What Is Motivational Interviewing?
There is no doubt that recovery from substance addiction improves one’s life for the better. However, many people who are in the grips of drug or alcohol addiction are reluctant to seek treatment for a variety of reasons. Some believe sobriety is unrealistic or even undesirable.
Some people know that substance use is ruining their lives but they may find it hard to admit that they need to change their lifestyle. Others don’t even recognize that they’re addicted or they think their addiction isn’t that serious. Some people also fear the consequences of quitting such as experiencing withdrawal symptoms or losing their circle of friends.
In these cases, motivational interviewing (MI) may be helpful. If you’re unfamiliar with this type of therapy, you’ll want to keep reading. In this article, we’ll take a close look at exactly what is motivational interviewing and how it helps with overcoming resistance to treatment.
Motivational interviewing is a counseling technique that assists individuals in overcoming their ambivalence surrounding sobriety. It was first described by Professor William R. Miller in a 1983 issue of Behavioral Psychotherapy.
More recently, it has been defined by Miller and Rollnick as “a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”
Motivation is one of the biggest barriers some people face when struggling with addiction. Even when faced with legal, financial, and health-related challenges that are a direct result of their substance abuse, they don’t feel the drive to quit drinking or using drugs.
Motivation interviewing assumes that everyone struggling with addiction is at least partly aware that drug abuse has negative consequences. In addition, each individual is assumed to be at a specific stage of readiness in relation to changing their behavior. Therefore, the role of the MI therapist is to guide the individual in overcoming their ambivalence or fear of change.
Motivational interviewing is beneficial for a wide range of people. Not only is it effective for people who willingly seek out treatment but it also helps individuals who have been pressured into rehab by loved ones or ordered by the court system.
MI can also be useful for people who didn’t get much success from cognitive behavioral therapy. Changing a person’s patterns of thinking and behaving can be very difficult so sometimes, it is better to undergo MI first. MI is also preferred over CBT for people who need a closer relationship with their therapist, validation of their feelings, and extra support on their journey.
Another group of people who can benefit from motivational interviewing is made up of those who have relapsed after attempting to get clean. Relapse is a normal part of recovery but repeated relapses may indicate ambivalence concerning the consequences of drug abuse.
Increasing internal motivation can be more effective than trying to get a person to quit through guilt or pressure. Motivational interviewing can, therefore, reduce the risk of further relapse and promote long-term sobriety.
Types of Motivational Interviewing Techniques
Therapists use a variety of techniques to draw out responses designed to change the way clients think about their ability to get sober. One technique follows the OARS acronym:
- Open questions – The interviewer asks questions that require more than a yes or no response so the client can tell their story. For example, they may ask “why do you think you need to change your drinking habits?” or “what can you tell me about your history of drug use?”.
- Affirmations — The interviewer uses genuine statements and gestures to help the client recognize their strengths and the positive steps they’re taking towards recovery. This helps to build confidence in their ability to change. “You’ve shown a lot of courage in our sessions.” is an example of an affirmation.
- Reflective listening – The interviewer listens to the client carefully and then reflects their statements back to them. Reflective listening can include repeating, rephrasing, or paraphrasing what the interviewee says and reflecting on their feelings. This may sound like “It seems as though you’re saying you know using cocaine is harmful but it allows you to bond with your peers.”.
- Summaries – This is when the interviewer summarizes what the client said throughout the session while looking for signs that the person recognizes there’s a problem, expresses concerns, and wants to change.
The focus of MI is on determining what clients want rather than what the counselor believes is best for them. This mean means the counselor needs to form a strong bond quickly, display high levels of empathy, and engage in reflective listening. The RULE acronym can be helpful here.
The interviewer needs to:
- Resist the righting reflex. Healthcare professionals have a tendency to give patients advice about the best way to improve their health. This makes sense since they are experts in their fields. However, telling some patients what is right for them can have an unintended effect.
It can actually reinforce the idea of maintaining the status quo. When people are ambivalent about change, they tend to resist persuasion and they double down on the reasons for continuing in their current behavior. That’s why MI counselors have to suppress their righting reflex.
- Understand the patient’s motivations. Behavioral change results from the patient’s reasons for change. Counselors need to be curious about the patient’s concerns and interests so they can understand what’s driving and hindering the motivation to change.
- Listen with empathy. The only way the counselor will understand a patient’s motivation is to listen attentively. It is generally recommended that the interviewer spends equal amounts of time listening and talking.
- Empower the patient. Patients need to be active participants in their treatment. This helps to improve treatment outcomes. Therapists can empower patients by allowing them to come up with ways in which they can make changes to improve their health.
Patients can draw on their own knowledge of what has worked for them in the past and the practitioner can support them by providing the hope that change is attainable.
Motivational interviewing techniques vary among practitioners. However, there are seven key points that should always be observed. There are that:
- Motivation comes from internal sources rather than external ones
- It’s the client’s responsibility to address their ambivalence and not the counselor’s
- Direct persuasion isn’t enough to resolve ambivalence
- The interviewer quietly draws out information from the client
- The interviewer guides the client in identifying and resolving their ambivalence
- Readiness to change isn’t a trait; it fluctuates in response to interpersonal interactions
- The relationship between the client and the interview should be similar to a partnership
Motivational interviewing can be completed in just a few sessions. It starts with the counselor talking to the client about their hopes and concerns and setting up a trusting relationship. This is called engaging. Next, the counselor narrows the conversation down to the habits and patterns the person wants to change.
This phase is called focusing. The next step is to draw out the client’s motivation for change by heightening their sense of the importance of change, boosting their confidence that change can occur, and improving their readiness for new habits and behaviors.
Motivational interviewing is designed to be a brief intervention that’s delivered on an outpatient basis in two to four sessions. It doesn’t assume a long-term relationship between the counselor and the patient but mobilizes the client to use their own resources to effect change.
MI takes place within the context of other types of treatment. There are multiple benefits of using motivational interviewing to treat substance abuse disorders. These include:
- Behavioral change after just a single session
- Increased retention rates in treatment programs
- Increased likelihood of a positive outcome
- Higher abstinence rates following treatment
Limitations of Motivational Interviewing
Even though many people have been able to get on the path to recovery by participating in motivational interviewing, it’s not the best course of treatment for every individual struggling with addiction. People who have co-occurring mental disorders or complex challenges with addiction may need more than motivation.
They’ll require intensive counseling and possibly medication before they can begin to get motivated. Individuals with major depressive disorder often fall into this category since a lack of motivation is usually one of the symptoms they experience.
People who don’t have the cognitive ability to analyze pros and cons or devise a plan are also unlikely to benefit from MI. This includes individuals with intellectual disabilities or severe mental illnesses such as schizophrenia or bipolar disorder.
People who have recently started taking medications for mental illness may also experience short-term side effects that make it hard for them to focus. They may need some time to adjust to their medication or even switch medications before motivational interviewing would be beneficial for them.
Beyond patient-related issues, the success of motivational interviewing also depends on the counselor. It can be difficult to excel in this treatment method since the practitioner needs to be able to gain the trust of several different types of people. No two clients will be the same and anyone can develop a substance addiction. Counselors need lots of patience and understanding but they also need to advance the process quickly.
It’s also important to note that even though MI is effective in eliciting change, it may not be more effective than other forms of therapy. Since it can reduce substance abuse particularly in the short-term, it needs to be followed by other interventions.
MI can be used to increase a person’s motivation to change. When they’re ready to make that change, they can move on to therapies that address their specific problems with drug and alcohol abuse and addiction.
Motivational interviewing can help individuals struggling with addiction to decide whether they really want to quit drinking or using drugs. It is clear that there are many mental, physical, financial, and legal reasons to choose sobriety and seek treatment. However, many people who are addicted to substances can identify several reasons not to quit and they feel justified in their decision to continue using. Others are unsure about what they want. They may feel motivated to quit immediately after suffering a negative consequence but lose that drive in the subsequent hours and days.
In motivational interviews, patients identify the pros and cons of quitting their substance abuse based on their own goals and values. It becomes easier to change for the better when they address their denial and take stock of what change looks like and how they can effect it.
Instead of feeling that they’ve been coerced into giving up something they love, they go after changes that they’ve identified with guidance from the counselor.
If you’re struggling with an addiction to any substance, you need to seek professional help. At the Discovery House in southern California, we offer a wide variety of treatment options that can be tailored specifically to each person’s needs. After careful assessment, your treatment team will make recommendations depending on your unique circumstances. If appropriate, your recovery plan may include motivational interviewing. Since this normally forms part of a formal rehab program, it may be covered by insurance. Contact us today if you have questions about addiction treatment or the types of services we offer. We’ll provide you with the information you need and even verify your insurance.