Motivational Interviewing Basics
Have you tried, again and again, to walk away from drugs and alcohol, and found that you keep going back? Have your friends and family told you over and over again that you just need to stop - until you’re sick and tired of hearing it? Have you ever thought that you just need to have the willpower to stay away from drugs, only to wonder where you’re ever going to find that willpower?
If you said yes to any of these questions, then Motivational Interviewing may be helpful for you. Motivational Interviewing is an evidence-based practice that’s been shown to be incredibly effective in helping people start living an addiction-free life.
What Is Motivational Interviewing?
In short, Motivational Interviewing1 is a conversation about change. The conversation is designed to help people get unstuck and take steps towards actually making healthy lifestyle changes once and for all.
The History of Motivational Interviewing
Renowned psychologist Dr. William Miller started developing the practice of Motivational Interviewing2, otherwise known as MI, back in the 1970s. After working in substance abuse treatment for many years, he realized something that many of his clients probably knew all along: the counseling they were receiving wasn’t working. Not only wasn’t it working, but it also often made his clients feel degraded and manipulated, like they didn’t know anything at all about what was best for their own lives.
Dr. Miller3 started to experiment with different ways of interacting with his patients. His therapeutic practice was largely based on Carl Rogers’ work in human-centered therapy, but he realized quickly that human-centered listening alone wasn’t quite enough to guide his patients towards actually giving up drugs and alcohol.
Together with his colleague Dr. Stephen Rollnick, Dr. Miller developed the practice of Motivational Interviewing in 1983 - which was, at the time, a revolutionary way of treating patients with addiction. Founded in the basic philosophies of Rogerian therapy, MI takes things one step further by using those principles toguidepatients towards making healthy changes in their lives.
The Basic Principles of Motivational Interviewing
Miller and Rollnick taught (and the subsequent research has confirmed) that when practitioners push for any kind of behavioral change, the patient is actually less likely to change at all. MI takes the opposite approach: practitioners treat clients as equal partners and don’t push for anything whatsoever.
Motivational Interviewing and Autonomy
If you’re a human being, you can probably understand intrinsically that pushing for change just doesn’t work. Think about it the last time that someone told you that you had to do something; that you had no choice. How likely were you to do it just because they told you that you had to? Probably not very likely - and you may have even felt less likely to do it after they told you that you had to.
That’s because our motivation to change is inherently based on choice and ambivalence. No one can make you change; you have to make that decision for yourself, at the end of the day. One of MI’s basic principles is autonomy or the respect for people’s irrevocable right to make their own choices. There might be consequences for those choices, but in the end, you can’t take away people’s right to choose.
Motivational Interviewing and Ambivalence
On top of that, people have their own reasons for wanting to change or not wanting to change. Those reasons may have nothing to do with why you think somebody should change.
As a case in point, we’ll ask you this: how many of you actually drink 8 glasses of water a day? Eat complete servings of vegetables every day? Exercise at least 20 minutes every day? Maybe some of you do, but likely not all of you.
That’s because knowing we should do something isn’t the same as actually doing it. And each of us probably has our own reasons for wanting to do some of these things and not wanting to do it. Maybe I’m too busy to get my exercise in, but you simply get bored while you’re on the treadmill.
That’s what, in Motivational Interviewing, is called ambivalence. Instead of shaming people for feeling ambivalent about making changes in their lives (even important changes like getting off of drugs), MI practitioners accept ambivalence as a natural part of the change process. Ambivalence is worked with, instead of fought against.
MI practitioners work with ambivalence by using the concepts of change talk and sustain talk. Instead of telling clients why they “need” to change (we’ll remind you again: no one needs to change), they draw out from within each client their own reasons for wanting to change - even if these reasons are quite different from the practitioner’s reasons. In MI, these reasons are referred to as “change talk”.
When patients get the opportunity to talk about their own reasons for wanting to make healthy changes in their lives, the research shows, the more likely they are to actually make a change. All of us, at the end of the day, are more convinced by our own arguments than someone else’s.
The Four Processes of Motivational Interviewing
There is no set amount of time that the MI technique lasts for. Some people may receive just one 15-minute MI session, and others may come back for weekly visits. The research does show, however, that people accomplish actual change much faster with MI than with traditional talk therapy.
There are four processes of MI that practitioners try to go through. Again, these aren’t time-limited; a practitioner could get through all four of these processes in one session, and other patients might stay in the engagement process for several sessions. MI’s flexibility is one of its greatest attributes.
These four processes are not linear, and some patients may go back and forth between them. However, they are built upon one another. These processes, in this foundational order, are:
Engagement: This is the building of therapeutic trust and rapport between the practitioner and the patient. It’s worth noting that this process isn’t unique to MI; therapeutic rapport is an important component of all psychotherapy methods.
Focusing: This is the process in which a direction of movement is collaboratively decided upon between the practitioner and the patient. In short, what is the change that the patient is trying to make?
Evoking: This process lies at the heart of MI, and is where this practice becomes really unique. In the evoking process, the MI practitioner draws out (or evokes) the reasons that the patient wants to make this change. The metaphor of a “deep well of wisdom” is often used in the MI community; in the evoking process, the practitioner draws from the patient’s deep well, trusting that they know what’s in their best interest.
Planning: This process, interestingly, is thought to be unnecessary to the overall practice of MI. The principal role of the MI practitioner is to help patients resolve their ambivalence about making a change. Once their ambivalence is resolved, people often are able to problem-solve and make a plan on their own. If planning is required, the MI practitioner’s role is to help strengthen the patient’s commitment to the plan-of-action.
Again, think of these processes more as a pyramid rather than a straight line; it’s totally possible to keep returning back to previous processes when it’s necessary and helpful to do so.
What is Motivational Interviewing Used For?
As you can probably guess, Motivational Interviewing can be used for a variety of different problems. Basically, any time that somebody needs to make a personal change but hasn’t (for whatever reason), MI can be helpful.
Motivational Interviewing for Substance Abuse
As we already learned, MI was first developed to help people recover from addiction. That means that most of the research that has been conducted on the effectiveness of MI has been conducted with people who are battling substance abuse issues.
An extensive amount of research4 has been conducted, and in general, MI has been proven to be effective in both engaging and retaining clients in substance abuse treatment, and even for other types of behavioral addictions such as eating disorders.
Using MI, the practitioner would help you get to the root of why you want to quit drugs and alcohol. Maybe you don’t care so much about the physical effects of these substances, but it does bother you that it’s starting to seriously affect your relationships. Unless you start focusing on your own reasons for wanting to give it up, it’s unlikely that other people’s reasons are going to make a difference.
Other Uses for Motivational Interviewing
However, addiction recovery is far from the only personal change that MI can help people to make. MI has been shown to be extremely effective in helping people make other healthy changes5, from helping people with diabetes make healthier food choices to helping people with obesity exercise more.
MI can also be conducted to help people feel less ambivalent about following through with other treatment methods. MI isn’t considered a comprehensive psychotherapy technique on its own, but when patients receive an MI session before they go through another intervention, they’re more likely to stick with treatment. For example, the combination of CBT and MI6has been shown to make the CBT portion of the intervention more effective.
There needs to be more research conducted on many of these areas, but the research has shown so far that MI can be used to help basically anybody if what they’re struggling with is making a personal change in their lives.
Interested in Motivational Interviewing for Addiction or Mental Health?
Maybe you’re tired of clinicians telling you that you have to quit drugs and alcohol (as if it were that easy!). Maybe all the information in the world about how terrible drugs are for your health hasn’t really made a difference in your ability to quit.
We at All Points North Lodge understand that each client has their own reasons for wanting to recover from addiction and yet, for years, being unable to.
If you’re interested in receiving Motivational Interviewing intervention to help you walk away from drugs and alcohol, give us a call. MI is one of many evidence-based practices our counselors use, and we’re here to walk this journey with you, step by step.