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Motivational Interviewing (MI): Definition, Application, Activity and Effectivity.

Motivational Interviewing and Addiction Treatment 

Therapists use many different modalities, counseling techniques, and theories to bring about positive changes in their clients. While some theories are relatively mainstream, such as Cognitive-Behavioral Therapy, others are still largely unknown to the public. Motivational Interviewing, or MI, is a very common type of counseling used in substance use treatment.
You might be wondering what MI is, how it’s helpful, and how it helps with change. This will give you more information about MI and why it’s useful for addiction treatment.

What Is Motivational Interviewing?

MI was created by Stephen Rollnick and William Miller. This is an evolving counseling method that has changed dramatically to keep up with clients and to improve the positive force of change it provides.
Marriage counseling session

Unlike the previous form of substance use counseling that was more forceful and confrontational, MI is client-centered and draws on the motivation inherent within clients. This helps clients to find their motivations for changing, enhancing that motivation and giving clients the will to make their own decisions. MI also ensures that clients are thinking about how their choices affect themselves and others.

A core tenet of MI is that this is a collaborative relationship. The therapist is not the expert. They are instead just a guide that helps the client recognize and enhance their own motivation. Many clients come to therapy thinking they have no motivation to change, but they might soon recognize that family, friends, internal drives, or even work are reasons they want to reduce or stop using substances.

MI uses reflective listening, recognition of discrepancy, and the ability to overcome resistance since many clients become confrontational with clinicians during the early stages of change. A proficient MI therapist will be able to work with these clients while helping them understand their reasons for change.

MI and Other Theories 

An important distinction for clinicians, though perhaps not as important for clients, is whether MI can be used simultaneously with other counseling theories. A counseling theory such as CBT creates an entire framework that determines how the counselor approaches the client, what topics they discuss, and how they go about guiding the client. Many clinicians tend to blend two or more theories when working with clients.

Despite seeming like a theory, the creators of MI have asserted that it’s more of a technique that can be seamlessly blended into any other theory. It is most often combined with CBT, but it can also be combined with other theories and even by those who aren’t mental health professionals. This is meant to be used in settings where clients have low motivation to change or poor adherence to guidelines and need help getting to a consistent point.

    When combining MI with CBT, the clinician can use CBT to help a client explore their thoughts, feelings, and behaviors while MI keeps them motivated and consistent with treatment.

Spirit of Motivational Interviewing

Known as the MI Spirit, these are guiding steps for the clinician to keep in mind when speaking with clients. These steps have also been shown to help clients in addiction treatment as they are given more autonomy over their care while having a real collaborative relationship with their therapist. Instead of the therapist being an expert and the client having to listen to them, the two work together on figuring out the concerns and how to best go about correcting them.
Sadness in support group

The first element of the MI Spirit is collaboration. This means that the client and clinician are a team and are collaborating on a problem. This changes the perspective of the therapist being the expert and always being right and instead makes it a team of two people trying to discover what the true issues are along with what works and what doesn’t.

Close-up of woman's hands during counseling meeting with a profe

This doesn’t imply that the clinician and client will always agree. There will be times when you disagree with what your therapist is saying and times when they disagree with how you’re going about the change process. These should be discussed thoroughly as two equal team members who are negotiating a disagreement.

The second element of the MI Spirit is evoking. A trained therapist has likely heard all sorts of different reasons for change, and they have read about many reasons as well. The most common reasons why people want to change include family, friends, or internal reasons.

In reality, you may or may not care about these motivators. They need to be personalized for you. MI teaches therapists to listen to your words and to draw out your reasons for changing instead of imposing what they think the reason should be. For example, a confrontational therapist might tell you that you’re hurting your family and must change for them. An MI therapist will hear you talk about your family and will figure out why you want to change for them and how to best help with that.

The third element is autonomy. This means that you have the autonomy to change. The truth is that no therapist can force you to change. Lasting change must be a very personal decision for the addict.

By giving you autonomy, you learn very early on that you’re responsible for your change. The therapist is a guiding force, but you’re tasked with avoiding your triggers, using your supports, and utilizing the services available to you. This lets you build confidence in your ability while letting you know that you truly can change.

Young grumpy couple at marital counseling therapy

The last element is compassion. No matter how the process goes, the therapist will not judge you and will strive to demonstrate a compassionate attitude. An MI therapist understands that you’re trying your best and that change takes on many forms and can be messy at times. They will be there for you to help you even after a lapse or other difficulties.

Change and Sustain Talk

Whether about substances or any other behavior, clients will experience both change and sustained talk. You’ll notice this about yourself whenever you speak about substances, especially if you are on the fence about changing your behavior.
MI therapists are trained to listen for change and sustain talk. They will bring out and enhance change talk while helping you reduce sustained talk. What exactly are these? Change and sustain talk are simply different ways of speaking that you might normally overlook.
Sustain talk means talking in a way that sustains a habit. This could be saying that it’s too hard to change, so it’s best to just keep things as they are. It might mean that you like how you feel while using or that things haven’t been that bad, so there’s no reason to change.
Change talk is a pattern of speaking that shows you want to change your behavior. This can manifest itself in several ways. For instance, you may find yourself saying that you want to reduce your use, that you want to change for your family, or that you are making strides in avoiding your triggers.
It’s common to have both. A therapist will try to tip the balance so that there is more change talk. They will also try to keep you on the side of change and becoming healthier.
A trained clinician also knows that change talk that comes from you is far more important than them saying it for you. A therapist can give you reasons to change, and you might nod and say that you’ll try. It’s more important and impactful if you state your own reasons for changing.
The therapist will help you figure out why you want to change and keep you on that path.

Is Motivational Interviewing Evidence-Based?

You might be wondering if MI is really useful, especially since it seems counterintuitive based on how people used to think about substance use. It used to be thought that punishment and confrontation would reduce substance use and other problematic behaviors, but that is rarely done now. Many clinicians now practice MI and use it when speaking with clients.
Female health insurance broker presenting his insurance benefits to businessman fill out insurance

MI is considered an evidence-based modality that is quite successful. There are over 1,100 peer-reviewed articles and upwards of 200 clinical studies about MI.

It has been found that this helps with promoting healthy behaviors while reducing problematic ones. While it’s used primarily for substance use, it’s also been found to help with other behaviors as well. This is because it finds your reason for wanting to change and keeps that at the forefront.


If you are looking for addiction treatment near Columbus, OH, then look no further than White Light Behavioral Health. Our trained clinicians use MI and other evidence-based modalities to help guide clients toward change. This can help you on the road to recovery and ensure that you stay strong along the path even when it gets tough.

Contact us today, and let us help you recover. We will draft a treatment plan that treats you with respect and dignity and helps with your unique needs.

Ryan Wakim MD
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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If you or a loved one is grappling with addiction, don’t face it alone. White Light Behavioral Health is here to guide you on the path to recovery. With a compassionate team and a proven approach, we’re dedicated to helping you reclaim your life. Reach out to White Light Behavioral Health today and take the first step towards a brighter, addiction-free future. Your journey to healing begins with a single call. Please reach out to us today at (844) 297-3995 to book your appointment! And start your healing journey at our convenient facility.

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