Motivational interviewing (MI) is a counseling method first developed in the early 1980s by William R. Miller and Stephen Rollnick. This method was created in part to assist individuals in treatment for substance misuse disorders to resolve ambivalence regarding making changes in their lives. However, this method can be used to support any individual who is looking to make changes in their lifestyle, but having difficulty finding motivation to make these changes. In MI, the therapist and clinician work as a collaborative team, in which the therapist accepts the client’s ability to make autonomous decisions about the changes they would like to make. The therapist facilitates conversation about change and evokes ideas about how to change from the client, supports those changes with compassion and empathy, and allows clients to develop their own sense of self efficacy. In essence, the therapist acts as a partner in the change, but accepts the client themselves as the leader in the change process.
Learn about the Stages of Change and How Change Happens
The MI model accepts that individuals come to therapy in various stages of readiness to embody changes in their lives. The six stages of change, initially identified by Prochaska and DiClemente in 1977, are the names given to these various phases individuals go through in regards to these changes. They are as follows:
In this stage, individuals do not have an intention to make a change regarding their problem behavior. This may be due to lack of insight about the need for a change (i.e., they do not believe the behavior is problematic), or due to having no intent to stop engaging in the problematic behavior any time soon. In this stage, the therapist’s goal is to establish a rapport and trust with the client, as well as to express concern, elicit the client’s perception of any risks involved with the behavior, and discuss benefits and risks to making changes in this behavior. This work is non-directive and non-judgmental; the therapist is allowing the client to make decisions about the behavior rather than coerce the client into making said change.
In this stage, individuals are beginning to think about making the behavioral change but are ambivalent. Individuals are beginning to recognize the potential benefits of change, but also recognize the drawbacks and potential losses involved in making these changes. During this stage, the therapist emphasizes the client’s autonomy in making this change and that this ambivalence is normal, while also assisting the client in developing an accurate understanding of the benefits and drawbacks of making the change and of not making the change. The therapist will also assist the client in weighing the pros and cons of these consequences and assist the client in developing self-efficacy in their ability to change.
In the preparation stage, the individual has made a commitment to change, but have not yet made the change. The goals of this stage include goal setting, planning for change, and setting realistic expectations for change. An important consideration for the therapist in this stage is to remain non-judgmental, even about perceived positive goals and changes. The therapist acts as a collaborator, assisting in goal setting, offering guidance if and when needed, and assisting the client in establishing necessary social supports in making these changes.
In this stage, individuals are beginning the process of actively committing to and implementing change. The client is fully committed to making the agreed upon change in the way that they have decided is best. During this stage, the therapist’s goal is supporting and assisting clients in these changes. Initially, the therapist may need to acknowledge the difficulty in implementing these changes and work with the client in identifying barriers to change. The therapist may also assist the client in finding ways to reinforce the changes they have made. Assisting the client in adding appropriate community and social supports to reinforce change may be important as well, as often during this stage clients find that existing social supports are not conducive to their behavior change.
In this stage, individuals have integrated the behavior change into their daily life, usually after at least 6 months of work in the action stage. In this stage, the new behavior is firmly part of the individual’s life. During this stage, the therapeutic relationship becomes on of support and affirmation, as well as assisting the client with supporting self-efficacy and ongoing resolve. Therapy in this phase is supportive in nature.
At any time in the process of change, including during the maintenance phase, individuals may find themselves having difficulty sustaining change. In MI, relapse is seen not as a failure, but as an experiment that did not have the expected results. In relapse, the therapist assists the client in identifying “what went wrong” or what they could have done differently to change the outcome. The therapist and client use the relapse as a unique learning experience to gain knowledge and understanding about the way in which change was attempted.
Movement through the stages of change is considered fluid. An individual in the contemplative stage, for example, may move back to pre-contemplation due to setback, peer influence, or any number of reasons. A key aspect of an MI therapist is the ability to express empathy for individuals in any and all stages of change, respect an individual’s commitment to change, and meet the individual at their personal stage of change throughout the work together.
Learn About Who Can Benefit from Motivational Interviewing
Initially, MI was utilized with individuals recovering from substance misuse disorders. However, this method of treatment has been found to have success with individuals wishing to change a multitude of behaviors. Smoking cessation, medication adherence, health-related behaviors such as diet changes related to diabetes or blood pressure, and anger management are all examples of problem behaviors which can benefit from the use of MI techniques. In short, any individual expressing ambivalence about making a change in a behavior can benefit from MI.