Chapter 7.Integrating Motivational Interviewing With Other Psychotherapies

An important question that often arises when working from a motivational interviewing (MI) stance is whether MI can be woven into other forms of psychotherapy. There is a menu of psychotherapeutic treatment options for patients with substance use disorders, one of the most common indications for MI (Najavits and Weiss 1994). MI is compatible with many of these therapeutic modalities (Miller and Rollnick 2013), and combining MI with other psychotherapies not only enhances the efficacy of both treatments but also sustains the MI effect (Hettema et al. 2005). Intuitively, one would expect the importance of MI to be at its peak early in the process of engaging in treatment, when patients are often still contemplative about addressing their substance use or other behavioral goals (see, e.g., Brady et al. 2001). Accordingly, MI has often been described as a “prelude” to other interventions. It is important to underline that MI need not be abandoned once a patient has mustered sufficient motivation to move forward and engage in treatment. Motivation is a fluid phenomenon, and its strength inevitably fluctuates. A skilled therapist is able to use MI in a manner that is tailored to the individual patient’s needs by continuing to assess progress through a motivational lens. This allows for the selective reintroduction of MI principles at therapeutic choice points when ambivalence resurfaces.