Motivational Interviewing

The modality aims to fuel the fire of intrinsic motivation to transform one’s lifestyle habits through the use of empathy, collaboration, and respect for individual autonomy. At its core, motivational interviewing is designed to strengthen personal ambition and subsequent action by guiding clients to explore their motivation for change with compassionate, non-confrontational dialogue.

Key Takeaways

• Motivational interviewing is a collaborative, evidence-based approach designed to assist individuals in resolving inner conflict and embracing long-term behavioral changes. The practice centers on empathy, respect for self-determination, and guiding clients to reflect on their inner desire for change without pressure or judgment.
• The core techniques used by MI therapists are open questions, affirmation, reflective listening, and summarizing (which together form the acronym OARS). These methods of communication serve to prompt honest therapeutic discussion and gently offer feedback, instead of directly confronting resistance or offering unsolicited advice.
• MI has been proven effective across a wide range of populations in improving outcomes for a range of conditions and challenges (including substance use disorders, diabetes, psychiatric symptoms, sleep issues, and relationship difficulties). The therapy works best for clients who are reluctant to change, rather than self-motivated individuals.

Understanding Motivational Interviewing

Motivational interviewing (MI) is an evidence-based psychotherapy that was developed in the 1980s by William R. Miller and Stephen Rollnick. Originally conceptualized as a treatment for alcohol use disorder, the modality is now used to inspire change in ambivalent individuals facing a wide range of behavioral challenges (including both physical and mental health conditions). ^{[1] [2]}

As there is limited modern research on motivational interviewing, definitions differ wildly, with some reflecting outdated or incorrect interpretations. In light of this, the most recent and comprehensive explanation of MI can be found in the third edition of Motivational Interviewing: Helping People Change by Miller and Rollnick, which was published in 2013. ^[3]

In the book, the pioneers of motivational interviewing describe the practice as being “designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring [a client’s personal] reasons for change within an atmosphere of acceptance and compassion.” ^[3]

Motivational interviewing has been found useful in inspiring change in those with substance use disorders and individuals with behavior-based health challenges who initially present as reluctant to adopt a new way of life. Additionally, MI has been found to promote co-operation with treatment adherence and to improve the effectiveness of medical care. ^[2]

What is Ambilivence to Change?

While the motivation to change one’s behaviour ranges significantly from person to person, it is common for individuals to feel conflicted when facing a significant lifestyle shift that requires leaving their comfort zone and diving headfirst into the unknown. Addressing this inner confusion is the primary goal of motivational interviewing. ^[2]

Studies have found that often, it is ambivalence (or reluctance) to change, and not a lack of knowledge or ability, that stands in the way of progress. Ambivalence is a common experience for individuals working through the process of change and is natural for most people when faced with any type of adjustment, ranging from minor daily habits to major lifestyle transformations. ^[2]

For example, while some individuals with substance use disorders may be in complete denial of the risks surrounding drug or alcohol use, others are fully aware of the consequences, yet continue to abuse substances. With this in mind, ambivalence should be viewed not as stubborn defiance but as inner conflict where a person desires change while simultaneously resisting it. ^[2]

How Motivational Interviewing Works

Motivational interviewing can be thought of as a style of communication rather than an intervention, and the modality can be used independently or alongside other therapeutic approaches. MI therapists place strong emphasis on compassion and respect for a client’s ability to work through ambivalence and make positive choices based on personal choice. ^{[2] [3]}

Motivational interviewing psychologists collaborate with clients as equals, avoiding unsolicited advice, confrontation, instruction, direction, or warnings. In other words, the aim of MI is not to force change, but to support and empower conflicted individuals by guiding them to explore their intrinsic reasons for change and to tap into their willingness to take action-based steps. ^[3]

Simply put, MI therapists understand and acknowledge a client’s natural resistance to adjusting behaviors that feel second nature, while aiming to strengthen their confidence in their ability to transcend unhealthy habits. The modality encourages transparent dialogue with compassion and gently guides clients to recognize discrepancies between current behaviors and goals.

To achieve this, motivational interviewing counsellors balance reflective listening with requesting permission to offer information or advice when beneficial. Reflective listening forms the core of the four fundamental motivational interviewing processes designed to address ambivalence and spark the desire to change (engaging, focusing, evoking, and planning). ^{[2] [3]}

These processes are used in MI sessions, where a therapist begins by engaging with the client to connect and build trust. Next, they move into the focusing phase, where a collaborative approach is used to identify key issues and goals. During the evoking stage, the psychologist helps the client explore their reasons for change before entering the planning phase, during which a practical strategy is discussed. ^[3]

What are the Stages of Change?

Although the Stages of Change model was first conceptualized in the late 1970s, a 2025 review provides an updated overview of the model, confirming its continued relevance. Additionally, the study emphasizes the recent understanding that individuals may cycle back and forth between stages, reflecting the non-linear nature of behavior change. ^[4]

Behavioral transformation typically unfolds gradually, often with multiple attempts and occasional setbacks. Motivational interviewing centers around the understanding that change is a journey rather than a single event. The 2025 model of the Stages of Change identifies six stages, as opposed to the original five: ^{[4] [5]}

• Precontemplation: An individual has no intention of changing their behavior in the near future, and is often unaware or only minimally aware of the problem
• Contemplation: At this stage, a person recognizes an issue and is considering making a change within the next six months, often feeling ambivalent
• Preparation: Plans to take steps towards behavioral change soon (typically within the next month) and may have already started making small changes
• Action: In this stage, an individual is actively working to change by exploring new behaviors
• Maintenance: Continuing to sustain the behavior change over time
• Termination: Feels fully confident and devoid of temptation to revert to old habits, although this stage is debated as relapse remains a possibility

While research has revealed that motivational interviewing can be effective during all the stages of change, it is considered to be especially powerful during the Precontemplation and Contemplation phases (when individuals desire change while resisting it). This inner conflict tends to increase as a person moves from the Precontemplation to the Contemplation stage.^{[2] [3]}

Although the ambivalence to change can sometimes motivate individuals to pursue growth, more often than not, the discomfort of learning to cope while embracing a new way of life causes people to avoid confronting the issue. This can take the form of denial, escapism, or other cognitive distortions that are not an accurate reflection of reality. ^[3]

How Common Is It?

Although motivational interviewing is widely used in research and clinical trials across various health fields, there remains a need for more large-scale, real-world studies to measure its application and integration in everyday clinical practice.

The existing evidence supports MI’s overall effectiveness; however, most studies conducted so far are of a moderate size, and data surrounding its prevalence in the general population and across healthcare settings is currently limited.

Techniques Used in Motivational Interviewing

Motivational interviewing makes use of a core set of communication skills represented by the acronym “OARS”. The acronym stands for Open-ended questions, Affirmations, Reflective listening, and Summarizing. ^{[2] [3]}

Additionally, MI therapists pay particular attention to a client's language, taking note of words or phrases that convey resistance versus desire to change. These techniques encourage complete honesty through the artful exchange of attentive and compassionate dialogue. ^{[2] [3]}

OARS Techniques

The OARS techniques are used in a wide range of therapeutic modalities, yet what makes the OARS model unique in motivational interviewing is the way in which these methods are used to resolve individual thought processes surrounding ambivalence to change while honoring a client’s autonomy.

Open-Ended Questions Used in Motivational Interviewing

Open-ended questions are phrased in a manner that invites individuals to share their story, viewpoints, and ideas as opposed to providing a short answer. These evocative questions aim to guide reflection on why change may be beneficial or achievable. ^{[2] [3]}

MI therapists typically first ask “obvious questions” that the client already knows the answer to, before offering relevant information or feedback (with the person’s permission), and finally exploring their thoughts or reactions to it with more open questions. ^[3]

This is known as “exchange of information,” or more specifically, the elicit-provide-elicit MI framework. Essentially, open-ended questions ensure that the exchange of information takes the form of a conversation rather than a lecture. ^[3]

The elicit-provide-elicit MI model includes:

• Elicit: Initial elicitation involves open questions asking what the client already knows (for example, “What have you heard about how alcohol affects sleep?”)
• Provide: After eliciting information from the client, an MI therapist offers to provide feedback with permission (for instance, “Thank you for sharing that. Research shows that alcohol can disrupt sleep and may even lead to insomnia, even if it seems that it helps with sleep initially.")
• Elicit: After providing feedback, the psychologist asks open questions exploring the client’s thoughts or opinions on the new information (for example, "What are your thoughts on that?" or "How does that fit with your experience?")

Other examples of open-ended questions used in motivational interviewing include:

• What concerns, if any, do you have about your current use of substance or behavior?
• Can you tell me what a typical day looks like when you are using substances?
• In what ways has this behavior affected your health or daily life?
• What would be different in your life if you made a change today?
• How do you feel about where things are right now with your drinking, smoking, nutrition, or exercise?
• What have you tried previously in your attempts to make a change, and what was that like for you?
• Can you think of any reasons you might want to make a change?
• How do your current habits benefit the concept of the life you want to create for yourself?
• What would it take for you to feel ready to try something different?
• What skills or support could help you make this change?

Affirmation

Affirmation holds the potential to raise clients’ awareness of their strengths, which can serve to motivate individuals who are change-resistant (provided that the person is open to the idea that the affirmation rings true). Even in circumstances where this is not the case, over time, repeated affirmation can build self-esteem, hope, and instill confidence in one’s capacity to change. ^[3]

When affirmation is used in motivational interviewing, the aim is to truthfully acknowledge progress rather than offering inauthentic praise. Affirming small steps taken in the mental process that encompass the Stages of Change often go unnoticed amid the confusion of inner conflict, and yet incremental progress holds the potential to motivate further behavioral shifts.

Examples of affirmations that may arise during a motivational interviewing session include:

• You have shown great courage by voicing this today
• It sounds like you are feeling more committed to making a permanent change
• You have been through a lot, and you are still showing up and trying your best
• Your line of thought shows that you care about your health and well-being
• I can see how much thought you have put into this
• You handled that issue with creativity and resilience
• It takes courage to be honest about what you are going through
• You have made real progress, even if it does not feel like it yet
• You are taking important steps, no matter how small they seem
• You are resourceful and have already learnt some tools that can help you move forward

Reflective Listening

Reflective listening involves the MI therapist listening attentively and seeking to grasp the client’s overall message by restating, rephrasing, or offering a thoughtful interpretation of what has been expressed. This skill acts as a key method of conveying empathy and is fundamental to the motivational interviewing modality. ^[3]

While simple techniques (such as repeating or rephrasing what a client says) can facilitate engagement, more complex strategies (where different words are used to reflect the underlying meaning or emotion behind a client’s statements) are used in an effort to provoke deeper self-reflection. ^[2]

For example, a client with alcohol use disorder might say, “I know drinking is causing chaos in my life, but it is the only way I know how to relax after work.” To which a motivational interviewing counsellor might respond, “It sounds like drinking helps you unwind, even though you are aware it is creating difficulties for you.”

Summarizing

Summarizing is a key skill used in motivational interviewing to help clients hear their own thoughts in a more organized way. The technique brings together important elements of a conversation, which can reinforce insight, self-belief, and motivation. Summaries can occur after long discussions or to highlight ambivalence versus the desire to change.

Summaries repeat the key points that a client has shared and can be used to connect different aspects of a conversation. For example, a therapist might say, “You have spoken about how alcohol eases your stress, but also expressed how it has been affecting your relationships.” This statement gently draws attention to the discrepancy between an individual’s behavior and goals. ^[3]

Summaries can also provide comparisons between past and present experiences to raise awareness of an individual’s progress. For instance, a psychologist may remind their client with diabetes, “You have come a long way - from feeling completely hopeless a month ago to now actively searching for solutions and thinking more clearly about what you want to achieve.”

Language of Change

In addition to the OARS techniques used in motivational interviewing, MI therapists pay attention to the language of change. This involves recognizing statements that support a passive attitude toward current issues (sustain talk) and those that express motivation or reasons for change (change talk). ^[3]

Over time, MI has shifted its understanding of resistance, viewing it as a natural aspect of ambivalence, rather than an underlying defense mechanism. Clients may express resistance through sustain talk, which expresses the “no change” side of their ambivalence. A therapist’s response to sustain talk can either reinforce resistance or spark further consideration of change. ^[2]

Unsurprisingly, a higher frequency of sustain talk in motivational interviewing sessions is generally associated with less favorable outcomes. In contrast, when counselors use MI-consistent approaches that focus on drawing out and reinforcing change talk (particularly strong expressions of commitment), clients tend to have more positive treatment results. ^[2]

Conditions It Can Help With

A 2023 review found that motivational interviewing can benefit a wide range of chronic issues, both physical and mental. From managing weight and diabetes to reducing symptoms in psychiatric disorders, MI has been found to effectively motivate behavior-based health conditions. ^[5]

This includes inspiring recovery in people with substance use disorder and assisting in building holistic habits that support the mind-body connection. Additionally, when used before other therapies such as cognitive behavioral therapy, MI can inspire clients to share more openly, subsequently enhancing progress. ^[5]

Weight and Diabetes Management

Motivational interviewing supports weight control and diabetes care by inspiring individuals to commit to lasting lifestyle changes. In fact, research shows that the modality can lead to reductions in body mass index (BMI), increased intake of fruits and vegetables, and decreased consumption of unhealthy foods (particularly when paired with telehealth or digital tools). ^[5]

Psychiatric Conditions

Motivational interviewing encourages the practice of mindfulness (present moment awareness), which can improve self-awareness, insight, and emotional balance, factors that serve to highlight an individual’s goals. MI has been found to reduce psychiatric symptoms, improve suicide prevention, and enhance recovery planning and participation for various disorders. ^[5]

Substance Use Disorders

Motivational interviewing is well-reknowned for its potential to help reduce both substance and behavioral addictions by working with their resistance to change. This is evidenced by studies showing that the modality leads to significant reductions in substance use, cravings, and risk behaviors. MII is also effective in reducing shame and increasing motivation to seek treatment. ^[5]

Sleep Disorders and Dysfunction

Motivational interviewing has been shown to improve sleep by helping individuals with sleep disorders or challenges to remain committed to treatment and home management. MI has been found to increase both the amount of time people use sleep devices and their confidence in coping with sleep difficulties. ^[5]

Behaviour-based Physical and Mental Health Influences

There is a solid body of growing evidence that physical and mental health have a bidirectional relationship, meaning that when either the body or mind is out of balance, each can negatively influence the well-being of the other.

In addition to recent research showing the benefits of motivational interviewing on specific psychiatric and biological health conditions, the modality holds the potential to inspire lifestyle adjustments in the form of healthy habits that support the mind-body connection.

Improving Overall Wellness Through Movement

Motivational interviewing can help individuals improve health and longevity by evoking the motivation to embrace physical activity in a personalized manner. Recent research has shown that MI has the ability to increase daily step count, support long-term exercise habits, and improve various health markers after attending sessions regularly. ^[5]

Supporting Holistic Health with Nutritional Habits

MI encourages individuals to reflect on their eating patterns and align them with their health goals, improving both physical and emotional well-being. Studies show MI-based programs can reduce sugary drink intake, lower waist size, improve blood sugar and blood pressure, and support long-term weight management for optimal well-being. ^[5]

Improving Relationships for Emotional and Physical Wellness

Strong relationships and social connections have a significant effect on both mental and physical health. Fortunately, motivational interviewing has been shown to reduce loneliness and social anxiety, especially in older adults and people struggling with confidence in social situations. ^[5]

Benefits of Motivational Interviewing

Motivational interviewing is a multifaceted therapeutic modality that centers around compassion, patience, tolerance, and gentle encouragement when a client is conflicted about implementing behavioral changes. As a result, the therapy has a myriad of benefits that support behavioral transformation in numerous areas of life.

• Equally as effective as other evidence-based therapies: When tested in formal studies, motivational interviewing was found to work just as well as other trusted therapeutic modalities. MI is also flexible and can be combined with many different therapies and disciplines. ^[3]
• Encourages patient engagement: Motivational interviewing provides a safe, non-judgmental space that inspires individuals to feel comfortable when sharing openly about their challenges, thoughts, opinions, and goals. This leads to more constructive discussions and improved involvement in self-care. ^[6]
• Allows for constructive feedback: It is natural for change-resistant individuals to shut down upon receiving unsolicited advice or direction. MI addresses this through its overarching spirit of acceptance, empathy, and respect for autonomy, while encouraging a client’s personal motivation for change. ^[3]
• Supports long-term behavior change: Motivational interviewing is designed to help people work through change-related inner conflict and draw out the internal motivation required to achieve various goals. This serves to support more sustainable long-term behavioural changes. ^[6]
• Improves holistic health outcomes: Research shows that MI can significantly improve physical health (for example, by lowering blood sugar in people with diabetes, reducing high blood pressure, and helping individuals adhere to their medications). Additionally, the modality encourages mindful practices, which can reduce psychiatric symptoms. ^{[5] [6]}
• Addresses complex behavioral concerns: MI can also be of benefit for individuals with more complex challenges, such as substance-based or behavioral addictions, risky sexual behavior, parenting difficulties, and even illegal or harmful behaviors such as violence. ^[3]
• Effective in multiple settings: Motivational interviewing has been used successfully in healthcare, education, addiction recovery, prisons, parenting, and mental health support. The therapy is effective across different cultures, age groups, and identities, and can be practiced one-on-one, in groups, or even via phone, text, or video. ^[3]
• Builds communication skills and enhances relationships: While motivational interviewing is a professional skill, many of its core ideas (such as the OARS techniques) are simple and intuitive. Clients may benefit from learning and using these techniques in their personal lives to enhance communication and relationships. ^[3]

Risks and Considerations

While motivational interviewing is widely regarded as a safe and promising approach for supporting behavioral change, the modality can not guarantee radical lifestyle transformations. Like any therapeutic method, successful outcomes depend both on the skill of the therapist and the cooperation of the client, along with the specific issue being addressed.

What are the Limitations of MI?

• Limited risk-related scientific data: Systematic reviews and meta-analyses have found no direct harm linked to MI. However, most of the studies to date have not investigated potential negative effects, meaning adverse outcomes cannot be ruled out entirely.
• Effectiveness may vary depending on condition: While motivational interviewing is an effective catalyst for shifting multiple health-related behaviors, some conditions (such as eating disorders) have shown limited benefits from MI in large-scale reviews. ^[7]
• Influence of human and structural factors: Variations in practitioner skill, session frequency, and client willingness can result in reduced effectiveness and inconsistent therapeutic outcomes. ^[8]

Barriers to Effective Outcomes

• Lack of standardization: The absence of uniform protocols in both research and clinical practice means that the delivery of motivational interviewing can differ from therapist to therapist, affecting the validity of scientific evidence. ^[8]
• Practitioner-related challenges: MI requires strong communication skills and tolerance of inner conflict, which can be difficult to maintain without patience, compassion, and a genuine passion for helping others. ^[8]
• Client-based factors: Motivational interviewing is not as effective for clients who do not acknowledge an issue or desire change. Additionally, psychiatric disorders and intellectual challenges can impact the efficacy of MI for some individuals.

Effectiveness of Motivational Interviewing

Motivational interviewing has shown success in helping people from various walks of life improve mental health disorders and behavior-based medical conditions in a wide range of settings among people of all ages, genders, cultures, and races. ^[2]

The modality is most well-known for its efficacy in helping individuals with substance use disorder reduce or quit use, with over 200 high-quality studies recognizing the efficacy of MI for treating substance use disorder. ^{[2] [5]}

According to recent research, the benefits of motivational interviewing (particularly regarding a decreased desire to use substances) can be seen after only four weeks in approximately 60 to 80% of clients. ^[5]

In addition to MI’s efficacy in treating substance use disorder, the therapy has also been found to significantly decrease psychiatric symptoms, strengthen suicide prevention efforts, and support more active involvement in recovery planning across various mental health conditions. ^[5]

Furthermore, the modality has been found to improve behaviors related to health, including:^[5]

• Sleep dysfunction
• Mindfulness
• Exercise
• Nutrition
• Weight management
• Dental hygiene
• Adherence to treatment plans
• Communication and relationships

Where to Find Motivational Interviewing

In light of the degree of influence practitioner skill holds over the efficacy of motivational interviewing, finding the best psychologist is crucial to successful outcomes. Many MI therapists have websites where prospective clients can learn about their qualifications, experience, special interests, and personal story.

It is recommended to thoroughly read through the website of each potential local motivational interviewing therapist to evaluate compatibility and skill. Motivational interviewing centres around empathy, so it is imperative to source a therapist with these skills. To assess this, endeavour to read between the lines of the psychologist’s “About” section, to discern whether they have a passion for their work.

In terms of compatibility and skill, wherever possible, read reviews from clients who have experienced their services before booking an appointment. Additionally, it is important to keep in mind that while in-person sessions are preferable for many clients, MI is just as effective when delivered via telehealth, online platforms, and conversational apps. ^[5]

In the event that a prospective client cannot find a good fit in the form of a local therapist, these digital tools can be used to reap the same benefits. Although health insurance may only cover online therapy or telehealth within its country of origin, this option opens the door to highly skilled professionals around the globe.

Does Insurance Cover Motivational Interviewing?

Insurance coverage for motivational interviewing in the U.S. is fairly common, though whether a person will be covered or not depends on the specific insurance plan and condition that motivational interviewing is being used to treat.

The modality is most often covered as part of a broader treatment plan (such as for substance use disorders or mental health issues), and a number of treatment facilities report that major insurance providers typically include MI sessions as part of standard care packages.

That said, motivational interviewing may also be covered when used for mental health or chronic disease support, although this varies depending on individual insurance companies and plans.

While some reimburse motivational interviewing directly, others may only do so when the modality is combined with other approved therapies or not at all. For this reason, it is essential to confirm the specific coverage details with your health insurance.

To confirm whether motivational interviewing is covered by a specific health insurance company, you can:

• Call your insurance company
• Check their online directory for in-network therapists offering MI
• Ask your primary care doctor for a referral

Is There Anyone Who Shouldn’t Try Motivational Interviewing?

While scientific literature investigating the adverse effects (including specific human risk factors) of motivational interviewing is limited, the modality is not recommended for individuals who are already clear, confident, and committed to making a change. This is because MI is designed to support people who are unsure, hesitant, or conflicted about change.

That said, the modality is not a magic bullet or cure, and requires at least a degree of willingness in terms of a client's desire to learn a new way of life. In scenarios where individuals are unaware that their behavior is problematic (as is the case with those in denial, experiencing delusions, or facing other cognitive challenges), MI is unlikely to spark change.

Additionally, motivational interviewing has been shown to work best during the Precontemplation and Contemplation phases of the Stages of Change model (when individuals desire change while experiencing strong reluctance) as the modality was developed specifically to address this natural ambivalence.

While MI can be effective throughout the Stages of Change, those working through the preparation, action, maintenance, and termination stages (where individuals have already overcome inner conflict and begun to make changes independently) may experience limited benefits from motivational interviewing.

Final Thoughts

Motivational interviewing (MI) is a form of psychotherapy designed to inspire and encourage lasting behavioral changes spanning a wide range of health-related adjustments for both physical and mental conditions. The modality is specifically designed to guide conflicted individuals who are change-resistant towards finding intrinsic motivation.

MI’s evidence-based success lies in its ability to meet people where they are and help them explore their personal reasons for change without offering unsolicited advice. By emphasizing empathy, collaboration, and self-directed decision-making, motivational interviewing respects the client’s pace and process while gently providing feedback with permission.

This form of therapy has been proven highly effective in the treatment of substance use disorders, psychiatric conditions, and behavior-based health concerns such as diabetes. With growing support from research, technology, and clinical practice, MI continues to invite individuals to take the next step, not because they are told to, but because they truly want to.

Author

Star Gorven

Star Gorven is a wellness and mental health writer with a talent for crafting evocative and evidence-based content across a wide range of topics. Her work blends analytical research with imagination and personality, offering thoughtful insights drawn from her exploration of subjects such as psychology, philosophy, spirituality, and holistic wellbeing.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Jennifer Brown

Dr. Jennifer Brown is dual board-certified in family medicine and obesity medicine. She currently works for Amwell Medical Group, providing virtual primary care services, including mental health treatment.

Activity History - Medically reviewed on March 23, 2026 and last checked on March 19, 2026