Igniting Internal Drive
Motivational Interviewing
Motivational Interviewing (MI) is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen a person's personal motivation for and commitment to a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion. MI is most often used to resolve ambivalence—the normal, natural hesitation people feel when contemplating significant behavioral change.
Who Created Motivational Interviewing?
Motivational Interviewing was first developed by clinical psychologists Dr. William R. Miller and Dr. Stephen Rollnick in the early 1980s. Dr. Miller initially created the approach while working with individuals with alcohol use disorder, finding that a directive, confrontational approach was ineffective. He discovered that guiding clients to voice their own reasons for change (known as "Change Talk") was far more successful. The formalized approach, integrating the work of both Miller and Rollnick, has been refined and broadened over several decades (Miller & Rollnick, 2013).
Perspectives in MI
The Therapist's Perspective
The MI practitioner adopts a non-judgmental, collaborative, and client-centered perspective. They believe that motivation for change resides within the client and is not something that the therapist installs or forces. The therapist's stance is defined by the four guiding principles (DDRS):
Develop Discrepancy: Highlighting the gap between the client's current behavior and their stated goals or core values.
Express Empathy: Showing accurate, reflective listening and acceptance of the client's experience.
Roll with Resistance: Avoiding confrontation when the client voices reasons against change ("Sustain Talk") and inviting them to explore new perspectives instead.
Support Self-Efficacy: Affirming the client's ability to successfully change, even if past attempts failed.
The therapist's role is to elicit and strengthen Change Talk, not to lecture or persuade.
The Client's Perspective
The client shifts from feeling argued with or coerced by external pressures to feeling understood and empowered. They move from a defensive, resistant posture to an internal dialogue where they are actively exploring the benefits of change.
The client learns that:
Their Ambivalence is Normal: Their hesitation is accepted as a natural part of the change process.
They Hold the Answers: Their inherent values and reasons for change are the most powerful motivators.
They Direct the Pace: They determine the timeline and scope of change, which fosters autonomy and commitment. The focus is on "The client talking themselves into changing," not the therapist.
What to Expect in an MI Session
MI is a flexible communication style, often embedded within other forms of therapy, but utilizes specific skills and a four-process structure.
Engaging: Building a trusting, collaborative working relationship through empathetic listening and acceptance.
Focusing: Collaboratively clarifying the target behavior or goal (e.g., stopping smoking, exercising more).
Evoking: This is the core of MI. The therapist uses specialized skills (see OARS below) to elicit Change Talk(desire, ability, reasons, need, commitment) and explore the client's reasons for change.
Planning: Once commitment is strong, the therapist supports the client in developing a specific, step-by-step action plan that aligns with their values and goals.
The therapist relies on four fundamental skills (OARS):
Open-ended questions
Affirmations (statements of recognition and support)
Reflections (deep, often complex restatements of what the client has said)
Summaries (linking change talk and discrepancies)
How MI Can Help a Person
MI is highly effective because it resolves the underlying conflict of ambivalence, which is the biggest barrier to change.
Decreases Defensiveness: By "rolling with resistance" rather than confronting it, the client is less likely to dig in their heels and argue against change.
Strengthens Intrinsic Motivation: By drawing out the client's own motivations, the commitment to the goal is stronger and more sustainable than motivation based on external pressure.
Increases Commitment: Through the process of hearing themselves voice strong reasons for change, the client's commitment to action naturally increases, moving them toward the "Preparation" and "Action" stages of change (Miller & Rollnick, 2013).
Common Uses and Applications (DSM-5 Disorders and Life Problems)
MI is a trans-therapeutic approach used widely across health and mental health settings. It is specifically designed for behavioral change and ambivalence.
Substance Use Disorders (DSM-5): The primary use, highly effective for increasing readiness to change drug and alcohol use.
Gambling Disorder and Internet Gaming Disorder (DSM-5): Addressing ambivalence about reducing addictive behaviors.
Health and Medical Problems: Increasing adherence to treatment plans, diet changes, medication compliance, and exercise routines (e.g., diabetes management, weight loss).
General Life Problems: Increasing motivation for difficult but necessary changes, such as leaving a toxic relationship, returning to school, or reducing aggressive behaviors.
References
Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). The Guilford Press.
Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care: Helping patients change behavior. The Guilford Press.
Ready to Find Your Own Path to Change?
If you are feeling stuck, conflicted, or unsure about making a necessary life change, MI can help you uncover your inner wisdom and clarify your direction.
Book with a therapist skilled in Motivational Interviewing to help you resolve ambivalence and commit to a life aligned with your values.
