Motivational Interviewing

Substance-using clients are often uncertain about how to begin the process toward sobriety. Although they want to stop using and are aware of the dangers of their abuse, many continue using substances anyway. Even after entering a treatment program, some clients downplay the severity of their addiction. Motivational interviewing is a conversational approach that can resolve the ambivalence that prevents clients from achieving their personal goals.

This technique was built off the ideas of humanistic theories addressing individual’s capabilities to exercise free choice and self-actualization. In other words, everyone has the ability to engage in self-growth and integrate their real and ideal selves. Motivational interviewing is a style of counseling in which the clinician or the interviewer directly expresses acceptance of their client and offers encouragement. The role of the interviewer is to strengthen their self-motivation and help them commit to the behavioral changes necessary to reach their goal.

The Aim Is Change

Essentially, motivational interviewing aims to activate change in the client for the better good. While some substance-using clients can continue positive change on their own, others need more structured treatment and support during their journey of recovery.

Motivational interviewing is based on four assumptions.

1. Ambivalence about substance use is completely normal.
2. Ambivalence is an obstacle that can be solved by discussing the client’s intrinsic motivation and values. It is essential to understand the client’s ambivalence as it is usually the primary problem hindering them from progressing through the recovery process.
3. The partnership between the interviewer and the client is collaborative, both work together to reach the client’s goal of sobriety.
4. The counseling style needs to be empathic and supportive in order to create a comfortable environment in which behavioral change can occur. For example, change is less likely to occur if the counseling style is aggressive or confrontational. Motivational interviewing focuses on supportive rather than argumentative strategies.

Four General Principles

The interviewer upholds four general principles. They express empathy through listening, develop discrepancy, support self-efficacy, and adjust to resistance. Empathic motivational interviewing provides a basis for clients to feel understood, making it more likely that they will share their experiences with the interviewer. Exploring the discrepancy between where the client is and where they want to be helps the client become aware of current behaviors that are leading them away from their goals. They are likely to have increased motivation to make lifestyle changes after examining their discrepancies. Self-efficacy is the client’s belief that change is possible. Motivational interviewing is an approach that believes clients have the strength within themselves to make successful changes. In motivational interviewing, the interviewer avoids confronting the client. For example, if the client resists the treatment, the interviewer rolls with it and prevents any struggle or argument from occurring.

For individuals seeking addiction treatment, two of the most common obstacles are ambivalence and the fear of making a personal change. Motivational interviewing is an evidence-based treatment that has been proven to be effective in treating addiction and has higher post-program abstinence rates. At the Genesis Recovery program, all clients are encouraged to reflect on where they are in comparison to where they want to be, and how their behavior is helping them work toward or away from their goals. Motivational interviewing activates intrinsic motivation and will encourage the client to take the steps toward recovery.

Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.) Chapter 3— Motivational Interviewing as a Counseling Style. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK