Motivational Interviewing: What It Is, How It Works, and Techniques Used

Is there a change you want or need to make in your life, but you’re not sure if you can do it? You might not feel ready. Maybe you have mixed feelings about making the change. Or maybe you’re not sure how to even start.

Motivational interviewing may offer an effective way to work on making changes. This evidence-based approach to encouraging behavior changes may help you reach within yourself and find the motivation needed to make changes. 

Below, we’ll explore what motivational interviewing entails, how it works, and why it’s so effective.

What is motivational interviewing?

William Miller and Stephen Rollnick developed motivational interviewing in the 1980s as a treatment for alcohol addiction. Today, it’s used for many other purposes that also focus on making positive life changes. 

Change can be scary, and the thought of making changes can feel overwhelming. In some cases, you may know that making a change is what’s best for you, but you might not have a strong desire to do it. Motivational interviewing isn’t about having someone else tell you what you should do or how to do it. Rather, it’s about helping you feel empowered and motivated to make changes to improve your life. 

What is motivational interviewing used for?

Motivational interviewing is used to help people find motivation to make necessary or beneficial changes for a healthier or more fulfilling life. It’s meant to help you if you feel unprepared, unmotivated, or even angry about making changes. It may also help prepare you for other forms of psychotherapy or behavioral therapy.

Some specific uses for motivational interviewing include:

• Eating a healthier diet 
• Following a treatment plan for a chronic condition like diabetes, cancer, or heart disease 
• Getting regular physical activity 
• Giving up smoking 
• Losing weight 
• Taking medication
• Treating anxiety disorders when combined with cognitive behavioral therapy (CBT)
• Treating substance use disorders

The four processes of motivational interviewing 

Motivational interviewing is a collaborative process overall. It’s made up of four processes that help guide you toward finding and strengthening your motivation. Below, we’ll explore these processes. 

1. Engaging 

In general, therapy is most effective when therapists and clients have a good relationship. The engaging process in motivational interviewing focuses on building rapport and a trusting relationship between you and your therapist. 

This involves your therapist listening to you and showing empathy. During this process, your provider works on understanding all aspects of your situation, but they don't step in to try and “fix” it for you.

2. Focusing 

The focusing process helps you identify areas you have mixed feelings about. Your therapist might ask you what’s important to you or help you set an agenda. They may also ask you to think about current behaviors that may be stopping you from achieving your goals.

This process helps clarify the direction of change. It also helps you identify and concentrate on specific goals. Keep in mind that there’s no set timeframe for the focusing process. Everyone is different; it may take several sessions for you to be able to do this, and that’s okay. Do your best to have patience with yourself during any therapeutic process — and motivational interviewing is no exception.

3. Evoking 

Once you have your goals in mind, it’s time to work on your motivation. The evoking process is a critical phase in motivational interviewing. This process involves your therapist drawing out your motivations for change rather than giving you advice or instructions. 

During the evoking process, you’ll explore your own reasons for making changes to your behavior. You’ll also discuss the desired outcomes of these changes. For example, your personal reason to quit smoking might be that you lost a loved one who smoked to lung cancer. The desired outcome for you is lowering your risk of also getting this illness.

4. Planning 

When you’ve found motivation from within, you’ll be ready to focus on finding ways to make changes. This is the final step in these stages of change. During the planning process, you and your therapist will think of actionable steps and strategies you can take to achieve your goals.

For example, let’s say you’re motivated to recover from a substance use disorder. Your actionable steps and strategies might include going through an addiction recovery program, joining a support group, or moving on to another form of therapy, like CBT.

Techniques used in motivational interviewing 

Motivational interviewing involves the use of certain techniques. However, keep in mind that therapists may adapt these techniques to better fit their clients’ situations. Your experience in session might differ in terms of how techniques are used, depending on your therapist’s approach. 

In the following sections, we’ll review the techniques most commonly used in motivational interviewing.

OARS framework 

The acronym OARS (open questions, affirmation, reflections, summarizing) aims to help you and your therapist establish a therapeutic relationship. This is done using the following methods. 

Open questions 

Your therapist asks you open-ended questions that allow you to do most of the talking. This helps them learn more about you, including your goals and concerns. If you want to lose weight, for example, you might be asked what concerns you have about your weight rather than simply whether or not you’re concerned about your weight. 

Affirmation 

Your therapist shows that they understand what you’re experiencing. They might compliment you or let you know that they appreciate you sharing your thoughts with them. Affirmations may support you and validate your thoughts and experiences. For example, your therapist might thank you for talking about your substance use.

Reflections 

Your therapist does most of the talking with this method. This involves rephrasing or paraphrasing what you’ve said to help you understand your motivations better and reinforce your desire to make changes. 

Reflections might also encourage you to keep exploring your personal thoughts on changing your behavior. For example, your therapist might rephrase the reasons you’ve given for wanting to control diabetes better, like lowering the risk of health complications or feeling healthier overall.

Summarizing 

Your therapist checks in with you to make sure you both understand the discussions you’ve been having. This lets you know that they understand your perspective. Your therapist might also mention differences or discrepancies between your goals and your current situation. For example, they might review your concerns about giving up smoking and ask for your feedback on this summary.

RULE framework 

Motivational interviewing may be a lengthy process, which could make it difficult to do if you have limited sessions. The RULE framework from Miller and Rollnick helps simplify it with guiding principles for therapists to follow:

• Resist the righting reflex: Avoid trying to “fix” or correct clients. 
• Understand the patient’s own motivations: Focus on the client’s motivations to change behavior. 
• Listen with empathy: Use good listening skills, like reflective listening, to understand the client’s perspective. 
• Empower the patient: Give clients space to think about how they can make changes and what has worked for them in the past. 

Change talk 

Talking about change may make you more likely to follow through. This is the basis behind the use of change talk in motivational interviewing. These statements include preparatory change talk and implementing change talk. Your therapist will elicit change talk or guide you toward using these kinds of statements during sessions. 

Examples of preparatory change talk include “I want to change” and “I can change.” Examples of implementing change talk include “I’m taking actions to change” and “I will make changes.” 

Scaling questions 

Your therapist may use scaling questions to assess your perception of your goals, motivation for change, or other aspects of counseling. This involves asking you to rate different aspects, like your priorities, treatment progress, or coping strategies. This gives your therapist more insight into your readiness to make changes. 

Benefits of motivational interviewing 

Motivational interviewing has been used successfully for decades thanks in part to its many potential benefits:

Increases motivation for change 

This approach may enhance your desire to make positive changes in your life. Let’s say you know you drink too much alcohol, and it’s having several undesirable effects on your life. But you’re having trouble getting motivated to change. It seems too hard, or you think you’re bound to fail.

Motivational interviewing helps you explore the reasons why you should change your drinking behavior. It helps you understand why you’ve been struggling with the idea of change. It ultimately helps you find intrinsic motivation to make those life-improving changes. 

Reduces resistance to change 

When you know you should make certain changes in your life, you might be reluctant to do so. You might be skeptical that you’ll be able to make those changes — or doubt that it will really improve your life. Motivational interviewing offers a great way to help you overcome this resistance to change. 

Your therapist may use a technique known as “rolling with resistance.” This involves avoiding confronting you directly about this resistance. Instead, they’ll listen to you, express empathy, and encourage you to think of possible solutions. This may help reduce your reluctance or skepticism toward change. 

Improves self-efficacy 

Your chance of changing your behavior increases when you believe in yourself and your ability to achieve your goals. Motivational interviewing helps boost and support self-efficacy. Your journey toward finding motivation from within helps you gain the confidence needed to start making changes. 

Research supports this. A 2021 review and meta-analysis finds that motivational interviewing helps increase self-efficacy in patients with chronic heart failure, leading to better self-care. 

Respects client autonomy 

As a person-centered therapeutic style, motivational interviewing helps you maintain and strengthen your sense of autonomy. It also encourages and supports self-direction during the change process. Instead of having a therapist tell you why you should change and how to change, you can motivate yourself to change your behavior and achieve your goals. 

Connect with a therapist for your needs with SonderMind 

If you’ve been having difficulty making a behavior change, motivational interviewing might help. Change can be challenging, but you don’t have to navigate it on your own. A therapist can provide the support and understanding needed to help you self-reflect and feel empowered to make positive changes.

SonderMind’s network of experienced therapists can help you make the changes you want to see in your life. Connect with a therapist through SonderMind to start your journey toward better well-being.