Change you don't have to be argued into.

MI is a collaborative, person-centered counseling approach developed by William R. Miller and Stephen Rollnick in the 1980s, initially from Miller's observations about what actually helped people change their relationship with alcohol. Validated across more than 200 randomized controlled trials, it's one of the most extensively researched approaches in behavioral health.

The core insight is that people already carry within themselves the motivation to change. The therapist's role isn't to supply that motivation from the outside, or to persuade, argue, or confront — it's to create the conditions in which the person can access and strengthen their own reasons for change. MI operates through four core skills: open questions, affirmations, reflective listening, and summarizing.

MI sessions feel different from most therapy. There's no agenda imposed by the therapist, no list of changes the client should make, and no confrontation of resistance as a problem to overcome. The session is structured by your own concerns, values, and goals. I open with questions that invite your perspective: what you're considering changing, what feels uncertain, what you value that's in tension with the current pattern.

This isn't passive listening. Skilled MI requires active tracking of change talk — your own arguments for change — and sustain talk, the pull toward staying the same, and responding in ways that strengthen change talk without creating more sustain talk through pressure. Sessions move through recognizing ambivalence, strengthening motivation, and, when you're ready, planning concrete steps.

MI is most strongly indicated where ambivalence about change is the primary obstacle: substance use, alcohol use, addictive and compulsive behaviors, treatment resistance, and any situation where a person recognizes that something needs to change but can't translate that into sustained action. Research across more than 200 trials demonstrates effectiveness for substance use disorders, smoking cessation, medication adherence, and health behavior change.

Beyond formal diagnosis, MI is particularly useful for high-functioning adults who understand their patterns clearly and still find themselves returning to them. MI addresses the motivational layer beneath cognition: the competing values, fears, and attachments that keep a person in a pattern their rational mind has already rejected. It connects naturally with IFS — the ambivalence MI explores is often organized by the parts IFS identifies.

I use MI because it's the most honest framework I've found for working with genuine ambivalence, and I hold an LCADC credential reflecting specific training in its application to substance use and addictive behavior. Most approaches to behavior change carry an implicit agenda: change is the goal and therapy is the mechanism. MI rejects that structure — the therapist doesn't know better than the client what change is appropriate, at what pace, or whether abstinence is the right outcome.

The intersection of MI with IFS is where I find the most clinical traction. When ambivalence can be understood as a conversation between internal parts with different needs and fears, rather than a character failure or lack of willpower, the work shifts from trying to override sustain talk to building understanding between the parts generating it. That shift produces more durable change.

Alchemy Psychotherapy is a private-pay, out-of-network practice. A reduced fee is available in limited circumstances based on financial need and current caseload. I do not bill insurance directly, but I provide a Superbill on the first of each month for clients with out-of-network mental health benefits, and HSA and FSA cards are accepted. Under the No Surprises Act, you have the right to a Good Faith Estimate of expected charges before treatment begins.