Motivational interviewing: What it is and how it works

Reviewed by Susan Radzilowski, MSW, LMSW, ACSW

Written by

therapist.com team

Last updated: 05/15/2025

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What is motivational interviewing?

Motivational interviewing (MI) helps people change their behavior by guiding them through conversations about the mixed feelings they may have about making changes.¹ It centers on helping clients find their own reasons for change rather than relying on outside pressures.

Originally developed to treat alcohol addiction in the 1980s, MI is still widely used for substance abuse disorders.² It’s also been expanded to address many other mental and physical health concerns. Today, it’s used to help with management of chronic health conditions, improving diet and exercise habits, addressing anxiety or depression, and reaching personal goals.³

How motivational interviewing works

If you’ve ever felt unsure about making a change or taking action, motivational interviewing might be helpful for you. During MI, therapists ask open-ended questions about your feelings toward a potential change or action.⁴ They then reflect your thoughts back to you in a way that emphasizes your own reasons for change.

Research suggests that how a person comes to speak about certain actions during sessions may actually predict behavior change.⁵ In other words, when you hear yourself talking about making changes, you become more likely to actually make those changes.

MI is built on a person-centered foundation, meaning a strong relationship between therapist and client is crucial.⁶ The term “spirit of MI” is used to refer to the special and collaborative energy that underlies the entire MI process.⁷ This energy is supported and marked by four elements: partnership, acceptance, compassion, and evocation (PACE).

• Partnership: Your therapist works with you collaboratively, recognizing your expertise in your own life
• Acceptance: Your therapist accepts you as you are, respecting your worth and potential through empathy and support of your autonomy
• Compassion: Your well-being and needs are prioritized throughout the process
• Evocation: Your own internal motivations and values are explored, rather than new ones being imposed; instead of trying to pass on wisdom or give advice, interviewers attempt to draw out what you already know or believe.

These values help create an atmosphere where you feel heard and respected, making you more open to exploring change at your own pace. If you’re interested in exploring MI, you can find a therapist who specializes in this approach through our directory of mental health professionals.

Motivational interviewing techniques

During MI sessions, your therapist will likely use several techniques to help you explore your motivation for change.

OARS

The OARS skills form the foundation of effective motivational interviewing practice:⁸

• Open-ended questions encourage deeper exploration than simple yes/no ones. They invite you to share more about your experience and feelings. For example, instead of asking “Did you exercise this week?” your therapist might ask “What kinds of physical activity have you enjoyed lately?”
• Affirmations acknowledge strengths and efforts, boosting confidence. For example: “I’m impressed by how you managed to drink water instead of soda. I know it’s hard when you’re under extra pressure.”
• Reflective listening involves your therapist repeating back what they heard from you in their own words. This practice shows they understand your reasoning and could lead you to go further into the topic.
• Summarizing allows your therapist to pull together several points from your conversation. It can be used to focus on related points that create a narrative or highlight those areas where you yourself mentioned wanting a change.

The 5 As

The 5 As provide a structured approach for guiding conversations about behavior change.⁹ A therapist following the 5 As might do the following:¹⁰

• Ask about the current situation with curious, non-judgmental questions. They will help you understand how you feel about your own behavior while avoiding blame.
• Assess willingness to change by exploring ambivalence. Ambivalence is a normal part of both life and the process of change. Your therapist might help you explore it using scaling questions like “On a scale of one to ten, how important is making this change to you? Why that number and not a lower one?”
• Advise by offering clear, personalized suggestions based on specific circumstances. Your therapist will ask permission before giving advice to maintain the collaborative spirit.
• Assist/Agree by helping identify barriers and goal-oriented solutions. This might involve brainstorming strategies together or connecting you with resources.
• Arrange follow-up support and accountability. This could be scheduling future sessions or helping you build a support network for your journey.

Your therapist might also use these important, but less structured, strategies:¹¹

“Rolling with resistance” by not arguing with you when you don’t want to make a change. Instead of confronting actions which may be working against your goals, the therapist “pulls up alongside” you. They acknowledge your perspective and reflect back to you without judgement.

“Eliciting change talk” by encouraging you to express your own desires, abilities, reasons, and needs for change. A therapist may ask you scaling questions like “On a scale from one to ten, how important is making this change to you?” or “Why did you choose that number instead of a lower one?” In doing this, they help you voice your own opinions and explore what changes you want to make.

Clarifying your values by exploring the ways your current behavior and your core values (or life goals) do and don’t align. A therapist may help you identify the values you feel are important and the way your choices do or don’t move you closer to them. For example, if you value being a present parent but find yourself constantly checking work emails during family time, your therapist might gently help you notice this disconnect.

Information exchange following an “elicit-provide-elicit” framework. Instead of cautioning you on the risks of continuing a certain behavior, MI therapists may introduce new information in a more neutral way. They first elicit your understanding, then provide new information, before eliciting what this information might mean for you.

The goal of these MI strategies isn’t to convince you to change. It’s to help you discover your own motivations and build confidence in your ability to succeed.

The motivational interviewing process

MI works hand-in-hand with the stages of change (SOC) model.¹² The model suggests people move through distinct phases of readiness when changing behavior:

• Pre-contemplation: You don’t yet recognize a need for change. You might think, “I don’t have a problem,” or “I’m not really harming anyone as I am.” MI uses gentle awareness-building to help you explore the potential benefits of change without pushing.
• Contemplation: You’re aware of the issue but uncertain about changing. You might say, “I know I should make a plan, but I’m not sure I’m ready.” MI helps explore these mixed feelings and build confidence.
• Preparation: You’ve decided to take action and are ready to set goals and make plans for change. At this point, you might ask, “What can I do to get started?”
• Action: You’re actively changing your behaviors or working toward a goal. Your therapist helps you develop skills and strategies while speaking with commitment about the future.
• Maintenance: You work to maintain the positive changes you’ve made by identifying triggers and developing healthy coping strategies.

MI is particularly effective in the early stages when readiness is low, though it can be useful throughout the entire change process.¹³ This is especially helpful if you’ve tried to make changes before but found yourself slipping back into old patterns.

The MI processes

Rather than following rigid phases, MI uses overlapping processes that better reflect how it works in practice.¹⁴ The four processes that work together in MI are engaging, focusing, evoking, and planning.

Engaging: The foundation of the therapeutic relationship. This involves:

• Building trust through respectful, empathetic conversation
• Using OARS skills
• Creating a safe space to comfortably share your thoughts and feelings

Focusing: Finding a clear direction for conversations and the counseling process by:

• Working together to find what changes matter most to you
• Identifying specific behaviors to discuss and work on
• Clarifying goals while respecting your priorities

Evoking: Drawing out your own motivations for change by:

• Exploring your mixed feelings about changing
• Highlighting areas where your behavior and personal values don’t align
• Strengthening your confidence and hope for change
• Looking for signs you’re ready for change

Planning: Developing specific steps once you’re ready by:

• Creating a plan for change that feels realistic
• Thinking about what might get in the way and how to deal with it
• Strengthening commitment to act

Throughout this process, your therapist will meet you where you are. If you’re not ready to make a change, they won’t pressure you. If you’re eager to take action, they’ll help you come up with clear steps to get started.

Evidence for motivational interviewing

Research shows that motivational interviewing can help many people make positive changes in their lives. The approach has been shown to work particularly well with:

• Addiction treatment: MI has been shown to be effective in reducing substance use and improving outcomes for alcohol and tobacco addiction, though there’s less consistent evidence for its effectiveness with other substances.¹⁵
• Medication adherence: Studies indicate that MI could improve adherence to medication and treatment plans for conditions like diabetes, HIV, and heart disease.^16,17,18,19
• Lifestyle improvements: MI is effective in promoting healthier lifestyle choices, such as increased physical activity and better dietary habits.²⁰

One meta-analysis showed that MI techniques outperform simply giving advice.²¹ This means that being guided to find your own motivation may create more change than being told what you should do.

Using motivational interviewing with other approaches

Motivational interviewing doesn’t need to be used as a standalone treatment. It works well when combined with other therapeutic methods, such as:

Cognitive behavioral therapy (CBT): Many people undergoing CBT for depression or anxiety feel ambivalent about change. MI addresses this ambivalence, helping resolve mixed feelings about challenging components, while CBT provides practical skills for modifying thoughts and behaviors.²²

Brief behavioral activation therapy (BATD): Combining MI with BATD helps address depression by increasing your motivation to engage in meaningful activities.²³ Your therapist can help you both identify activities that matter to you and build the motivation to actually do them.

Other therapeutic approaches that can be integrated with MI include:

• Dialectical behavior therapy (DBT)²⁴
• Acceptance and commitment therapy (ACT)²⁵
• Family therapy²⁶

If you’re interested in motivational interviewing, search our directory for a therapist with training in this approach. You can also ask potential therapists about their experience with MI during your initial consultation.

Finding the right therapist may take time, but MI depends on a strong therapist-client relationship. Start your search today to start down the path to better mental health.