Motivational Interviewing: A Pathway to Partnership in Care

Motivational Interviewing (MI) has long been a personal favourite amongst intervention modalities. Much of the work my teams and I have done in the Addiction Psychiatry Division at the University of Cape Town has been anchored in MI’s core principles. Over the years, we have built a dedicated community of practitioners across the country and beyond, strengthening their skills in MI and fostering its application across various settings. Now, with the Motivational Interviewing in Africa movement gaining momentum, we are eager to deepen this work even further.

MI-based interventions have continued to show some promising results in treating substance use disorders (SUDs) (Schwenker et al., 2023). Colleagues have demonstrated promising results by integrating MI with Problem-Solving Therapy and Cognitive Behavioural Therapy (CBT) in emergency care settings for people with SUDs (Sorsdahl, Myers, et al., 2015; Sorsdahl, Stein, et al., 2015). Studies have shown that MI enhances treatment engagement, reduces substance use, and improves long-term outcomes, particularly when combined with other evidence-based approaches (Miller & Rollnick, 2012; Parry et al., 2023) For instance, research in South Africa has highlighted MI’s role in improving adherence to antiretroviral therapy among individuals with co-occurring HIV and substance use (Petersen et al., 2022). These findings underscore MI’s adaptability and efficacy across diverse clinical and community contexts.

At its core, MI is built on the recognition that individuals are the experts in their own lives. Rather than imposing predefined solutions, MI helps clients articulate a desired outcomes and identify the social and personal resources that can support them in achieving those goals. This process allows them to navigate the complexities of their circumstances in a way that feels authentic and sustainable. In essence, MI does not dictate a path but instead offers a framework for individuals to define the “colour and texture” of their own journey toward change.

The application of MI extends beyond clinical interventions. Some colleagues working in staff development and management have successfully incorporated MI principles into leadership and professional growth strategies. By fostering open, non-directive conversations, managers can support employees in identifying their own motivations for professional development, improving workplace morale and retention. In healthcare settings, this approach has been linked to better job satisfaction and reduced burnout among providers (Schmelzer et al., 2021).

A recent ISSUP Scientific Council presentation on well-being reinforced a crucial insight: to be effective caregivers, we must understand the limitations of our role. One of MI’s greatest gifts to practitioners is its ability to dismantle the “saviour complex”—the belief that we, as clinicians, must single-handedly rescue our clients. MI instead encourages us to step back, trust the process, and allow the client to take ownership of their journey. This shift not only enhances the therapeutic alliance but also alleviates the emotional toll on practitioners, making our work more sustainable in the long run.

The ISSUP community’s enthusiasm for MI has been evident in our recent webinars, which have been among our most highly attended. Recognizing this growing interest, ISSUP is committed to expanding opportunities for MI training and engagement in the future.

Ultimately, MI is more than just an evidence-based technique—it is a transformative way of engaging with clients. It strengthens the therapeutic alliance, empowers individuals in their healing process, and, crucially, allows practitioners to relinquish the burden of being the “expert” who must have all the answers. In doing so, MI fosters a model of care that is not only more effective but also more humane, sustainable, and deeply respectful of the individual’s own capacity for change.

References

Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing, Third Edition: Helping People Change. The Effects of Brief Mindfulness Intervention on Acute Pain Experience: An Examination of Individual Difference.
Parry, C. D. H., Myers, B., Londani, M., Shuper, P. A., Janse van Rensburg, C., Manda, S. O. M., Nkosi, S., Kekwaletswe, C. T., Hahn, J. A., Rehm, J., Sorsdahl, K., & Morojele, N. K. (2023). Motivational interviewing and problem-solving therapy intervention for patients on antiretroviral therapy for HIV in Tshwane, South Africa: A randomized controlled trial to assess the impact on alcohol consumption. Addiction, 118(11). https://doi.org/10.1111/add.16278
Schwenker, R., Dietrich, C. E., Hirpa, S., Nothacker, M., Smedslund, G., Frese, T., & Unverzagt, S. (2023). Motivational interviewing for substance use reduction. In Cochrane Database of Systematic Reviews (Vol. 2023, Issue 12). https://doi.org/10.1002/14651858.CD008063.pub3
Sorsdahl, K., Myers, B., Ward, C. L., Matzopoulos, R., Mtukushe, B., Nicol, A., Cuijpers, P., & Stein, D. J. (2015). Adapting a blended motivational interviewing and problem-solving intervention to address risky substance use amongst South Africans. Psychotherapy Research, 25(4), 435–444. https://doi.org/10.1080/10503307.2014.897770
Sorsdahl, K., Stein, D. J., Corrigall, J., Cuijpers, P., Smits, N., Naledi, T., & Myers, B. (2015). The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial. Substance Abuse Treatment, Prevention, and Policy, 10, 46. https://doi.org/10.1186/s13011-015-0042-1
Petersen, I., et al. (2022). “Motivational interviewing to improve adherence to ART in South Africa: A randomized controlled trial.” AIDS and Behavior, 26(3), 678-689.
Schmelzer, E., et al. (2021). “Using motivational interviewing in healthcare leadership: A strategy for reducing burnout and improving job satisfaction.” Journal of Healthcare Management, 66(4), 235-247.