Recovery works best when you’re doing it for yourself, not to please someone else. Simply put, if you want to be free from an addiction, you must have your own reason to quit. Not because you are guilted, not because you are pressured or forced, and not to make someone else happy.
Motivational interviewing (MI) is built around this fact. A person’s desire to change must come from them. In motivational interviewing, the person in recovery does not get told how to change — they are shown how to find their own reasons for wanting a better, healthier life.
What Is Motivational Interviewing?
Motivational interviewing is client-centered, evidence-based counseling that increases intrinsic motivation for achieving desired behavioral change by identifying personal reasons for making those changes.[1] MI facilitates client-directed change through the process of collaboratively working through ambivalence, creating “change talk,” and increasing the client’s capacity for positive change.
Motivational interviewing is practiced by licensed therapists and clinicians, including social workers and psychologists, in hospitals, in drug addiction treatment centers at all levels of care — inpatient, residential, outpatient, and aftercare — in prisons, and many other healthcare settings. It is appropriate for adolescents and adults alike and has been shown to be effective with substance use disorders, mental health conditions, and various health behaviors.
At All In Solutions, motivational interviewing is used as part of the overall treatment plan for all clients, both as a standalone technique and as a guiding philosophy throughout the recovery journey.
The History of Motivational Interviewing
Motivational interviewing was developed by Dr. William R. Miller, a clinical psychologist, whose early work with people struggling with alcohol abuse in the early 1980s led him away from the traditional confrontational addiction approach that was used at the time and toward a more empathic and nurturing style of counseling. Dr. Miller noticed that this approach produced significantly better results than confrontation and began developing many of the key philosophical tenets and framework that would make up MI.Miller collaborated with British psychologist Dr. Stephen Rollnick to formally refine the concept of MI and create a book to help others better understand its practice. Their first edition of Motivational Interviewing: Helping People Change was released in 1991 and is currently in its third edition, providing definitive literature for this particular therapy.
Two other dominant theoretical sources of MI are the person-centered psychotherapy of Carl Rogers, which serves as a basis for the principles of MI, and the Stages of Change model developed by James Prochaska and Carlo DiClemente. This model describes addiction in terms of stages people move through, including precontemplation, contemplation, preparation, action, and maintenance, making MI an extremely useful method of working with people with addiction, meeting them in whatever stage they are in.
The Principles and Spirit of Motivational Interviewing
The Spirit of MI
The spirit of MI plays an equally important role as its techniques. The spirit of MI is based on four core experiences of the therapeutic relationship: partnership, acceptance, compassion, and evocation.
In MI, the clinician is not the expert handing down commands but a collaborative partner assisting a client in accessing their own inner wisdom and going through the process of change. The spirit of MI separates it from other counseling methods and is fundamental to its effectiveness.
The Four Core Principles
MI has four principles governing its practice, frequently referred to by the acronym RULE. The following guidelines are what MI therapists strive to do during each session:
E — Empower the client
R — Resist the righting reflex (the impulse to tell clients what to do)
U — Understand the client’s own motivations
L — Listen with empathy
Each of these principles is applied to all processes of MI, including the use of questions and handling of resistance.
OARS: The Core Techniques
The core techniques used in MI are represented by the acronym OARS, which stands for:
- Open-ended questions — Your therapist will ask open-ended questions to allow you to explore your experiences and motivation
- Affirmations — Helping you acknowledge your strengths and efforts and past successes, creating a sense of self-efficacy and enhancing the belief that you can change
- Reflective listening — Including paraphrasing and exploring what was said. This communicates empathy and allows you to hear themself
- Summaries — Reinforcing change talk and illustrating where your words are leading you
Change Talk and Ambivalence
One of the primary goals of MI is to elicit “change talk” — statements that reflect your desire, ability, reasons, and need for change. Based upon the research findings of Miller, Rollnick, and colleagues, it has been established that the greater the amount of change talk made by a client during a session, the greater the likelihood of them completing a behavior change.[2] Ambivalence (the desire to change versus the desire not to) is a normal part of the change process and should be viewed in MI with curiosity, not as resistance, validating and exploring any ambivalence the client may have.
How Motivational Interviewing Helps With Drug and Alcohol Addiction
Ambivalence is practically universal in early addiction recovery. Most people transitioning into recovery experience mixed feelings; they are aware that their substance use is harming them, but also associate their substance use with relief, pleasure, and a part of their identity.
Traditional confrontational approaches typically deepen the client’s sense of resistance to change. However, MI assists the client by working through their own frame of reference, their values, relationships, goals, and concerns, to help the client verbalize the discrepancy between their present behavior and the life they want to create. This discrepancy then becomes a powerful motivator. The motivation does not come from MI; MI merely assists the client in finding it.
MI has been proven to work well in the earlier stages of drug and alcohol addiction treatment, where readiness to change is often low and where clients are often fragile in their desire to engage. Multiple research studies support the fact that motivational interviewing is particularly effective in the early stages of treatment, where readiness to change is low, and has been shown to improve treatment engagement and retention.[3] MI also continues to be effective at key stages throughout the recovery journey, moments where client motivation may waver, when a relapse occurs, or as a client transitions from one level of care to another.
Motivational Enhancement Therapy (MET)
MET is a structured, short-term combination of MI techniques designed for the treatment of addiction, typically lasting four sessions. MET includes personalized feedback regarding the client’s substance use in conjunction with MI principles to accelerate engagement with their motivation to change. MET has demonstrated favorable outcomes in research studies, particularly with alcohol use disorder.[4]
The Efficacy of Motivational Interviewing in Addiction Treatment
Motivational interviewing is a well-studied psychotherapy model. MI has been recognized as an evidence-based practice by SAMHSA and is considered effective for various health conditions and populations.[5]
In addiction treatment, MI has been found to improve clients’ treatment engagement and retention as well as improve substance use outcomes. According to a meta-analysis published in the Journal of Consulting and Clinical Psychology, MI produced improvements in substance use outcomes compared to no-treatment conditions, with particularly strong effects for alcohol use.[6] Motivational interviewing is often delivered as a brief intervention and has been shown to produce meaningful improvements in substance use outcomes, making it well-suited for outpatient and early-stage treatment settings.[7]
MI has consistently produced strong results in research studies conducted as part of Project MATCH, one of the largest clinical trials in addiction treatment, where MET produced similar outcomes to CBT (is a structured, goal-oriented form of psychotherapy (talk therapy) designed to help individuals identify and change dysfunctional thinking patterns, emotions, and behaviors)and 12-step facilitation in significantly fewer sessions.[8] MI has been particularly effective with adolescents and young adults with substance use disorders, in part because its non-confrontational nature helps reduce resistance and supports engagement in treatment.[9].
What to Expect From Motivational Interviewing
The MI process involves a qualified clinician working with the client to incorporate MI skills and principles into all aspects of their therapy, including one-on-one therapy, intake assessment, and other treatment-related experiences, for the entire duration of their engagement in treatment.
Here is what you can generally expect in each session:
- Complete collaboration. You’ll be having a conversation with your therapist rather than sit through a lecture.
- Your clinician will ask open-ended questions about your experiences, values, and goals, and will listen and reflect carefully to help you explore both the reasons you wish to change and the reasons you feel ambivalent toward that change, without any judgment or coercion.
- You will not be told what to do. Rather, the clinician will help you work through defining what to do.
For those clients who have not yet fully committed to beginning the recovery process or who are experiencing significant ambivalence, MI offers an opportunity to be honest with themselves and the clinician without fear of confrontation. For clients who are committed to recovery but may be struggling with motivation, MI offers tools to reconnect them to the reasons they engaged in recovery in the first place and to the vision of the life they are building.
Motivational Interviewing at All In Solutions
Motivational interviewing is not just a technique used in some sessions at All In Solutions; it is a spirit that is integrated throughout the recovery journey. As we believe long-term recovery is based on intrinsic motivation, we use MI to assist clients in building that motivation. Our clinicians’ knowledge of MI and motivational enhancement therapy is incorporated into the treatment experience from the initial telephone call all the way through aftercare planning.
