What Is Motivational Interviewing?
Addiction counseling and treatment differs from traditional behavioral therapy in one important respect. Not all addicts want to give up their addiction. Because of this, treatment is often coerced or even enforced by court order. The difficulty for therapists then becomes, “How do I reach this person?”
Motivational interviewing, at its root, attempts to find out what internal motivations a client feels and use those to generate treatment strategies and to guide therapy. The interview process then becomes a kind of non-judgmental exploration of the patient’s perspective, rather than a push to meet some external goal.
Traditional addiction therapy assumed that clients saw their addiction in the same way that society at large did. The therapist would confront their subject with these goals in mind, but often, clients would react defensively. The dynamic was one where the therapist was in the position of arguing one side with the client taking the other. If they could sway the patient, that would work. Unfortunately, in many cases it just created a situation of combativeness – not the ideal for eliciting real change.
From the addict’s point of view, traditional confrontation meant they could simply put up with whatever authority was being used against them long enough to escape and continue to use. By engaging the inner motivations of the addict however, the person is recruited to help find those things important to them. Once these motivations are found, a pathway to meet their goals without drugs becomes the focus.
Typically, a session may start out with gathering information about why an addict uses and gains from the addiction. This is done without an attempt to “talk them out of it.” After exploring the roots of the addiction – how it makes them feel and what they get from it – the therapist is free to question them about what problems they may be having and how important these things are.
The downside of motivational interviewing is when a client is unable to perceive their motivations or find any real reason to stop using drugs. It can devolve into a series of self justifications. Only a skilled therapist can aid in redirecting a truculent addict who is loyal to his drug. In some respects, motivational interviewing can help separate out those who wish to change from those who are not likely to benefit from treatment at this time. A clip from the “inventor” of the technique can be found here.