Motivational Interview
Description
This unit focuses on introducing students to the essential elements of motivational interviewing, with a particular focus on understanding the psychological processes of reflection, motive, ambivalence, goal setting, resistance, and relapse .Learners will explore the essential elements of MI, including its empathetic and collaborative nature, and gain practical experience in applying its six key steps. Through case studies and guided exercises, learners will develop the skills to navigate complex conversations, support client autonomy, and effectively facilitate behavior change.
Learning Outcomes
By the end of the Unit, participants will have the essential tools and confidence to integrate motivational interviewing into their professional practice, contributing to more effective and empathetic approaches to substance abuse treatment.
- Basic Knowledge of Motivational Interviewing: Students will gain an understanding of the principles, techniques, and theoretical background of motivational interviewing.
- Insight into Addiction Patterns: The program aims to provide students with a foundational understanding of the psychological and behavioral patterns of addiction, allowing them to apply MI effectively in treatment.
- Skill Development in Motivational Interviewing: Through examples and practice, students will develop practical skills in using MI to motivate individuals to change their behaviors and seek help for addiction.
- Competence in Addiction Treatment: With continued practice, students should feel confident in applying MI techniques within addiction treatment settings, supporting clients to explore and resolve their ambivalence about change.
Knowledge
By completing this unit, students will gain knowledge about:
- The model for the motivational interview. Have a basic insight in the theory and overview of all the six steps in the manual.
- The six steps of motivational interviewing and their application in fostering behavioral change.
- The dynamics behind relapse, resistance and the anxiety that comes along with change of old patterns.
- Theory and praxis, how an actual conversation can look like
Skills
Upon completing this unit, students will develop skills to:
- Conduct client-centered conversations using MI techniques to promote motivation and behavior change.
- Be able to explain the six steps in the model. What does the individual step mean and how is the order of the steps.
- Use and adapt the different steps of the model in the daily work with clients.
Competences
By the end of the unit, students will be able to:
- Integrate motivational interviewing techniques into comprehensive intervention strategies for individuals with substance use disorders.
- Transfer the theoretical method to a practical and concrete frame for conversations with clients in the process of change. Use and adjust the theory in praxis.
Dynamization and Evaluation
The unit will be developed through:
- Lectures and Presentations:
- Provide theoretical knowledge about the principles, essential elements, and steps of motivational interviewing (MI).
- Provide theoretical knowledge about the principles, essential elements, and steps of motivational interviewing (MI).
- Interactive Workshops and Role-Plays:
- Offer hands-on practice with MI techniques through simulated client interactions.
- Offer hands-on practice with MI techniques through simulated client interactions.
- Case Study Analysis:
- Use real-world examples to demonstrate effective MI strategies and problem-solving approaches.
- Use real-world examples to demonstrate effective MI strategies and problem-solving approaches.
- Group Discussions and Peer Feedback:
- Facilitate collaborative learning and exchange of insights on challenges and solutions in MI practice.
The unit will be evaluated through:
- Quizzes or tests throughout the unit to assess understanding of key concepts
- Written assignments at the end of the unit on the role of assessment in treatment planning and progress monitoring
Introduction to Motivational Interviewing & Basic Model
Introduction: Motivational interviewing (MI) is a person-centered, goal-oriented communication method designed to enhance motivation for change. It is based on the understanding that people are more likely to make lasting changes when they are actively engaged in the process, rather than being told what to do. This approach focuses on creating a collaborative dialogue between the practitioner and the client, where the client’s own reasons for change are explored and strengthened.
The guiding principles of MI include open-ended questions, which invite thoughtful responses and encourage reflection; reflective listening, where the practitioner listens actively and reflects back what the client is saying, fostering deeper understanding; empathy, which helps to build trust and rapport; affirmations, recognizing the client’s strengths and efforts; empowerment, promoting the client’s autonomy and belief in their ability to change; and summarizing, which ties together the conversation and reinforces key points.
Motivational interviewing is particularly effective in working with individuals who face challenges such as addiction, as it helps them explore the ambivalence, they may feel about changing behaviors. The method can be used both in structured sessions, with clear goals and timeframes (e.g., one hour), or more informally in everyday interactions, where it subtly encourages clients to reflect on their own motivations and readiness for change. Whether used as a formal intervention or a supportive tool in daily practice, MI provides a flexible, non-judgmental approach to fostering positive change.
1. Reflection
The first step is reflection, sometimes there is a clear topic, for instance a substance abuse problem. Sometimes you start to unfold the life situation and look into the different areas of a person’s life. Work life, family life, spare time, education, and more. You can make a model of the aspects of the clients’ life.
Reflection, as a psychological, pedagogical, learning, and philosophical concept, involves the process of thoughtfully considering experiences to gain deeper understanding and insight. Psychologically, reflection enables self-awareness, helping individuals recognize patterns in behavior and thought. In pedagogy, reflection is essential for both teachers and students, allowing for critical thinking and the evaluation of teaching and learning practices. From a learning perspective, reflection facilitates the integration of new knowledge with prior understanding, enhancing problem-solving skills. Philosophically, reflection encourages individuals to question assumptions, values, and the nature of reality. It promotes growth through continuous self-examination and the re-evaluation of personal and societal beliefs. Ultimately, reflection is a dynamic process that leads to greater clarity, wisdom, and personal development.
2. Motive
It is very important to be motivated, when a person is going to make a big change in their life. They have to be clear about the motivation. Are they driven by internal or external motivators. Are you as a professional putting pressure and your own ambitions on to the client.
Motivation is the internal drive that directs behavior toward achieving goals and fulfilling needs. It can be classified into different types, each influencing human actions in various ways. Intrinsic motivation comes from within, where the activity itself is rewarding, such as enjoying a hobby or learning for personal growth. Extrinsic motivation, on the other hand, is driven by external rewards or pressures, such as money, recognition, or approval. Achievement motivation focuses on the desire to meet challenges and attain success, often linked to personal or professional goals. Social motivation arises from the need for connection, belonging, and social approval. Power motivation involves the desire to influence or control others. Fear-based motivation occurs when individuals are driven by the avoidance of negative consequences or punishment. Each type can vary in strength depending on context, and often, a combination of motivations influences behavior in complex ways.
3. Ambivalence
It is never simple, never black and white. If it was easy, the client would have made the change long ago. There is always something good in the bad pattern. It has probably been a part of the mental defense.
And there is always a fear and doubt. It is very important to investigate both the Pros and cons both with changing and staying the same pattern.
Ambivalence, as a psychological concept, refers to having mixed or contradictory feelings about a particular situation or decision. In the context of addiction and recovery, ambivalence is often a key barrier to change. Individuals may simultaneously desire to stop using substances while also feeling attached to the benefits, however fleeting, that substance use provides. This internal conflict can make it difficult for a person to commit fully to the process of recovery. Ambivalence can manifest in hesitations, doubts, or relapse, as the person struggles to reconcile their desire for sobriety with the comfort of the familiar addictive behavior. Addressing ambivalence is crucial in therapeutic settings, as helping individuals explore and resolve their conflicting feelings can promote motivation for change and increase the likelihood of successful recovery.
4. Goal
Setting the goal, you have to be thorough and very concrete in the conversation with the client. It has to be realistic and measurable. What to do, when to do it, where, for how long.
We must clearly be able to tell when the goal is reached. Make a plan and go ahead right away. Not next week or next month. Today or tomorrow.
Goals are essential for guiding personal growth and achieving meaningful change. The SMART framework—Specific, Measurable, Achievable, Relevant, and Time-bound—helps create clear and actionable goals. By being specific, goals define exactly what is to be accomplished, removing ambiguity. Measurability ensures progress can be tracked, offering motivation and feedback. Achievability makes sure the goal is realistic and attainable, avoiding frustration. Relevance ensures the goal aligns with broader values and long-term objectives. Finally, being time-bound adds urgency and commitment, providing a deadline for completion. Using SMART goals in the process of change enhances focus, boosts confidence, and increases the likelihood of success by breaking larger ambitions into manageable steps.
5. Resistance
There will always be an element of resistance against change. It is a difficult thing to change the way we think, act and react. There is a feeling of security in doing the same. We have to be ready, when the resistance comes. Be ready with our resource and we all need something or someone in these situations.
Resistance to change and learning can stem from various psychological factors, often rooted in fear, discomfort, or a desire to maintain control. From a psychological perspective, cognitive dissonance plays a significant role, as individuals may resist change when new information conflicts with established beliefs or behaviors, creating internal tension. Fear of failure and anxiety about the unknown can also make individuals hesitant to embrace change or engage in new learning experiences. Attachment to old habits provides a sense of security, leading to habitual resistance, even if those habits are detrimental. Additionally, self-esteem may be threatened when faced with the need to learn new skills or adapt, causing avoidance. Defensiveness can also arise when people feel their competence or identity is being challenged. Overcoming resistance requires addressing these psychological barriers through support, motivation, and creating a safe environment for growth and adaptation.
6. Relapse
For most people it’s inevitable to have a relapse in the process of changing your patterns. And it is good to know, to talk about and be prepared for.
If or when it happens don’t panic and give up. All is not lost. You just must help the client to pick it up and go back to the motivation. And you must be careful and caring at this point.
Relapse into old patterns, such as addiction, often occurs when change becomes difficult or overwhelming. During periods of stress, discomfort, or unmet needs, individuals may revert to familiar behaviors as a coping mechanism. The process of change is often nonlinear, and setbacks can trigger a return to old habits. Psychological factors like emotional dysregulation, low self-efficacy, or lack of coping skills can make maintaining new behaviors challenging. Additionally, environmental cues or social pressures may remind individuals of the ease and immediate relief that old patterns provided. Feelings of failure or hopelessness during setbacks can also undermine motivation for continued change, reinforcing the urge to return to substance use or other maladaptive behaviors. Recognizing relapse as part of the recovery process, rather than a complete failure, is crucial in sustaining long-term change. Support, self-reflection, and learning from setbacks help individuals rebuild their commitment to change.
Elaborating on Each Step of the Model
After the first introduction and description of the 6 steps, the next is extra descriptions and models to elaborate every step.
When you talk to the client about what they want to change in their life – make an overview, and here feel free to take models form for example coaching or therapy, and use different types of questions to manage the conversation:
The wheel of change: What are the life areas, and how is the balance? Where is there a call for change. Use for instance scale questions. From 0-10 how satisfied are you, what is the next level.
Motive – miracle questions
“What’s going to happen when the goal is reached?”
“Tell me about the scenario when you have made the change – describe your everyday life.”
“How proud will you be about yourself, when you succeeded and stand on the other side of the change?”
“How will it contribute to your life, relationships, health, work? “
“Describe your life before and after”.
Motivation
About motivation, it is very important to remember, that it is not either or. It is dynamic, in constant variation. Look at it as a scale from very high to almost nonexistent. Perhaps draw a long line and ask where the client is right now, and after talking about the miracle perspective, where is the client then.
It is good to know, that it is easier to move towards something, than away from something.
For instance, if the goal in a relationship, is to not argue and fight so much, it is a goal about getting out of a hard situation. The question could be what would You like instead. More dancing? Constructive conversation about your feelings and dreams? Then it is about getting there. And that movement is lighter and milder.
Ambivalence
As a professional or a next of kin, to a person with obvious problems, you have to be aware not only to strengthen the pros and to try and force the person to change. You have to acknowledge the reason people are as they are and follow certain patterns and the anxiety connected with change. When you talk about this side, it is very important not to be judging, but to be open and honest together.
SMART goals
Resistance against change is a serious aspect. There is a history behind every destructive pattern. A coping strategy, perhaps immature. So we have to learn new and better, more mature coping strategies before we can let go of the expired. Something new have to be build up, to withstand the anxiety and fear.
Relapse Is to be taken seriously. It is not either or, but again a scale or a long line, for instance from laid dry, abstinent to full on abuse. Where on the scale is the client? And how is the change form earlier and what is the next step. There is a tendency for some, that if you already failed and for instance drank one beer, you might as well take the hole case. You have to find the strength to call someone and have a lifeline in this situation.
Practical Example of Motivational Interviewing
An elderly man with many years of alcohol abuse. Earlier with an average life, job, economy and family. But in periods a big abuse, that eventually tore his life and family apart. In periods hospitalized and in rehabilitation. More and more physical and psychological problems and increasing social.
Reflection
We start with a conversation about his life, now and earlier. We talk about his dreams about not ending his life by drinking himself to death alone. But perhaps some kind of reunion with his grown-up children. We talk about health and anxiety. We draw the life wheel.
I give him open-ended questions and I listen reflective; I show my empathy.
Motive
We talk about the difference between his own wishes and his experience with the demands from the family, the fear of disappointing other people, for example, me right now for instance.
We talk about the life he almost doesn’t dare dream of anymore.
I give affirmations and empowerment.
Ambivalence
We make a map over the pros and cons, the overview of advantages and disadvantages. We have a honest conversation about what he also likes about intoxication, for instance escaping all of the responsibilities and demands he can’t live up to. The liberation of letting go.
I help him write it down and make summaries.
Goal
We talk about the long term goal; total abstinence – stop drinking for good. And we talk short term. Right away we call the doctor and make an appointment regarding Antabuse. We talk about appointments for conversations, perhaps a therapy group with like-minded. And when and how to talk to the family and friends.
I help with questions and framework. SMART.
Resistance
He is so afraid that it won’t happen, that he won’t succeed. That he will disappoint his family, that they won’t believe in him. Almost giving up again, and here I summarize and go back to the motive.
Take it slowly, and talk about change in general, about how it takes time, effort, and how a method like this one helps and sensitize the goal.
Relapse
He knows exactly when and where it will be extra difficult. Which gatherings, friends, places will be tempting with alcohol, days with sadness or sorrow that can lead to self pity and drinking.
In periods and in the beginning the Antabuse must be taken somewhere else. And there is 3 people he will ask to be supporting lifelines to call in times of trouble.
Practice with a Partner & Self-Reflection
Activities
Set Up a Practice Session:
Find a quiet, private place where you can focus. Set up two chairs facing each other and have a notebook or a copy of the MI model on hand.
Practice the Interview:
Work through the six steps of motivational interviewing with a partner (could be a client, a colleague, a fellow student, or a friend). Follow the steps as best you can:
- Start with engagement: Build rapport and establish trust.
- Move through focusing and evoking: Help the person explore their motivations and ambivalence.
- Continue with planning and implementing: Set concrete goals and talk about actionable steps.
End with reviewing and reflecting: Reflect on progress and reinforce commitment.
It’s not necessary to follow the steps perfectly in a strict sequence. You can move back and forth between steps as needed, but it is important to remain flexible and adaptive.
Take Notes:
As you go through the process, jot down keywords that summarize your conversation at each stage. At the end of the session, take time to summarize and reflect on where you are in the process.
Post-Session Reflection:
After completing the interview, write down your observations:
- What went well?
- What was difficult?
- What felt natural, and what felt forced?
- What would you do differently next time?
Additional Practice:
If possible, repeat the practice session with another partner or return to it after a few days to apply what you’ve learned. The more you practice, the more comfortable you will become with the MI process.