Essentially, the motivational interview (MI) is a technique that was designed to enhance intrinsic motivation to change. Though it was originally designed to aid with conflicting feelings about drinking, MI has been used with several populations and in different settings including the medical field. It works through exploring and settling ambivalence. This technique is client-centered and also directive. The focus is more on change versus resistance to change. Promoting natural change is a core component, so much of what will be explored will be generated from the client’s willingness to change. As a matter of fact, the goal of motivational interviewing is to energize and build on the client’s predisposition to change. Change is not built on the clinician instituting the shift with this style. MI assumes 5 things:
- Most clients who say they are motivated to change actually do change.
- Change occurs naturally.
- The best predictor of change is the confidence that comes from the client or therapist that change will occur.
- Change is influenced by communications with others.
- Expressing empathy is a way to promote change.
Although much of the focus is on change, ambivalence often stands in the way and must be reduced if deemed problematic. MI includes techniques to reduce ambivalence, such as highlighting the benefits of change and showing that change is possible (Lussier & Richard, 2007).
How Effective is Motivational Interviewing
Many professionals use MI as an adjunct to other approaches such as CBT. In fact, some research reports MI as a critical adjunct to CBT in treating patients with anxiety disorders, however, it is unlikely that MI alone will suffice. Many studies show promise that this technique may be beneficial for a range of clients experiencing anxiety. The research is not stable enough to confidently suggest that clinicians should routinely add it to the treatment of anxiety disorders (Randall & McNeil, 2017). Strong evidence suggests using MI with teens and adolescents is beneficial and improves treatment outcomes in medical and psychological settings (Reinauer et al., 2018). A study completed by Marker et al. (2020) showed that even small doses of MI improved treatment outcomes without lengthening treatment times.
Core Components of MI
Collaboration with the client is a core component of MI. The therapist should aim to be on the same level as the client versus having an authoritative style of therapy when engaging in MI. A high level of respect for the autonomy of clients is definitely needed in this style of counseling.
Professionals have to believe clients can and will do what they are aiming to do. This leads to the next component which is compassion. This can be accomplished by promoting their welfare and prioritizing their needs. Lastly, evoking the client’s own motivation is the icing on the cake. This part comes from the client instead the therapist establishing motivation for them. These components make up the style of MI. The foundation of integrating MI into practice includes engagement, focusing, evoking, and planning (Miller & Rollnick, 2013).
Clients that struggle with anxiety know the vicious cycle of being hijacked by those uncomfortable feelings. It is a familiar pattern and that can be why ambivalence to change presents itself. MI interviewing skills are extremely beneficial in these cases and are valuable as an overall therapeutic skill set that can be used when encountering ambivalence. William Miller and Stephen Rollnick, who created MI, have a highly rated text “Motivational Interviewing - Helping People Change”. You can check it out here Motivational Interviewing: Third Edition: Helping People Change (guilford.com) To learn more about using Motivational Interviewing visit this website to join us for Practical Use of Motivational Interviewing for Patients with Anxiety Webinar https://cbicenterforeducation.com/courses#list or call 724-609-5002 for more information.
Brittany Steiner, Pre-licensed Therapist
References
Lussier, T., & Richard C. (2007) The motivational interview: in practice. Can Fam Physician, 53(12):2117-8. PMID: 18077747; PMCID: PMC2231547.
Marker, I., Corbett, B., Drummond, S., & Norton, P. (2020). Intermittent Motivational Interviewing and Transdiagnostic CBT for Anxiety: A Randomized Controlled Trial. J Anxiety Disord, 75:102276. doi: 10.1016/j.janxdis.2020.102276. Epub 2020 Jul 31. PMID: 32768874.
Miller W, Rollnick S. Motivational Interviewing: Helping people change. 3. New York: The Guilford Press; 2013.
Randall, C., & McNeil, W. (2017). Motivational Interviewing as an Adjunct to Cognitive Behavior Therapy for Anxiety Disorders: A Critical Review of the Literature. Cogn Behav Pract, (3):296-311. doi: 10.1016/j.cbpra.2016.05.003. PMID: 28871216; PMCID: PMC5580948.
Reinauer, C., Viermann, R., Förtsch, K., Linderskamp, H., Warschburger, P., Holl, RW, Staab, D., Minden, K., Muche, R., Domhardt, M., Baumeister, H., Meissner, T. (2018). Motivational Interviewing as a tool to enhance access to mental health treatment in adolescents with chronic medical conditions and need for psychological support (COACH-MI): study protocol for a clusterrandomised controlled trial. Trials,19(1):629. doi: 10.1186/s13063-018-2997-5. PMID: 30428891; PMCID: PMC6236943.
