Motivational interviewing is an effective and dynamic therapeutic technique that encourages individuals to use tensions between personal values and actions to build motivation to change their behaviors.[1]
Despite its deceptively simple sounding premise, motivational interviewing involves an intricate dance of empathy, artful conversation, and deliberate strategic thinking that supports individuals to leap from contemplation to action.
Fortunately, with the right tools and framework, any therapist, counselor, or coach can incorporate motivational interviewing techniques in their practice in no time.
To get you started with this powerful technique, this article provides a comprehensive overview of what motivational interviewing is, why it’s an important skill for therapists and coaches to have, and some of the evidence behind its use.
We also explain how a digital platform like Quenza can help fast-track and enhance your ability to use motivational interviewing with clients.
What is Motivational Interviewing?
Motivational interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior.[2]
It is a practical, empathetic, and short-term process that takes into consideration just how difficult it is to make life changes. As such, it focuses clients towards a commitment to action rather than just finding solutions.
Motivational interviewing has been described as:[1]
A facilitative, client-centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence. It isn’t about forcing change, but rather helping clients visualize the disparity between where they are and where they want to be, thus propelling them toward action.
Where It All Began
Motivational interviewing has its roots in the field of addiction counseling.
It was first described by William Miller in 1983, as he was exploring better ways to work with individuals struggling with alcohol addiction.[3] Miller teamed up with Stephen Rollnick in the late 80s and early 90s to further develop and refine the technique, expanding its application beyond addiction.
Miller and Rollnick’s subsequent books and research have had a significant influence on the evolution and dissemination of motivational interviewing.
What About Stages of Change?
Many people confuse the stages of change model (also known as the transtheoretical model, or TTM for short) with motivational interviewing, often thinking the two are the same thing.
While both frameworks were developed around the same time, have similar applications, and can even be used in combination—they are distinctly different models.
Motivational Interviewing is a set of tools and techniques for exploring and working with someone’s ambivalence for change.
The transtheoretical model (aka stages of change) is a framework for clients and practitioners to better understand how people progress through change. Practitioners can then match their ideal approach to a person’s readiness to change.
The focus of this article is motivational interviewing. But if you frequently support clients with behavior change, it’s also worth familiarizing yourself with the 6 stages of change.
Elements and Processes of Motivational Interviewing
The core elements underpinning motivational interviewing are client autonomy, compassion, and evocation.[1]
- Autonomy recognizes the individual’s own values, abilities, and capacity for self-directed change.
- Compassion represents an active interest in the individual’s welfare and a commitment to prioritize their needs.
- Evocation involves eliciting the individual’s own motivations for change, rather than implanting extrinsic motivations.
These elements, combined with the 4 processes of motivational interviewing described below, foster an empathetic and supportive environment that encourages self-exploration and personal growth.
4 Processes of Motivational Interviewing
The 4 key processes of motivational interviewing described by Miller and Rollnick include:[4]
1. Planning
When the client expresses some level of readiness to change, practitioner and client can start a dialogue about what behavior change might look like. This might include the target behavior, likely obstacles or challenges, and long-term goals.
2. Evoking
Evoking involves the practitioner using motivational interviewing techniques, such as open-ended questions and reflections, to help clients identify and connect with their own motivations for change.
3. Focusing
Focusing extends the planning process. It is a collaborative effort aimed at the client deciding on specific changes to make. Examples could be stopping alcohol use for a month or starting a daily exercise habit.
4. Engaging
In motivational interviewing, the ongoing work between the practitioner and client is referred to as “engaging.” This involves a range of activities, such as establishing a trusting and respectful relationship, making the client feel safe and comfortable in therapy or coaching, and even gently challenging or questioning the client where appropriate.
Using OARS to Inspire Change
A technique that ties the elements and processes of motivational interviewing together to provide a framework for practice is OARS. The acronym stands for: Open-ended questions, Affirmations, Reflections, and Summaries.
- Open-ended questions encourage individuals to delve deeper into their experiences and feelings, promoting introspection.
- Affirmations acknowledge an individual’s strengths and accomplishments, bolstering self-efficacy.
- Reflections involve the counselor echoing the individual’s thoughts and feelings, validating their experiences.
- Summaries tie together the information shared, providing clarity and direction.
When a therapist or coach skilfully executes OARS, it can unlock deep-seated intrinsic (internal) motivation and drive transformational change.
The Significance of Motivational Interviewing
Motivational interviewing has emerged as a potent tool across diverse fields, including healthcare, mental health, education, addictions, and many more.
It has shown significant success in addressing a broad range of behavioral issues, including:[5]
- Substance abuse
- Diet and exercise
- Medication adherence
- Chronic disease management
- Mental health treatment engagement
The importance and significance of motivational interviewing lies in its capacity to empower individuals to drive their own change process, regardless of the circumstances in question.
For example, while the content of a discussion between practitioner and client would be quite different when working with substance misuse compared to managing diabetes, the core tools and techniques would remain the same.
For this reason, the vast majority of healthcare, mental health, and social service professionals receive some form of training in motivational interviewing. And may carry and develop these skills over to different areas of practice.
The Power of Questions
An important tool in motivational interviewing is the effective use of powerful questions.
Questions in motivational interviewing are designed to stimulate introspection, evoke personal narratives, and encourage the exploration of personal values and goals.
For instance, questions like…
- “What makes you think you need to change?”
- “What do you want to achieve?”
- “What are the benefits you see in making this change?”
…allow individuals to look inward and discover their motivations.
Crafting and delivering these questions effectively can be a powerful catalyst for change. And again, are relevant to virtually every area of therapy, counseling, and coaching.
Motivational Interviewing in Groups
Motivational interviewing has also shown promising results in group settings. As a result, it is increasingly utilized in settings such as substance abuse treatment, health education groups, and corporate training.[6]
Motivational interviewing in groups presents unique opportunities for participants to learn from each other’s experiences, receive mutual support, and foster a sense of community. However, it also poses unique challenges (especially in online groups), such as managing group dynamics and ensuring each participant’s needs are met.
If you are a therapist or coach currently involved in group work, or looking to add this element to your practice, Quenza Groups has a range of digital tools to get you up and running in no time.
To learn more, check out our guide to group coaching programs. Or check out the Quenza app today, by signing up for our 1-month full-access trial for only $1.
Is Online Motivational Interviewing Effective?
With the advent of digital technology, motivational interviewing has adapted to online therapy platforms, providing enhanced accessibility and convenience for many individuals.
Research indicates that online motivational interviewing can be as effective as face-to-face sessions.[7] However, practitioners must consider factors like maintaining rapport, establishing a good therapeutic relationship, managing technical issues, and ensuring confidentiality.
As technology evolves, the scope for online motivational interviewing is expected to grow, providing opportunities to reach more people in need.
A Strong Body of Evidence
There’s a robust body of research that supports the effectiveness of motivational interviewing.
A 2010 meta-analysis of 72 studies concluded that motivational interviewing outperformed traditional advice-giving in approximately 75% of the studies.[8] It was also found to be particularly effective in the treatment of addictive behaviors.
Despite its brevity and relative simplicity, motivational interviewing has demonstrated a significant impact on diverse behavior changes.
Comparison: Motivational Interviewing vs. Cognitive Behavioral Therapy (CBT)
Motivational interviewing and cognitive behavioral therapy (CBT) are both evidence-based therapeutic techniques with distinct goals and methodologies.
While motivational interviewing focuses on harnessing an individual’s internal motivation to initiate change, CBT is oriented towards identifying and restructuring maladaptive thoughts and beliefs.[9]
Both approaches can be highly effective, and in many cases, they complement each other. For instance, motivational interviewing can be used to enhance an individual’s motivation before embarking on CBT.[10]
How to Learn Motivational Interviewing
Effective motivational interviewing requires practitioners to develop a range of skills, such as:
- Active listening
- Expressing empathy
- Managing resistance
- Supporting self-efficacy
- Purposeful questioning
Developing these skills requires a mix of theoretical understanding, practical training, and continuous practice. Supervision and feedback from experienced practitioners can greatly enhance one’s proficiency in motivational interviewing.
Motivational Interviewing Training
Various institutions offer certifications, workshops, and online courses covering the theoretical principles and practical skills required for motivational interviewing.
Bodies like the Motivational Interviewing Network of Trainers (MINT) offer resources and training opportunities for those interested in this field. And these days, most health-related degrees and training courses will include units on motivational interviewing.
Inspiring Change with Quenza
The powerful, evidence-based tools on the Quenza platform enable practitioners of any background and skill level to start using motivational interviewing techniques right away to inspire change in their clients.
Our Expansions library contains over 250 resources covering topics like stress management, relationships, goal setting, habits and behavior change, anxiety, depression, and many more.
These ready-made, yet fully customizable Activities include motivational interviewing therapy tools and techniques that can be used as is, or modified to suit your needs. And sharing them with your clients is as simple as clicking a button.
We’ll provide a few examples below. But to see everything Quenza has to offer for yourself, you can sign up for a 1-month full-access trial right now for only $1.
Using Role Models to Facilitate Goal Achievement
This Activity is a great example of how Quenza takes evidence-based techniques like motivational interviewing and packages them into ready-to-use resources for your clients.
We start by introducing the concept of using a role model to inspire change.
Then use motivational interviewing techniques like planning and focusing.
Alongside a structured series of open-ended questions to inspire change and goal-directed behavior.
Initiating Physical Activity
Building a regular exercise habit is something many people struggle with. And no matter what long-term fitness goals any of us have, the first (and often hardest) step is always getting started.
To give therapists and coaches an effective tool to work with this issue, our initiating physical activity resource begins by detailing some of the reasons a client may wish to start an exercise habit.
Followed by a 4-step Activity covering everything needed to support a client with an individualized physical activity plan, including:
- Why a client wants to become more physically active
- What their preference is for exercise or activity
- When they might fit this into their schedule
- How they can overcome specific barriers
Here’s how we approach step 4. But remember, you can customize this however you wish.
The Costs and Benefits of Changing Behavior
A great way to explore a client’s level of ambivalence around change is to do a costs and benefits analysis.
Our costs and benefits of the Changing Behavior Activity starts with some education about why behavior change can be difficult.
Then takes a client through exploring the:
- Benefits of NOT changing the behavior
- Cost of NOT changing the behavior
- Costs of changing the behavior
- Benefits of changing the behavior
By the end of the activity, clients will have filled in all 4 quadrants of the costs and benefits analysis. This can then be used to stimulate a lively, informed, and personalized conversation around behavior change
Conclusion
With its unique and empowering approach, motivational interviewing has redefined the landscape of working with behavior change.
Its proven effectiveness, adaptability across various settings, and scope for online implementation make motivational interviewing a must-have skill for any therapist, coach, or counselor.
While it does take time to master, motivational interviewing can be used by practitioners of all backgrounds and skill levels, especially when working from high-quality, evidence-based templates like those available through Quenza.
To see how Quenza can help you integrate motivational interviewing techniques into your practice today, sign up for a full-access 1-month trial for only $1.
References
- ^ Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. Guilford press.
- ^ Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. The American psychologist, 64(6), 527–537.
- ^ Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioral Psychotherapy, 11(2), 147-172.
- ^ Miller, W.R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (Applications of motivational interviewing). 3rd ed. New York: Guilford Press.
- ^ Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual review of clinical psychology, 1, 91-111.
- ^ Wagner, C. C., & Ingersoll, K. S. (2013). Motivational interviewing in groups. Guilford Press.
- ^ Tarp, K., Bojesen, A. B., Mejldal, A., & Nielsen, A. S. (2017). Effectiveness of optional videoconferencing-based treatment of alcohol use disorders: randomized controlled trial. JMIR mental health, 4(3), e38.
- ^ Lundahl, B., Moleni, T., Burke, B. L., Butters, R., Tollefson, D., Butler, C., & Rollnick, S. (2010). Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials. Patient education and counseling, 81(3), 137-141.
- ^ Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
- ^ Arkowitz, H., & Burke, B. L. (2008). Motivational interviewing as an integrative framework for the treatment of depression. In H. Arkowitz, H. A. Westra, W. R. Miller, & S. Rollnick (Eds.), Motivational interviewing in the treatment of psychological problems (p. 145–172). Guilford Press.
