The road to recovery from drug or alcohol abuse is sometimes obstructed by a roadblock with a sign that says, “Resistant to change.” 

Now consider your options: 

1. You could turn around and go back the way you came. 
2. You could take a detour that brings you to your intended destination, but the route is longer, more circuitous, and labored. 
3. You can keep going around in circles, hoping that the roadblock will just go away on its own. 

Or you could break clear through the barrier once you realize the obstacle is your own perception making. 

Sometimes, however, this change doesn’t come that easily, and many people are insecure about taking action to address a mood disorder or a drinking problem. Seeking therapy is a proactive, important step to breaking through this resistance, a way to get to the core of mood disorders or substance abuse issues.  

Tried-and-true methods like cognitive behavioral therapy work to reconcile how your thoughts influence your behaviors. Still, many people who need treatment are often reluctant to pursue it for a myriad of reasons. 

Then, there are approaches that focus on the true nature of behavior change. Motivational interviewing (MI) is a type of therapy meant to resolve ambivalence and motivate you to want to make changes in your life.  

But how does MI work? What are some of its fundamental components, like OARS during motivational interviewing, all about? Let’s explore. 

What Is Motivational Interviewing (MI)?   

MI is a client-centered counseling approach that was developed in the 1990s by psychologists William R. Miller and Stephen Rollnick. MI is founded on the understanding that you’re more likely to embrace change when you actively want it for yourself. 

MI is, like its name suggests, an “empathic, person-centered counseling approach that prepares people for change by helping them resolve ambivalence, enhance intrinsic motivation, and build confidence to change,” notes a study. 

This inherent motivation is always within you, but MI sessions work to unblock mental and emotional barriers that may prevent you from finding it. Rather than telling you what to do, the goal of motivational interviewing is to help you feel empowered to explore your thoughts and feelings — without judgment or pressure — so you can modify your perspective and become comfortable with making different, healthier life changes. It can also make you more prepared for additional types of therapy (like cognitive behavioral therapy). 

“Rollnick and Miller described an underlying spirit of MI as a crucial component of its efficacy,” notes a study published by the National Institutes of Health (NIH): 

• MI is collaborative instead of authoritarian 

• It’s meant to evoke a client’s internal motivation rather than attempting to install it 
• MI honors your autonomy 

What Can Motivational Interviewing Help Treat?

When Miller and Rollnick structured MI as a therapeutic model, it was initially created to support people struggling with addiction. Over the years, MI has since expanded in the treatment community to help other types of substance use disorders and mental health conditions: 

Substance Use Disorders 

“An essential element in motivational SUD (substance use disorder) interventions is helping people who misuse substances raise awareness of their values and hopes for a healthy life,” says the Substance Abuse and Mental Health Services Administration (SAMHSA).  

Statistics from the National Institute on Drug Abuse show that 40.3 million people in the U.S. recently struggled with a substance use disorder, but only 6.5% received treatment. This could be because of a lack of affordable options and other factors, but also due to a reluctance or fear to get help — which MI is meant to address. 

MI acknowledges that hesitation is normal. Instead of focusing on why change should happen, it helps you explore what change talk could look like for you. It encourages you to examine the role substances play in your life, weigh the pros and cons of quitting, and strengthen your motivation to start on the road to recovery. 

Mental Health Disorders  

The National Institute of Mental Health estimates that more than 20% — one in five — of adults in the U.S. live with a mental illness. In 2022, that amounted to 59.3 million people, or 23.1% of the entire adult population. 

Over the last several years, MI has widened its clinical reach to help people conquer various mental health conditions, from mild to severe, including mood and anxiety disorders, to PTSD, bipolar disorder, and others.  

“Motivational interviewing (MI) … can be used to inspire patients who have any level of enthusiasm for change, including the all-too-often-encountered absolute-zero enthusiasm, to move toward an important change that could make their lives better,” notes a study published by the NIH. 

“The driving goal in MI,” continues the study, “is to move (someone) from a position of complacency to one of more ambivalence about their particular version of toxic habit and then on to a personal desire for change.” 

How Does Motivational Interviewing Work?  

When you ask what motivational interviewing is and how it works, what makes MI unique is a set of various value statements reinforcing its efficacy. 

Core Principles of Motivational Interviewing  

At its heart, MI remains guided by four fundamental principles: 

1. Expressing empathy: Empathy is the ability to identify and relate to the way someone else feels. By listening to you, empathizing with you, and validating your feelings, your therapist creates a safe, non-judgmental space where you feel understood. 
2. Developing discrepancy: One way that MI is effective is by allowing your therapist to help you identify discrepancies, or gaps, between where you are now and where you want to be — your current state and your future goals.  
3. Rolling with resistance: In MI, your therapist will not confront any uncertainty you may feel about behavior change directly or become defensive but rather work with you through open conversation so you can work toward finding a new perspective. 
4. Supporting self-efficacy: Perhaps most importantly, MI aims to build your confidence in your ability to change. This supportive stance sees you as capable, resourceful, and possessing the ability to change within yourself. 

What Happens During Motivational Interviewing?   

MI, according to SAMHSA, follows the transtheoretical model of the motivational interviewing stages of the change framework, which includes five phases: 

1. Precontemplation: You haven’t considered making a change to your mental health or substance use. 
2. Contemplation: Through MI, you realize that making a positive change talk is necessary. 
3. Preparation: With a therapist, you can start to make a plan and take the steps toward making that change. 
4. Action: The phase that involves making actionable changes, like quitting drugs or drinking. 
5. Maintenance: With substance use disorder, the maintenance phase of MI sees you making an effort to stick with the changes you’ve made and engage in positive behaviors to avoid relapse. 

MI sessions are structured but flexible, so you can explore your thoughts and feelings at your own comfortable pace. Instead of just prescribing solutions, your counselor helps you examine your thoughts, your feelings, your behaviors, values and goals so you can recognize and resolve conflicting feelings about the nature of change.

For example, maybe you want to stop drinking, but you’re afraid of how it might affect your social life. Perhaps you know that therapy could help you improve your mental health, but you fear it won’t work for you. You might accept that you’re using drugs to self-medicate, but you’re worried that if you stop, you won’t be able to handle your depression or anxiety on your own (or the withdrawal symptoms).  

Because MI is a collaborative process, you and your clinician work as partners. The conversation focuses on what matters to you, whether that’s finding motivation to take the next step, identifying barriers that are holding you back, or simply just a way to feel heard and understood.