and asking questions that can bring out the best in a person. Questions should help a person consider how their lives could be different, better, and healthier if they did not struggle with their addiction(s).
  • Partnership: A therapist in a motivational interviewing approach does not act as if they are better than or superior to a person in their care. Instead, the therapist shows acceptance and respect for a person and their individual needs and goals.

A typical motivational interviewing session may consist of several key components. This includes answering open-ended questions, focusing on what’s most important to a person, affirming all the positive qualities of a person, and planning for change.

For example, a therapist may start a motivational interviewing session by asking open-ended questions. Examples can include:

  • What brings you here today?
  • What has your history of substance abuse been like for you?
  • What are your reasons for changing your behavior?
  • How would you like things to be different for you than they are now?
  • What is your plan for making changes? How can I help you make these changes?

Throughout the motivational interviewing session, a therapist may point out observations that affirm a person’s positive qualities. This could include noting how brave a person is for seeking help for their addiction or recognizing a person’s previous efforts to get sober.

The ultimate goal of motivational interviewing is self-efficacy. This means the participant feels empowered to make a change in their behavior and to believe in themselves that change is possible.

Misconceptions of Motivational Interviewing

A common misconception about motivational interviewing is that it is a long-term approach to substance abuse care. Instead, motivational interviewing is typically regarded as a short-term therapeutic approach. Once a person is able to find their motivations to quit drug and alcohol abuse, they will then progress to other therapy types, such as cognitive-behavioral therapy. According to Psychology Today, motivational interviewing is more of a short-term counseling solution involving participation in only one or two sessions. However, it is possible that a person may complete another motivational interviewing session as they progress through their sobriety as a means to reaffirm their motivations.

Another misconception about motivational interviewing is that there is some element of confrontation, where a therapist will “call out” a person on their substance abuse or judge them for their past. This is far from the spirit of motivational interviewing, which involves fostering a spirit of compassion and empowerment. According to Miller and Rollnick, who are the “founding fathers” of motivational interviewing, the approach is not an argument, an authoritative relationship, or punishing therapy. Each of these techniques is a direct violation of the spirit of motivational interviewing.

The Effectiveness of Motivational Interviewing

According to Psychology Today, motivational interviewing is not effective for all people struggling with addiction. Motivational interviewing tends to be most effective in clients who may feel unprepared, unmotivated, or even hostile toward change. The therapeutic approach is not as appropriate for those who are already ready to make changes because they will have met the goals of motivational interviewing.

According to an article published by the Substance Abuse and Mental Health Services Administration (SAMHSA), a review of 11 clinical trials related to motivational interviewing found the approach was an effective one in treating those who struggled with substance abuse. Two of the 11 studies did not find that motivational interviewing was effective, but agreed the concept was a positive one, and that outcomes depended upon how well-trained in motivational interviewing the therapists were. The motivational interviewing approach has proven effective across a variety of situations, including drug treatment, weight loss, and obsessive-compulsive disorder.

What Training is Required for Motivational Interviewing?

Rehabilitation professionals with all types of training backgrounds may practice motivational interviewing techniques. This can include psychiatrists and nurse practitioners with advanced medical degrees who have chosen to offer motivational interviewing as a technique. Others may be licensed social workers or therapists. Some people may pursue additional certifications in motivational interviewing from certifying bodies.

If a person is considering pursuing motivational interviewing treatments, there are a few questions they may wish to ask a potential therapist. These include:

  • What training do you have in motivational interviewing?
  • How many sessions do you typically recommend?
  • What is your experience in the motivational interviewing practice?
  • How effective do you think motivational interviewing will be as a treatment for my substance abuse history?

Asking these and other questions as they arise can ideally help with finding the right therapist.

Where Can I Find Motivational Interviewing Treatments?

Organizations such as the Motivational Interviewing Network of Trainers maintains a list of members who have pursued additional education in motivational interviewing. Many also train other therapists and doctors in the practice. A person can visit the Motivational Interviewing Network of Trainers’ website and click on “Trainers/MINT Members” to find a list of all the registered trainers around the world who participate in motivational interviewing.

You can also contact your local drug rehabilitation facility and ask if therapists and medical professionals at the facility practice motivational interviewing techniques. If the facility does not offer these techniques, they may be aware of practicing therapists in the area who do.

How Can I Integrate Motivational Interviewing with My Life After Treatment?

Even if a person has participated in previous motivational interviewing sessions and has moved on to other therapy types, such as 12-step programs or behavioral counseling, they can still benefit from the occasional motivational interviewing session. Instead of focusing on reasons to get sober, a future motivational interviewing session may focus on reasons to stay sober and re-committing one’s self to sobriety.

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Focus, Healing, and Recovery

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