Motivational Interviewing

Many people seek therapy to help them overcome obstacles. You might be experiencing an unexpected change or want to create change. For many, therapy is most successful when it supports making meaningful life changes. Motivational interviewing is a therapeutic technique that can do just that. It provides therapeutic support and tools to help you make beneficial life changes.

So what is motivational interviewing? Below we review what motivational interviewing is, the principles that guide the theory, therapeutic techniques, and the stages of change.

What is Motivational Interviewing?

Motivational interviewing is a style of therapy that generally falls under the umbrella of cognitive behavioural therapy. It uses collaborative conversations between you and your therapist to generate motivation to change behaviour. The motivational interviewing technique ensures that your therapist views you as an equal partner in creating change in your life. Providing suggestions or direct advice for how to change is not recommended. Instead, motivational interviewing allows you to consider what you would like to accomplish, their concerns about achieving the goal, setting an intention to change, and making optimistic statements about your journey.

Motivational interviewing has proven a valuable form of therapy as it can support people in developing intrinsic motivation to make relevant changes in their life. In addition, this kind of therapy guides you to feel empowered to make changes and develop skills you can apply to personal goals after treatment ends.

There are many circumstances in which motivational interviewing may be the right therapy. It is frequently used in the health care setting to help people make the necessary changes to address their diagnosis of heart disease or diabetes. It was initially developed to treat alcoholism and continues to be relevant in the mental health field. Individuals experiencing depression, anxiety, obsessive-compulsive disorder, and addictions use motivational interviewing. It can also be used as a support for temporary or situational concerns. Changing relationships, spending, fitness, or adherence to medication protocols are all excellent reasons for using motivational interviewing therapy.

Motivational interviewing can be incredibly effective for women as they are often verbal problem solvers. Women may be more effective at explaining their feelings and motivations, making this style of therapy an efficient one. Motivational interviewing is also an effective treatment for eating disorders, a category of illness that has historically seen significantly more women than men.

Principles of Motivational Interviewing

The guiding principles of motivational interviewing include collaboration, accepting resistance, compassionate listening, and empowerment.

The collaboration component of motivational interviewing refers to the approach taken by your therapist and you. You are seen as the expert on your own life and journey, and your therapist is acknowledged as an expert in therapy. This perspective of the therapeutic experience creates a space that feels like two people working together for a common beneficial goal.

Accepting resistance means your therapist expects you to deny or resist some component of therapy. The motivational interviewing process doesn’t acknowledge or confront the opposition; it accepts it and continues on. Accepting resistance avoids conflict that may interrupt the established trust or cooperative mindset. It also keeps your mind moving forward rather than contemplating how to defend against the current critique.

Compassionate listening means your therapist listens without judgement and gives compassionate feedback. This principle means your best interest is always the focus of therapy. In addition, compassionate listening paves the way for trust; you will feel more confident partnering with your therapist and, therefore, more likely to make progress.

A feeling of empowerment is the best outcome for motivational interviewing. Empowerment results in feeling like you can make important decisions in a healthy way. When you know you are critical to making change, are not critiqued for resistant feelings, and are accepted for who you are, you can develop the emotional framework to feel empowered to make changes.

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Motivational Interviewing Techniques

If you are presented with motivational interviewing in a therapeutic setting, it may be beneficial to know the structure behind the process.

The process of motivational interviewing includes guidelines for conducting therapy sessions, and they are known by the acronym OARS. OARS stands for open questions, affirmation, reflective listening, and summarisation.

Open questions mean you are asked questions that allow you to respond in various directions. Open-ended questions don’t allow just yes or no answers. For example:

Do you get along with your siblings? This is not open-ended; you can easily answer this with yes or no.

Tell me about your relationship with your siblings. This open-ended question allows you to discuss whatever you want about those relationships.

The open-ended question is often more free of judgements. For example, when asked if you “get along” with your siblings, you may be reminded that your relationship with your siblings is something you have shame around. The lack of judgement in an open-ended question is compassionate and accepting.

Giving affirmations means reminding you of your accomplishments and your natural capacities. Your therapist affirms what you share with them and doesn’t add critique to resistant words or ideas. Affirmations include appreciating what you share and acknowledging your efforts as you strive to achieve your goals. Examples of affirmations include:

Thank you for sharing that with me.

That is a meaningful thing to say.

I agree that the situation would be very difficult.

I understand that concern; I may feel the same if I was in your shoes.

Affirming what is shared creates a supportive, collaborative environment.

Reflective listening is a critical component in most therapeutic or even relationship settings. This listening technique rephrases and repeats back what was said. The intention is to demonstrate that you are being heard. It also provides the opportunity for you to clarify your meaning, or you may recognise that what you said doesn’t actually reflect your feelings. Typically reflective listening statements begin with the following:

So you are saying…

I hear you saying you felt…

You said you have questions about…

Reflective listening can also help those who struggle with emotions or feel like their feelings have value. To have another recognise the emotions you have around an issue can be empowering.

Summarisation is like reflective listening, but it comes at the end of a discussion. Summarisation is a tool that is very useful for problem-solving or getting over roadblocks to achieving goals. It looks at the full discussion of a topic, summarises the essential pieces, and discusses the action that will be taken. An example of summarisation after a discussion of a career change may look like this:

The Problem: I really don’t like my job

Primary Concern: I don’t know how to change careers.

Action Step: I’ll sign up for free career counselling at the local college.

Positive Reflection: This problem does not need to be solved today. I can take small steps until I am able to change jobs.

Motivational Interviewing – Stages of Change

William Miller and Stephen Rollnick, the authors of the theory of motivational interviewing, identified six distinct stages of change one must travel through to experience lasting behavioural change. These stages are a useful framework as it helps to identify where you are in the process of change. Not everyone is at the starting line; some have made considerable progress and run into a roadblock they need help with. Using a framework like the stages of change can ensure that you and your therapist can begin where help is most needed.

The stages of change are as follows:

Stage 1: Precontemplation ~ the individual has begun to understand there is a problem that may need to be addressed.

Stage 2: Contemplation ~ this problem is acknowledged, and there has been thinking about the issue, but no action.

Stage 3: Preparation ~ actions have been taken to commit to a change. Information and helpers have been gathered.

Stage 4: Action ~ in this stage, the actions are taken to make changes to solve the problem to change behaviour.

Stage 5: Maintenance ~ here, the changed behaviour must continue over a sustained period of time.

Stage 6: Termination ~ the effort to change behaviour is no longer necessary as the new thoughts and actions have become habits.

This framework can also be learned and applied outside of therapy to analyse your progress when making positive changes.

Motivational interviewing is a beneficial therapy technique that can guide you in making significant life changes to achieve your goals. It empowers people to problem-solve and identify obstacles to the changes they need. Motivational interviewing is applicable outside of mental health care as well. It can also be used to make changes to benefit physical health and to overcome small challenges as you travel through life.

Not every therapist is trained in this technique; if you are seeking therapy and are interested in motivational interviewing, make sure to inquire about its availability before making an appointment with a practitioner.