MOTIVATIONAL INTERVIEWING
MOTIVATIONAL INTERVIEWING IS
A STYLE FOR:
Avoiding Resistance
Resolving Ambivalence
Inducing Change
MI is not primarily a “nondirective” approach. Although client-centered
strategies are employed, the process of eliciting self-motivational
statements is intentional and “directive”
RATIONALE AND BASIC
PRINCIPLES

Motivational Interviewing
•
•
•
Assumes that responsibility and
capability for change lies
within the client
Therapist’s task is to create a
set of conditions that will
enhance the client’s own
motivation for and
commitment to change
Mobilize the clients inner
resources, helping
relationships, support intrinsic
motivation for change
FIVE BASIC PRINCIPLES
• Express Empathy
• Develop Discrepancy
• Avoid Argumentation
• Roll with Resistance
• Support Self-efficacy
FIVE GENERAL PRINCIPLES OF
MOTIVATIONAL INTERVIEWING

EXPRESS EMPATHY
 by communicating
acceptance of clients as
they are, they are freed to
change.
 Seek to compliment not
denigrate (build up)
 More listening, not telling
 Gentle persuasion

DEVELOP
DISCREPANCY
 to help clients see and feel
how their current behavior
threatens important
personal goals or is
inconsistent with more
central personal values.
FIVE GENERAL PRINCIPLES OF
MOTIVATIONAL INTERVIEWING

AVOID
ARGUMENTATION
 counterproductive
 makes clients
defensive
 resistance may
indicate a need to
change strategies

ROLL WITH
RESISTANCE
 use resistance to
help build
motivation
 reframe statements
 acknowledge
ambivalence as
natural
FIVE GENERAL PRINCIPLES OF
MOTIVATIONAL INTERVIEWING

SUPPORT SELF - EFFICACY
 explore past successes in other problem
areas and apply to present situation.
 Client is responsible for choosing and
carrying out personal change.
THOUGHTS FROM RESEARCH

This treatment strategy does
not guide a client step-bystep through recovery

It employs motivational
strategies to mobilize the
client’s own change
resources

It looks at motivating
clients through short/brief
encounters

There is evidence that the
therapeutic “style” forms
the core of Motivational
Interviewing
• Accurate empathy (Rogers)

There are six elements that
have been described as
active ingredients of the
relatively brief interventions
that have been shown to
induce change in problem
behaviors: F.R.A.M.E.S
FRAMES

FEEDBACK
 very persuasive
 use information from an
objective intake
evaluation as a basis for
feedback to build
motivation
 should be personal, not
about general dangers of
substance abuse

RESPONSIBILITY
 emphasis on client’s
personal
responsibility and
freedom of choice
FRAMES

ADVICE
 giving client clear and
direct advice as to the
need for change and
how it might be
accomplished
 should be given in a
supportive, not
authoritarian
(domineering) way

MENU
 to facilitate choice
there must be
alternatives from
among which to
choose
 there’s more than
one “right way” to
change
FRAMES

EMPATHY
 maintain a clientcentered approach,
listening to and
reflecting feelings.
 the opposite of
confrontation

SELF - EFFICACY
 communicating
optimism that
change can be
achieved.
 Helping clients
develop necessary
skills to change
 encourage client to
feel s/he can change.
PHASE I
BUILDING MOTIVATION FOR
CHANGE

ASSESS CLIENT’S CURRENT
SITUATION

IDENTIFY PROBLEMS OR ISSUES

EVOKE SELF-MOTIVATIONAL
STATEMENTS
PHASE I
BUILDING MOTIVATION FOR
CHANGE

FIVE EARLY STRATEGIES IN MI:
 OPEN-ENDED QUESTIONS
 REFLECTIVE LISTENING
 AFFIRMING
 SUMMARIZING
 ELICITING SELF-MOTIVATIONAL
STATEMENTS
AFFIRMING

Compliments and statements of appreciation and
understanding

Shows respect for client and their efforts
 “I appreciate how hard it must have been for you to …”
 “I think it is great that you…”
 “That must have been difficult for you”
 “You’re certainly a resourceful person, to have…”
 “That’s a real good question”
SUMMARIZING

Used to link together material that has been
discussed.

Should be done periodically.

Reinforces what has been said.

Shows that you have been listening carefully.

Prepares the client to move on.

One of the more “directive” applications of MI
COMPONENTS OF A GOOD
SUMMARY STATEMENT

Restates client’s statements regarding problem recognition,
concern, reasons for change, and optimism about the change
If client is ambivalent, it is useful to capture both sides
(double-sided reflections)
It is legal to include information from other sources (I.e.,
family, courts, other counselors, etc.)
Don’t ramble - be concise

End with an invitation for client to respond:



 How did I do?
 If this is a fair summary, are there other points?
 Is there anything you want to correct or add?
GOALS FOR EVOKING SELFMOTIVATIONAL STATEMENTS

How client sees the problem

What the client’s concerns are about
the problem

Intention to change

Belief in their ability to change
(optimism)
STRATEGIES AND TECHNIQUES FOR
EVOKING SELF-MOTIVATIONAL
STATEMENTS


EVOCATIVE
QUESTIONS
 using open-ended
questions to ask for
statements
DECISIONAL
BALANCE
 discussing pros and
cons

ELABORATION
 asking for examples
or clarifications

USING EXTREMES
 imagining the worst
consequences

LOOKING BACK
 remembering times
before the problem, and
comparing to present
situation
STRATEGIES AND TECHNIQUES FOR
EVOKING SELF-MOTIVATIONAL
STATEMENTS

LOOKING FORWARD
 envisioning a changed future

EXPLORING GOALS
 discussing client’s most important values and/or
goals

PARADOX
 agreeing with client’s perception of “no
problem” in order to evoke the opposite
behavior
USING ASSESSMENT / FEEDBACK
TO BOOST MOTIVATION

WHAT ASSESSMENT RESULTS TO COVER IN
FEEDBACK?
 Choose parts of the assessment / evaluation package
already used, e.g.
 Results of any medical tests
 Results of diagnostic interview / checklist
 Any test scores / results that compare clients to others (the
general population / norms)
 Problem areas that are related to substance use (e.g.
Employment, family problems)
USING ASSESSMENT RESULTS /
FEEDBACK

WITH WHAT STYLE TO GIVE FEEDBACK?
 Empathy - check in with client to see their reaction to
feedback. Try to keep resistance down to they can “take
in” feedback and use it
 Developing Discrepancy
 Avoid Argumentation
 Roll With Resistance
 don’t insist the client accept everything you’re saying
 Self-Efficacy
 encourage client; be optimistic about change
PHASE II
STRENGTHENING COMMITMENT
TO CHANGE
SIGNS OF READINESS FOR CHANGE







Decreased resistance
Decreased questions about the problem
Resolve
Self-motivational statements
Increased questions about change
Envisioning
Experimenting
PHASE II
STRENGTHENING COMMITMENT
TO CHANGE

Client is ready to change

Client has not made a firm
commitment to change

Contemplation / Preparation
PHASE II
STEPS TO STRENGTHENING
COMMITMENT TO CHANGE

RECAPITULATION
 summarize the
client’s current
situation based on
your interaction in
order to evaluate
what to do next

KEY QUESTIONS
 ask clients what
they want to do
 use open-ended
questions
 encourages client to
reflect and talk
about change
PHASE II
STEPS TO STRENGTHENING
COMMITMENT TO CHANGE

INFORMATION AND
ADVICE
 in response to client
questions, provide the
information or ideas
 wait for invitation from
client to provide advice
 do not fall prey to the
“yes, but” pattern

NEGOTIATING A
PLAN
 set goals
 consider change options
 arrive at a plan
PHASE II
STRENGTHENING COMMITMENT
TO CHANGE
HAZARDS

Understanding Ambivalence
 does not disappear quickly

Overprescription
 developing a plan that is unacceptable to the
client

Insufficient direction
 providing too little guidance / direction
NON-VERBAL ROLES

What it was like growing up in my home

Ways in which I have changed as a person over the years

The good things and not so good things about my high school years

What I hope and plan to do over the next ten years

Describe one of your parents, or someone else close to you

How I came to do the kind of work I am doing