Integrating Motivational Interviewing and Stages of Change in Addiction Counseling

By O'Mara, Eileen McCabe | Addiction Professional, September 2005 | Go to article overview
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Integrating Motivational Interviewing and Stages of Change in Addiction Counseling


O'Mara, Eileen McCabe, Addiction Professional


Resistant to using a new online travel system, I called for help. The assistant listened to my complaints and responded in the language of Motivational Interviewing. I calmed down and began to make the changes necessary to work this system. When the call ended, I hung up feeling empowered and competent to navigate the tricky waters of online travel arrangements!

The listener had assessed my ambivalence and, with the tools of validation and empowerment, supported a behavior change. This simple example illustrates the impact that effective integration of Stage of Change assessment and Motivational Interviewing techniques have on a resistant client.

This article demonstrates integration of Motivational Interviewing and Stage of Change theory and gives counselors tips on implementing these theoretical systems into their practice. A Motivational Interviewing approach when combined with Stage of Change theory gives counselors the tools for moving clients from resistance to readiness for treatment, and then through the treatment process into a recovery lifestyle.

Understanding ambivalence

At the core of both Stage of Change theory and Motivational Interviewing is the importance of understanding and accepting ambivalence. The counselor's job is to continually assess stage of change while using Motivational Interviewing responses to facilitate client movement into the next stage.

For example, when denial is looked at as resistance and resistance is looked at as ambivalence, denial is less formidable. The counselor embracing these paradigms approaches the client in pre-contemplation, who owns no responsibility for his/her addiction, by assessing stage of change and applying Motivational Interviewing's OARS method (open-ended questions, affirming statements, reflections, and efficient summarization) to move him/her to contemplation or to begin thinking about making a behavior change.

The counselor's task is to embrace ambivalence, increase awareness, and raise the client's consciousness around his/her addiction, encouraging the client to use inner resources to mobilize change behavior.

The therapeutic relationship

William Miller's message "Go out and love your clients" in his speech at the 2002 Hazelden Graduate School of Addiction Studies graduation ceremony affirmed the importance of the therapeutic relationship in the treatment of addiction. In the March 2005 issue of Addiction Professional, David Powell reported Duncan, Hubble and Miller's evidence that the most important change factor in counseling is the therapeutic alliance.

Motivational Interviewing suggests a therapeutic relationship that incorporates the processes of collaboration, evocation and autonomy. By collaboration, the authors refer to the creation of a partnership that creates the space for change to occur by honoring the client's expertise and perspective. The counselor must, therefore, invite ambivalence to be freely discussed. The counselor's task is to elicit feelings, and by reflecting and reframing to assist the client's exploration of options.

By evocation, the authors mean that the collaborative process allows the resources for change that reside within the client to emerge. The evocative counselor primarily listens, encouraging the client to express thoughts around the issue. The counselor's task is to focus on eliciting the client's rationale.

Finally, by autonomy the authors mean that the responsibility for change lies with the client. The counselor's role is to accept the client in the here and now and to affirm his/her ability for self-direction and informed choice. Paradoxically, when faced with choices, clients are more likely to choose change.

Working in this paradigm demands that the counselor approach the client with respect for his/her innate capacity for change. The counselor must continually assess the change process and appropriately use Motivational Interviewing techniques, providing the framework for a collaborative journey through change.

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