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What Is Motivational Interviewing and How Does It Work?

Developed by psychologists William R. Miller and Stephen Rollnick in the 1980s, MI is grounded in empathy, respect, and partnership. It’s not about convincing or pressuring someone to change — it’s about helping them discover their own reasons and readiness to move forward.

By Taylor Pagniello, RP, M.A.

Nov 03, 2025

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Change is rarely easy. Whether it’s breaking a habit, improving health, or shifting a mindset, many people know what they need to do but still struggle to follow through. Motivational Interviewing (MI) is a compassionate, collaborative approach designed to help people resolve ambivalence and strengthen their own motivation to change.

Developed by psychologists William R. Miller and Stephen Rollnick in the 1980s, MI is grounded in empathy, respect, and partnership. It’s not about convincing or pressuring someone to change — it’s about helping them discover their own reasons and readiness to move forward.

The Core Principles of Motivational Interviewing

At its heart, MI recognizes that lasting change comes from within, not from external force. Therapists using this method act as guides rather than experts, helping clients explore their feelings, identify barriers, and strengthen confidence in their ability to change.

Four guiding principles shape every MI conversation:

  1. Express Empathy – Through reflective listening, therapists communicate understanding without judgment or persuasion.
  2. Develop Discrepancy – Clients explore the gap between where they are and where they want to be, which can help them clarify their values and motivations.
  3. Roll with Resistance – Instead of confronting defensiveness, therapists meet resistance with curiosity and respect, inviting clients to explore ambivalence.
  4. Support Self-Efficacy – MI focuses on a client’s existing strengths and capabilities, empowering them to believe change is possible.

How Motivational Interviewing Works in Therapy

A typical MI session feels more like a conversation than a lecture. The therapist uses open-ended questions, affirmations, reflections, and summaries — a communication style known as OARS — to foster exploration and insight.

For example, rather than saying, “You need to quit smoking,” an MI therapist might ask, “What do you enjoy about smoking, and what worries you about continuing?” This approach allows clients to hear themselves articulate both sides of their internal conflict, often leading to greater clarity and readiness for change.

MI can be a standalone approach or integrated into other evidence-based therapies like Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), or trauma-informed care. It is especially effective when motivation, confidence, or readiness are central concerns.

What Motivational Interviewing Can Help With

Motivational Interviewing was originally developed for treating substance use, but research now supports its effectiveness across a broad range of challenges, including:

  • Addiction and substance use recovery
  • Health behaviour changes (diet, exercise, sleep)
  • Managing chronic illness
  • Medication adherence
  • Anxiety, depression, or trauma recovery
  • Career and lifestyle transitions

It’s often used in both clinical and medical settings, as well as coaching, education, and organizational development — anywhere change requires personal commitment.

The Spirit of MI

More than a set of techniques, MI is a mindset. Therapists embody what Miller and Rollnick describe as the spirit of MI — a combination of partnership, acceptance, compassion, and evocation.

This means the therapist doesn’t tell clients what to do, but collaborates with them as equals. They trust that clients already possess the wisdom and strength needed to grow — the therapist’s role is simply to help draw it out.

This compassionate stance helps reduce shame, resistance, and defensiveness, creating space for genuine self-reflection and motivation to emerge naturally.

Why Motivational Interviewing Works

MI aligns with how humans actually change: not through pressure or guilt, but through understanding, choice, and empowerment. When clients feel heard and respected, they are far more likely to engage in their own growth process.

By helping clients explore why change matters to them and how they can realistically achieve it, MI bridges the gap between intention and action. It supports autonomy, confidence, and ownership — the foundations of sustainable, long-term change.

Final Thoughts

Motivational Interviewing reminds us that people don’t need fixing — they need understanding. When therapy shifts from persuasion to partnership, it honours each person’s readiness and pace for growth.

Whether someone is contemplating a major life change or feeling stuck in cycles of avoidance or ambivalence, MI provides a safe, empowering space to reconnect with one’s values and sense of direction. It’s not about telling people why to change — it’s about helping them remember why they want to.

  • Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press.
  • Lundahl, B., Moleni, T., Burke, B. L., et al. (2013). Motivational interviewing in medical care settings: A systematic review and meta-analysis. Patient Education and Counseling, 93(2), 157–168.
  • Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91–111.
  • Magill, M., & Naar, S. (2021). How motivational interviewing works: A technical hypothesis. Psychotherapy, 58(2), 189–195.
  • Rollnick, S., & Allison, J. (2004). Motivational interviewing in substance use. Behavioral and Cognitive Psychotherapy, 32(1), 29–36.
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