The Program
Motivational Interviewing (MI) is an evidence-based, person-centered practice that encourages engaging and communicating with the individual respectfully, empowering them to change. This collaborative, goal-oriented communication style strengthens personal motivation and commitment to a specific goal by exploring a person’s reasons for change in a compassionate and accepting environment. Motivational interviewing requires the use of relational skills and technical skills, which are crucial to its efficacy. Practitioners must intentionally demonstrate compassion, a sense of partnership, acceptance and affirmations, accurate empathy, deliberate mentions of autonomy, genuine curiosity about the client and their motivations, and how the client thinks they can achieve that change.
Intended Audience
Motivational interviewing can be effectively applied to various culturally diverse populations.
Implementation
Motivational Interviewing is used in primary, mental, and behavioral health fields to support change that aligns with an individual’s values and concerns. This practice can be implemented in various settings beyond healthcare, such as schools, correctional institutions, coaching, social work, home visitation, and any organization focusing on behavioral change. Motivational interviewing is designed to be a brief intervention delivered in 2 to 4 sessions, with no specific dose-response requirement. A small amount of motivational interviewing is more likely to be effective at moving a client towards change rather than lecturing, providing information without engagement, or premature goal setting. This practice can be implemented both in-person and virtually with either an individual or a group. It is ideal to use motivational interviewing when addressing behaviors related to substance use, health promotion, medical adherence, and mental health issues. Effective use depends on the fidelity of practice and the staff’s ability to maintain a reasonable proficiency in delivery. Staff must have time and opportunities to participate in continued coaching, feedback, and practice to reach proficiency. More training or implementation leads to the risk of failing to achieve proficiency in this practice.
Outcomes
Motivational interviewing can be used to guide individuals toward positive behavioral changes. Initially, motivational interviewing was intended to help people with alcohol use disorders overcome their ambivalence about stopping or reducing use. The first published research article about this practice found that motivational interviewing was the opposite of standard practices at the time in many ways. Research also supports the effectiveness of motivational interviewing across a broad range of problematic behaviors. A significant early finding of this practice showed that motivational interviewing does not have a dose-response requirement, and short sessions can increase treatment engagement and adherence.
Evidence
Evidence that supports the effectiveness of motivational interviewing includes over 250 randomized controlled trials and thousands of articles in peer-reviewed journals. These findings span across multiple professions and client issues. Results have also shown that motivational interviewing is more effective than no treatment, standard care, or being on a wait list before receiving the intervention. The most substantial evidence of this practice still lies in treating substance use disorders (SUDs) with small to medium effects for facilitating health-related behavioral changes across a wide range of populations and practices.
Key Strategies to Implementation & Sustainability
Organizational Factors
Regardless of the intervention, support from organizational leadership is crucial to implementing motivational interviewing. This practice differs from other models because motivational interviewing is not a program but a communication style and method of interacting with an individual. This demonstrates the necessity of adopting motivational interviewing at an organizational level and being understood by everyone, especially leadership. Motivational interviewing can be used at all levels of care and does not require clinical training.
Cultural Factors
Motivational interviewing centers on the needs of the individual, and the practitioner decides how it can best be applied to the individual within the context of the population they serve. As a result, motivational interviewing can work well across all communities and cultures. With centering the individual, motivational interviewing holds space for all experiences and can affirm individuals along the gender spectrum.
Implementation Challenges and Solutions
Motivational interviewing is not a widespread common practice, leading to a general lack of understanding from staff. This leads to difficulties applying the practice, mainly if practitioners are used to traditional health and mental health training. Challenges can also arise from practitioners reverting to familiar practices. Motivational interviewing may only be a good fit for some. For example, individuals who are reactive and controlling may not find any benefits from the practice. The skill necessary to apply motivational interviewing is complex, hard to maintain, and requires constant practice and support, and some practitioners may need help to commit to this practice.
Additional Resources