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What is Motivational Interviewing?

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Motivational interviewing is a method of psychological treatment founded by William R. Miller, Ph. D. It focuses on behavioral change, and is often used to treat substance abuse.

The four basic tenets of motivational interviewing are: establishing empathy with the patient; developing discrepancy; rolling with resistance; and supporting self-efficacy.

Motivational interviewing helps people to decide they need to change, and to find their own reasons for doing so, rather than their psychologist or counselor telling them they need to change. If they can link their recovery or behavioral change to something they care about, the change is more likely to happen. If a patient feels coerced, they may become defensive and decide to rebel against that control, but if they have chosen to change, they are much less likely to rebel against themselves. The therapist establishes empathy with the patient by putting him or herself in the patient’s shoes, and helping the patient find reasons to change within him or herself.

Motivational interviewing helps patients consider that their way of tackling a problem isn’t the only way to handle it; therapists explore different plans of attack, and help patients think differently about their problems. The issue of “discrepancy” is explored: the therapist helps patients to compare their lives at present to what they would like their lives to be in the future. The psychologist also encourages patients to look ahead and see what they could gain in their lives through making changes. Since change can be frightening, the motivational interviewer guides the patient and teaches him or her to value change:

In motivational interviewing, the psychologist helps patients explore their ambivalence about changing their behavior. Some psychologists view reluctance to change as an abnormal, or pathological, behavior, especially if the patient is refusing to change very destructive behaviors. Motivational interviewing accepts that patients will come to therapy with different levels of reluctance about changing their actions and thoughts: therapists are discouraged from chastising the patient for this reluctance. The level of ambivalence will also depend on how the patients came to counseling: if they were forced to come, either by law or by some other force in their life, they may be more reluctant; if they came voluntarily because they themselves had decided to seek treatment, they may be more willing to change.

The motivational interviewer supports the patient’s self-efficacy by remembering, and reminding the client, that he or she has the power to make these changes him or herself. The therapist’s role is to help the patient make the changes – not to try to make the changes for him or her. It’s important for the therapist to remember that even if the patient decides not to change, that is the patient’s decision, not the therapist’s failing.