Motivational interviewing

Motivational interviewing (MI) is a collaborative counseling style designed to inspire personal motivation for behavior change. First developed by psychologists William Miller and Stephen Rollnick in the 1980s, it’s since been regarded as an effective way to help address substance use disorders, smoking cessation, medication adherence, and to instill overall healthier habits.

MI uses structured interviews to help people identify their negative feelings and thoughts and to create healthier habits. With this approach, the therapist listens and offers guidance, while empowering the client to connect with their reasons, motivation, and capacity for change. A key component of the process is “change talk” which is when a person explains why and how they might change.

“It’s a way of having a conversation about change that is the opposite of telling people what’s wrong with them and what to do. It’s more about inviting them to tell you about their own reasons for change, their own motivations for change, and their own ideas about how to do it,” Miller explained on a podcast last year.

“Put simply, this involves coming alongside the person and helping them to say why and how they might change for themselves,” wrote Rollnick on his website.

Motivational interviewing relies on structured interviews to help people unpack their feelings and thoughts to create healthier habits. Below are the four leading motivational interviewing skills that are designed to inspire behavior change.

Open-ended questions

During a motivational interviewing session, a therapist typically asks open-ended questions to encourage a thoughtful discussion. While closed questions usually elicit limited responses, open-ended questions are better for engaging in conversation and reflection. Instead of a simple “yes” or “no,” there is an opportunity to more deeply discuss your feelings and experiences.

Examples of open-ended questions that a therapist might ask include:

• How can I help you with ___?
• What was your experience with ___?
• How would you like things to be different?
• What is your fondest memory from your childhood?
• What gets you out of bed each morning?
• What treatments have you tried in the past, and what did you like or not like about them?

Affirmations

Affirmations are personalized statements that can be used to change a person’s mindset. Sometimes it is difficult to recognize our power to create positive change in our lives, so affirmations offer people a chance to gain that understanding.

During motivational interviewing, therapists use positive affirmations to help a person identify their strengths, motivations, and reasons for wanting to change. To be an effective part of therapy, affirmations must be genuine so it’s helpful to base the statements on specific behaviors and acknowledge small successes.

Examples of affirmations from a therapist include:

• It took a lot of awareness and self-control to navigate that situation.
• I appreciate you taking the time out of your day to attend our appointment. I know it isn’t easy to take the first step.

Reflective listening

Another technique that therapists use during motivational interviewing is active listening. Also known as reflective listening, the therapist’s role is to listen while you guide the conversation based on your thoughts and feelings.

Below are a few examples of how your therapist might practice active listening:

• Repeating your thoughts to confirm they understand
• Paraphrasing your thoughts and feelings
• Using feeling statements to express empathy

Summaries

Summaries are the last of the motivational interviewing techniques. These are other tools therapists use during motivational interviewing to recap your thoughts and feelings. They help highlight important aspects of the conversation and are a natural way to redirect the conversation if you feel like you’re hitting a wall. The summary allows you to revisit any topics you’re still working through, and ensures that you’re ready to continue the conversation next session.

Motivational interviewing was originally created as a tool to help people living with substance use disorders. Today, many still consider it an evidenced-based, best-practice approach in SUD treatment and just as effective as other treatments for addictive behaviors related to alcohol, tobacco, and marijuana.

Other use cases for motivational interviewing are to help people adopt healthier lifestyle habits—such as diet, exercise, and medication adherence. Some mental health professionals even use motivational interviewing to help people leave unhealthy relationships or to support those experiencing homelessness. Therapists also use motivational interviewing to supplement cognitive behavioral therapy (CBT) for anxiety, depression, and trauma, but it’s considered to be a less effective treatment for those conditions on its own.

Motivational interviewing’s success also largely depends on a person’s mindset. For example, it might not work as well for those who are already highly motivated to make a behavior change or for those who are adamant that they don’t have a problem requiring change.

In addition to cognitive behavioral therapy work, Charlie Health uses a comprehensive suite of modalities to customize each client’s treatment program based on their individual mental health needs. CBT in combination with other types of online therapy, is a highly effective, evidence-based way to address serious mental health challenges.

About Charlie Health’s virtual IOP

Our virtual Intensive Outpatient Program is designed for teens and adults who either need:

• Therapy more than once per week, or
• Support as they transition out of an inpatient or residential facility

Charlie Health’s virtual IOP uses a combination of individual therapy, supported groups, and family therapy to comprehensively and effectively treat people struggling with severe mental health issues. If you are struggling with the current level of care you’re receiving or need assistance as you return home from an inpatient setting. Our Admissions Team is available 24/7 to discuss your needs and goals. Reach out today.