Motivational Therapy / Motivational Interviewing (MI) is an evidence-based therapy that increases your motivation to quit using drugs or alcohol. It works by removing doubts about rehab and sobriety while also building up your confidence and desire to change.
Benefits of Motivational Interviewing:
- Less likely to drop out of rehab.
- More motivated to change.
- More confident in their ability to succeed in rehab.
- Less likely to relapse after treatment.
Why It’s Important for Recovery?
The desire to quit rehab is a huge barrier. Some people don’t think their habit is serious, don’t want to give up the positive sensations of drug use, or they fear withdrawals and cravings. MI helps clients overcome their denial and come to their own conclusions about the pros and cons of drug abuse.
Once they find their desire to change and see how they could make that change, it’s easier to feel like they’re pursuing something they’ve chosen instead of feeling like they’re being forced to give up something they enjoy. It gets them “off the fence” about quitting by helping them find what they want from their recovery .
Motivational Interviewing Techniques: How Does It Work?
Motivational Interviewing uses questions to understand your thinking, asks clarifying questions to make you think about all the different parts of your position, and moves you toward deciding you want to make small changes. All of this comes down to 4 techniques that help someone sustain the motivation to pursue their sobriety:
Questions that cannot be answered simply and open a dialogue. This allows the therapist to better understand your thoughts and feelings about something or ask more questions to learn more. These questions may also help you think about things differently, decide what your goals are, or help you make plans to overcome obstacles .
Examples of Open-Ended Questions:
- Tell me about your family / What’s your family like? 
- Tell me about the last time you got high / What was it like the last time you got high?
- When someone suggests detoxing, what do you think about?
- What would it look like to not drink for a day?
- What does overdrinking mean to you?
Reflections or reflective listening means summarizing what someone has said, either as a question or statement. It’s a way for a therapist to make sure they understand both what you said and what you meant after you’ve answered something. Reflections can also encourage you to evaluate your thoughts and feelings in a way you hadn’t considered before.
Examples of Reflections:
Client: I don’t know why my wife is worried about this. I don’t drink any more than my friends.
Therapist: So your wife is worrying needlessly? 
Client: I can smoke weed and be a good father.
Therapist: It seems like you believe that you’d interact with your daughter the exact same way whether you were using marijuana or not.
Client: Maybe not the exact same…
Therapist: What do you think would be different?
Client: Well weed messes with your memory. Sometimes it’s hard for me to remember things.
Therapist: The idea of not remembering seems like it troubles you. What are you afraid of forgetting?
Client: Just special moments with her I guess.
Therapist: Forgetting those is a scary thought.
Therapists praise positive progress, change, or actions in therapy. Sometimes it’s difficult for people recovering from addiction to see or acknowledge their own successes. Affirmation lets them know someone sees them succeeding and opens the door for them to admit it as well.
Examples of Affirmation:
- That was a big step .
- I think that’s a great idea.
- That shows real progress.
- That could not have been easy. Well done. You should be proud.
At the end of a topic or session therapists might make sure they and the client “are on the same page” by summarizing what they talked about and what they decided forward progress would be before the next session. It’s a way to prepare to move forward.
Example of Summarization:
Therapist: It seems like you want to be more present with your daughter. You seemed concerned about forgetting any special moments, and said you wanted to try not using marijuana the next time she’s around, right?
Motivational Interviewing Principles:
Motivational Interviewing has 5 principles that therapists use to motivate patients towards making positive changes . These are not techniques learned in a manual as much as they are ways of being around clients.
Develop Discrepancy Between Goals and Actions:
We are more likely to change if we see that our current thinking or actions don’t line up with our goals. Part of MI is using reflections or open-ended questions to help you see how you might be slowing your progress. It can also be a way to help you realize how your actions conflict with your values  .
- What do you think are some good and not-good things about continuing to drink/use drugs? 
- On the one hand, you say that doing well in school so you can get a good job is important but on the other hand, you say you want to keep drinking even though you keep missing class. Can you help me understand how those fit together?
- You said saving money for BLANK is important. How do you think drinking/smoking affects that? What’s a rough or not-rough guess of how much you spend every week on drinking/drugs?
- How would you have described yourself before you started drinking/using drugs? How would you describe yourself now?
A way of showing that the therapist sees the world through your eyes. When we feel understood we tend to open up more and be more willing to take action. If we feel misunderstood we can become defensive or cling to our actions. To effectively express empathy a therapist makes it clear that while they may not agree with your actions, they accept you  .
- I can appreciate how difficult that is .
- That must have been hard on you.
- If I were going through what you are, I can imagine that I would feel similarly
Amplify Ambivalence to explore doubts:
Sometimes we know we need to change but haven’t realized all the reasons why. This doubting can get in the way of sustaining new behaviors so therapists help you explore all the reasons change could be positive and encourage you to explore your doubts  .
- What have others said about this problem? Why do you think it’s a problem?
- What do you think your life would be like if you didn’t change anything?
- What was your life like before you had problems with drinking/smoking/drugs/etc?
- How has your life changed now?
- What is most exciting to you about not drinking/smoking/doing drugs/etc.
- What is most scary to you about not drinking/smoking/doing drugs/etc.
Roll with Resistance:
Change is hard and most of us are resistant to it. Rolling with Resistance is a way for therapists to avoid arguing with you while staying respectful and empathetic if you seem resistant. Therapists recognize that you wouldn’t be here if part of you wasn’t open to change, so if you’re resistant it means that the conversation needs to be changed to better reflect what you want or need  .
Client: I don’t want to quit drinking.
Therapist: You don’t think abstinence would work right now? 
Client: I am not an addict.
Therapist: That word seems to bother you. What does it mean to you?
Client: I can’t do it.
Therapist: What do you think a first step would look like?
Client: It doesn’t matter I’ve tried before and it didn’t work.
Therapist: What do you think went wrong?
Self-efficacy is our belief in ourselves to do something. If we don’t believe we can change, we are far less likely to succeed. That’s why therapists try to build our confidence. This isn’t false praise or empty words. It’s a way to make sure someone knows they’re doing well  .
- It seems as though you have put a lot of thought into these goals .
- You say you’re still struggling with making these changes, but I see that you’ve had a lot of success so far.
- Looks like you made real progress.
Motivational Interviewing Stages of Change:
MI believes that anyone struggling with substance abuse would choose to be sober if they thought the pros of doing so outweighed the cons. MI helps resolve this internal battle over whether to quit or remain sober by moving people through the 5 stages of change .
Stage 1. Pre-contemplation: They are most resistant to change at this point. They do not intend to change, don’t think they need to change, or they might have tried and failed already and are trying to avoid thinking about change.
Stage 2. Contemplation: They are starting to think about changing. They are willing to admit they might have a problem and that there would be benefits to changing but are also aware of the costs
Stage 3. Preparation / Determination: They have decided to take action and are preparing for the change (buying a book, seeing a doctor, making calls to treatment).
Stage 4. Action: They try to deal with their problem by changing their life.
Stage 5. Maintenance: They try to maintain the changes they’ve made.
Become Your Best:
At Tree House Recovery we believe that everyone wants to get better and that change takes time, patience, and direction. We can help you realize your infinite potential and value. Call us to get started: (855) 202-2138