The spirit of Motivational Interviewing is based on three key concepts: collaboration between the therapist and the person with the addiction, rather than confrontation by the therapist; drawing out the individual's ideas, rather the therapist imposing their ideas; and autonomy of the person with the addiction, rather than the therapist having authority over them.
Collaboration vs Confrontation
Collaboration is the partnership that is formed between the therapist and the person with the addiction. This partnership is based on the point of view and experiences of the person with the addiction.
This contrasts with some other approaches to addictions treatment, which are based on the therapist confronting the person with the addiction, and imposing their point of view about the person's addictive behavior. Collaboration has the effect of building rapport between the therapist and the person with the addiction, and allows the person with the addiction to develop trust towards the therapist, which can be difficult in a confrontational atmosphere.
This does not mean that the therapist automatically agrees with the person with the addiction. Although the person with the addiction and their therapist may see things differently, the therapeutic process is focused on mutual understanding, not the therapist being right and the person with the addiction being wrong.
Drawing Out Rather Than Imposing Ideas
The approach of the therapist drawing out the individual's own ideas, rather than the therapist imposing their opinions is based on the belief that the motivation, or wish, to change comes from the person with the addiction, not from the therapist. No matter how much the therapist might want the person to change their behavior, it will only happen if that individual also wants to change their behavior. So it is the therapist's job to "draw out" the person's true motivations and skills for change, not to tell the person with the addiction what to do.
Autonomy vs. Authority
Unlike some other treatment models that emphasize the doctor or the therapist as an authority figure, Motivational Interviewing recognizes that the true power for making changes rests within the person with the addiction, not within the therapist. Ultimately, it is up to the individual to follow through with making changes happen. This is empowering to the individual, but also gives them responsibility for their actions.
How Change Happens in Motivational Interviewing
Four guiding principles form the basis of the Motivational Interviewing approach. Although each person's process of overcoming an addiction will be different, the therapist will hold true to these principles throughout each individual's process. These principles are vital to establishing trust within the therapeutic relationship.
Empathy and Acceptance
People with addictions are often reluctant to go into treatment, because they don't believe that the therapist, who, after all, is working to end people's addictions, will understand why the addictive behavior means so much to them. Many, especially those who have put up with other people criticizing their behavior, believe they will be judged, some even feeling guilty about their behavior and feeling judgment would be valid. But judgment simply is not what Motivational Interviewing is about.
Instead of judging the person with the addiction, the therapist focuses on understanding the situation from the addicted person's point of view. This is known as "empathy." Empathy does not mean that the therapist agrees with the person, but that they understand and that the individual's behavior makes sense to them (or did at the time the behavior was carried out). This creates an atmosphere of acceptance.
Helping People to Make Up Their Minds
Motivational Interviewing recognizes that people with addictions are usually ambivalent and uncertain about whether or not they want to change. Their addiction has probably already had consequences for them, which have brought them into treatment. Yet they have developed their addiction as a way of coping with life, and they do not necessarily like the idea of giving that up.
Motivational Interviewing helps people to make up their minds about how to move forward, by helping the individual to look at the advantages and disadvantages of different choices and actions. So without pressurizing the person, goals and actions can be developed in this trusting, collaborative atmosphere, which are based on the individual's own needs, wishes, goals, values and strengths.
Developing New Understanding
Motivational Interviewing as an approach recognizes that change does not always happen easily or just because the individual wants it. It is natural for the person to change their mind many times about whether they want to give up their addiction, and what that process, and their new lifestyle, will look like.
Rather than challenging, opposing or criticizing the person with the addiction, the therapist will help the individual to reach a new understanding of themselves and what their addiction means to them. They do this by re-framing, and offering different interpretations of situations that come up in the change process, typically which increase the person's motivation to change. All of this is based on the individual's own goals and values, which have already been explored.
The therapist will always support the person's belief in their own power to make the changes they want. At the beginning, the therapist may have more confidence in the individual than they have themselves, but this changes with ongoing support.
Miller, W. & Rollnick, S. Motivational Interviewing: Preparing People for Change. Second Edition. New York: Guilford Press. 2002.