Motivational Interviewing in Action:

Examples from the Field

by Regina Sewell, PhD, LMHC &
Jennifer Salimbene, LCSW-R, CASAC, CDAC, TEP

*Note: Names have been changed in order to ensure privacy

Motivational Interviewing, developed by Rollnick and Miller (1991), is a directive yet supportive approach to counseling that helps clients identify their own intrinsic motivations and values and realize for themselves the discrepancy between their current behavior and their goals and values. Using Motivational Interviewing, counselors are able to meet clients where they are at, help them resolve their ambivalence and help them choose to change.

Techniques stemming from Psychodrama and Sociodrama enliven Motivational Interviewing by helping clients see for themselves the costs of their destructive behavior patterns, experience how things could be if they changed, and practice doing things differently in a supportive environment.

The psychodramatic technique of doubling goes beyond reflective listening and empathy to enable therapists to help their clients give voice to things they are reluctant to admit or have trouble articulating and/or help clients deepen their emotional response. Doubling is a collaborative, non-judgmental technique that communicates respect for and acceptance of clients and their feelings. Future Projections allow clients to step into their own future to experience the consequences and benefits of several different choices.

For example, Amelia*, a 13 year old girl, had been cutting for several months. Through doubling her therapist was able to help her admit the shame she felt about her behavior and her guilt about the worry it caused her mother as well as the fact that it was the only way she knew how to deal with the intensity of feelings that sometimes came up. She was invited to step into the future (using the future projection technique) as if it were in the here and now and explore what would happen if she didn’t stop cutting. In this trajectory, she felt isolated because she realized that she would not be able to go to the beach in the summer without people seeing her arms or wondering why she was wearing long sleeves. When she explored the possibility of not cutting, she felt proud of herself and saw how relieved her mother was. In doing so she found her own internal motivation to change.

Psychodramatic Role Training Exercises help clients practice doing things differently in ways that align with their personal goals. For example, Mark*, a 38 year old man stuffed his feelings with food because he was afraid that he would hurt someone if he expressed his anger. Through role training, he was able to practice different responses to the comments and actions that made him angry. He discovered that anger doesn’t have to be destructive and that it felt better to express appropriate anger than to stuff it down. Sociodramatic and Psychodramatic Role Training also provides the space for clients to rehearse situations that may prove challenging to their sobriety.  For example, Ana* in a group of adolescents was able to practice different ways to say “No” when her peers offered alcohol or other drugs. 

The Social Atom is a map of relationships that helps clients see how their relationships impact them and how their choices impact their relationships. Role Reversal is a psychodramatic technique that allows clients to step into the shoes of someone they love and experience how their current or past behavior has impacted this person. More than simply helping clients think about how their loved one feels, role reversal allows clients to feel the impact of their behavior at the body level. Clients have reported that reversing roles with their loved one has increased their desire to change.  For example, when Mary* explored her social atom, she realized that she was resentful of her parents because they seem to have withdrawn their support for her.  When she reversed roles with her parents, she was able to see how her substance abuse had pushed them away.  In doing so, she was able to let go of her resentment towards her parents by taking responsibility for her own behavior. 

Regina Sewell, PhD/ MEd, LMHC, PCC, CP is certified by the American Board of Examiners as Certified Practitioner of Psychodrama. She is on the faculty on the Hudson Valley Psychodrama Institute. In her private practice, Regina specializes in co-dependency, addictions, LGBT issues and stress management.

Jennifer Salimbene, LCSW-R, CASAC, CDAC, TEP is a senior faculty member of Hudson Valley Psychodrama Institute. She has over 25 years of experience in the field of addiction and co-occurring disorders and has been a clinical director of both in inpatient and outpatient addiction programs. In her private practice she specializes in the areas of addiction treatment, co-dependency, trauma, PTSD, tweens, adolescents and families. She is certified in EMDR.