Motivational interviewing in Ohio

Motivational interviewing is a way of having a conversation about change with someone who is of two minds about it. You do not sign up for it. Clinicians use it inside whatever level of care you are in, and it is most visible at the assessment and through the first weeks.

The premise is that ambivalence is the normal state. Part of you wants the drinking to stop and part of you wants tonight to be manageable. When someone else argues the case for change, the other half tends to speak up and defend the status quo. So the clinician asks questions and reflects back what they heard, and the reasons for change come from you. Those reasons in your own words are what the method calls change talk.

Nobody argues with you and nobody has decided in advance what you should do. Sessions can feel slower and less directive than expected, and silence is allowed to sit.

• Open questions, with room to answer them
• Reflections: the clinician says your own point back to you, sometimes slightly differently
• Summaries that pull the thread together every so often
• Scaling questions. On a scale of zero to ten, how important is it to stop right now? If you answer four, the follow up asks why four and not two, and that answer is your own case for change
• Questions you may not expect, such as what a normal day looks like, or what you would lose if you stopped

Most of the evidence concerns getting people into treatment and keeping them there. In Project MATCH, funded by the National Institute on Alcohol Abuse and Alcoholism, a short course of motivational enhancement therapy produced drinking outcomes comparable to longer courses of cognitive behavioral therapy and twelve step facilitation.

The National Institute on Drug Abuse is specific about the limits. Results have been better for alcohol and marijuana than for other drugs, and the approach does more for engagement and retention than for long term change on its own. It is used as a component alongside other treatment.

Clinicians holding LCDCIII, LICDC, LSW, LISW, LPC and LPCC credentials use it at both facilities, alongside cognitive behavioral therapy, dialectical behavior therapy and family therapy.

• At the assessment, where the job is to find out what you actually want
• In individual sessions through the first weeks, while the reasons for being here are still being worked out
• In therapy group, including with people attending because a court or a family member insisted
• When someone says they want to leave treatment early