Understanding Motivational Interviewing Techniques, Motivational Interviewing Questions & OARS Motivational Interviewing

Motivational interviewing (MI) is a process where medical professionals work together with their patients for a certain therapeutic outcome. A variety of skills and tools are utilized based on the stage of change the patient is at, working with the individual's internal motivations for behavioral change. Continue to read more about motivational interviewing for addiction and mental health treatment.

By We Level Up | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: June 20, 2023

What is Motivational Interviewing?

We Level Up Treatment Centers offer Motivational interviewing at select locations. Motivational interviewing (MI) is a counseling approach to motivate clients to change destructive behaviors. MI was first described by Professor William R. Miller, Ph.D., in an issue of Behavioral Psychotherapy in 1983. Call to learn about the We Level Up Motivational Interviewing program availability. Motivational Interviewing facilities and treatment are subject to change.

This technique is often used for substance use disorders as a lack of motivation to quit can be one of the most significant barriers for individuals struggling with addiction, despite health issues and financial, social, and legal consequences.

The thought behind motivational interviewing is that all individuals dealing with substance use are at least partially aware of the negative consequences of addiction. Each individual is also currently in a particular stage of readiness when changing their behavior. The MI therapist facilitates getting “ready to change” by overcoming ambivalence or a fear of change, increasing the client’s motivation.

What is Motivational Interviewing Used For?

Motivational interviewing is used for various purposes and can be applied to various behavioral changes and challenges. Some common areas where MI is utilized include the following:

  • Addiction treatment.
  • Health behavior change.
  • Mental health.
  • Chronic disease management.
  • Risky behaviors.
  • Counseling and coaching.

Overall, motivational interviewing is a versatile approach that can be applied across numerous domains to facilitate behavior change, increase motivation, and support individuals in reaching their desired recovery outcomes.

Motivational Interviewing Stages of Change

Motivational Interviewing aligns with the Stages of Change model, also known as the Transtheoretical Model of Change. This model recognizes that individuals go through different stages when contemplating and making behavioral changes. The stages of change motivational interviewing framework include the following:

StagesChange Process
PrecontemplationIn this stage, individuals are not yet aware of or do not acknowledge a problem or a need for change. They may be resistant to considering change and often exhibit a lack of motivation or readiness to take action.
ContemplationIndividuals start to recognize a problem and consider the possibility of change. They may have mixed feelings and experience ambivalence about making the change. They are more open to discussing the pros and cons of change and exploring their options.
PreparationThey may gather information, seek support, or set goals and action plans. They are getting ready to take the necessary steps to initiate change.
ActionThe action stage is characterized by individuals actively engaging in specific behaviors and strategies to bring about change. They implement their action plans and make noticeable modifications to their behavior, environment, or circumstances. This stage requires effort and commitment to sustain the new behavior.
MaintenanceIndividuals have successfully made the desired changes and are working to sustain those changes over time. This stage involves ongoing self-monitoring, coping strategies, and support systems to maintain progress.
Possible RelapseIt refers to a return to old patterns of behavior after making progress. Relapse can be seen as an opportunity for learning and reassessment, where individuals can reengage in the change process.
Relapse is not a linear stage in the MI model but a recognized possibility throughout the change process.

Individuals may cycle through these stages multiple times before achieving lasting change. Motivational interviewing recognizes and respects the individual’s stage of change, tailoring interventions and strategies to facilitate progress and support successful behavior change.

Effectiveness of Motivational Interviewing for Addiction Treatment

This counseling method appears to be especially effective for alcohol addiction, likely because it’s easier to be ambivalent about the use of legal substances due to greater social acceptance than there is about the use of illicit drugs. According to an analysis of studies published in the Journal of Clinical Psychology, MI is up to 20 percent more effective than other treatment methods for alcohol addiction.

Motivational interviewing helps you overcome addiction and equips you with essential life skills and relapse prevention techniques. It empowers you to navigate challenges, manage stress, and make healthier choices, valuable skills applicable to various areas of your life.
Motivational interviewing helps you overcome addiction and equips you with essential life skills and relapse prevention techniques. It empowers you to navigate challenges, manage stress, and make healthier choices, valuable skills applicable to various areas of your life.

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Top 5 Motivational Interviewing Principles

What are the 5 principles of motivational interviewing? The top 5 principles of Motivational Interviewing (MI) are the following:

  1. Expressing Empathy: MI emphasizes the importance of empathy in the therapeutic relationship. The therapist strives to understand the client’s perspective, show empathy, and create a non-judgmental and supportive environment. This helps build trust, fosters a collaborative relationship, and encourages open communication.
  2. Developing Discrepancy: MI focuses on helping individuals recognize the discrepancy between their current behavior and their desired goals or values. The therapist guides the client to explore and amplify this discrepancy, highlighting the negative consequences of their current behavior and the positive aspects of change. This discrepancy helps motivate the client toward behavior change.
The motivational interviewing therapist helps individuals feel validated and understood, which can increase their motivation to make positive changes in their addictive behaviors. It creates a space where individuals feel safe to discuss their challenges and explore potential solutions openly.
The motivational interviewing therapist helps individuals feel validated and understood, which can increase their motivation to make positive changes in their addictive behaviors. It creates a space where individuals feel safe to discuss their challenges and explore potential solutions openly.
  1. Rolling with Resistance: MI therapists aim to “roll with” resistance rather than engage in confrontation or argumentation. They accept and explore the client’s resistance without forcing or persuading change. By acknowledging and understanding resistance, the therapist can maintain a collaborative and non-confrontational stance, reducing defensiveness and facilitating the exploration of ambivalence.
  2. Supporting Self-Efficacy: MI emphasizes the belief in an individual’s capacity for change and self-efficacy. The therapist supports and reinforces the client’s confidence in their ability to make and sustain behavior change. This involves highlighting the client’s strengths, successes, and resources and encouraging them to identify and utilize their solutions and strategies.
  3. Engaging in Collaborative Conversation: MI is a collaborative approach where the therapist and client engage in an open and respectful dialogue. The therapist actively listens, asks open-ended questions, and reflects on the client’s statements, promoting deeper exploration and understanding. The focus is on eliciting the client’s thoughts, values, and goals related to change rather than imposing the therapist’s agenda.

Motivational Interview Questions Fact Sheet

Motivational Interviewing Definition

What is a motivational interview? Motivational Interviewing (MI) is a collaborative, person-centered therapeutic approach to enhance motivation and facilitate behavior change. It is rooted in the belief that individuals have the inherent capacity for change and autonomy in making decisions about their own lives. MI is characterized by its empathetic and non-judgmental stance, where the therapist actively listens and supports the client’s self-exploration.

The goal of MI is to evoke and strengthen the individual’s intrinsic motivation to make positive changes in their behaviors, beliefs, or attitudes. It recognizes that ambivalence is a natural part of the change process and seeks to resolve it by exploring and amplifying the client’s motivations for change.

MI employs various techniques, including open-ended questions, reflective listening, affirmation, and summarizing, to facilitate a collaborative conversation and elicit “change talk” from the client. Change talk refers to statements the client makes that indicate their desire, ability, reasons, and need for change.

Motivational Interviewing Book

“Motivational Interviewing: Helping People Change” is a renowned book by William R. Miller and Stephen Rollnick. This seminal work introduces and explores the concepts, principles, and techniques of Motivational Interviewing.

William R. Miller, author of the book motivational interviewing.
William R. Miller, author of the book motivational interviewing.

Examples of Motivational Interviewing

Below is an example of a motivational interviewing therapist with a patient struggling with liver health issues and alcohol drinking.

One of the core principles of Motivational Interviewing (MI) in addiction therapy is the non-judgmental stance taken by the therapist. MI therapists strive to create a safe and accepting environment where individuals feel comfortable discussing their addiction-related issues without fear of judgment or criticism.

Clinician: “We took a blood sample at your last appointment, and I would like to discuss the findings with you. Your values are normal—only one liver enzyme value is elevated. You can see here your gamma-GT is 220; a normal value would be 66 at the most. The gamma-GT level generally rises when, over a long period, one drinks more alcohol than the liver can break down. How does that sound to you?”

Patient: “I can’t imagine that; I don’t drink that much. Okay, sometimes when I’m under a lot of stress at work, I’ll have a few more beers in the evening than usual, but otherwise, I have my after-work beer and never any hard stuff.”

Clinician: “So this surprises you….”

Patient: “Yes, of course; I don’t drink that much. I mean, I hardly ever get drunk.”

Clinician: “Overall, you’ve got your drinking well under control; you only really drink a bit more when you’re under a lot of stress.”

Patient: “Of course, I’ll admit that now and again, I need something in the evening to switch off. But I can’t imagine my liver can’t cope; after all, I used to drink a lot more while training and never had any problems.”

Clinician: “You don’t see any problems with your alcohol consumption, and now the findings bother you. Would you be interested in the link between alcohol consumption and liver values?”

Patient: “Oh well, why not? Of course, I once read that too much alcohol is not good for the liver, but not in the case of one or two after-work beers….”

Clinician: “Recent studies have shown that alcohol consumption, even in comparatively small amounts, can cause several physical effects. Low-risk alcohol consumption is considered to be a daily amount of no more than two small alcoholic drinks in healthy men, which corresponds to about half a liter of beer. Higher alcohol consumption increases the risk of health consequences such as liver and cardiovascular diseases. Also, the recommendation is not to drink alcohol two days a week. What does hearing that make you think?”

Patient: “Well, to be honest, I’m already above that. I sometimes have four or five beers in the evening. But it never seemed that much to me—it doesn’t make me drunk. But what you’ve told me about my liver values does, of course, sound quite worrying….”

Clinician: “On the one hand, you found your alcohol consumption quite normal, but on the other, you’re worried now….”

Patient: “Of course, I don’t want it to worsen. But does that mean I can’t ever drink beer again?”

Clinician: “The idea that your liver values will continue to worsen scares you. From a medical perspective, it would be a good idea to abstain from alcohol completely for the time being so that your liver can regenerate, but only you can make that decision. So what do you think about what we’ve discussed so far?”

Patient: “Well, I suppose I should cut down. To start with, no more alcohol until my liver is okay again. How long will that take?”

Clinician: “Not drinking anything for a while might be a good option. It generally takes 2–3 months for liver values to return to normal. How does that sound to you?”

Patient: “Well, 2–3 months sounds like a long time—I mean, I can manage it if I have to, but it’s probably okay to drink a beer occasionally with friends. Isn’t it? The main thing is that I don’t drink as much as I have been drinking.”

Clinician: “You’re not sure whether you want to see this through for so long. On a scale of 0–10, how important is it to you at the moment not to drink alcohol for 2–3 months? If 0 means “not at all important” and ten means “very important”?

Patient: “Well, definitely a 6 or 7.”

Clinician: “Being able to sustain temporary abstinence is quite important. Why did you choose a 6 or 7, not a 3 or 4?”

Patient: “If I’m honest, the thing with the liver values does make me think, and you did say that it takes that long for the values to normalize. And perhaps I could prove to myself simultaneously that I can still do that.”

Clinician: “Besides the physical health aspect, you could prove that you don’t need the alcohol. What would happen for your importance rating to increase from a 6 or 7 to an 8 or 9?”

Patient: “I’d need to have some plan for what to do when I’m with my buddies. It would be weird to have water.”

Clinician: “It is normal to drink alcohol with friends. How could you nevertheless abstain from drinking alcohol in those situations?”

Patient: “A good friend of mine once cut out beer on a diet, and everyone accepted it. Maybe I could try that too.”

Clinician: “That’s an excellent idea! If you tell them you’re not drinking for health reasons, that might help you feel less weird about the situation. So to recap: At the moment, you’re worried about your liver values, and you can imagine, in principle, giving up alcohol completely for a while. That way, you would also prove that you don’t need that after-work beer. It would initially feel strange when you meet up with friends, but if you tell them in advance, it shouldn’t be a problem. So what could your next step be?”

Patient: “I think, to start with, I’ll try not to drink any alcohol for the next two months. Maybe that will already make a difference to my liver values, as you said.”

Clinician: “That’s a great idea! I suggest we make an appointment in six weeks and see how it went, and do another blood test simultaneously.”

Motivational Interviewing Techniques PDF

Download the below motivational interviewing pdf for more motivational interviewing examples. This SAMHSA advisory file consists of motivational interviewing questions pdf and motivational interviewing training. The Substance Abuse and Mental Health Services Administration (SAMHSA) addresses the application and fundamentals of motivational interviewing for addiction treatment.

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Motivational Interviewing Statistics

One research published by the (NCBI) National Center for Biotechnology Information provided a systematic review and meta-analysis of randomized controlled trials using motivational interviewing as the intervention.


1

More than 1 encounter with the patient confirms the effectiveness of MI.

Source: NCBI

64%

When using MI in brief sessions of 15 minutes, 64% of the studies showed an effect.

Source: NCBI

75%

In roughly three out of four studies, MI had significant and clinically relevant development, equalizing physiological (72%) and psychological (75%) diseases.

Source: NCBI


Models of Motivation Interviewing

Motivational Interviewing (MI) incorporates several models and theoretical frameworks to guide its practice. The three common models include the following:

EPE Motivational Interviewing

“Elicit, Provide, Elicit” (EPE) is a specific technique within the framework of Motivational Interviewing (MI). It refers to a sequence of communication aimed at increasing the client’s motivation for change:

  • Elicit: The therapist elicits the client’s perspective, thoughts, and feelings regarding the behavior or issue.
  • Provide: After listening actively and understanding the client’s viewpoint. The therapist provides relevant and accurate information or feedback. This information can help the client understand the topic better, clarify misconceptions, or explore potential consequences or options related to change.
  • Elicit: Following the provision of information. The therapist elicits the client’s reactions, thoughts, and further exploration. By engaging the client in a collaborative conversation, the therapist encourages them to integrate the provided information into their perspective, promoting a sense of ownership and autonomy in decision-making.

The EPE technique balances the therapist’s role as an expert or source of information with a person-centered approach that respects and values the client’s autonomy and unique experiences. It helps to elicit the client’s motivation for change by incorporating their perspectives and fostering a collaborative therapeutic relationship.

DARN-C Motivational Interviewing

“DARN-C” is an acronym used in Motivational Interviewing (MI) to help guide the therapist’s communication and evoke change talk from the client. Each letter represents a different type of change talk:

  • Desire: The therapist encourages clients to express their desires, wishes, or goals related to behavior change. By exploring what the client wants and values, the therapist helps to amplify their motivation and create a vision for change.
  • Ability: The therapist focuses on eliciting the client’s beliefs in their ability to make the desired change. By exploring the client’s strengths, past successes, and available resources, the therapist helps build confidence and self-efficacy.
  • Reasons: The therapist encourages clients to articulate their reasons for wanting to change. The therapist amplifies the client’s motivation and commitment by exploring the positive aspects of change and the potential benefits.
  • Need: The therapist explores the reasons and urgency for change with the client. By discussing the negative consequences of the current behavior and highlighting the potential risks or costs of maintaining the status quo, the therapist helps to reinforce the need for change.
  • Commitment: The therapist engages the client in a discussion about their commitment and specific steps they are willing to take towards change. This involves exploring the client’s readiness to take action, setting goals, and developing a plan for behavior change.

What is OARS Motivational Interviewing?

OARS is a set of foundational communication skills used in Motivational Interviewing (MI) to foster effective conversations and elicit change talk from the client. Each letter in OARS represents a specific skill:

  • Open-Ended Questions: Rather than asking closed-ended questions that can be answered with a simple “yes” or “no,” open-ended questions encourage the client to provide more detailed and reflective responses. They promote exploration, encourage clients to share their thoughts, feelings, and experiences, and facilitate a deeper understanding of their motivations and ambivalence.
  • Affirmations involve recognizing and acknowledging the client’s strengths, efforts, and positive qualities. They provide support, build rapport, and help to reinforce the client’s self-belief and confidence in their ability to change. Affirmations also contribute to creating a non-judgmental and respectful therapeutic environment.
  • Reflective Listening: Reflective listening involves actively listening to the client and then reflecting back on what has been said. It demonstrates empathy and understanding, validates the client’s perspective, and encourages further exploration of their thoughts and feelings. Reflective listening helps the therapist gain a deeper understanding of the client’s experiences and assists in building trust and rapport.
  • Summaries: Summaries are concise recaps of what the client has expressed during the conversation. They help to organize and integrate the client’s thoughts and feelings, highlight key points, and provide a sense of structure to the conversation. Summaries demonstrate active listening, validate the client’s experiences, and assist in identifying patterns or discrepancies for further exploration.

Benefits of Motivational Interviewing OARS

Using the OARS skills, MI therapists create a supportive and collaborative environment, elicit the client’s motivations and reasons for change, and facilitate the exploration of ambivalence. These skills contribute to developing a therapeutic relationship that empowers the client and enhances their intrinsic motivation for positive behavior change.

Effectiveness of OARS in Motivational Interviewing

The OARS skills, including open-ended questions, affirmations, reflective listening, and summaries, are foundational to MI and have been shown to enhance client engagement, increase change talk, and improve treatment outcomes in various domains. Research indicates that the effective use of OARS skills in MI sessions is associated with positive client outcomes and greater readiness for behavior change.

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Benefits of Motivational Interviewing

The following are the benefits of motivational interviewing in the treatment of substance abuse disorders:

Motivational interviewing may also be especially beneficial for those who have relapsed after attempting to get clean. Ambivalence about the consequences of drug abuse can be an essential factor in repeated relapse.
Motivational interviewing may also be especially beneficial for those who have relapsed after attempting to get clean. Ambivalence about the consequences of drug abuse can be an essential factor in repeated relapse.
  • Increased treatment program retention rates.
  • Increased treatment program participation rates.
  • Increased probability of successful treatment outcomes.
  • Higher treatment post-program abstinence rates.
  • Well-suited for managed care setting.
  • Designed as a brief intervention.
  • Generally delivered in 2-4 sessions.
  • Triggers change in high-risk lifestyle behaviors.
  • Significant effects from brief motivational counseling have held up across various real-life clinical settings.
  • Mobilizes client’s resources for change.
  • Invokes behavior change.
  • Delivered within the context of a more extensive healthcare delivery system.
  • Compatible with health care delivery.
  • Do not assume a long-term client-therapist relationship.
  • Single sessions have invoked behavior change.
  • Emphasizes building client motivation — a strong predictor of change.
  • Clients learn something likely to help them within the first few sessions.
  • Enhances adherence which improves treatment outcomes.

Motivational Interviewing can be very beneficial for those who have not had good results with Cognitive Behavioral Therapy (CBT). A lack of motivation can make changing one’s thoughts and behavior patterns difficult, so addicted individuals experiencing ambivalence about quitting may need to go through MI first. MI is also better than CBT for individuals who need a lot of support, validation of their feelings, and a close relationship with their counselors and feel that CBT does not provide this. 

Motivational Interviewing Drug Addiction

The main point of MI is overcoming the internal battle over whether one wants to quit. Even though there are many reasons to stop abusing drugs or get severe treatment for an addiction to an addicted individual, there are also many reasons not to. Clients may go back and forth many times, feeling motivated to quit after encountering health or legal consequences of drug abuse or a conversation with a loved one but losing that motivation the following day.

In one study, students addicted to tobacco who received this treatment were four times more likely than those in the control group to either attempt quitting or cutting down.

MI aims to lay out the pros and cons of quitting based on what the client feels is necessary. Once clients overcome denial and conclude the pros and cons of drug abuse, their desire to change, what that change looks like, and how they want to implement it, it becomes much easier for that change to occur. Clients don’t feel forced to give up something they love. Instead, they’re pursuing a life change that they have chosen.

Motivational Interviewing in the Treatment of Anxiety and Depression

When it comes to anxiety and depression, motivation is everything. If you’re not motivated to seek treatment and change your lifestyle, it’s unlikely that any progress will be made. Motivational interviewing is a technique that therapists use to help their patients overcome this hurdle. It’s based on the premise that people are more likely to change their behavior when given intrinsic rather than external motivation.

In other words, people are more likely to stick with treatment if they do it for themselves rather than someone else. This doesn’t mean that therapists don’t provide support and guidance. But ultimately, it’s up to the individual to find the motivation to make the necessary changes.

Reclaim Your Life From Addiction With Motivational Interviewing

Individuals addicted to drugs or alcohol don’t think their substance abuse problem is as severe as it is. They don’t want to give up the positive sensations associated with their drug use. They fear the consequences of ceasing substance use, including withdrawal symptoms and cravings. Many addicted persons go through stages of grief after giving up their drug of choice.

Substance abuse disorder is a condition that can cause significant health, social, and economic problems that should not be taken lightly. We Level Up treatment, rehab, and detox center can provide you, or someone you love, motivational interviewing with professional and safe care. Feel free to call us to speak with one of our counselors. We can help you explore treatment resources and options.

Motivational Interviewing For Alcohol Abuse

MI treats alcohol use disorder by helping individuals overcome their ambivalence about changing their drinking behaviors. At the beginning of treatment, MI may help individuals identify their reasons for wanting to make changes and increase their motivation to implement and engage in treatment.

MI is usually very effective in the beginning stages of change, especially for individuals who don’t want to be criticized or lectured about the need to stop drinking. However, MI can also be used throughout alcohol treatment to help strengthen or re-establish your commitment to achieving your goals while helping you actively re-engage in your treatment plan.

According to the National Institute on Drug Abuse (NIDA), research has shown that the effectiveness of MI can vary based on the substance of abuse. However, MI has been demonstrated to be very effective for people who have an alcohol use disorder because it helps them engage in treatment and reduce problem drinking.

One study showed that participants who received MI at the beginning of treatment-experienced double the total abstinence rate at 3–6 months after inpatient or outpatient treatment. In addition, different meta-analyses have shown that MI is better than or equal to cognitive-behavioral treatments or pharmacotherapy (medication) for helping people decrease alcohol use.

Motivational Interviewing is effective not only in clients who have voluntarily sought out treatment but also in those who have been given required addiction treatment as part of a legal settlement or pressured into it by loved ones.
Motivational Interviewing is effective not only in clients who have voluntarily sought out treatment but also in those who have been given required addiction treatment as part of a legal settlement or pressured into it by loved ones.

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Top 3 What Motivates You Interview Question? FAQs

  1. What is the primary goal of motivational interviewing?

    The primary goal of motivational interviewing is to elicit and strengthen an individual’s intrinsic motivation to change problematic behavior. It is a collaborative and person-centered approach that aims to resolve ambivalence and increase motivation for positive change. The five key principles of motivational interviewing are expressing empathy, developing discrepancy, rolling with resistance, supporting self-efficacy, and engaging in collaborative conversation.

  2. What is motivational interviewing therapy?

    Motivational interviewing helps individuals explore and resolve their mixed feelings about change by emphasizing their autonomy and personal choice. The goal is not to force or persuade someone to change but to assist them in finding their reasons, values, and goals for change. Enhancing intrinsic motivation makes individuals more likely to commit to and sustain positive behavioral changes over the long term.

  3. What differentiates motivational interviewing from person-centered therapy?

    Motivational interviewing (MI) is a specific therapeutic approach under the broader umbrella of person-centered therapy (PCT). While both approaches share common principles, MI focuses on resolving ambivalence and enhancing motivation for behavior change, particularly in addiction or problematic behaviors. MI incorporates specific techniques such as open-ended questions, reflective listening, and exploring discrepancies to elicit and strengthen motivation for change. On the other hand, PCT is a broader humanistic approach that emphasizes the client’s autonomy, unconditional positive regard, and empathetic understanding without necessarily targeting behavior change as the primary goal.

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Sources

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