Motivational Interviewing: History, How it Works, Effectiveness

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Motivational Interviewing: History, How it Works, Effectiveness

THC Editorial Team January 18, 2023
Photo by Alex Gruber on Unsplash (article on motivational interviewing)
Photo by Alex Gruber on Unsplash

Contents

What Is Motivational Interviewing?

Motivation is often incorrectly perceived as an innate capability or characteristic. More accurately, it is a socially influenced quality related to a person’s desire to pursue a goal or act in a particular way. Notably, this quality is instilled or enhanced within individuals if they are ready to accept change. Motivational interviewing does just that; it is a counseling style that challenges people to develop the internal motivations necessary to counteract or change certain behaviors they consider problematic in their lives.1 This form of counseling can act as a precursor to other psychological interventions, work in adjunct to psychotherapy, or be a stand-alone technique to change a particular behavior.

Changing negative behaviors allows people to develop healthier choices, which, in turn, affects long-term physical and mental health outcomes.2 Motivational interviewing is helpful for individuals who have addictions or physical health issues and those who lack motivation, display hostility, or are unready to commit to change. The main goal is to elicit self-motivation by helping people see how tapping into motivation and generating lasting change are possible and accessible.3

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History of Motivational Interviewing

Motivational interviewing was first developed in the 1980s by clinical psychologists William R. Miller and Stephen Rollnick to support patients with substance use disorders.1 Over time, other professionals have implemented motivational interviewing in public health, medical care, criminal justice systems, education, and familial systems.

As a counseling method, motivational interviewing has grown tremendously over the last few decades and is now an established, evidence-based practice. Its success is rooted in its view that the practitioner does not impose change; instead, practitioners who use this method cultivate and support self-directed change in their clients.

How Does Motivational Interviewing Work?

Motivational interviewing encourages clients to verbalize the changes they believe to be necessary and to explain their reasons for wanting change.3 The interviewer can be a psychologist, mental health counselor, social worker, or health care professional.

The interviewer’s job is to spark a conversation with a client about creating and committing to lasting change. Initially, interviewers will ask open-ended questions, listen reflectively, summarize and affirm the client’s points, and encourage self-motivational statements. This is a short-term type of counseling that lasts one or two sessions.

The Spirit of Motivational Interviewing

The spirit of motivational interviewing includes the following values:4,5

Partnership.

  • The counselor and client work collaboratively

Acceptance.

  • The counselor accepts a client’s autonomy and ability to make their own choices in accordance with themselves.

Compassion.

  • An empathic and supportive response to suffering in oneself and in others.

Evocation.

  • The client already contains within themselves the antidote to change. The best ideas for the client come from the client.

Core Skills of Motivational Interviewing

Four core skills required by a therapist for successful motivational interviewing include:5,6

Open Questions.

  • Questions that call for more than a yes/no answer encourage the client to discuss what is on their mind openly.

Affirmations.

  • Positive feedback to build and reinforce a sense of belief in self

Reflections.

  • Mirroring what the client is thinking and feeling and stating it back to the client to help demonstrate understanding, attunement, and empathy in the therapeutic relationship

Summaries.

  • Selective summaries of some of the client’s own reasons for why change might be a good idea

Principles of Motivational Interviewing

Motivational interviewing is based on the following principles:3,6

Express Empathy.

  • cultivate empathy through reflective listening

Develop Discrepancy.

  • discern individual goals/values from current behaviors

Roll with Resistance.

  • avoid argumentative language
  • adjust to the client’s resistance rather than opposing it

Support Self-Efficacy.

  • support self-efficacy and optimism

A trained professional will individually guide the interview using an empathetic, supportive, and direct approach. Interviewers strive to form a trusted alliance with clients—one in which clients feel they can express themselves openly. An interviewer will actively examine a client’s problematic behaviors to assess what obstacles impede the client’s efforts to cultivate motivation and progress.

Four Main Techniques of the Motivational Interviewing Process

The four main steps for the motivational interviewing process are engaging, focusing, evoking, and planning.6,7

Engaging.

  • Practitioners initially engage clients in establishing a trusting relationship. They utilize reflective listening to deeply understand current events and concerns in the client’s life. This stage focuses on developing rapport, easing a client’s guard, and pushing past ambivalence. If at any point the practitioner loses engagement with the client, they must reengage to move further in the process.

Focusing.

  • Practitioners must then focus and establish a clear initiative and goal with their clients. This stage allows the client to state the target behavior or issue they want to address while recognizing potential barriers. This focus on a target is the goal-oriented aspect of motivational interviewing.

Evoking.

  • Practitioners evoke their clients’ motivation and reasons for change. They aim to elicit their client’s ideas by actively listening and pointing out when their client uses language regarding change. This step focuses on drawing out the client’s internal motivation and reinforcing ways they can build it and target it toward a specific behavior.

Planning.

  • Practitioners help their clients effectively plan once there is significant engagement, a clear goal, and sufficient motivation. They help their client develop the skills to identify the target behavior to change, remove any barriers, and establish tangible steps.

Effectiveness of Motivational Interviewing

Motivational interviewing is very effective in many ways. For example, in a 2011 study of meta-analyses of randomized control trials of people dependent on or abusing substances, researchers concluded that motivational interviewing could reduce substance abuse compared to no treatment.8

A 2018 study found that motivational interviewing improved treatment outcomes (i.e., how well the therapy improves a client’s symptoms) for individuals with anxiety disorders when used as an adjunct to cognitive behavioral therapy for anxiety disorders.9

In a 2017 study, a group of Australian psychological researchers found that two motivational interviewing sessions that lasted for as little as 15 minutes effectively enhanced clients’ attendance in mental health treatment.10

Motivational interviewing may also improve health care management for adolescents with chronic illness and enhance group treatment engagement for adolescents with anxiety and mood disorders.11,12

As an additive value, motivational interviewing helped improve symptoms of depression in clients in primary care settings.13

Additionally, substantial evidence indicates that combining motivational interviewing with other existing treatments enhances overall treatment engagement.14

Summary/Outlook

Although motivational interviewing was initially developed to treat substance abuse, it has been extended to treat many mental health problems. The change it elicits from clients is valuable and positively affects many aspects of mental health care, such as reducing symptoms and increasing treatment attendance.

References

  1. Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation for change in substance use disorder treatment. Treatment Improvement Protocol (TIP) Series, No. 35.
    https://www.ncbi.nlm.nih.gov/books/NBK64964/
  2. Hettema, J., Steel, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91–111.
    https://doi.org/10.1146/annurev.clinpsy.1.102803.143833
  3. Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Facilitating change (3rd ed.). Guilford.
  4. Corcoran, J. (2016). Motivational interviewing: A workbook for social workers. Oxford University Press.
  5. Matulich, B. (2013). Introduction to Motivational Interviewing. Retrieved 2022, January 25, from
    https://www.youtube.com/watch?v=s3MCJZ7OGRk&t=3s
  6. Ingersoll, K. (2019). Motivational interviewing for substance use disorders. Retrieved January 25, 2022,
    https://www.uptodate.com/contents/motivational-interviewing-for-substance-use-disorders
  7. American Addiction Centers. (2019, June 10). What are the 4 general processes of motivational interviewing? Retrieved February 26, 2021, from
    https://sunrisehouse.com/treatment-therapies/motivational-interviewing/
  8. Smedslund, G., Berg, R. C., Hammerstrøm, K. T., Steiro, A., Leiknes, K. A., Dahl, H. M., & Karlsen, K. (2011). Motivational interviewing for substance abuse. The Cochrane database of systematic reviews, (5), CD008063.
    https://doi.org/10.1002/14651858.CD008063.pub2
  9. Marker, I., & Norton, P. J. (2018). The efficacy of incorporating motivational interviewing to cognitive behavior therapy for anxiety disorders: A review and meta-analysis. Clinical Psychology Review, 62, 1–10.
    https://doi.org/10.1016/j.cpr.2018.04.004
  10. Lawrence, P., Fulbrook, P., Somerset, S., & Schulz, P. (2017). Motivational interviewing to enhance treatment attendance in mental health settings: A systematic review and meta-analysis. Journal of Psychiatric and Mental Health Nursing, 24(9–10), 699–718.
    https://doi.org/10.1111/jpm.12420
  11. Reinauer, C., Viermann, R., Förtsch, K., Linderskamp, H., Warschburger, P., Holl, R. W., Staab, D., Minden, K., Muche, R., Domhardt, M., Baumeister, H., Meissner, T., & COACH Consortium. (2018). Motivational interviewing as a tool to enhance access to mental health treatment in adolescents with chronic medical conditions and need for psychological support (COACH-MI): Study protocol for a clusterrandomised controlled trial. Trials, 19(1), 629.
    https://doi.org/10.1186/s13063-018-2997-5
  12. Dean, S., Britt, E., Bell, E., Stanley, J., & Collings, S. (2016). Motivational interviewing to enhance adolescent mental health treatment engagement: A randomized clinical trial. Psychological Medicine, 46(9), 1961–1969.
    https://doi.org/10.1017/S0033291716000568
  13. Keeley, R. D., Brody, D. S., Engel, M., Burke, B. L., Nordstrom, K., Moralez, E., Dickinson, L. M., & Emsermann, C. (2016). Motivational interviewing improves depression outcome in primary care: A cluster randomized trial. Journal of Consulting and Clinical Psychology, 84(11), 993–1007.
    https://doi.org/10.1037/ccp0000124
  14. Westra, H. A., Aviram, A., & Doell, F. K. (2011). Extending motivational interviewing to the treatment of major mental health problems: Current directions and evidence. Canadian Journal of Psychiatry, 56(11), 643–650.
    https://doi.org/10.1177/070674371105601102

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