Motivational Interviewing

When people are on the fence about changing behavior, motivational interviewing can help them in their decision-making. Often used by mental health professionals, this technique empowers people to make choices that are best for them. The strategy works well with family members, too, and has been found to create positive results—especially when combined with recovery coaching, which can make the results even more effective.At Ria, our coaches recognize that fact, and are experienced with this technique. Motivational interviewing is one of the many strategies we use to help our members achieve lasting change in their relationship to alcohol.

Learn more about our coaching program.

What Is Motivational Interviewing?

Motivational interviewing (MI) was developed by William R. Miller and Stephen Rollnick in 1991, and explained in their book, Motivational Interviewing: Preparing People to Change Addictive Behavior. (They later revised the book in 2002, and the latest edition, published by Guilford Press in 2013, is titled Motivational Interviewing: Helping People Change.)

Miller and Rollnick derived their philosophy from work by psychologist Carl Rogers and his humanistic, person-centered approach, which puts the client in the driver’s seat. Similarly, MI meets people “where they are at” in the process of their recovery and uses strategies to build motivation to move to the next step. Here are the five “stages of change”:

Stages of change:

1. Pre-contemplation: They do not recognize that there is a problem. 
2. Contemplation: They know there is a problem, but they are unsure if they want to address it. 
3. Preparation: They have decided to address the problem and are making plans for how to do so. 
4. Action: They are actively implementing change. 
5. Maintenance: They have successfully replaced the old behavior with the new behavior.

MI is heavily used when people are in the pre-contemplative and contemplation stages of change. An experienced MI professional can help people build awareness of the negative impact of their behaviors and overcome the ambivalence they have about change. During recovery, ambivalence can sometimes return. It’s normal for people to switch back and forth between these five stages, rather than progressing through them in order.

How Motivational Interviewing Works: The Basic Principles

The practice of MI is guided by four basic principles:

1. Collaboration. This principle values the client as an expert on themselves, with the therapist there to help guide and empower; the therapist and the client are on equal playing fields. They work together to actually define recovery itself, and identify goals.
2. Evocation. The client is in charge of recovery, and the therapist is alongside, guiding them. The therapist uses OARS (explained below) to empower the client to think about their situation on a deeper level. If a client is thinking more about change, their words will emanate increased desire, ability, reasons, or needs.
3. Acceptance. When people aren’t addressing their behavior, being confronted by someone overly insistent—telling them what they should or need to do—may backfire. Instead, people respond more positively when they are accepted for the person they are right now, including their current decision to maintain the status quo. They may not stay static forever, but may need a little extra time to think about the act of changing, and what that will mean.
4. Compassion. For most humans to feel safe in exploring their ambivalence, they need to feel cared for. Being compassionate is important in making them feel heard and understood. 

These principles are crucial when trying to empower others to identify decisions that will be helpful. Studies have found that therapists who ignore MI principles don’t have the same success in effecting change among their clients. At Ria, we employ these principles as part of our holistic approach.

How and When MI is Useful in Recovery

MI is useful throughout the entire recovery process. As mentioned earlier, people typically move up and down the stages of change, and ambivalence about transformation can come and go. Here are some other times when motivational interviewing is useful: 

• When people have low confidence that they have the right tools 
• When they don’t have the desire to modify their behavior
• When the process itself is low on their priority list

In these situations, MI can be useful because it empowers people to think about their issues on a deeper level than they normally might. 

Sometimes, people are not happy with their current status, but barriers prevent considering something different. MI can help them identify those barriers and realize that getting to the other side is possible. Once they see it’s possible to live a different way, their desire and confidence often go up.

Motivational Interviewing in Addiction Coaching

How does this all look put together when it’s used by coaches? 

It may sound complicated starting out—as if coaches (or therapists) need to remember dozens of things at once in order to help an individual. But motivational interviewing represents a shift in the way we think about clients. Typically, when people want to encourage new behavior, they try reasoning and logic—telling clients what could happen if they don’t change. But usually people don’t respond to this approach, because they have already been told these things, repeatedly, by others. 

Fear, shame, and doubt are some of the mental barriers that make it difficult to think about living differently. A good addiction coach uses MI principles to empower the person to explore what their life would look like, both with and without that change. These techniques encourage the individual to look at their situation more broadly—to figure out how to overcome those barriers so they can make better decisions.

In practice, these techniques appear much like a conversation between two people. At the most general level, MI is a conversation in which the coach (or therapist) keeps an open mind toward the client and listens to their unique story. MI encourages exploration of ambivalence in a safe space, free of judgment. 

How MI Can Be Useful with Your Loved Ones

There are specific techniques that therapists and counselors use when implementing MI that can also be used with loved ones. Adopting boating terminology, these are known as the OARS: 

• Open-ended questions. Some questions require more than a yes or no answer. They tend to start with “why,” “how,” or “what.” Asking open-ended questions is helpful in getting someone to give more detail, and encourage them to guide the conversation. 
• Affirmations. Sometimes clients (especially in addiction) feel like nothing they do is right. Everyone around them is complaining, and this can be draining. Using affirmations points out their strengths, and helps empower them. 
• Reflections. Reflections can be delivered in one of two ways. The simpler version reflects back what was said. For example, “I don’t know what my life would be like without alcohol” might cause a mirror response, “You can’t see your life without alcohol.” The second is slightly more complicated, but equally helpful: finding meaning in what was said. For the same statement, one might reply, “It’s scary to think about giving up alcohol because it’s all you’ve known for years.”
• Summarize. Similar to reflections, summaries are used to transition from one topic to the next, to keep track of what you’ve talked about so far. Staying focused is important. 

When someone requires change, they are likely already aware of it, to some degree. From their perspective, something is acting as a barrier to making that leap. The Ria Health coaching team is experienced in using MI as a part of each member’s unique plan. The goal is to offer them a safe space, free of judgment—to encourage people to think about these barriers, and imagine a different way of living.

Have questions about online alcohol treatment?

Schedule an Appointment

or call (800) 504-5360