What Is Motivational Interviewing? When You Want Change but Aren’t Sure You’re Ready
Change is complicated.
You can know that something in your life isn’t working and still feel unsure about changing it.
You can want things to be different and also be afraid of what different might require.
You can recognize that substance use, a behavior, or another pattern is causing problems while another part of you isn’t ready to let it go.
Those feelings can seem contradictory. But uncertainty about change is a common human experience.
Motivational Interviewing (MI) is a counseling approach designed to help people explore that uncertainty through a collaborative, respectful conversation.
Rather than beginning with “Why won’t this person change?” MI invites a different question:
“What matters to this person, and what might help them discover their own reasons for change?”
What Is Motivational Interviewing?
Motivational Interviewing is a collaborative, goal-oriented counseling approach that helps people explore their motivation for change.
It is built around the understanding that someone can have meaningful reasons to change while also having meaningful reasons to continue doing what they are doing.
Core Principles of Motivational Interviewing
Rather than relying on persuasion or unsolicited advice, a clinician using MI works with the individual to explore their experiences, values, concerns, goals, and reasons for considering a change.
MI emphasizes partnership, acceptance, compassion, and drawing out the person’s own motivation. It respects the individual’s role in making decisions about their life while helping them examine what they want to be different.
The goal is not to make someone feel pressured into change. It is to help them better understand their own reasons for it.
What Is Ambivalence?
Ambivalence means having competing feelings about something.
Imagine someone who recognizes that alcohol is creating problems in their relationships but also believes drinking helps them relax and connect socially.
Both feelings can exist at the same time.
Someone may believe therapy could help but feel nervous about discussing painful experiences.
A teenager may recognize that substance use is affecting school or family relationships while worrying that stopping could affect friendships or belonging.
A person may want relief from depression while struggling to imagine having enough energy to make changes.
From the outside, these situations can look like resistance or a lack of motivation.
From the individual’s perspective, however, there may be a genuine internal conflict.
Motivational Interviewing treats ambivalence as something worth understanding rather than something to dismiss or argue away.
“One of the most important things we can do as clinicians is meet people where they are, not where we think they should be. Someone may recognize that something in their life needs to change while still feeling uncertain about taking that next step. Our role is to create a space where they feel heard, respected, and supported as they begin to explore what change might look like for them.”
— Jessica Hillen, Clinical Director, LMSW, River’s Bend West
How Is Motivational Interviewing Different From Telling Someone What to Do?
When we care about someone who is struggling, the instinct to persuade them can be strong.
We explain why something is harmful and list reasons they should change. It’s common to remind them what happened last time or tell them what we think needs to happen.
The intention may be caring.
But repeating advice does not necessarily help someone resolve their uncertainty.
Motivational Interviewing takes a different approach. Instead of making the case for change on someone else’s behalf, the clinician helps the individual examine the relationship between their current circumstances and what matters to them.
This does not mean that the clinician ignores harmful behavior or avoids discussing concerns. MI is an active, purposeful counseling approach—not simply listening without direction.
The distinction is that the conversation seeks to strengthen the person’s own motivation and commitment, rather than relying on pressure or confrontation.
“When someone is struggling, it can be tempting to focus on what they need to do differently. But meaningful conversations often begin by understanding what matters to that person, what they are afraid of losing, and what they hope might be possible. Meeting clients where they are means recognizing that their concerns, experiences, and goals are an essential part of the conversation.”
— Jessica Hillen
What Does Motivational Interviewing Sound Like?
An MI conversation may feel different from what someone expects a discussion about behavior change to sound like.
Rather than beginning with a lecture or a list of instructions, a clinician may use open-ended questions, reflective listening, affirmations, and summaries to help the person explore their perspective.
For example, questions might include:
- What concerns you about what is happening right now?
- What do you value about the way things are?
- What would you like to be different?
- What might make a change worthwhile to you?
- If you decided to take a first step, what do you think might help?
These are illustrative examples, not a script for a River’s Bend appointment. SAMHSA identifies open questions and reflective listening among the core communication skills used in MI.
A clinician might also reflect something the person has said, helping them hear both sides of their uncertainty more clearly.
For example, someone might say:
“I know my drinking is affecting my family, but it’s also the only way I know how to relax after work.”
A reflective response might acknowledge both concerns:
“You’re worried about what drinking is doing to your relationships, and you’re also unsure how you would manage stress without it.”
The purpose is not to argue with either side of the person’s experience. It is to create room for a more thoughtful conversation about what matters to them and what they may want to do next.
Is Motivational Interviewing Only Used for Substance Use?
Motivational Interviewing is closely associated with substance use treatment, where uncertainty about changing alcohol or drug use can be an important part of the recovery process.
However, MI has also been applied in other healthcare and behavioral health settings, including conversations about treatment participation, medication adherence, and health-related behavior change.
The common thread is not a particular diagnosis.
It is a situation in which a person is considering a change but may feel uncertain about its importance, their ability to make it, or whether they are ready to begin.
MI is one approach a trained professional may use in these circumstances. It is not a substitute for a comprehensive assessment or for other treatment that may be appropriate to someone’s needs. If substance use is the concern, Substance Abuse Evaluation: A Clear First Step Toward Recovery explains an evaluation pathway.
What If Someone You Care About Doesn’t Think They Need Help?
Watching someone struggle while they remain uncertain about treatment can be frustrating, frightening, and painful.
It can also create pressure to find the argument that will finally convince them to seek help.
Motivational Interviewing offers a useful perspective: readiness for change can itself be explored in a conversation.
That does not mean family members need to ignore harmful behavior, abandon boundaries, or manage serious concerns on their own. And learning about MI does not make a family member responsible for acting as someone else’s therapist.
Outside an immediate safety concern, listening to understand what a person values, fears, or feels uncertain about may create more room for conversation than repeatedly arguing about what they should do.
Families can also seek professional guidance for their own questions about how to respond and what type of support may be appropriate.
If you are concerned about a loved one’s mental health or substance use, you do not have to determine the right treatment—or resolve their uncertainty—by yourself. For more on supporting a loved one while respecting boundaries, read Helping Without Hurting: Supporting a Loved One with Addiction Before They’re Ready for Help.
Does Motivational Interviewing Mean a Clinician Never Challenges You?
No.
Respecting someone’s autonomy is not the same as agreeing with every choice or avoiding difficult subjects.
An MI conversation may explore the difference between a person’s goals and their current behavior. It may involve discussing concerns, considering consequences, and examining what could happen if nothing changes.
The difference is how those conversations take place.
MI emphasizes partnership and avoids using shame, confrontation, or unsolicited advice as tools for forcing change. The clinician helps the person consider their options and develop their own reasons for moving toward a change goal.
The person remains an active participant in the process.
Change Doesn’t Have to Begin With Certainty
People sometimes believe they need to feel completely ready before seeking treatment.
They don’t.
You can enter a conversation feeling uncertain.
You can have questions.
You can recognize that something needs to change without knowing exactly what you are prepared to do about it.
You can even want help and feel hesitant about accepting it at the same time.
Those feelings do not necessarily mean the conversation should wait. They may be an important part of what needs to be discussed.
Change can begin before certainty does. For a related perspective, read What Healing Really Looks Like: The Micro-Wins That Matter in Therapy.
“People sometimes believe they need to have everything figured out before reaching out for help. They may think they need to be completely ready to change or know exactly what kind of treatment they need. At River’s Bend, we want people to know that they can come to us with questions, uncertainty, and mixed feelings. Meeting someone where they are means starting with the person in front of us and helping them explore what support may be right for them.”
— Jessica Hillen
Finding the Right Support at River’s Bend
Understanding Motivational Interviewing may help you recognize that feeling conflicted about change is something you can discuss with a behavioral health professional.
But you do not need to know which therapeutic approach—or which level of care—is right for you before reaching out. You can ask about available care without committing to a particular program.
River’s Bend provides outpatient behavioral healthcare for individuals and families experiencing mental health and substance use concerns. The appropriate starting point depends on the individual’s needs, symptoms, circumstances, and treatment goals.
Levels of Care and Support Options
If you are unsure what kind of help you need, a comprehensive clinical assessment can help clarify your concerns and inform recommendations about an appropriate level of care.
If you are wondering what working with a therapist might involve, learning about Individual Psychotherapy may help you understand what to expect.
For one-on-one support, explore River’s Bend’s Individual Therapy service.
For individuals who need more structured treatment, River’s Bend offers a Mental Health Intensive Outpatient Program (IOP), a Substance Use Disorder Intensive Outpatient Program (IOP), and a Partial Hospitalization Program (PHP). These pages describe levels of care, not whether MI is used within them. For a general explanation of structured care, read What Is an Intensive Outpatient Program (IOP)? or What Is Partial Hospitalization (PHP)?.
The important first question is not whether you are ready for a particular treatment approach.
It is whether you are ready to begin a conversation about what you are experiencing and what kind of support may help.
Start With a Conversation
You do not need to have everything figured out before asking for help.
If you or someone you care about is struggling with mental health or substance use concerns, River’s Bend can help you explore an appropriate next step.
