Motivational Interviewing
Motivational interviewing is a client-centered approach that helps explore readiness for change and resolve ambivalence towards it. It was originally developed by William R. Miller, PhD, and Stephen Rollnick, PhD, in the 1980s to help people with substance use disorders. It is an evidence-based approach that has been proven to help address barriers to change for issues such as, substance misuse, addiction, anxiety, and depression.
The collaborative nature and line of questioning in motivational interviewing is designed to promote curiosity and get to the heart of the issue by exploring a client's reasons and motivation for change. It draws upon clients' strengths rather than focusing solely on problems and weaknesses. Ultimately, it aims to elicit clients' motivations for change rather than convincing them of reasons.
Motivational interviewing follows the old adage that people usually are best to follow their own advice. In fact, a systematic review of over 70 clinical studies found that motivational interviewing had greater efficacy compared to traditional advice-giving in 80% of studies (Rubak, Sandbaek, Lauritzen, & Christensen, 2005). People generally listen to their own wisdom, which tends to arise through understanding their motivations and barriers surrounding change. Suggestions from therapists might become more useful after they've taken time to collaboratively explore the client's presenting issues and discussed a treatment plan (i.e., evidence-based practices, reflection exercises, behaviour experiments).
Four Basic Processes in Motivational Interviewing
- Engaging: building an alliance and working relationship.
- Focusing: shared idea of the main focus of the time together.
- Evoking: bring out the client's own arguments for change and their hopes for themselves, their values, and goals.
- Planning: client is willing to envision an important change and how they might go about making it.
Stages of Change Model
Motivational interviewing can also incorporate the Stages of Change Model, otherwise known as the Transtheoretical Model. This helps people better understand where they are in the process of making change and taking action.
Read more about the individual stages in the model and corresponding techniques by clicking here.
Common Interpersonal Styles Used in Motivational Interviewing
- Open-ended questions
Example: "I understand you have some concerns about your smoking. Can you tell me about them?" - Affirmations
Example: "Good on you for showing up today even if you didn't feel like it. I'm glad to see you." - Reflections or rephrasing a statement to capture the implicit meaning
Example: "You enjoy the reliability of relief smoking provides, and you've also started to care more about your health. You have conflicting feelings about it now; on one hand there's a sense of comfort and pleasure with it and on the other hand, you're feeling guilty because it's taking away from your health and time with family." - Summarizing
Example: "Let me see if I have this right: up until this point, your way of going about things has worked quite well for you, but now these old strategies aren't doing what you'd hoped. You feel exhausted by your efforts to feel better, you're feeling lost, but hopeful for change. You're simply needing some guidance on where to begin. Is that accurate?"
"People are the undisputed experts on themselves. No one has been with them longer, or knows them better than they do themselves." - William Miller & Stephen Rollnick, 2013
References
- Hall, K., Gibbie, T., & Lubman, D. I. (2012). Motivational interviewing techniques: facilitating behaviour change in the general practice setting. Australian family physician, 41(9), 660-667.
- LaMorte, W. W. (2019, September 9). The transtheoretical model (stages of change). Boston University School of Public Health. https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories6.html#:~:text=The%20TTM%20posits%20that%20individuals,change%20for%20health%2Drelated%20behaviors.
- Rubak, S., Sandbæk, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: a systematic review and meta-analysis. British journal of general practice, 55(513), 305-312.
- Stephen Rollnick. (n.d.). About motivational interviewing. https://www.stephenrollnick.com/about-motivational-interviewing/
- The BMJ. (2010, April 27). Motivational interviewing. https://www.bmj.com/content/340/bmj.c1900/
Benefits:
- Effectiveness. Research shows that online therapy can be just as effective as in-person therapy for issues related to mental health.
- Accessible. Accommodates those living in rural or remote areas, people living with disabilities that prevent them from leaving the home, and eliminates transportation barriers.
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Considerations:
- Coverage. Some insurance companies may not cover it. We encourage you to check with yours.
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- Distractions. Possibilities for disruption depending on your living circumstances and others in the home.
Benefits:
- Trust and Body Language. Some people may prefer viewing the entire body language of their therapist for more effective communication.
- Severe mental health or psychiatric concerns. A more appropriate and accommodating option for people that may need crisis intervention that is better supported with in-person care.
- Participation. It is an opportunity to engage in an activity outside of your home.
Considerations:
- Time consuming. Ensuring commute time may be challenging for busy schedules.
- Expenses. Possible parking and transportation fees.
All virtual sessions are conducted using secure, HIPAA-compliant software. Research has shown that psychotherapy offered through telehealth is an effective solution for mental health treatment. The efficacy of either option depends on individual preference and comfort level.