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Motivational Interviewing for Addiction Treatment

The desire to change is an essential element of addiction recovery. The patient has to have the intrinsic motivation to be the best version of themselves they can be. The best results come when that motivation is internalized rather than at the insistence of someone else.

Many people who struggle with addiction truly want to change, and know they must, at least on an elemental level. At Cliffside Malibu, we stand beside our patients, serving as partners in their recovery. There are a multitude of therapies that seek to address the root causes of addiction, which is a crucial part of recovery. Restoring the patient’s self-efficacy is equally important as it allows them to move forward in their healing process. Motivational interviewing is a therapy designed to give power back to the individual. With its unique and welcoming approach, motivational interviewing can give people who are recovering from addiction the tools necessary to live a successful, healthy life.

What is Motivational Interviewing?

Addiction is rooted in pain and the maladjusted patterns of destructive behavior that people use to address that pain. The person struggling with addiction often experiences a disconnect between logical thought and emotion. For example, they might understand that substance abuse has severely damaged their health, career and interpersonal relationships, but still lack the emotional drive to change their behavior.

Awareness is central to motivational interviewing (MI). MI begins with the premise that the patient understands change is necessary, but they lack the emotional tools to achieve it. There are three facets to motivational interviewing:

  • It is short in duration
  • It is patient-centered
  • It is semi-directive

Motivational interviewing traces its roots back to Dr. William Miller. who first coined the term during an interview in Behavioral Psychology in 1983. Dr. Miller later built out MI as a therapeutic tool in conjunction with his colleague, Dr. Stephen Rollnick. MI relaxes the rigidity found in other therapeutic methods and is short in duration, with typically no more than four or five sessions that are one hour each. MI is often used in conjunction with other therapeutic techniques to foster long-term sobriety.

The goal of motivational interviewing is to overcome a patient’s natural tendency to be defensive by re-centering the conversation —and its resolution— on them. At its core, it is a partnership rather than a strict, guided therapy. Through motivational interviewing, the therapist helps the client embrace their own personal reasons for changing, and acknowledge that resistance to change is a normal part of the recovery process.

The concept of ambivalence is also important to successful motivational interviewing. Resistance to change comes from ambivalence, whether it is based in fear, apathy or some other mix of emotions.

Motivational interviewing serves as a tool to help the client resolve their ambivalence toward recovery. With motivational interviewing, the therapist is a partner who respects the individual’s values, fostering collaboration rather than competition.

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Conducting a Motivational Interview

Despite being a semi-directive therapy, MI uses a prescribed method to achieve results. Motivational interviewing thrives on five key principles:

  • Communicating empathy toward the patient
  • Fostering trust and collaboration
  • Developing discrepancy
  • Adapting to resistance
  • Increasing the patient’s self-efficacy

In order for motivational interviewing to be successful, the therapist must seek to develop a partnership with their patient based on trust and understanding. Empathy provides the cornerstone. A therapist trained in motivational interviewing will communicate empathy through reflective listening. Reflective listening involves absorbing the speaker’s message and summarizing it to check for understanding.

It is equally important to establish a therapeutic dynamic based on collaboration rather than competition. The therapist will purposefully avoid arguments with their patients, nor will they seek to impose their own viewpoint. The patient is in the driver’s seat; the therapist simply helps to navigate.

Developing discrepancy is a pivotal step in the process. It is essential to help the patient understand the difference between the life they want and their current status. They have to see the cause and effect of their actions and the resulting consequences. Awareness of discrepancy is a vital step towards progress.

Patients will naturally be resistant to change. Part of motivational interviewing is accepting reluctance as a part of human nature and adapting to it. It is important that the therapist not assert their point of view, but rather “roll with the resistance.”

No therapeutic approach is complete without follow through. The end goal of motivational interviewing should be providing patients with a set of tools to increase their own self-efficacy. Self-efficacy centers the decision to change on the patient; it is their choice, one they ultimately must come to on their own.

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OARS Interviewing Techniques

The OARS method provides therapists with a structured model for conducting interviews. There are four components that make up the OARS method. They are:

  • Open-ended questions
  • Affirmation
  • Reflections
  • Summaries

Motivational interviewing is a semi-directive methodology; the interview itself lacks rigid structure. During the process, therapists will pose open-ended questions that cannot be answered with a simple yes or no in order to elicit conversation. During the course of that conversation, the therapist will provide numerous points of affirmation, helping to point out and validate the patient’s strengths.

Reflection proves to the patient that the therapist is listening. The doctor will respond to the client’s statements reflectively in order to clarify understanding. These reflective statements aim to summarize what the speaker is saying, fostering trust and collaboration.

How Does Motivational Interviewing Help Patients?

Ambivalence can be dangerous. It is extremely detrimental to an individual’s recovery process. A patient may understand the need for change on a cognitive level, but getting them to take ownership of the situation and embrace change on the emotional level is a different matter altogether.

Ambivalence is a major factor for people who relapse after initial treatment. Motivational interviewing is most powerful when a person is continually resistant to change. MI effectively helps those who are initially resistant to treatment. It eliminates the adversarial nature of some therapies, instead setting up a relationship where the patient themselves feels internal motivation to undergo treatment.

Through motivational interviewing, a trained therapist can help their patient to build long-lasting sobriety based on the patient’s own personal motivation rather than external factors. At Cliffside Malibu, our professional therapists understand the power of self-efficacy. They are trained in MI practices and can help guide you or your loved one to a healthier lifestyle and a brighter future.


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