Motivational Interviewing
Core Mechanism
Resolving ambivalence through evocation of client's own change talk; autonomy support increases intrinsic motivation
Ontology
Ambivalence about change is normal; confrontation increases resistance, empathy reduces it
Therapeutic Voice
"On one hand you want to stop, and on the other hand it's serving an important function. What would you lose if you quit?"
View of the Person
An autonomous agent whose ambivalence about change is normal and whose own arguments for change are most powerful
Evidence
NICE: recommended for substance use. SAMHSA: listed
200+ RCTs
Multiple Cochrane reviews; Lundahl et al. (2010)
Very strong evidence base, especially for substance use and health behavior change.
Conditions
Epistemology
Blind Spots
Not a standalone treatment for most conditions; may feel insufficient when clients need more than ambivalence resolution
Contraindications
Situations requiring immediate behavioral compliance (e.g., acute medical emergencies), clients already firmly committed to change who need skill-building rather than motivational work, active psychosis impairing capacity for self-reflection
Training
Graduate training + self-study sufficient. Workshop training + coaching deepens proficiency
MINT (for trainers only)
Workshop: 16-24 hrs; ongoing coaching
$500-2K
Philosophical Roots
Rogers (empathy, autonomy); Kierkegaard (stages, either/or); Festinger (cognitive dissonance); Deci & Ryan (self-determination theory)
Related Modalities
Clinical Vignettes
See how Motivational Interviewing formulates these cases:
Test Yourself
What is the 'righting reflex'?
Show answer
The clinician's urge to fix — which paradoxically increases resistance.