Motivational Interviewing

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It should come as no surprise that Motivational Interviewing (MI) is considered an effective therapy approach in the field of addiction treatment because that’s the very place where it was developed. At present, there are more than 1,200 publications that relate to Motivational Interviewing, and the approach is used internationally. This technique focuses on how to help people take steps to bring about change in their lives. For this reason, a main goal of MI is to help a person create and execute a plan that will bring about a meaningful change on a main issue of concern, such as drug abuse.

Cathy Cole, LCSW and a Motivational Interviewing expert and trainer, notes that this technique was truly revolutionary when it emerged because it gave control over the therapy process to the recovering person. The therapist sets the agenda, but the client sets the goals. Motivational Interviewing sessions unfold in such a way that recovering individuals can see the difference between their goals (e.g., maintaining abstinence, improving relationships with family, finishing school, or getting a desired job) and their current reality. When clients can clearly see the difference between what they have and what they want, they are then in the right position to make a change.

This article identifies some of the main concepts of Motivational Interviewing and the core skills MI counselors use. While Motivational Interviewing can be used in different areas, the focus here is on the use of this approach in the area of drug addiction treatment.

Core Concepts in Motivational Interviewing

Dr. Bill Matulich, a clinical psychologist and author of the ebook How to Do Motivational Interviewing, provides a comprehensive overview of some of the core concepts of MI. As Dr. Matulich explains, the following are some of the main ideas and practices that a person in recovery would come across during MI sessions with a counselor trained in this method: collaboration, acceptance, compassion, and evocation. Each concept is explored in turn, as follows.

Motivational Interviewing is a collaborative process. MI very clearly posits that the therapist and client must work together. The therapist is not an expert or an authority figure. This approach ties into a key concept within MI: Change is most likely to occur when it comes from within a recovering person. In this way, the key is to support, motivate, and guide a recovering person to a place where achieving and maintaining abstinence is a desirable goal. It has been proven time and time again that telling people in recovery what to do simply does not work. If change could occur that way, it wouldn’t be as challenging, or rewarding.

Motivational Interviewing relies on acceptance of the addiction. In MI, the client’s perspective on the addiction takes center stage. The therapist may have great ideas and lots of advice, but so do a lot of people. The key is for the recovering individuals to undergo a shift in perspective, one that takes them from drug-oriented thoughts and behaviors to abstinence-oriented ones. The therapist accepts the client’s current thinking, emotions, and behaviors, and works from that place toward change. A core idea in MI is that recovering people are really not resisting change; they just don’t know how to bring it about. This is the reason why MI is keyed to creating a plan for change. Of course, drug abuse cripples change – that’s one of its main features and why rehab treatment is the prevailing and most effective response. It’s the rehab process, including therapy such as MI, that provides new, abstinence-oriented ways of thinking, behaving, and feeling.

A therapist trained in Motivational Interviewing is one who has worked on developing compassion. In this way, MI puts the recovering person’s interests first, while at the same time respecting the person’s current thoughts, behaviors, and emotions. Again, there is a general sentiment in MI that a person who abuses drugs wants to achieve and maintain abstinence. Being drug-free may not be a person’s current reality, but change is possible. By taking clients as they are, a therapist performing MI can walk alongside a client, providing helpful guidance and encouragement, to cross into a new future, one that is free from drugs.

Unfortunately, before the advent of research-based therapies and other addiction treatments, people who were experiencing drug abuse were often ministered to, stigmatized, and shamed. These approaches were not helpful, and if a person internalized this feedback, the drug abuse would likely continue to spiral out. However, today, it is well understood that a compassionate approach is the best one to take to help a person in need of drug recovery treatment.

In Motivational Interviewing, a therapist uses evocation to help clients develop their own plans for change. Again, there is general consensus that people tend to perform more effectively under plans they have created compared to plans that are set on them. Aware of this general tendency of human nature, a therapist using MI will focus on the recovering person’s perspective on the addiction, desire for change, and guide the person in creating a plan of action that can lead to and support abstinence. This process is aided by the respect the therapist gives the client, including making sure the client felts heard and valued. It’s not only that the recovering person creates a plan for change, but also that each step in the planning process is provided with the best intention of support.

Core Skills Therapists Use in Motivational Interviewing

Motivational Interviewing, from the practitioner’s vantage point, involves general and specific concepts, as well as a set of tools to help clients bring about change in their lives. Known as the OARS method, the following are some of the core skills that therapists trained in Motivational Interviewing use in client sessions:

  • Open questions: This technique ties back to evocation discussed earlier. A therapist will strategically ask open questions about the drug abuse rather than closed ones. For instance, the question, “How long have you been using drugs?” sets up a short response, such as the exact number of months or years, without implicitly asking for greater elaboration. An open question would be, for example, “What role do drugs play in your life?” This type of question can help a client identify some of the core issues around the drug abuse. Also, the therapist can collect information, to guide the process going forward.
  • Reflections: This is also called reflective listening. The therapist listens to how the recovering person is explaining thoughts, behaviors, or emotions and repeats them back in a nonjudgmental way. In this way, recovering clients feel heard and understand that they are truly driving the therapy process. This approach also helps to ensure that the therapist and recovering person are on the same page during each session. The recovering person would be expected to correct whatever the therapist says back if it’s not accurate. In this way, the therapist and client are building their bond of trust, collaborating, and developing meaningful and clear communication skills.
  • Affirmations: The therapist is aware that the recovering person has most likely experienced significant criticism about drug abuse from family, friends, colleagues, and others. There is a general tendency in human nature for people to internalize or embody the negative (and positive) feedback that they receive from others. The therapist, as part of the therapy process, can draw the recovering person’s attention to the positives, in order to build hope, confidence, and work toward change. For instance, a family member may make an unhelpful statement to a person in recovery, such as, “If you had started rehab sooner, [fill-in the blank] wouldn’t have happened.” Understandably, a person could hear this and feel guilty. A therapist trained in Motivational Interviewing, on the other hand, might say something like, “It took a lot of courage for you to start the recovery process.” The latter approach is not only compassionate, but it is also a true statement.
  • Summaries: These are distinguishable from the statements made after reflectively listening to a client, but there is a similar technique at work. A therapist will provide recovering clients with a summary that includes more than one statement about the client’s reasons for change. In this way, the client can see that the therapist is holding onto the many threads of conversation and highlighting the most significant ones. These summaries can be used to draft a plan for change.

As the foregoing concepts and skills in Motivational Interviewing reflect, healthy communication is at the heart of this approach and, indeed, most all therapy approaches. Therapists have the goal of helping to heal people psychologically, but they make it their life’s work to become expert communicators in order to do so. In fact, in addition to all of the benefits discussed, a therapist may be able to serve as a healthy role model of communication for a recovering person. Since there is transparency in the process, the therapist is essentially sharing skills and tools with clients that they can use in their own lives to improve their communications with others and interpersonal skills in general.