Motivational Interviewing: An Overview

January 12, 2022

Healthy behavior is linked to improved well-being for individuals, families and communities. The challenge of addressing unhealthy behavior can be complex and often depends on sustained behavior change at the individual level. Motivational Interviewing is a counseling approach that can help people identify their feelings about behavior change, resolve inconsistencies with how they feel about making behavior change(s), and then make a plan to follow and update as needed. Motivational Interviewing, first introduced by Bill Miller in 1983, has been commonly used to help people address addiction and adopt better health habits. The person-centered approach is based on conversational techniques guided by relationship-based awareness and specific skills that can lead a person to find their own reasons for deciding to change their behavior. Motivational Interviewing is approved for use by the Family First Prevention Services Act (FFPSA) as described on the Prevention Services Clearinghouse.

Many times, the root of behavior change lies in the degree and consistency of motivation felt by the individual who needs to alter their decisions and behaviors on both a short- and long-term basis. Ambivalence is a state of feeling two competing ways about a behavioral issue or problem, such that someone may want to change in a general sense but also have difficulty with implementing or continuing with the change. Intrinsic motivation is an internal drive, rather than an external pressure. Participating in supportive conversations with someone who uses Motivational Interviewing skills and spirit can help resolve ambivalence and maintain, or even increase, intrinsic motivation over time.

Training in Motivational Interviewing (MI) principles and skills can prepare the interviewer to help the interviewee through the change process. During the change process, a person may share statements of desire where they say they are interested in making a change, wish they could do things differently or want things to be different. They also may also share about their perception of their ability to make the changes they desire, whether moving forward or what they have tried in the recent past. A conversation partner who can help a person come up with their own change language can support the change process by guiding an individualized pace of change that can lead to increased motivation over time.

MI consists of three primary elements commonly referred to as the “spirit” of MI: 1) Collaboration between interviewer and interviewee to identify the knowledge and resources that can be used to support the interviewee in making changes, 2) Evocation of the information from the interviewee by the interviewer who can highlight information and personal characteristics that the interviewee may not have noticed in themselves previously and 3) Autonomy Support where the interviewer works to support the interviewee’s freedom to make their own choices and decisions. These are all used within the context of relational factors, which include the interviewer’s ability to display empathy and acceptance of the interviewee.

Specific skills an interviewer can use when engaging clients can be summarized with the acronym OARS:

Open-Ended Questions: Based in a who, what, where, when or how format, these invite the interviewee to share information beyond yes or no answers. Example: “How would you like to spend this time together?” “What is it about the situation that you wish you knew more about?”

Affirmations: Statements that acknowledge the interviewee’s strengths, characteristics and behaviors that are positive attempts to change, or actual change. Affirmations can be provided by the interviewer acknowledging something an interviewee has shared, or by the interviewee themselves sharing what makes them proud.

Reflections: Types of statements interviewers use to mirror back to the interviewee what was previously shared. Each type has a different purpose, depending on what might best support the interviewee in their change process. Reflections include:

Simple: Repeat or rephrase what an interviewee said, with no additional meaning
Complex: Rephrase what interviewee said, or has not yet clearly stated, with added terminology for showing empathy or guidance about potential implications
Double-Sided: Repeat or rephrase what an interviewee said, with an emphasis on showing both sides of ambivalent feelings
Amplified: Repeating or rephrasing what the interviewee said, with careful directness that does not include sarcasm and may help the interviewee vocalize another perspective

Summaries: Long reflections that allow a pulling together of what has been discussed during the interview process, allowing a more organized delivery and highlighted review of progress made and agreed-upon next steps.