Motivational Interviewing

For people with addictions, counseling sessions and doctors’ appointments can resemble lectures. Each time they walk into the treatment area, they’re provided with a long list of tasks they should complete, along with a series of numbers and figures that demonstrate how much better their lives would be if they would make a few key changes. Unfortunately, many people just don’t respond to lectures and facts and figures. When they’re told to do something, they simply turn off and shut down. For them, change really needs to come from within, stemming from an innate desire to do something different. Motivational interviewing (MI) is designed to provide people with that impetus to change. In this conversational therapy, people learn how to make small steps that add up to big changes, and they move at a pace that seems comfortable to them.

Starting With the Client

motivational interviewingA person who walks into an inaugural MI session might be surprised to learn that the therapist has no goals and no set timeline for treatment. In fact, the MI therapist might not do much talking at all in the early sessions. Instead, the therapist might spend a significant amount of time trying to determine how the client feels and what the client wants. In a way, the treatment might seem more like a deep talk one might have with a close friend, rather than a speech coming from an expert.

The tone of motivational interviewing is so gentle, in part, because the therapy is designed to allow treatment professionals to assess their clients carefully and look for tiny indications that might signal that the person is both ready and willing to change. As the Substance Abuse and Mental Health Services Administration puts it, “This approach accepts a person’s level of motivation — whatever it is — as the starting point for change.” The therapist doesn’t dictate how the person should live or grow or change. All of the goals, and the pace of the therapy, come from the person in treatment.

Gentle Questions

There are a variety of methods therapists can use in order to spot a motivation to change in the person they’re treating. Often, in motivational interviewing sessions, those methods involve open-ended questions. Instead of lecturing the person or providing the person with outside reasons that might indicate that change would be helpful, the therapist attempts to draw the person out and really listen to what the person might say. Common techniques for questions, according to experts Dr. Linda Sobell and Dr. Mark Sobell, include:

  • Asking permission. “Can we discuss this?” is a good example of a question that opens up the conversation.
  • Evoking change. “Why do you think that change might be good for you?” could be a good question for almost anyone. Those with difficulties concerning change might need slightly more forceful questions, such as, “If you decided to change tomorrow, what are two things you’d have to do right away?”
  • Looking forward. Those who don’t want to change at all might be motivated with a question such as, “What happens if you never change? Will your life improve or not?”
  • Open-ended questions. Queries that can’t be answered with monosyllabic words can allow the conversation to flow. Good examples include, “Why did you come to therapy today?” and “How did this begin?”

Other Approaches

Not all of therapy involves asking questions and jumping from topic to topic. In fact, there are a variety of other techniques mental health professionals can use in a motivational interviewing session. Sometimes, for example, therapists might use active listening techniques, repeating the concepts a client uses in a slightly different way. Therapists might also work hard to validate the feelings and thoughts of their clients by reassuring them that their feelings are part of the spectrum of behaviors experts might consider reasonable and normal for people who are preparing to do something so extraordinary and difficult.

Some clients are remarkably resistant to the idea of change, no matter what phrases their therapists might try, and these clients might benefit from approaches in which the therapist juxtaposes a goal the client has and the behaviors that might stand in the way of reaching that goal. Reminding clients that their behavior isn’t really helping them to succeed in life could help them to see that change really should be a part of their future.

Encouraging Small Steps

Some people find change so difficult because they envision the hundreds of thousands of ways in which they need to amend almost everything about their lives. They can’t see how change starts with just one little step forward, but motivational interviewing can help them to do just that. Clients might be encouraged to take one fewer drink per week, for example, or they might be encouraged to think about how they might transition from one drug to another as a first step toward sobriety. Often, these little modifications take place in quick MI therapy that’s held in just one or two sessions. Research suggests that this kind of therapy can be remarkably helpful for people with addictions.

In a study in the journal Addiction, researchers found that people given just one MI session were able to moderate their use of drugs such as cannabis and alcohol, and those changes were still present three months later. Just one little conversation about drugs had the power to help people to amend their lives in such a transformative way, and make changes that had the power to stick. Sometimes, the conversations had such resonance that people were able to do yet more in the months that followed. For example, in a study in the journal Substance Use and Misuse, researchers found that people who had MI therapy tended to transition into a new phase of their addiction, using phrases that are similar to those who are getting ready to change their lives for good. The therapy seemed to put them on the right track, as it were, and provide them with a foundation they can build upon as they continue to fight their addictions.

Some families use motivational interviewing as a follow-up to an intervention. These families may be dealing with a person who simply will not enter a formal treatment program for addiction, but they might know that leaving things as they are means leaving their loved one exposed to the severe dangers that an ongoing addiction can cause. By enrolling the person in a few sessions of MI, they may help that person to stop some of the most egregious behaviors associated with addiction, and in time, that person might stop using altogether. Even just one small step might be right for these people, leading to more revolutionary changes down the line.

Making Big Changes

While small steps might be enough for some addicted people and their families, there are some people who have such difficulties with their addiction and such impairments in their function that they need to make big changes, and they need to start that process right now. Motivational interviewing might be helpful for these people as well. In their therapy sessions, they might develop a deeper commitment to the healing process, and they might become yet more interested in participating in therapy and sticking with their aftercare regimen when their treatment programs are complete. These people might walk into their treatment programs because a person they love gave them a push, but they might walk out of their programs with a newfound respect for the healing that can come with change, all because of their MI sessions.

Performing studies on this sort of benefit is difficult, as people who have MI sessions for addiction tend to have other treatments taking place at the same time. The benefits they get from one sort of treatment program might be difficult to separate from the benefits they might get from a different type of therapy. The lines can bleed, blend and blur just a little, when so much is being done to fight the problem. Even so, the studies that have been done do suggest that people who get MI as a part of their treatment programs have the remarkable ability to make real changes and take their therapies to heart.

For example, in a study in the Journal of Consulting and Clinical Psychology, researchers suggest that a 56-percent reduction in client drinking and a 51-percent improvement overall could be directly attributed to MI. These clients may have transitioned to more intensive therapies when their MI was complete, and they may have found that the MI just helped to make that subsequent therapy a little easier to commit to.

Finding a Balance

Motivational interviewing can be a good therapy for people who need to change but can’t see how to make it happen, but it isn’t the right therapy for everyone. Some people find that the treatment doesn’t push them hard enough, and they can slide right back into dysfunction as a result, while others find that the treatment makes them examine their lives too closely, and that examination makes them uncomfortable. In general, however, it is considered a useful way to start someone on the road to wellness, and for people with addictions, it might be one of the best therapies they receive.

If you’d like to know more about how we incorporate motivational interviewing concepts into the treatments we provide at Axis, just call. We’re happy to outline our treatments for you, and discuss how you might heal with the help of this gentle form of therapy. We can even start the enrollment process over the phone. Just call to get started.