Motivational interviewing (MI) is a type of intervention used by counselors, clinicians, psychologists and diverse professionals to create change from within the client by helping the client identify, analyze and resolve ambivalence about a particular problem. MI has been used to help resolve alcohol, marijuana and opiate addiction. However, there are several disadvantages to the approach, and it is not always successful.
Failure of the Method
In a study by the University of New Mexico Center on Alcoholism, Substance Abuse and Addictions by William R. Miller and colleagues, more than 200 inpatients and outpatients were assigned either to receive MI or as controls. Returning to drug use was assessed by self-report, urine toxicology and collateral reports at 3-month intervals for 1 year. MI showed no effect on drug use outcomes. Patients had been responding well and showing strong commitment language to change until the therapist switched from empathizing and working with the client to identify the problem, to giving assessment feedback and pressing for an actual plan of change. At this point many of the clients became resistant.
No Methodology for Resistive Clients
While a learned and effective psychologist may be able to treat patients who resist, MI does not have an official methodology for dealing with clients who are not ready for feedback. MI is based on the idea that a client must be willing and able to work with a professional and change negative behavior. A client in denial will be unaffected by MI questions and advice. For example, a person who is overweight may receive questions from the MI leader such as, “On a scale of 1 to 10, how would you assess your desire to change your eating habits?" or “Do you think your life would be improved if you were thinner?” A client who doesn’t see or want to see himself as overweight will be unmoved by such questions and remain in denial.
Outside Influences May Be Stronger
MI seeks to change an individual’s motivation to perform an action. If greater forces are applied, the client could just as easily switch back to the negative behavior. While in a clinical setting, a patient may be very motivated to end her drug or alcohol addiction, but when she returns home with peers and daily life pressures, her motivation may cease.
Does Not Address Urgency of Change
A person may not understand the urgency of changing now. He may understand that he is addicted or overweight, but feel that he can change later. A person can feel that the power to change lies outside his range of capability. He may think “I was born this way” or that it is not possible to change.
MI also relies on the effectiveness of the MI leaders. They must be able to empathize with the client’s needs, feelings and circumstances. They must shun arguing for effective listening. They must be able to ask probing questions and have the patience to allow the client to develop her own insight and resolution rather than providing their own. An MI therapist will not be successful if he is not able to set goals with the client, exchange information, build confidence and consistently maintain a nonjudgmental approach.