What it is
A conversation, not a lecture.
Motivational Interviewing (MI) is a collaborative, person-centered approach developed by William R. Miller and Stephen Rollnick, now in its fourth edition. Its core aim is to strengthen a person's own motivation for change — not to argue for it, not to impose a timeline, and not to create shame around ambivalence.
The clinician's job is to draw out what matters to the person in front of them — not to deliver a predetermined message about what they should do or who they should become.
"Motivational Interviewing is not about arguing for change. It is about exploring a person's own reasons for it, and trusting that they are the expert on their own life."
— Miller & Rollnick, Motivational Interviewing: Helping People Change and Grow, 4th ed. (Guilford Press, 2023)How it connects to Medication First
The visit itself is the support.
Our Medication First approach separates the receipt of buprenorphine from any requirement to attend separate counseling sessions. Motivational Interviewing is why that works clinically. A counseling style that lectures, pressures, or conditions its support is counterproductive. Motivational Interviewing does not do any of those things.
Every appointment at MyStreetHealth includes time to talk — about where you are, what matters to you, what's getting in the way. That conversation follows Motivational Interviewing. You don't opt into it. It's just how we talk with you.
The four processes
How a session moves.
Motivational Interviewing is organized around four processes — not rigid steps, but overlapping activities that recur throughout any conversation about change.
01 — Engaging
Establishing a working relationship built on trust and genuine curiosity. Not an intake checklist.
02 — Focusing
Agreeing on a direction for the conversation. The agenda comes from you, not from us.
03 — Evoking
Drawing out your own reasons for change. Change talk you generate is far more powerful than advice we give.
04 — Planning
When you are ready — building a concrete, self-directed plan at your pace, on your terms.
What Motivational Interviewing is not
To be clear.
Not a requirement for your buprenorphine prescription — medication and this conversation are offered independently
Not a separate group session or a meeting you must attend
Not confrontational — Motivational Interviewing explicitly avoids argumentation and unsolicited advice
Not open-ended therapy — Motivational Interviewing is most effective in brief, focused conversations
Not something you opt into — it is simply how your physician talks with you