We all know what we ought to do; we are aware that exercise is beneficial, that smoking is harmful, that sleep is important and that too much time in front of screens is likely to have a negative effect on our productivity. However, knowing what we should do and actually altering our behaviour are two completely different matters. It is possible for a person to want to give up smoking and yet still take a cigarette when having a stressful day. Someone might really want to exercise but keep telling themselves that they’ll start next Monday. Another person might understand how important it is to take their medication but still forget to do so regularly.
It is in the gap between knowing and doing that Motivational Interviewing (MI) becomes interesting. Rather than just telling people what changes they should make, MI looks at the situation from the individual’s point of view by asking them what they want, what is preventing them from acting, what they are uncertain about, and most important of all, why they would like to change.
What Exactly Is Motivational Interviewing?
MI was first developed in connection with individuals who had alcohol-related problems and has since become a widely adopted method for helping with changes in addiction, healthcare, physical activity, diet and other lifestyle behaviours (Miller, 1983; Miller & Rose, 2009). The key principle of MI is that people are generally more likely to take action when the reasons for changing relate to their own values and priorities rather than being provided by someone else. Motivational Interviewing is a method of discussing change cooperatively. The practitioner does not merely act as a lecturer, a persuader or someone who gives out instructions. Rather, the individual is encouraged to look into their own behaviour, doubts, goals and the reasons for wanting to change (Miller & Rollnick, 2013).
One of the key aspects of MI is acknowledging ambivalence. It is possible for people to genuinely want two opposite things at the same time. For example, a person might say, “I want to stop drinking since it is harming my relationship,” while at the same time thinking, “But it is by drinking that I relax with my friends.” Another person who is trying to lose weight may desire better health yet still enjoy their present eating habits. Such contradictions are normal. Instead of seeing ambivalence as an indication that a person is lazy or unwilling to change, MI regards it as something that should be investigated. Its objective is not to push the person towards the “right” answer but to assist them in understanding their own conflict and then making a decision.
Read More: Motivational Interviewing: Where Change Starts within a Conversation
What Causes People Actually To Want To Change?
The psychology of MI is closely linked to motivation, self-efficacy and personal values, and Miller and Rose (2009) regard it as a means of enhancing motivation as a result of the interaction between the practitioner and the individual. A key concept is that of discrepancy, this involves noticing the gap between what a person is currently doing and what they would like for themselves. Suppose there is someone who smokes and has recently begun to feel breathless; although they enjoy smoking they also want to stay healthy so as to be able to play football with their child. When they themselves realise this contradiction, the reason for making a change becomes personal.
Self-efficacy is just as important; for instance, if a person thinks to themselves, “I’ve tried to exercise in the past and always failed”, they may not think that another attempt will succeed. During an MI conversation it is possible to look at the various situations in which the individual has previously successfully changed a difficult habit. The purpose here is not to provide unrealistic reassurance but rather to help the person spot evidence that they are capable of making a change.
Read More: The Cycle of Change in Addiction: Understanding How Recovery Really Happens
The Conversation Matters
The organisation known as MI makes use of a number of communication techniques, many of which are remembered by means of the OARS method: open questions, affirmations, reflective listening and summaries (Miller and Rose 2009). Allowing people to give an explanation of their experiences rather than just providing one-word answers is the approach. Instead of asking, “Do you want to stop drinking?”, the practitioner could ask, “What is most concerning to you about your drinking at the present time?”
What reflective listening involves is demonstrating that you have understood the other person’s experience. For example, if a person says, “I know I should exercise, but after work I am exhausted”, a suitable reply would be, “You’d like to get more active, but by the end of the day you have almost no energy left”. Rather than offering a solution right away, the practitioner first focuses on understanding the problem.
Affirmations point out real strengths or efforts. For instance, “You have already reduced your smoking from ten cigarettes to five a day, so you’ve shown that you can make changes.” Summaries then put the most important points of the conversation together and thus help the person to hear their own thoughts more clearly. Although these techniques may appear to be simple, MI is not just about being polite or being a good listener; the practitioner must direct the conversation in a way that leads to meaningful change without compromising the person’s autonomy (Phillips & Guarnaccia, 2020).
Read More: Urgent Action Needed To Protect Youth From E-Cigarettes
The “Yes, But…” Side Of Change
People frequently provide reasons in favour of changing as well as against it. For example, someone who is trying to reduce their alcohol intake might say, “I dislike feeling tired the morning after, but I drink because that’s how I socialise.” Another person who wants to start exercising might say, “I would like to feel healthier, but I don’t have any time.” MI keeps a close eye on change talk, these are statements which show a person’s desire, ability, reason or need regarding change. For example, statements like “I want more energy”, “I think I could start walking three times a week” or “I don’t want my children to see me smoking” give indications of what is important to that person.
Research has discovered a connection between the behaviour of practitioners who are consistent with the MI approach and clients’ use of change-oriented language, although the relationship between change talk and real long-term behaviour change is more complex (Miller & Rose, 2009; Magill et al., 2013). That is the reason why MI is not about winning an argument; if a person does not want to exercise, constantly telling them that exercise is important may cause them to become defensive, whereas asking them, “If you did become more active, what would you hope would be different in your life?” sets up a completely different kind of conversation.
Read More: Transtheoretical Model of Health Behaviour Change
From Addiction To Everyday Health
MI has a strong background in the field of addiction treatment and can assist individuals in examining their willingness to reduce or stop using alcohol or substances as well as in understanding the personal consequences of continuing with the behaviour. Research shows that MI has useful effects with regard to several substance-use and health behaviours, even though the strength of the results varies from behaviour to behaviour. A large meta-analysis identified benefits in the case of problems concerning alcohol, drugs, diet and exercise, while the findings were less consistent when it came to smoking and some other behaviours (Hettema et al., 2005).
MI has also become important in the field of healthcare since a great many health outcomes depend on the things that people do on a daily basis. Take the example of a person who has diabetes. A healthcare professional may explain why it is important to take medication, engage in physical activity and make changes to one’s diet, but it can still be difficult to follow these recommendations because of work, family duties, habits or financial constraints.
Instead of providing the individual with ten instructions at once, an MI-style conversation might ask, “Which change seems most realistic to you at the moment?” This gives them a degree of control over where to start. Research has shown that MI can lead to improvements in some metabolic and psychosocial outcomes for people who have diabetes, although the results differ from study to study (Bilgin et al., 2022). MI has also been looked at in relation to physical activity. Recent evidence indicates that behavioural interventions based on MI can lead to better physical activity outcomes in certain adults, although the magnitude of the effect differs (Zhu et al., 2024).
Why Personal Reasons Matter
The MI places a great deal of importance on intrinsic motivation, that is, motivation which is related to things that matter personally to an individual. Picture two individuals who have begun to exercise; one does so because their doctor has continually advised them to lose weight, while the other exercises in order that they may have enough stamina to play with their children without becoming tired. They might be carrying out the same kind of activity, but their motivations are different.
The second person has associated exercise with something significant, and this idea is also in line with Self-Determination Theory, which stresses the need for autonomy, competence and relatedness in order to be motivated. Research that has looked at MI and Self-Determination Theory has discovered important similarities, especially in the area of promoting more self-directed motivation (Phillips & Guarnaccia, 2020). It doesn’t follow that external motivation has no value; rewards, deadlines, social expectations and medical advice can all have an effect on people’s behaviour. Yet reasons that are meaningful to the individual can help them feel that the change is their own decision rather than something that has been imposed on them.
Read More: Deadlines and their Negative Impact on Workers’ Mental Health
But Does MI Always Work?
The evidence is encouraging, but it by no means makes MI into a magic formula. A systematic review of motivational interviewing in primary care revealed that about half of the studies demonstrated positive effects on behaviours including physical activity, diet, and alcohol use (Morton et al., 2015). The fact that there is this variation is significant since it indicates that MI does not work just as effectively for every individual or for each behaviour.
The importance of training practitioners should also be noted. Since MI requires certain communication skills, research indicates that training can enhance practitioners’ skills in this area, although there are considerable variations in the methods of training and the results obtained (Kaczmarek et al., 2022).The quantity and form of the intervention can also make a difference; a short talk might be enough to get someone to make a small change, while more complicated behaviours could require several sessions as well as some extra psychological or medical assistance.
Conclusion
Motivational Interviewing offers a different way of looking at behaviour change. Instead of assuming that people simply need more information or stronger advice, it asks a more useful question: What would make this change meaningful to the person themselves? Its focus on collaboration, autonomy, ambivalence, self-efficacy and personal values makes it relevant to areas ranging from addiction treatment to everyday health behaviour. A person may already know that they need to change; what they may not have figured out is whether they are ready, what is stopping them, what matters most to them and how they can realistically begin.
Research suggests that MI can support meaningful behaviour change, but its effectiveness depends on the person, behaviour, setting, practitioner and way in which it is delivered. It is therefore better understood as a way of helping people work through the psychology of change, rather than as a guaranteed technique for making people change. Perhaps that is what makes MI useful beyond clinical settings too. Most people do not need someone constantly telling them what they should do. Sometimes, they need a conversation that helps them understand what they want to do, why it matters to them, and whether they believe they can actually do it.
Read More: Addiction: A Sin or A Relief?
References +
- Bilgin, A., Muz, G., & Erdogan Yuce, G. (2022). The effect of motivational interviewing on metabolic control and psychosocial variables in individuals diagnosed with diabetes: Systematic review and meta-analysis. Patient Education and Counselling, 105(9), 2806–2823. https://doi.org/10.1016/j.pec.2022.04.008
- Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91–111. https://doi.org/10.1146/annurev.clinpsy.1.102803.143833
- Kaczmarek, T., Kavanagh, D. J., Lazzarini, P. A., Warnock, J., & Van Netten, J. J. (2022). Training diabetes healthcare practitioners in motivational interviewing: A systematic review. Health Psychology Review, 16(3), 430–449. https://doi.org/10.1080/17437199.2021.1926308
- Magill, M., Stout, R. L., & Apodo, L. (2013). Therapist motivational interviewing skills and client change talk: A meta-analysis. Journal of Consulting and Clinical Psychology, 81(6), 973–983. https://doi.org/10.1037/a0033891
- Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147–172. https://doi.org/10.1017/S0141347300006583
- Miller, W. R. (1996). Motivational interviewing: Research, practice, and puzzles. Addictive Behaviours, 21(6), 835–842. https://doi.org/10.1016/0306-4603(96)00044-5
- Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), 527–537. https://doi.org/10.1037/a0016830
- Morton, K., Beauchamp, M., Prothero, A., Joyce, L., Saunders, L., Spencer-Bowdage, S., Dancy, B., & Pedlar, C. (2015). The effectiveness of motivational interviewing for health behaviour change in primary care settings: A systematic review. Health Psychology Review, 9(2), 205–223. https://doi.org/10.1080/17437199.2014.882006
- O’Halloran, P. D., Blackstock, F., Shields, N., Holland, A., Iles, R., Kingsley, M., Bernhardt, J., Lannin, N., Morris, M. E., & Taylor, N. F. (2014). Motivational interviewing to increase physical activity in people with chronic health conditions: A systematic review and meta-analysis. Clinical Rehabilitation, 28(12), 1159–1171. https://doi.org/10.1177/0269215514536210
- Phillips, A. S., & Guarnaccia, C. A. (2020). Self-determination theory and motivational interviewing interventions for type 2 diabetes prevention and treatment: A systematic review. Journal of Health Psychology, 25(1), 44–66. https://doi.org/10.1177/1359105317737606
- Wintle, E. B., Taylor, N. F., Harding, K., O’Halloran, P., & Peiris, C. L. (2025). Physical therapist-delivered motivational interviewing and health-related behaviour change: A systematic review and meta-analysis. Brazilian Journal of Physical Therapy, 29(1), 101168. https://doi.org/10.1016/j.bjpt.2024.101168
- Zhu, S., Sinha, D., Kirk, M., Michalopoulou, M., Hajizadeh, A., Wren, G., Doody, P., Mackillop, L., Smith, R., Jebb, S. A., & Astbury, N. M. (2024). Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: Systematic review and meta-analysis. BMJ, 386, e078713. https://doi.org/10.1136/bmj-2023-078713
