Motivational Interviewing Principles

Motivational Interviewing (MI) is a counseling approach designed to help people identify and explore their ambivalence and build their motivation to change. This counseling approach can be done in both inpatient and outpatient settings, led by a counselor, licensed therapist, or other qualified treatment professional.

Motivational interviewing follows the principles of person-centered counseling: genuineness, unconditional positive regard, and accurate empathy, but also guides conversations toward specific, client-driven goals.

MI is based on the following assumptions:

• Ambivalence about behavior change, including substance use, is normal and is a critical motivational barrier to substance use related change.
• Resistance to change is an expression of ambivalence about change, not a client-specific characteristic.
• Resolving clients’ ambivalence about substance use is a necessary step towards change.
• A compassionate and supportive counseling style promotes conditions under which change can occur.
• People have their own motivations, strengths, and resources. The role of treatment professionals is to help activate and guide those resources to facilitate health-enhancing change.

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What Is Ambivalence?

Ambivalence means having mixed feelings or being of two different, often opposing minds (part of the person wants to change and another part of them does not).

All choices and courses of action, whether they are healthy or unhealthy, have trade-offs: benefits versus costs and advantages versus disadvantages. As a result, even when a behavior is risky or potentially dangerous, it serves a purpose and meets some need for that individual, influencing them to continue.

Moreover, significant life change, such as moving from active addiction to recovery, is hard because there is a natural fear of the unknown and the uncertainty that goes with it. This is true even when someone knows that change is necessary, and they want it.

It can be difficult to do anything that’s different or unfamiliar because the unfamiliar tends to be uncomfortable, and it takes strength and courage to do anything uncomfortable. That’s why people often stay in situations that are unhealthy and painful (including addiction) because they are intimately familiar with the pain of that situation. This provides a certain perverse sense of security.

Invariably, substance use that progresses to the point of creating problems in important life areas like health, finances, and family relationships and responsibilities generates ambivalence. In this way, ambivalence is intrinsic to addiction.

Motivational interviewing enhances a person’s inherent motivation to change by helping them examine and move through their ambivalence in a nonjudgmental and compassionate way.

Motivation Is Key To Substance Use Behavior Change

In MI, ambivalence can be resolved in part by exploring the client’s intrinsic motivations for change. Motivation relates to the probability that a person will begin, continue, and maintain a specific change strategy. Rather than being a fixed client trait, motivation is a fluid state in that it fluctuates.

Substance use disorder (SUD) treatment professionals can influence positive behavior change by identifying and enhancing existing motivation and developing a therapeutic relationship that respects and builds on the client’s autonomy.

In MI, the provider’s use of empathy, as opposed to authority and power, is fundamental to growing clients’ motivation to change. This motivation is strengthened, and ambivalence reduced as a client’s commitment to particular goals, such as recovery, increases.

Candidates for MI include people across the spectrum of substance use, from at-risk drinking or other drug use to those with a severe SUD. In the context of MI, whether someone has a SUD or not is less relevant than their perception that they need to make some changes in their lives. Using an MI approach, the person’s perspective on their addictive behaviors is the most important factor, and the goal of the treatment professional is to help them shift that perspective. Rather than conceptualizing the person as having an alcohol or drug addiction, they are viewed as being stuck in unhealthy behaviors and, thus, can become unstuck.

Unhealthy behavior patterns are understood as the result of ambivalence and competing motivations to make changes versus to remain the same. When the perceived benefits of changing outweigh the costs and remaining the same becomes less desirable, people can begin to add new behaviors that directly change or eliminate substance use-related behaviors.

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Motivational Interviewing Can Help

Motivational interviewing has been used for varied age groups, in diverse settings (including primary care, specialty care, and the criminal justice system), and with a wide range of substances. Extensive research has demonstrated that MI reduces substance use among individuals with SUD, including alcohol addiction. In fact, analysis of more than 200 randomized clinical trials found significant efficacy of MI in the treatment of substance use disorders.

MI is consistent with a harm reduction strategy. Harm reduction is characterized by a willingness to work for incremental changes that reflect progress toward reduced risk and improved health rather than requiring complete behavior change (in the case of addiction, total abstinence).

MI is impressively efficient, typically achieving its effects in one to four 20 minute sessions. However, more sessions have been associated with greater efficacy.

Overall, MI enhances a person’s motivation to change by clarifying and strengthening the inherent human interest in living a more fully consistent, fulfilling life.

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