Limitations of Motivational Interviewing

You can't use many of the tools you learned in school when you're practicing motivational interviewing.
i Stockbyte/Stockbyte/Getty Images

Motivational interviewing is a counseling technique often used to treat people with disorders like addiction and overeating. It requires counselors to be more supportive than coercive to give patients time to come to their own conclusions about their issues. It does have its limitations, however, such as getting clients to return for multiple sessions. Even though patients may recognize their problems, they can have difficulty building the motivation they need to change.

You Need Time to Build a Relationship

    Clients often become very resistant to changing when they don’t like their therapists. According to a 2009 article in the "Journal of Clinical Psychology," counselors must take a step back and, even though they may be able to clearly see the ongoing issues, have to let the clients believe they are the experts on their own lives. A confrontational approach can alienate a client and cause her to only dig in her heels even deeper, refusing to change. With motivational interviewing, you need time to build trust with patients, who sometimes don’t have the time to come to their own conclusions because of impending legal issues or health problems.

Patients Need Cognitive Clarity

    Motivational interviewing only works if clients can participate fully in the process. If they are suffering from a mental disorder that is physically based, such as bipolar disorder or depression, they have little control over their responses unless they take medication to control their conditions. Once a client is medicated, you run into additional problems that could interfere with motivational interviewing treatment styles. While the technique has proven successful in treating alcoholism, for example, even if a person knows she has a drinking problem, she has to be able to reach that conclusion on her own, figure out that she needs to change, and then make and stick to plans for treatment.

Not One-Size-Fits-All

    Unlike other therapies you may have learned in school, you can’t take the techniques used in motivational interviewing and apply them equally across the board, according to the National Institute on Drug Abuse. It’s a very individual style of treatment, and you must be able to change the way you do business for each and every client. As such, therapists employing motivational interviewing must themselves be prepared to change the way they deliver treatment with each client. For example, every person displays their readiness to change in different ways and at different times. Additionally, there aren’t really any clinical tools you can use for this process; you have to follow your instincts as much as anything else, which can be difficult for some professionals who rely on their training and subjective counseling tools. Practitioners refer to the “spirit of motivational interviewing,” instead of any one-size-fits-all technique.

Follow-Up Is Crucial

    Since behavior modification is the primary goal of motivational interviewing, it must be tied into some kind of follow-up treatment for a substantial period of time. That often isn’t possible, especially if the client relies on insurance reimbursement to pay for her treatment. The client may have changed the harmful behavior, but it may not last. Once you’ve completed your sessions and the client has gone into treatment or agreed to a healthy eating plan because she had diabetes or was overweight, motivational interviewing lacks a definitive process for making sure the commitment sticks, despite other treatment mechanisms, such as support group participation, according to the American Diabetes Association.

the nest