We often think that the different psychological interventions aimed at treating mental health problems consist simply of therapy itself. However, an interview can also be a psychological technique and be part of a therapy, as we will see.

In this article we will know the motivational interview of William Miller and Stephen Rollnick , developed in 1999 and focused on treating addictive behaviors. We will know its phases, its principles and the strategies it uses to produce the therapeutic change.

Motivational interviewing: characteristics

Motivational interviewing was developed by W. Miller and S. Rollnick in 1999, and was aimed at treating addictive disorders such as addiction to alcohol or other substances (as well as different addictive behaviours). That interview was originally conceived as a brief therapy approach, to address the ambivalence towards change characteristic of this type of patient.

The interview starts from a theoretical basis that considers that the motivation for change is not imposed from outside , but arises from the patient’s ambivalence.

Furthermore, it is an approach in line with the Prochascka and DiClemente’s Trans-theoretical Model (which we will see later), which is also consistent with the findings of contemporary research on the factors that account for the effectiveness of psychotherapy.

For their part, authors W. Miller and S. Rollnick have always claimed that motivational interviewing is an approach with a particular philosophy, rather than a technique.

Who is it aimed at?

Motivational interviewing has been and is applied to patients who have some kind of addictive disorder, either due to abuse or problematic use of substances, with the aim of promoting adherence to treatment also of people with mental health problems and chronic health disorders.

In addition, it also helps to adopt healthier lifestyles (physical exercise, balanced diet, safe sex, etc.)

Therapeutic Principles

Motivational interviewing is based on a number of principles; they are as follows:

1. Expression of empathy

The first principle establishes that the empathy of the therapist is something essential ; thus, the acceptance by the therapist, both of the patient’s problems and of his addiction itself and his behaviour, facilitates therapeutic change.

2. Develop the discrepancy

The change appears as a consequence of the discrepancy perceived by the patient between his actions, his thoughts, and what he really wants to achieve in the long term (partial or total abstinence).

3. Accepting resistance

The third principle of motivational interviewing holds that the therapist should not confront the patient in their disagreements, nor provide arguments about the need for change; it considers that the therapist should exercise a more “free or neutral” role in that sense.

4. Supporting self-efficacy

The fact that the patient actually believes that change is possible is motivating for him. The therapist should support this feeling of self-efficacy when it appears.

Phases

Motivational interviewing takes place in two distinct phases:

Building motivation for change

The first phase will be aimed at helping to build a real motivation for change, to permanently stop the drink or drug in question (or reduce consumption, depending on the agreed therapeutic objective).

The following techniques are used in this phase: the use of open questions, reflexes, summaries, recognition, acceptance of resistance and provocation of discrepancy.

2. Strengthening the commitment to change

In this phase of the motivational interview, the patient’s commitment developed in the previous phase is fortified. Here, everything that has been worked on so far is summarized, and in addition: goals or objectives are set , the different options for change are considered, an action plan is designed and the patient’s commitment is extracted.

Evidence

Motivational interviewing has been shown to be more effective than non-treatment for addictions; it is especially useful in the empowerment of other treatments , improving adherence, participation and patient satisfaction.

When is it used?

This type of interview is used in the contemplation stage of a person addicted to some substance; the contemplation stage is the one in which the patient has doubts regarding the process of change .

The stages through which a person with some kind of addiction goes, were proposed in the Trans-theoretical Model of Prochaska and Diclemente. Let’s see what they are (in order of appearance in time):

  • Precontemplation : no intention to change yet.
  • Contemplation : the option to change is considered.
  • Preparation for action : the person prepares to act.
  • Action : the person takes action and leaves the substance.
  • Maintenance : the person remains abstinent for at least 6 months.
  • Relapse : the person uses again.
  • Completion stage : the addiction is overcome.

According to Prochaska and Diclemente, people with some kind of addiction to some substance go through these phases; normally they would go in order, but there can be regressions in the stages, turns, changes, repetitions, etc. For example, a person could go from maintenance to relapse, from relapse to maintenance, and back to relapse.

Bibliographic references:

Horse (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2. Madrid. Siglo XXI.
Miller, W. (1995) Motivational Enhancement Therapy with Drug Abusers. Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque: The University of New Mexico.
Pacheco, M. (2011). Motivational Interview by William Miller and Stephen Rollnick. Center for the Development of Brief Strategic Psychotherapy, 1-43.