Motivational Interviewing: Definition, Principles and Techniques

Motivational interviewing (MI), also known as motivational enhancement therapy, is a client-centered counseling approach aimed at helping people find the motivation to make a behavioral change. Dr. William R. Miller and Stephen Rollnick, authors of Motivational Interviewing: Helping People Change, first developed MI as a substance abuse treatment. However, motivational interviewing is an effective intervention strategy for addressing several behavioral, physical, and mental health conditions. Instead of relying on the advice of a counselor, motivational interviewing enables clients to find their own reasons to make positive changes that will improve their well-being.

Initially developed to help clients manage substance use disorders, specifically alcohol abuse, motivational interviewing can supplement cognitive-behavioral therapy (CBT) to help with any behavioral change and can work for both adults and adolescents. Some of the most popular applications in mental health care include:

• Diabetes control
• Eating behaviors
• Medication adherence
• Obesity prevention
• Physical activity
• Sexual behaviors
• Smoking cessation

Three key elements define the MI counseling style. Providers focus on:

1. 1. Autonomy: When using the motivational interview style, the counselor does not assume a position of authority. It’s up to the client to engage in the process of change. Ultimately, the client takes responsibility for decision-making and implementing the changes they want to see in their own life.
2. 2. Collaboration: Some forms of psychotherapy involve a confrontational style in which a therapist imposes their point of view on the client. However, motivational interviewing is a collaborative process that centers on the client’s point of view. The therapist aims to build a therapeutic relationship based on trust and mutuality.
3. 3. Evocation: Motivational interviewing hinges on the idea that intrinsic motivation is more potent than imposed motivation—that the most sustainable change comes from within. Motivational interviewers resist the righting reflex—the urge to set their client on a path to healthful behaviors. Instead, they focus on evoking the patient’s motivation by drawing out their client’s ideas of how to address their own behavior.

According to the Motivational Interviewing Network of Trainers (MINT), five principles are foundational to motivational interviewing strategies.

1. 1. Develop discrepancy. A person is more likely to find the motivation to make a change when they can see the difference between their current behavior and where they want to be. A therapist should identify the discrepancy between their client’s current situation and future goals.
2. 2. Express empathy. Counselors aim to provide a judgment-free environment in which they seek to validate their client’s points of view and make them feel understood. Learn how to be empathetic with Pharrell Williams.
3. 3. Roll with resistance. As clients progress through various stages of change, it’s normal for them to change their minds from time to time. Motivational interviewing doesn’t condemn this pattern. Instead, it encourages clients to explore the source of resistance and reframe negative thinking.
4. 4. Support self-efficacy. Self-efficacy is a person’s confidence in themselves to achieve a target behavior. A counselor provides support and encouragement, empowering their clients in the behavior change process.

A clinician will use the following four MI techniques when facilitating a motivational interview:

1. 1. Affirmations: Affirmations are statements that recognize a person’s positive attributes and strengths. Counselors provide positive affirmations to help their clients build self-confidence.
2. 2. Open-ended questions: Therapists avoid asking questions that could produce simple yes or no answers. Instead, they ask open-ended questions that elicit change-talk—statements about the types of changes clients wish to make. Counselors can ask follow-up questions to help clients dig deeper.
3. 3. Reflective listening: Reflective listening involves providing validating verbal feedback so that a client feels heard. It’s an effective method for expressing empathy.
4. 4. Summaries: Summarizing involves providing clients with an overview of their own words. Hearing their comments in a concise summary can help provide emotional and mental clarity.

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