Empowering Change: Motivational Interviewing in Mental Health Therapy

Motivational interviewing, in essence, is a collaborative conversation style that strengthens a person’s drive to change. Originally developed in the 1980s by William R. Miller and Stephen Rollnick to support people with substance use disorders, motivational interviewing has since expanded. Since its development, motivational interviewing has evolved into a powerful tool used in realms beyond mental health, including education, criminal justice, public health, sports, and even parenting.

Grounded in the idea of empowering people to change their lives from within, motivational interviewing is centered on autonomy. This approach recognizes that ambivalence toward change is a normal part of the human experience, and people should not be punished for resisting. Instead, therapists trained in motivational interviewing techniques can help navigate this ambivalence and spark the motivation needed for change.

Therapists create a safe space to support people through recovery by asking open-ended questions while affirming the individual’s strengths and efforts. Accepting change is an essential part of developing healthy habits, but people often feel compelled to hold on to their way of being, no matter how harmful it may be. Counseling can help people set themselves free of toxic patterns.

In the context of motivational interviewing (MI), ORS stands for “Oars.”  OARS is an acronym that represents four fundamental communication techniques used in MI:

O is for Open-ended questions: These are questions that require more than a simple “yes” or “no” response and encourage the person to provide detailed answers. Open-ended questions facilitate exploration, reflection, and expression of thoughts and feelings. They help to gather information and deepen understanding.

Example: “How do you feel about your current situation?”

A is for Affirmations. Affirmations involve acknowledging and highlighting the strengths, efforts, and positive qualities of the person. They are used to build rapport, enhance self-confidence, and promote self-efficacy. Affirmations can be related to past accomplishments, personal qualities, or any positive aspects of the person’s experience.

Example: “I appreciate your commitment to making positive changes in your life.”

R is for Reflective listening. Reflective listening involves paraphrasing or summarizing what the person has said to demonstrate active listening and understanding. It allows the person to hear their own thoughts and feelings and can help clarify their motivations, values, and concerns. Reflective listening promotes empathy and encourages further exploration.

Example: Person: “I’ve been feeling really overwhelmed lately.”

Reflective listening: “It sounds like you’ve been experiencing a lot of stress recently.”

S is for Summaries. Summaries are concise recaps of what the person has shared. They can be used to tie together different pieces of information, highlight patterns or discrepancies, and provide a sense of structure. Summaries help to reinforce the person’s understanding of their situation and can serve as a transition to the next phase of the conversation.

Example: “So, it seems like you’re feeling frustrated with your current job, but you’re also uncertain about making a career change.”

These OARS techniques form the foundation of effective communication in motivational interviewing. They help create a supportive and non-judgmental environment, encourage exploration and self-reflection, and foster the person’s motivation and commitment to change.

Change talk refers to the verbal expression of a client’s own arguments for change. It is the language of change and is considered a key mechanism in motivational interviewing. This type of communication can involve expressions of desire to change, ability to change, reasons to change, or the need for change. Change talk can signal that the client is considering or ready for change. It’s the therapist’s role to evoke and reinforce this change talk to help the client progress towards their goals.

As motivational interviewing suits multiple different disorders, situations, and needs, it is a highly adaptable method. Therapists can tailor each session to meet each individual’s circumstances and needs, which is easily done as the patient will often lead the discussion.

Therapists might focus on exploring the person’s ambivalence towards change or concentrate on building their confidence to overcome challenges. What remains constant in every approach, however, is the therapist’s empathy, non-judgmental attitude, and effort to empower the client to become an active participant in their recovery journey.

Motivational interviewing is a counseling approach designed to help anyone who feels reluctance toward change. When this resistance to change has harmful impacts, it may be important to seek professional help to adjust these negative thought patterns. People with the following mental health disorders in particular may benefit from motivational interviewing:

• Depression: Depression can often create feelings of hopelessness and inertia, making change feel impossible. Motivational interviewing for depression aims to combat this by tapping into the individual’s own reasons and motivations to move towards a healthier state of mind.

The therapist helps the individual explore and resolve their ambivalence and supports them in establishing their own goals for recovery. They then guide the individual to draw upon their internal strengths and resources to achieve these goals.

• Anxiety Disorders: Motivational interviewing can be a highly effective approach for clients grappling with anxiety disorders. The cornerstone of this technique involves helping the individual find their own motivation for change, which can be particularly helpful for those dealing with the debilitating effects of anxiety. Clients often feel overwhelmed or stuck due to their anxious thoughts and feelings. Through the empathetic and nonjudgmental space created in motivational interviewing, motivational interviewing in therapy can help clients recognize how anxiety may be affecting their life and relationships. This understanding can often spark the desire to change.
• Substance Abuse and Addiction: MI offers a non-confrontational and empathetic approach that promotes self-awareness and intrinsic motivation to change substance abuse behaviors. Through the use of MI techniques, individuals can examine the impact of their substance use, identify personal goals, and develop strategies for change. Research has consistently demonstrated the effectiveness of MI in reducing substance abuse, increasing treatment engagement, and improving outcomes
• Eating Disorders: MI has shown promise in helping individuals struggling with eating disorders. By employing MI techniques such as open-ended questions, affirmations, reflective listening, and summaries, therapists can create a supportive and non-judgmental environment to explore the underlying motivations and ambivalence related to disordered eating behaviors. MI can assist individuals in recognizing the negative consequences of their behaviors, enhancing their readiness to change, and fostering self-efficacy.
• Personality Disorders: The high-quality listening and non-judgmental approach employed by motivational interviewers can help individuals understand their disorder and take active steps toward managing their symptoms.

Recently, Motivational interviewing (MI) has emerged as a promising approach to address Gestational Weight Gain (GWG) during pregnancy. Incorporating MI techniques in antenatal interventions can have significant benefits for GWG outcomes. By utilizing open-ended questions, affirmations, reflective listening, and summaries, MI creates a supportive environment that helps women explore their motivations, concerns, and ambivalence related to GWG. This approach promotes intrinsic motivation, facilitates behavior change, and empowers women to make informed decisions about their weight management during pregnancy. Studies have shown that MI interventions can lead to lower total gestational weight gain and increase the proportion of women achieving recommended GWG.

At LifeStance Health, we firmly believe in empowering our patients to lead their own journey toward improved mental health. There is no one-size fits all solution to mental health recovery, which is why we connect people with a variety of methods in therapy and counseling. Getting better starts with a simple choice—reach out for guidance today.