Wednesday, February 2, 2011

Inverse motivational interviewing

I devised this theory when I was working on alternative ways of doing what is known as motivational interviewing.

Motivational interviewing is a process that developed in the field of addictions counselling. It is designed to afford the client an opportunity to develop a higher level of motivation to change their behaviour, in this instance to increase their motivation to stop, reduce or somehow change their drug use.

Typically this can be done in two ways. It can be an Adult ego state exercise where the therapist helps the client list all the positives and negatives about their drug use. The purpose of this is the client will have the negatives highlighted and thus their motivation to change their drug use is heightened.

Woman drinking wine

The second way is more of a Child ego state exercise. In this case the therapist helps the client to understand how their drug use supports their life script. By using drugs the client is staying in their Conforming Child ego state. The therapist then uses what are called ‘heighteners’ to encourage the client to move into the Rebellious Child ego state. If achieved then the client's motivation to change is increased as the person rebels against the script message that involves them using drugs.

There is one other way one can work with this and it involves the ‘stuck’ client. Some client’s will report that they feel stuck in their life in some way and a drug user can be this. They will report that they are in a rut or habit or life style where they seem to be getting no where and have a sense of just going around and around. This can include the person who has a desire to alter their drug use but they are not changing that behaviour in any consistent way.

With people who reports a sense of stuckness I will search for some way in which they are psychologically stuck. This can be in a variety of ways.

Brick carrier

1. Some people are stuck in their feelings. That is they are stuck in a particular feeling or they are stuck in avoiding a particular feeling. For instance the person who carries around an anger at their ex partner. This person is stuck in their anger and if they can become unstuck by dropping it or getting over it then that person may experience a significant increase in their psychological readiness to change (in other terms their motivation to change increases).

Then there is the woman who is stuck in depression. She is angry at her husband but for some reason she is too uncomfortable to express it so she becomes chronically depressed. If she expresses her anger she becomes unstuck and thus her readiness to change increases.

2. Some people are stuck in a relationship. Instead of being stuck in a feeling this person is stuck in a relationship in some way. A woman may feel very unhappy about her marriage but she does not know what to do about it. She tries many ways to change things but none seem to amount to anything. Thus she has a sense of stuckness in her marriage and this reflects as a stuckness in her own psychology such as excessive alcohol use or depression. If she can make a change in her marriage then her motivation to change her alcohol use increases.

4 on bench

3. Some people are stuck in an event. Some traumatic event happened to them and they are not willing to deal with it. The loss of a loved one can be this. People who are not willing to discuss an episode are exhibiting a sense of stuckness about that event. Again this can be reflected in a sense of stuckness in their psychology.

People who abuse alcohol and drugs can exhibit this type of situation. They are contemplating changing in their drug use but it is just not happening. They are treading water or in a holding pattern as they say. They want change but they will not actually go ahead and do it. Thus one has a sense of stuckness. When this happens one can look for how they are stuck in their feelings, relationships or in reaction to a particular event. Once found then one can seek to facilitate a break through in that. If that happens then one is freed up in this psychological way.

If this happens then one has an increased motivation to change because the psychological block they have is reduced and it is easier for them to carry out the behavioural change they are contemplating. That can be a change in their drug use.


This is an interesting addition to the various methods of motivational interviewing. The two methods first described seek to increase the level of disquiet or angst in the individual about their drug use. The method described here works another way. It does not seek to increase the disquiet but sees the non behaviour change in drug use as a reflection of some psychological impasse or stuck point in the persons psyche. If that impasse can be broken then it is easier for the person to alter their alcohol and drug use.

One can argue that their motivation to change has not increased but the level of motivation that is require for change has decreased. Thus we have a kind of inverse motivational interviewing.



  1. Interesting post. You said for people who are stuck, if you can get them to make a change with something else in their life where they are stuck, it takes less motivation for them to give up their addiction. Does this also play a part in relapse? Does change encourage change (which might be good or bad), or is relapse just part of a cycle of being stuck?

  2. That is a good comment KYLady,

    Does change encourage change?

    As far as he human psyche goes I would tend to say yes, at least initially. Interesting thing to ponder.

    If a person moves on from a stuck point in a psychologically important area like their feelings or relationships then I would say thatthere is likely to be a psychologically healthy move in other ways as well (Like reducing problematic drug or alcohol use).

    To use Rogers theory. If one moves on from such a stuck point then that innate drive towards health and psychological growth is charged up and will impact on the person. Thier natural drive towards health kicks into action again.

    Thanks for your comment


  3. Good post Tony, Motivational Interview covers a wide area it seems.Cognitive therapy mixed with relational styles is very effective in my experience. Even with unwilling clients.


  4. Hi Ken,

    I think you make a good point about the combination different approachs. So many therapies seem to have the belief that one size fits all