Most of the time, our unhelpful, unhealthy, and problematic behaviours begin with simple repetition. When we repeat a certain behaviour, it becomes a habit; when our habits are continuously repeated, they become our lifestyle. This means that, as an occasional alcohol drinker, an individual can develop an addiction to alcohol use.

Changing these behaviours does not happen overnight. It takes courage, effort, and consistency to make a behavioural modification. Here at Liberty Home Clinic, our primary goal is more than reducing symptoms of any condition; it is to promote internal drive and the need for change to achieve complete recovery and prevent relapse. We do this using a motivational interviewing approach.

What is Motivational Interviewing (MI)?

Motivational Interviewing (MI) is a client-centred counselling strategy that prepares individuals for change by helping them resolve ambivalence, enhance internal motivation, and build confidence in change. MI is empathetic and practical, involving change talk and a short-term process considering individuals’ challenges in making life changes.

The essence of MI is not for the therapist to provide external motivation or various tools to change but to elicit and create a way to guide the conversation to activate a person’s motivation, autonomy, and resources for change.

Generally, MI helps individuals become motivated and facilitate change in their behaviours, which prevents them from making healthier choices.

What are the Principles of Motivational Interviewing?

Motivational Interviewing is grounded in a collaborative approach and respectful stance, focusing on building rapport in the initial stage of counselling relationships. A central concept of MI involves identifying, examining, and resolving ambivalent feelings about changing an individual’s behaviour. The principles of MI are summarised as follows:

In MI, empathy is about seeing the world through the individual's eyes. This involves thinking about what the individual thinks and feeling about what the individual feels. This motivational interviewing process evokes understanding and acceptance of the individual's feelings and perspectives, essential in building rapport and trust and making the person feel heard, appreciated, and valued. This allows the individual to be more comfortable and honest when sharing their in-depth experiences.

Express Empathy

MI is a strength-based approach that emphasises the capabilities of the individual to change successfully. Here, the individual's self-efficacy, or belief that change is possible, is empowered to instil hope. Typically, individuals have previously tried to achieve and maintain the behaviours they wanted to change but failed to achieve them, which leads to doubt in their ability to succeed. Hence, MI encourages the individual to make use of their own ability to change by highlighting some of their past successes and strengths to build confidence.

Support Self-Efficacy

From the MI perspective, if the individuals are having difficulties changing, they may resist potential solutions, including the therapist's recommendation or guidance. These reactions are based on the individual's ambivalent feelings about change. When this happens, the therapist aims to avoid becoming argumentative or defensive. Instead, they acknowledge and explore resistance and help the individual find the solution and motivation for change. In addition, the therapist does not impose any viewpoint but assists the individual in considering multiple perspectives.

Roll with Resistance

This principle of MI helps individuals recognise the discrepancies between present circumstances and future goals, specifically where they are and where they want to be. When the individual identifies that their current behaviour is not aligned with self-identified goals, they are more likely to experience increased motivation to make important life changes. Generally, MI helps individuals identify discrepancies and find solutions to reduce them.

Develop Discrepancy

OARS: An MI Strategy

One of the main strategies in MI is OARS, which stands for open-ended questions, affirmations, reflections, and summaries, initially developed in the 1980s by Miller and Rollnick. This technique encourages the individual to explore ambivalent feelings about changing the target behaviour. Specifically, OARS helps individuals feel a safe and non-judgmental space, take responsibility for their behaviours, establish trust and therapeutic relationships, and promote their internal motivation.

Open-Ended Questions

This strategy helps the individuals understand their perspectives and explore their ambivalent feelings about making changes by asking questions about their experiences, including their thoughts and feelings. Open-ended questions differ from the typically closed-ended questions that are only answerable by ‘yes or no.’

These questions are ways for the therapist to encourage the individuals to uncover their stories spontaneously and without leading them in a specific direction. For example, the therapist might ask the individual, “What encourages you to seek therapy?” This question can serve as a starting point in exploring the reasons for asking for help. Some other useful open-ended questions that can be used in MI include:

Why do you want to make this change?
Have you ever tried to make any changes before?
How would you want things to be different?
How might you go about making this change?
What are the good things about making change?
What are the best reasons for you to do it?
How important is it for you to make changes? And why?
What do you think you will do to make these changes happen?

Affirmations

An affirmation is a statement that recognises and acknowledges the individual’s strengths, efforts, and victories to help them rebuild their confidence and promote internal motivation for change. It also helps to identify something positive about the individual, such as a trait, behaviour, attitude, perspective, past or present accomplishment, or anything that can build esteem and confidence, no matter how big or small it may be.

Some of the ways that the therapist demonstrates these statements are by responding congruently and genuinely to the individual when acknowledging efforts to make changes, such as ‘I appreciate the way you are approaching the problem, I can see that you are committed, and I can sense that you can succeed in our programme. Other examples of affirmations include:

Thank you for coming today for our session.
I appreciate that you are willing to talk to me about your problem.
That is a great choice.
You’ve got a lot of useful ideas.
I know it is difficult to share all these things, but I appreciate your efforts.
That is a good suggestion.
Despite facing those challenges, you handled yourself well in those situations.

Reflective Listening

Reflective listening is a skill that helps the therapist and individual empower the therapeutic relationship, build trust, and foster motivation to change. It involves restating or paraphrasing the individual’s statement, which demonstrates empathy and helps them feel validated and understood. In addition, it also encourages personal exploration and helps individuals deeply understand internal motivations, which can reinforce the desire for change.

There are two types of reflection: simple and complex. The former simply repeats or rephrases and is used to clarify what the individual has said or to reflect on a specific change talk, while the latter affirms and encourages change.

Some common examples of reflective listening include:

It sounds like you…
It seems as if…
I get a sense that…
What I hear you saying is that…
So you feel…
You’re wondering if…

At some point, reflective listening may appear easy, but it takes a lot of practice and repetition to master this skill. It helps individuals organise their thoughts and recognise their own change talk.

Summarising

Summarising is a long reflection or a special application of reflective listening. It can be used throughout the conversation and helps transition a session, end it, merge the talk’s content into a single theme, or review what the individual has said.

It also helps ensure mutual understanding of the conversation, identifies discrepancies between the individual’s present situation and future goals, and demonstrates effective listening and understanding of their perspectives. Some of the statements you might hear when the therapist is summarising include:

Let me see if I could capture and understand what you have shared so far…
Is there anything that you want to correct or add?
Okay, let me know if I have missed something…

Another way of summarising is by combining what the individual thinks and feels. This helps promote their internal motivation and commitment to change and provides a basis for the subsequent sessions.

Benefits of Motivational Interviewing

MI can provide a wide range of advantages in treating various addiction and mental health conditions. Particularly, MI helps the individuals to:

Understand their conditions better
Prepare for action-oriented intervention
Improve engagement in treatment
Gain rapport and reduce resistance
Make an informed decision
Increase motivation

Who Is Motivational Interviewing For?

There have been a lot of research studies confirming the effectiveness of MI in treating both psychological and physical health disorders as well as helping people change their problematic behaviours. MI can be applied to various conditions, including but not limited to substance use, gambling, internet addiction, eating disorders, illegal behaviours, smoking, weight loss, and those individuals with treatment resistance.

What Substances Does Liberty Home Treat With MI?

Liberty Home utilises MI as part of our comprehensive intervention for individuals with substance use problems and other forms of addiction. MI helps these individuals recognise the problem and identify goals, which are essential in the first step of the recovery process.

Alcohol and Drug Addiction

MI is used as one of the therapeutic interventions for individuals with alcohol and substance addiction. Although it does not address any underlying factors that cause the problem, MI helps these individuals increase their internal motivation and commit to change. In addition, MI also provides a space where individuals feel validated, appreciated, valued, and hopeful. The therapist emphasises that individuals do not lack the resources to change but the motivation to change their behaviours. During the MI process, individuals are expected to experience different stages of change.

Precontemplation Stage

The initial stage of change shows that the individual has little to no intention of changing problematic alcohol and substance use. They have no awareness of what has to be changed or why they need to be changed.

Contemplation Stage

At this stage, individuals can identify the problem and often evaluate whether action is necessary. They may want to change and may even have considered changing their behaviour, but they have not invested any effort into it. Individuals explore both the positive and negative aspects of their lifestyle choices.

Preparation Stage

The individual starts the action plan to change the problem behaviours. Commitment to self-identified goals is likewise observed. The therapist assists individuals in building skills and encouraging them to take small steps.

Action Stage

Although behaviour changes have not yet reached a stable state, individuals remain consistent in taking steps to modify their behaviour and are dedicated to making lifestyle changes.

Maintenance Stage

The individual continues to work on identified goals, and the therapist helps to build some strategies to cope with risky situations. The individual consolidates the gains achieved during the previous stages to prevent relapse.

Discover Readiness for Change and a Substance-Free Life With Liberty Home

MI is an evidence-based and client-centred approach that empowers individuals to find their path to behaviour change. By fostering collaborative therapeutic dialogue, MI can help you tap into your intrinsic motivation, confidently overcome challenges, and make healthier life choices.

If you feel inspired by this approach, consider working with our clinician at Liberty Home Clinic to explore how MI can further support your journey.