Practice Goals
Motivational Interviewing (MI) is a brief client-centered, semidirective psychological treatment approach that concentrates on improving and strengthening individuals’ motivations to change. MI aims to increase an individual’s perspective on the importance of change. When provided to those who abuse substances, the long-term goal is to help them reduce or stop using drugs and alcohol.
Target Population
MI targets individuals who are less motivated or ready to change, and who may show more anger or opposition. MI can target a wide range of problem behaviors, such as smoking, gambling, or eating disorders. But it was originally developed to change substance abuse behaviors (Dunn, Deroo, and Rivara 2001). Substance abuse generally refers to the overindulgence in and dependence on a drug or other substance (such as alcohol) that leads to detrimental effects on an individual’s physical and mental health or the welfare of others (Smedslund et al. 2011). MI can target substance abusers who may be ambivalent about changing their behavior.
Practice Theory
The practice involves a form of supportive and empathic counseling style put forth by Rogers (1951). He described a client-centered counseling approach that takes a specific form of reflective listening (or accurate empathy), which is one of the basic principles of MI (discussed below) [Burke, Arkowitz, and Menchola 2003]. Miller and Rollnick (1991) developed the foundation of MI as a way to help people work through their ambivalence about changing their problem behavior, to increase their motivation and commitment to change.
Practice Components
MI is a brief intervention. The substance abuser and the MI counselor will typically meet from one to four times, for about 1 hour each session. The settings of delivery can vary and consist of aftercare/outpatient clinics, inpatient facilities, correctional facilities, halfway houses, and other community-based settings.
MI incorporates four basic principles into treatment: 1) expressing empathy, 2) developing discrepancy, 3) rolling with resistance, and 4) developing self-efficacy.
Expressing empathy takes a form of reflective listening in MI (Rogers 1951). Part of this principle consists of viewing an individual’s reluctance to change as a normal part of the human process, rather than as a mode of defensiveness (Smedslund et al. 2011).
With the second principle, developing discrepancy, the MI counselor works to help an individual understand the discrepancy between where he or she is and where that individual wishes to be. Individuals are guided by specific types of questions to help them examine and recognize the discrepancies between their current problem behaviors and future goals, to become motivated to make important life changes.
The third principle, rolling with resistance, guides the MI counselor to not oppose an individual’s resistance to change, but to accept and flow with it, using reflective listening skills (Burke, Arkowitz, and Menchola 2003). The counselor doesn’t challenge the resistance but further explores an individual’s views on change.
Finally, an essential part of MI is developing an individual’s self-efficacy. This involves enhancing the person’s ability to handle obstacles and succeed in changing (Burke, Arkowitz, and Menchola 2003).
MI can be delivered as a standalone intervention or as a prelude to another type of treatment. However, MI is usually not delivered alone; it is typically combined with feedback or other forms of treatment (Hettema, Steele, and Miller 2005). For example, adaptations of motivational interviewing (AMIs) combine the clinical method of MI with other intervention components. AMIs incorporate the core principles of MI with additional non–Motivational Interviewing techniques, such as feedback. Feedback, often provided to substance abusers, is provided based on an individual’s results from a standardized assessment tool, such as the Drinker’s Check-Up. Feedback focuses on the severity level of the individual’s problem behavior (i.e., alcohol or drug use) compared with norms, and is delivered in a style of MI that elicits possibilities for change in a nonthreatening manner (Burke, Arkowitz, and Menchola 2003).
