• Motivational Interviewing and Understanding Addiction

     I think that the concepts of attachment, control and self-image all relate to anxiety with regard to addictions. All of these issues can be tied with a state of ambivalence that many clients enter therapy with.

    What is ambivalence?

    According to Miller and Rollnick’s motivational interviewing model, (2002), ambivalence is not pathological, but rather a normal part of being human. There may be the desire for change, and yet at the same time a desire not to. They may fully realize the consequences of their behavior on their lives, yet for various reasons there may be a very strong attachment to the addictive behavior that they may not be ready to let go of.  This can produce quite a great deal of anxiety for the client. There may be feelings of guilt and shame over not being able to completely give up the substance, and the self-image may suffer as a result. I think that the idea of self-image is tied to how much confidence he or she has that they can change. If self-image is low, then there may be heightened anxiety and a low sense of self-efficacy. Building self-efficacy is an important part therapy. It is my view that self-image is tied to the aspect of control. The client may suffer from a poor self-image, and this can feed into the feeling of being out of control in aspects of his or her life. The addiction may serve as a way to escape from feeling anxious about this lack of control.         

    Motivational interviewing stresses the importance of the client ultimately having control over shaping his or her life. The humanistic notion of personal responsibility I feel can be very empowering for a client who suffers from anxiety and ambivalence related to his or her addiction. One of the conflicts of ambivalence is the very strong attachment that can be created through a conflict that is approach-avoidance (Miller & Rollnick, 2002). It is a love hate relationship that a person may develop with a substance. A person may feel that he or she cannot live with the substance, yet cannot really live without it. Weighing the costs and benefits can tilt the decisional scale of an ambivalent relationship, and motivate an individual towards change.

    I believe that everyone has within them the capacity to change. People have the strengths and the resources within them to overcome their addictions if they are ready and willing to do so. A person’s motivation to create the change they desire is within them. This intrinsic motivation is something that cannot be forced upon by the therapist. A therapist can only work with what the client provides in terms of goals and values. There must be a respect for the client’s ability to decide what it is they want and what is ultimately best for themselves in their process of overcoming addiction.

    I welcome any thoughts you may have on this topic.


    Miller, W.R., & Rollnick, S. (2002). Motivational Interviewing: Preparing People to Change Addictive Behavior. 2nd Ed. London, TheGuilford Press.

    Author: Dr. Masha Godkin,Psy.D, MFT  is a professor of counseling psychology, a licensed Marriage and Family Therapist in the state of Ca. with an Online Therapy Practice, as well as a former child actor. One of her specialties is in addictive behavior and counseling those in the performing art professions. Visit  http://www.onlinetherapywith-dr-masha.com to learn about the Online Therapy service options that are available.

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