Therapy approach
Motivational Interviewing (MI)
A collaborative conversational style for working through ambivalence, particularly useful when part of you wants to change and part of you doesn't.
1980s
decade the approach was developed
OARS
core skill set used throughout
Strong
evidence base for substance use interventions
Brief
format, often just a few sessions
Understanding it
About Motivational Interviewing (MI)
Motivational Interviewing (MI) was developed by William Miller and Stephen Rollnick, originally for addiction treatment, as a way of helping people explore and resolve their own mixed feelings about change rather than being told what to do. It's built on the recognition that ambivalence is normal and that lasting motivation tends to come from within, drawn out through a particular kind of conversation rather than persuasion or advice-giving.
Most people facing a change — cutting down drinking, addressing a health issue, ending an unhelpful pattern — hold both reasons to change and reasons to stay the same, often simultaneously. MI treats this ambivalence as the central territory to work with, rather than something to argue someone out of, on the basis that direct persuasion tends to provoke defensiveness and 'push back' towards the status quo.
The approach uses specific skills, often summarised by the acronym OARS: open questions, affirmations, reflective listening and summaries, all aimed at helping someone hear themselves articulate their own reasons for change, known as 'change talk'. The therapist deliberately avoids the 'righting reflex' — the urge to fix, warn or convince — because research suggests that arguing for change often has the opposite effect.
MI isn't a stand-alone treatment for most conditions but a way of having conversations that's frequently combined with other approaches, such as CBT for addiction or health behaviour change, or used briefly at the start of therapy to build genuine readiness before more structured work begins.
How it shows up
You might recognise some of this
Nobody has all of it. Most people recognise a handful — and that's enough to start.
Best suited to
- Genuine ambivalence about a change, rather than clear-cut readiness or refusal
- Substance use, drinking or other addictive behaviours
- Health behaviour changes such as diet, exercise or medication adherence
- Situations where previous advice-giving has met resistance
What sessions involve
- Open, curious questions about your own view of the situation
- Reflective listening that mirrors back what you've said, often in a way that develops it
- Deliberately eliciting your own reasons for and against change
- Summaries that draw together the 'change talk' you've expressed
What changes
- Increased clarity about your own reasons for change, in your own words
- Reduced defensiveness or resistance around the topic
- A specific, self-generated plan rather than one imposed from outside
- Greater confidence in your own ability to follow through
Signals
When this helps
- Ambivalence about changing drinking, drug use or other habits
- Difficulty sticking with health behaviour changes
- Resistance to previous advice or treatment
- Building readiness before starting more structured therapy
The work
How therapy helps here
Helps you articulate your own reasons for change rather than being told what to do
Reduces the defensiveness that direct persuasion often triggers
Builds a specific, self-generated plan that's more likely to be followed through
The evidence
What the research actually says
Plain-English summaries of the guidance our therapists work from.
Well-established for substance use
MI has one of the stronger evidence bases among brief interventions, with numerous trials supporting its effectiveness for reducing alcohol and drug use, often as a brief, standalone or adjunct intervention.
Good support for health behaviour change
Systematic reviews support MI's use in areas like smoking cessation, weight management and medication adherence, generally showing modest but consistent positive effects.
Effects can be modest and vary by delivery quality
Because MI depends heavily on the practitioner's skill in avoiding advice-giving and genuinely eliciting the client's own motivation, poorly delivered MI shows much weaker effects than well-delivered MI in trials.
What to expect
How a course of therapy usually unfolds
A guide, not a script — your therapist shapes this around you.
- 1
Engaging
The practitioner builds rapport and understanding of your situation without judgement or an agenda to persuade.
- 2
Focusing
Together you clarify which specific change, if any, is the focus of the conversation.
- 3
Evoking
Open questions and reflections draw out your own reasons for change, strengthening 'change talk'.
- 4
Planning
If and when readiness develops, you collaboratively build a specific, realistic plan.
- 5
Ongoing use
MI principles are often revisited briefly throughout a longer course of other therapy or support.
Worth saying
Common worries, honestly answered
“It's a way of subtly persuading someone to change.”
Genuine MI avoids persuasion altogether; it aims to help you access motivation you already hold, not manufacture it for you.
“It's only for addiction.”
It's now widely used for health behaviours, mental health treatment engagement and many other areas of ambivalence.
“It means the therapist just agrees with everything.”
It's an active, structured style of listening and questioning, not passive agreement.
Between sessions
Small things that genuinely help
None of these replace therapy — but they're a gentle place to begin today.
- Write down your own reasons for and against a change, honestly
- Notice when you're getting advice you didn't ask for, and how it lands
- Try asking yourself open questions rather than 'should' statements
- Reflect on times you've changed something successfully before, and how
- Be patient with your own ambivalence rather than treating it as a failure
FAQs
Frequently asked
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