Motivational Interviewing

Motivational interviewing is a style of counselling that focuses on helping the individual explore and resolve ambivalence about change. The patient’s own reasons for change are elicited and used to motivate movement towards action and drinking reduction. Motivational interviewing is directive in that it guides the patient towards resolution of ambivalence and towards change. The term ‘interviewing’ was chosen to reflect the therapist’s enquiring, non-confrontational approach. The therapist is not viewed as an expert but rather as a facilitator. 

Motivational interviewing is effective and should be used as a first-line treatment to address patient ambivalence toward drinking reduction, or as an adjunct to other treatment modalities for alcohol dependence. As a stand-alone treatment to reduce drinking, it is effective in the short-term and in patients with less severe dependence. The principles underpinning Motivational Interviewing are: 

• collaboration – the therapist and patient pursue change together; there is no coercion, rather facilitation of exploration and discovery 
• evocation – the patient is believed to possess the intrinsic goals and resources for change, which the therapist elicits 
• autonomy – the therapist respects the patient’s right and capacity for self-direction and facilitates informed choice. 

The guiding concepts of Motivational Interviewing are: 

Express empathy 

In expressing empathy, the therapist listens non-judgmentally and conveys acceptance of the patient. Reluctance to change problematic behaviour is viewed as an understandable and normal part of human experience. The basic premises are that acceptance facilitates change, skillful reflective listening is fundamental, and ambivalence is normal. 

Develop discrepancy 

Discrepancy and tension is created empathically between the patient’s present behaviour and their broader goals and values. This requires an exploration and understanding of the patient’s goals and values as well as an understanding of their current concerns. A discrepancy between these two sets of circumstances will reflect the importance of change to the patient. If change is important, then eliciting reasons for change should not be difficult. If change is not important to the patient, behaviour change may be difficult to achieve and maintain. 

Managing resistance 

Resistance in Motivational Interviewing is viewed as an interpersonal phenomenon between patient and therapist. The therapist avoids argument. A resistant response from the patient is a sign that the therapist’s style may be too confronting or insistent and that a different approach is needed. Engagement with resistance is expected to increase resistance. New perspectives are invited but not imposed. The patient is viewed as the source of new answers and solutions. The therapist’s role is to facilitate exploration of options. Recent theoretical revisions deconstruct "resistance" into sustain talk (speech favouring no change) and discord in the counselling relationship (e.g., arguing, interrupting), preferring the use of these more precise terms.

Support self-efficacy 

Self-efficacy refers to a person’s belief in their ability to carry out and succeed with a specific task. Self-efficacy is a key element in motivation for change and is a good predictor of change.