Motivational Interviewing: A Counseling Style That Can Keep You Committed to Recovery

The Stages of MI

Like most treatment models, MI doesn’t proceed in a strictly linear fashion. But there are some key stages of MI that you’ll often experience when you’re receiving an MI intervention:

Engagement

The provider will first work to develop a trusting relationship with you. If you feel attacked or judged by your provider, then no intervention (including MI) is likely to work. MI practitioners will build engagement with you by using a collaborative approach, which includes reflective listening techniques.

Focusing

MI is designed to help patients make a change. To do that, you and your provider need to agree about what change you actually want to make. Focusing is a collaborative process in which you will decide on a goal together. You might have other goals that you want to work on, in addition to overcoming addiction, and these goals will always be honored.

Evoking

Evoking is at the heart of motivational interviewing. In this process, your MI provider will draw out change talk, or your reasons for wanting to quit using a substance. Evoking involves asking you questions and reflecting your answers back to you in a meaningful way. However, your provider won’t give you unsolicited advice or try to pressure you into a particular course of action.

Planning

Planning is the only stage of MI that’s optional, meaning you may or may not ever get here. In this stage, you collaborate with your provider to create a plan for how to maintain your commitment in the future. While some patients find this helpful, others prefer to create a plan without the provider’s help.

It’s important to note that there is a manualized version of MI, called Motivation Enhancement Therapy (MET). This is a more rigid version of MI, in which patients go through these stages in a more linear and orderly fashion.

Benefits of Motivational Interviewing

Like any treatment model, MI has both benefits and limitations. It’s not a miracle cure, and it’s not intended to be. But it can be a good fit for people who feel ambivalent about recovery. This framework has several noteworthy benefits:

• It saves time. MI is a time-limited, cost-effective intervention. Practitioners don’t typically need a lot of time to help people make changes. In fact, just one MI intervention before treatment has been found to improve engagement.⁸
• It works. Hundreds of studies have been published about the use of MI to treat substance use disorders. One literature review found that motivational interviewing is more effective than traditional advice-giving⁸ approximately 80% of the time.
• It can help you commit. Unlike most other treatments, MI helps patients resolve their indecisiveness about substance misuse. This may be especially helpful for patients who want to make a change, but are unsure of how to commit to that process.
• It increases your self-efficacy. MI helps you build the confidence you need to stay committed to recovery, rather than depending on outside sources.
• It respects your agency. MI is a good treatment option for people who don’t like being told what to do. MI practitioners respect your autonomy. They understand that pushing patients too hard isn’t likely to work, and it may even intensify your resistance to change.
• It helps you get in touch with your reason for recovering. Often, people in recovery never take the time to pinpoint their personal “why” of substance use recovery. They may have a vague notion that they “should” quit using drugs and alcohol, but sometimes, that isn’t enough to see them through. MI can help you to discover and remember your reasons for doing so.

Limitations of Motivational Interviewing

Like any intervention, MI also has some limitations. This model may not be a good fit for every person, and isn’t meant to be used as a treatment for every issue.

• Motivational interviewing is not a comprehensive psychotherapy model,⁹ so it’s not the right fit for every condition. For example, it may not be an appropriate way to approach depression or PTSD. However, research has found that MI may be an effective component of treatment for patients with dual diagnoses.¹⁰
• The effectiveness of motivational interviewing¹¹ depends on who delivers it. This isn’t unique to MI; the therapeutic relationship is key to the success of most mental health interventions. However, since people who aren’t licensed therapists can use MI, their levels of training and competency may differ more widely than it does in other models of psychotherapy. If you decide to pursue MI, you may want to consider working with a counselor that has been trained by a member of the Motivational Interviewing Network of Trainers (MINT).
• Motivational interviewing may or may not be an appropriate intervention¹² for every type of substance use disorder. For example, more research is needed into MI for people with a history of opiate or methamphetamine misuse. If you have an opiate or methamphetamine addiction, there are other treatments specifically designed for you that may be more effective.

Committing to Change with Motivational Interviewing

Motivational interviewing can be extremely helpful for some patients, but it’s just one aspect of recovery. Because this framework can be integrated with other treatment models, it may be a good fit for people with a wide variety of mental health concerns.

Remember that no intervention, including MI, is a quick fix for healing from addiction. While this approach may help you resolve ambivalence, it won’t resolve all the underlying reasons you began misusing substances. If you’re interested in pursuing MI, talk to your team of providers about whether it would fit with the other treatments you’re engaged in.

If this approach interests you, visit our directory of rehabs offering MI to browse centers near you and see photos, pricing, reviews, and more.

Reviewed by Rajnandini Rathod

1. Rollnick, S., & Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23(4), 325–334. https://doi.org/10.1017/S135246580001643X [↩]
2. Bein, T. H., Miller, W. R., & Boroughs, J. M. (1993). Motivational interviewing with alcohol outpatients. Behavioural and Cognitive Psychotherapy, 21(4), 347–356. https://doi.org/10.1017/S135246580001167X [↩]
3. Oveisi, S., Stein, L. A. R., Babaeepour, E., & Araban, M. (2020). The impact of motivational interviewing on relapse to substance use among women in Iran: A randomized clinical trial. BMC Psychiatry, 20(1), 157. https://doi.org/10.1186/s12888-020-02561-9 [↩]
4. Calomarde-Gómez, C., Jiménez-Fernández, B., Balcells-Oliveró, M., Gual, A., & López-Pelayo, H. (2021). Motivational interviewing for cannabis use disorders: A systematic review and meta-analysis. European Addiction Research, 27(6), 413–427. https://doi.org/10.1159/000515667 [↩]
5. Naar-King, S., Parsons, J. T., & Johnson, A. M. (2012). Motivational interviewing targeting risk reduction for people with hiv: A systematic review. Current HIV/AIDS Reports, 9(4), 335–343. https://doi.org/10.1007/s11904-012-0132-x [↩]
6. Carroll, K. M., Ball, S. A., Nich, C., Martino, S., Frankforter, T. L., Farentinos, C., Kunkel, L. E., Mikulich-Gilbertson, S. K., Morgenstern, J., Obert, J. L., Polcin, D., Snead, N., & Woody, G. E. (2006). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study. Drug and Alcohol Dependence, 81(3), 301–312. https://doi.org/10.1016/j.drugalcdep.2005.08.002 [↩]
7. Barnett, E., Sussman, S., Smith, C., Rohrbach, L. A., & Spruijt-Metz, D. (2012). Motivational Interviewing for adolescent substance use: A review of the literature. Addictive Behaviors, 37(12), 1325–1334. https://doi.org/10.1016/j.addbeh.2012.07.001 [↩]
8. Rubak, S., Sandbæk, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A systematic review and meta-analysis. The British Journal of General Practice, 55(513), 305–312. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463134/ [↩] [↩]
9. Miller, W. R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37(2), 129–140. https://doi.org/10.1017/S1352465809005128 [↩]
10. Moore, M., Flamez, B., & Szirony, G. M. (2018). Motivational interviewing and dual diagnosis clients: Enhancing self-efficacy and treatment completion. Journal of Substance Use, 23(3), 247–253. https://doi.org/10.1080/14659891.2017.1388856 [↩]
11. Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. The American Psychologist, 64(6), 527–537. https://doi.org/10.1037/a0016830 [↩]
12. DiClemente, C. C., Corno, C. M., Graydon, M. M., Wiprovnick, A. E., & Knoblach, D. J. (2017). Motivational interviewing, enhancement, and brief interventions over the last decade: A review of reviews of efficacy and effectiveness. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 31(8), 862–887. https://doi.org/10.1037/adb0000318 [↩]