Introduction to Motivational Interviewing

Main Ideas, Concepts, and Lessons

Motivational Interviewing (MI) definition

• Motivational Interviewing (MI) is an effective way of talking with people about change.
• “Effective” is evidence-based, supported by about 1,200+ publications across respected journals and varied settings, problems, and countries.

Why MI is needed

• People often don’t change quickly or easily, even when they know change is important.
• Change is hard not only due to lack of information or “resistance,” but often because of:
  • Ambivalence: wanting and not wanting change at the same time.
  • Ambivalence creates anxiety, which people try to avoid—leading to procrastination.

MI reframes “resistance”

• MI avoids the term “resistance.”
• What may look like resistance is often ambivalence, a normal result of weighing pros and cons.

How MI helps

• Resolves ambivalence
• Helps the client move toward healthy behavior change
• Elicits the client’s own motivation and the client’s own reasons/arguments for change

---

Underlying MI “Spirit” (4 Principles)

• Partnership

  • Counselor and client work collaboratively
  • Counselor avoids an expert/authoritarian role

• Acceptance

  • Counselor respects the client’s autonomy
  • Recognizes the client’s right to make decisions, along with their strengths/potential and perspective
  • Counselor tries to see the world through the client’s eyes

• Compassion

  • Counselor keeps the client’s best interests in mind

• Evocation

  • Best ideas about change come from the client
  • Client is more likely to act on ideas that arise from them than from the counselor

---

Core MI Counseling Skills (OARS) — With Detailed Instructions/Examples

O = Open Questions

• Ask questions that require more than yes/no
• Purpose: encourages the client to talk about what’s on their mind rather than being interrogated from the counselor’s agenda

Examples (closed → revised open):

• “Are you in pain?” → Not open
• “How do you feel?” → open
• “How much alcohol do you drink a day?” → framed as a closed-style question in the example
• “What role does alcohol play in your life?” → open
• “Don’t you want to move to a safer place?” → yes/no
• “What are the advantages that you see in moving to a safer place?” → open

A = Affirmations

• Make statements about anything positive the counselor notices
• Purpose: build self-confidence / self-efficacy

Examples:

• “You really care a lot about your family.”
• “This is hard work you’re doing.”
• “You were successful in changing in the past.”
• “That took a lot of courage coming in today knowing that you had a dirty urinalysis.”

R = Reflections (Reflective Listening)

• Reflect what the client is thinking and feeling, and say it back
• Reflections are statements, not questions
• Purpose: convey empathy/understanding and help the counselor see from the client’s perspective

Examples (reflection statements rather than questions):

• Client: “I don’t think I have PTSD.”
  • Reflection: “You’re not sure about the diagnosis of PTSD.”
• “I’ve been this way for so long I think it’s just my personality.”
  • Reflection: “All of this seems normal to you.”
• “I don’t like the road rage or getting angry with my wife.”
  • Reflection: “Road rage and anger at your wife are a couple of things you’d like to change.”

S = Summaries

• Longer reflections that combine more than one of the client’s statements
• Purpose: allow the counselor to be strategic, guiding the client by selectively summarizing the client’s own reasons for change

Example scenario:

• Client is ambivalent about moving to senior housing (reasons for moving and reasons against it)
• Summary example: acknowledge downsides (new doctors/unfamiliarity) and also benefits (safety, closeness to grandchildren)

---

MI Processes (A Typical Sequence)

1. Engaging

   • Establish a trusting, mutually respectful relationship
   • Not MI-specific, but required before change talk
   • Related terms mentioned: attuning, aligning, establishing a therapeutic relationship, connecting
   • Avoid in engaging (key “what not to do”):
     • Assessment trap: asking many questions immediately
     • Telling how to fix the problem: quick diagnosis → quick solution
     • Creating a power differential (acting like an authority figure)
     • Labeling the client or requiring acceptance of a label before help
   • Signs engagement is working:
     • Client feels welcome, comfortable, understood
     • Client feels mutual goals and hope

2. Focusing

   • An ongoing process of seeking and maintaining direction
   • Involves setting/agreeing on an agenda considering:
     • client goals/priorities
     • counselor goals/priorities
     • agency goals/priorities
   • Purpose: create clear direction for developing a change plan
   • Accomplished using OARS and attentive listening

3. Evoking

   • Eliciting the client’s own motivation for change (change talk)
   • Change talk definition: client speech that favors movement toward change (e.g., “I want to change,” “I wish I could,” reasons/benefits, “I will/can,” solutions, etc.)
   • Counselor actions:
     • Reinforce and encourage change talk
     • Generate more change talk when it’s low by asking questions such as:
       • “Why do you want to make a change?”
       • “What are the reasons from your point of view to make a change?”
       • “What benefits would you see?”
       • “How might you go about making the change if you wanted to be successful?”
       • “What would be your first step / next step?”
       • “What options do you see yourself having?”

4. Planning

   • Develop a specific change plan the client agrees to and is willing to implement
   • Plan should be SMART:
     • Specific
     • Measurable
     • Achievable
     • Relevant
     • Timely
   • MI ends once a SMART plan is formed

---

Speakers / Sources Featured

• Dr. Bill Matulich (clinical psychologist; motivational interviewing trainer; author)
  • Also referenced: author of the ebook “How to do Motivational Interviewing”
• Website mentioned (for more information): www.motivationalinterviewingonline.com