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Key points
- Clinicians too often conflate motivational speaking and motivational interviewing.
- Motivational interviewing never attempts to instill motivation.
- Motivational interviewing honors people's defenses while clarifying and deepening their ultimate goals.
I was recently asked while a panelist at a cannabis education conference, “What is the most common mistake clinicians make when using motivational interviewing?” My immediate answer was that too many fail to understand the difference between motivational speaking and motivational interviewing. The following explains and illustrates the difference.
Many fine motivational speakers have made a name for themselves by using the force of their personalities and emotionally charged images to increase people’s confidence that they can achieve their dreams. Much like a pep rally, motivational speakers are skilled at increasing their audience’s hopes for success and enthusiasm for making the effort needed to reach their goals. While this infusion of motivation is usually temporary, for those on the verge of a breakthrough or who are stymied by barriers that have been blown out of proportion, the boost in confidence and hopefulness provided by a motivational speaker can get them over some internal hump and alter the course of their lives.
I acted as a motivational speaker in the 1980s during the upwelling of awareness among adult children of alcoholics. It was a powerful experience to instill confidence and hope that examining the lasting impacts of childhood with an alcoholic parent can often unlock deep self-understanding acceptance. However, my training in psychodynamic psychotherapy discomforted me about playing the role of expert. At the same time, I felt a pull in the direction of increasing my work in this arena, which also added to my discomfort. The narcissistic hit that motivational speaking provided was too alluring. Instead, I began focusing more on the practice of individual and couples psychotherapy.
Motivational speaking has several shortcomings. One of the biggest is that it inevitably elevates speakers to the level of experts, which necessarily relegates audience members to the status of followers. Secondly, motivational speaking generally does not change the basic strategies people use in their striving for success.
This is especially true when motivational speakers stimulate people to ratchet up their intentionality and willpower without examining whether this is the best strategy for achieving one’s goals. For example, motivational speakers who promise increases in wealth misguide people who falsely believe wealth is the path toward happiness. I’ve treated too many millionaires and a few billionaires to understand that wealth and happiness are often unrelated.
Motivational speaking comes in many lesser forms.
Many family members of alcoholics and other drug addicts practice motivational speaking, constantly encouraging their addicted family members to try harder to abstain from using. But “trying harder” only encourages people to increase their willpower, to push harder against a disease that never yields to such an apparently reasonable strategy. Like diabetes, addiction does not get cured by willpower. Acceptance of the disease must come first. This principle is embodied in AA’s step one (see AA’s Step One: Confrontation With Reality)—believing we are powerless to push addiction out of our lives by an act of will.
This brings me to my main point: Even subtle efforts by therapists to encourage addicted people to “try harder” to get sober are counterproductive if they come before first exploring an individual’s motives for using alcohol or other drugs. Nonjudgmental exploration of why people enjoy getting high, what they believe getting high does for them, and what they are seeking has nothing to do with instilling motivation to get sober. Instead, motivational interviewing respectfully listens to and accepts whatever currently motivates people’s behavior, even their self-destructive behavior.
Few addicted people are motivated to destroy themselves. They are doing what makes sense to them at the moment. Exploring these motivations gives therapists an opportunity to also explore whether alcohol and drug use is ultimately the best strategy for achieving what they want, be it enjoyment, relaxation, destressing, distancing from the sequellae of trauma, or simply doing the best they know to survive the pain of existence.
Motivational interviewing never attempts to motivate.
It explores individuals’ motivations to deepen and clarify their true nature and eventually to uncover ambivalence regarding strategies used to satisfy these deeper motivations. For example, a client may come into therapy because a partner is frustrated with the amount of their cannabis use. The surface conflict is about cannabis and in exploring the reasons for continued cannabis use a therapist might find several motivations. Maybe the individual wants to destress at the end of the day, just relax and feel some pleasure with their partner. Cannabis works to help your client feel free, and they resent being criticized and controlled.
Rather than trying to increase this client’s motivation to abstain from cannabis, motivational interviewing explores whether the strategy of using cannabis is achieving the underlying goal of happiness and freedom. In brief—how’s it working? In other words, motivational interviewing allies with the client’s motivation to be happy in their relationship and not feel controlled. By allying with these normal motivations, resistance to exploring whether the strategy being used to achieve these feelings could be improved.
Personally, I don’t like the name “motivational interviewing,” although I understand its origin and didactic usefulness. MI has essentially repackaged the psychoanalytic principle of honoring the defense in a currently more acceptable language before analyzing the underlying impulse. It is much harder to deepen therapy when you start with “attacking” a person’s defense (i.e., trying to increase motivation for abstinence) or increasing motivation to continue flawed strategies (i.e., encouraging more willpower to not be addicted). Motivational interviewing understands that the only way to reduce clients’ resistance to change is to genuinely ally with their motivations, deepen and clarify their understanding of these motivations, and then help explore alternate strategies for getting what they ultimately want.
