Motivational interviewing: What it is and how it’s done

Motivational interviewing (MI) is a counseling technique designed to help clients confront their mixed emotions about change and find the internal resources to motivate action. The MI method is rooted in the notion that people are more successful in overcoming ambivalence when they hear their own arguments for behavior change. For example, someone who explores aloud the reasons they should pursue sobriety might be more likely to persuade themselves to attend an Alcoholics Anonymous (AA) meeting than someone who’s just advised to seek treatment for a substance use disorder.

Motivational interviewing takes place alongside a perceptive, skilled therapist or counselor who can help a client access their intrinsic motivation, then reflect and reinforce those thoughts back to the client.  

How Does Motivational Interviewing Work?

The motivational interviewing counseling approach begins with assessing the client’s readiness to change, then gearing interventions toward that stage. At certain points a client may open up about what they want to change and why. Therapists stimulate this commitment language in a way that reinforces the client’s desire to change. Licensed Clinical Social Worker Karen Koenig, MEd, utilizes motivational interviewing (MI) in her practice and explains why eliciting “change talk” is so effective:

“[Motivational interviewing] is based on the concept that clients do better when they figure out what to do as opposed to being told. When a client feels less pressured (by herself or her therapist), she has more of a chance of relaxing and wanting to talk about what’s on her mind.

Built on collaboration and predicated upon curiosity, compassion, and acceptance, it employs open-ended questions about motivation, barriers to motivation, and the change process. It helps clients tap into their own desires, circumventing their fears. Clients feel challenges in a positive, non-threatening way, as if you’re on their side, helping them access what they already know.”

Motivational interviewing helps clients overcome their ambivalence and fear, focus on their goals, develop confidence in their ability to meet those goals, and confront challenges in an effective manner. The therapist’s role is to gently guide them through this process by listening to and reflecting their change talk (i.e., practice reflective listening). 

Motivational Interviewing Techniques

Now, how exactly do therapists master this in counseling sessions? First, bear in mind that motivational interviewing doesn’t need to happen in dedicated sessions, as a stand-alone intervention. It can be woven throughout the therapy process, depending on how receptive a client is and what stage of change they’re in. MI can also help prepare clients for the therapy process itself. It can be incorporated into other evidence-based interventions, such as cognitive behavioral therapy (CBT). 

The motivational interviewing counseling approach is meant to be empathetic and supportive. This means that the client’s autonomy is respected. Their motivation must come from within. An experienced counselor must be able to sense client resistance and shift approaches. Here are some specific motivational interviewing techniques that may help therapists (and their clients) be successful:

1. The therapist uses open strategies. This means creating a safe, comfortable, judgment-free environment for their client. They should also ask open questions, which encourage the client to share and explore how they’re feeling.
2. The therapist utilizes the four basic principles of motivational interviewing. According to Stephen Rollnick and William R. Miller, these are expressing empathy, developing discrepancy (making the client aware of the difference between their values and their behaviors), rolling with resistance, and supporting self-efficacy. 
3. The therapist supports and maintains a strong working alliance—or what is often called the therapeutic relationship.
4. The therapist educates their clients about self-talk and assists them in adopting more positive self-talk that will support their progress. Through this practice, the client can talk about the problem at hand, recognize their need or desire to change, assert their ability to make the change, and then commit to taking the necessary steps toward change.
5. The therapist respects the client’s pace and encourages inner reflection. The client should be allowed to take the necessary time to process their emotions and understand the progress that they’re making in therapy. Contemplation tends to precede preparation and action. 

Motivational interviewing works because it makes the client the effective agent of change. But MI still requires an insightful therapist to help build this self-efficacy.