MOTIVATIONAL INTERVIEWING (MI)
FOR USE IN HIV/AIDS PREVENTION PROGRAMS
IN DEVELOPING COUNTRIES
ABY Project Training
Facilitator’s Guide
July 2006
Trish Long, MPH & Tom Davis, MPH
Motivational Interviewing Training
TABLE OF CONTENTS
TABLE OF CONTENTS ................................................................................................................................ 2
INTRODUCTION: MOTIVATIONAL INTERVIEWING IN THE CONTEXT OF BRINGING HOPE(BH)
AND ABSTINENCE & BE FAITHFUL FOR YOUTH (ABY) .......................................................................... 3
HOW THIS FACILITATOR’S GUIDE IS ORGANIZED ................................................................................. 5
ACHIEVEMENT-BASED OBJECTIVES: MOTIVATIONAL INTERVIEWING HIV/AIDS PREVENTION
IN DEVELOPING COUNTRIES .................................................................................................................... 6
TASK #1: W ELCOME AND INTRODUCTIONS EXERCISE ................................................................................... 8
TASK #2: IDENTIFYING BARRIERS TO CHANGE ............................................................................................. 9
TASK #3: MI AND HEALTH PROMOTION: HOW DIFFERENT ARE THEY? .......................................................... 13
Task #3 Script: Afiya and Imani Talk about HIV Prevention .............................................................. 15
TASK #4: EVIDENCE FOR THE EFFECTIVENESS OF MI ................................................................................. 19
TASK #5: PRINCIPLES OF MI ...................................................................................................................... 25
Part A Review & Synthesis ................................................................................................................. 29
Homework Assignment ...................................................................................................................... 29
TASK #6: OVERVIEW OF THE MI PROCESS.................................................................................................. 31
TASK #7: OPEN VS. CLOSED QUESTIONS ................................................................................................... 37
TASK #8: RECOGNIZING OARS ................................................................................................................. 40
Task #8 Script: Interview with James, a married truck driver ............................................................. 45
TASK #9: USING THE OARS ...................................................................................................................... 46
TASK #10: RECOGNIZING RESISTANCE TO BEHAVIOR CHANGE ..................................................................... 48
TASK #11: PRACTICE ROLLING WITH RESISTANCE ...................................................................................... 52
TASK #12: LISTENING FOR CHANGE TALK................................................................................................... 53
TASK #13: PRACTICE MOTIVATIONAL INTERVIEWING! .................................................................................. 58
Part B Review and Synthesis ............................................................................................................. 60
TASK #14: RECOGNIZING READINESS FOR CHANGE .................................................................................... 62
TASK #15: CREATING A PLAN FOR CHANGE................................................................................................ 64
Task #15 Script: Motivational Interviewing - Creating a Plan for Change In Practice ........................ 69
TASK #16: W ORKING WITH SPECIAL GROUPS ............................................................................................. 73
TASK # 17: W HO’S THINKING ABOUT CHANGE? ........................................................................................... 77
TASK #18: REVIEW - AVOIDING THE TRAPS! ................................................................................................ 78
TASK #19: OUTLINING A COMMUNITY-LEVEL MI TRAINING ........................................................................... 79
Part C Review and Synthesis ............................................................................................................. 82
REFERENCES ............................................................................................................................................ 83
ANNEX 1: FACILITATOR’S POWERPOINT .............................................................................................. 84
ANNEX 2: TASK 9 QUALITY CHECKLIST ................................................................................................. 85
ANNEX 3: CHARACTER SHEETS FOR TASK 13 ROLE-PLAYS ............................................................. 86
ANNEX 4: QUALITY CHECKLIST FOR MOTIVATIONAL INTERVIEWING TRAINING TASK # 13
AND SUBSEQUENT PRACTICE ............................................................................................................... 93
ANNEX 5: FINAL QUIZ ............................................................................................................................... 96
Answers to the Final Quiz ................................................................................................................ 102
ANNEX 6: MI COACHING CARDS ........................................................................................................... 103
2
Motivational Interviewing Training
INTRODUCTION: MOTIVATIONAL INTERVIEWING IN THE CONTEXT OF
ABSTINENCE & BE FAITHFUL FOR YOUTH (ABY) PROGRAMS
You may choose to present the information below to your own participants in any
way that you wish to help them connect this training to the goals of the participants’
programs. The facilitator’s slides (Annex 1) give this information in a more concise
format after the welcome exercise. Please note that this training was first developed
for use by a faith-based organization (Food for the Hungry) as part of their HIV
prevention programs. It is written in such a way as to be used with both secular and
religious groups.
Motivational Interviewing (MI) is one of the more successful counseling methods that
aims to help people change their behaviors for better health. It is the work of Dr.
William Miller of the University of New Mexico and Dr. Stephen Rollnick (a South
African) of the University of Wales, College of Medicine. These two men have
extensive experience counseling people in the United States and Europe in changing
addictive behaviors such as alcohol or substance abuse. Building on the work of
many colleagues in areas such as people-centered counseling, they developed and
tested a theory of how and why people change particularly difficult behaviors, and
how counseling styles can help or hinder them. Out of these experiences grew the
practices of motivational interviewing, a “way of being with people” which can help
them to change.1
One of the overarching goals of Food for the Hungry’s Abstinence & Be Faithful for
Youth (ABY) programs is to prevent new HIV/AIDS infections among youth and
families. In order to do this, several objectives related to behavior change must be
realized:
 Delay first intercourse among youth until marriage and increase abstinence in
youth and adults who have previously engaged in sexual activity but who are
not currently in a committed relationship.
 Increase faithfulness among married youth and adults.
 Build capacity of faith-based and community-based organizations to decrease
transmission of HIV/AIDS through the integration of abstinence and
faithfulness support programs for youth and adults, and HIV/AIDS awareness,
into the regular programs of targeted churches and mosques.
 Reduce sexual coercion, violence, cross-generational and other unhealthy
sexual behaviors that increase people’s vulnerability to HIV by involving
parents, teachers, pastors, volunteer mentors, and church leaders in learning
that guides them in how to take action to reduce these problems in their
communities. 2
1
2
Miller, W. R. and Rollnick, S. Motivational Interviewing: Preparing People for Change. 2nd Ed. 2002. Guilford
Press: New York.
Goals adapted from the “Healthy Choices Leading to Life: Improving Sexual Behavior of Youth in Ethiopia,
Haiti, Mozambique, and Nigeria” proposal by Food for the Hungry on behalf of the Association of Evangelical
Relief and Development Agencies (AERDO), HIV/AIDS Alliance (AHA).
3
Motivational Interviewing Training
Motivational Interviewing has been chosen as one of the vehicles to help people
change sexual behaviors which put them at risk for HIV/AIDS for HIV prevention
programs (e.g., the ABY programs) because it is useful when people are ambivalent
about changing their behavior and because it has been shown to be successful in a
developing country setting when applied by non-professional counselors.
Abstinence and faithfulness are both behaviors which often involve a high level of
ambivalence.
Please note that MI is a form of counseling that helps people to make decisions. It
has the goal of behavior change – usually in a particular direction (e.g., promoting
HIV prevention, smoking cessation, water purification), but not necessarily through a
single means. There are other forms of counseling that can be used when emotional
consolation (during grieving) or other another purpose (e.g., achieving peace of mind
concerning a situation that cannot be changed, like paralysis) is the goal of the
counseling. For these goals, another form of counseling would be more appropriate.
This course (1) places motivational interviewing in the context of community
development work, of a developing country, and of religious faith; (2) builds basic
skills necessary for high-quality motivational interviewing; and (3) discusses special
cases and problems which might arise while working in a developing-country in the
context of HIV/AIDS prevention.
GROUPS THAT SHOULD RECEIVE TRAINING IN MOTIVATIONAL
INTERVIEWING
The groups in the AERDO ABY project that should receive training in Motivational
Interviewing are:

MI Trainers in each country who will in turn train:

Community leaders (for counseling married couples and those in long-term,
socially-sanctioned relationships on primary and secondary faithfulness, and
unmarried youth on primary and secondary abstinence)

Religious leaders (counseling the same aforementioned groups, plus couples
that come to religious leaders for premarital counseling and couples counseling).

Youth Leaders (for counseling youth on abstinence, and counseling youth who
decide not to be abstinent on partner reduction and use of condoms which offer a
certain level of protection when used correctly and consistently).
The last task in this training guide is development of an outline for these communitylevel trainings. Training of the leaders mentioned above should be shorter than the
training-of-trainers and should focus on development of MI skills and convincing
participants of the usefulness of the principles of MI and MI techniques in counseling.
4
Motivational Interviewing Training
HOW THIS FACILITATOR’S GUIDE IS ORGANIZED
This guide was written for use by facilitators who will train others in Motivational
Interviewing in ABY HIV/AIDS prevention projects. It is organized as a set of
discrete tasks which may be divided up in any way necessary to meet your training
timeframe.
Each task should be written in its entirety where participants can clearly see
the task and its instructions at all times. We recommend the use of a white
board, newsprint flip chart, or slide presentation for this purpose.
Each task is presented in this format:
Participant Instructions:
Task #:
a. Description of task including any specific instructions for participants.
Time: Amount of time each part of the task is expected to take.
Guidance to facilitators is presented as shown below. Facilitators’ slides (in Microsoft
PowerPoint) may be found in Annex 1.
Facilitator Guidance:
Materials needed: Lists any additional materials participants will need to complete
the task. Prepare these materials, including all instructions and facilitation materials,
before the training.
Anticipated Time: Gives the anticipated length for each task in hours and minutes.
Purpose: Explains the purpose of the task, its relationship to the objectives of the
course, and any important instructions for the facilitator.
Slide Annotation: Provides instructions for using slides found in Annex 1 throughout
the training. The slide annotation identifies the slides by their title.
Specific instructions for the facilitator, including annotations denoting when to use a
particular slide, will appear in italics. Italicized text should not be read aloud.
Complimentary text for the slides, which the facilitator may choose to read or refer to
during the training, will be provided, and will not be italicized.
5
Motivational Interviewing Training
ACHIEVEMENT-BASED OBJECTIVES: MOTIVATIONAL INTERVIEWING
HIV/AIDS PREVENTION IN DEVELOPING COUNTRIES
Part A: What is Motivational Interviewing (MI)?
After completing Part A, you will have:
 Categorized people in various stages of change in Prochaska’s Stages of
Change Model and related their situations to key determinants described in
Barrier Analysis3;
 Compared an example of MI to an example of traditional health promotion;
 Reviewed evidence of MI’s effectiveness;
 Reflected on the key principles of MI and their relationship to development
work, your culture, and religious teaching;
Total Estimated Conduct Time, Part A: 3 to 4 hours
Part B. Basic MI Skills
After completing Part B, you will have:
 Examined an outline of the practice of Motivational Interviewing;
 Distinguished between open and closed questions;
 Assessed how reflective listening skills and open-ended questions can help
develop discrepancy between current behavior and personal values;
 Experienced, Heard, and Practiced reflective listening;
 Compared resistance and change talk as indicators of how the counseling
conversation is progressing towards the goal of behavior change; and
 Practiced using motivational interviewing skills in several role-playing
situations.
Total Estimated Training Time, Part B: 9 to 12 hours
3
Barrier Analysis is a rapid assessment tool that can help organizations to identify behavioral
determinants associated with a particular behavior so that more effective behavior change
communication messages and strategies can be developed. By focusing on eight determinants,
Barrier Analysis enables the user to gain a wide-angle view of why people are not choosing to
change and design programs to help change occur. Barrier Analysis, developed by Food for the
Hungry, has been used by many organizations on three continents to improve behavior change
activities and to tear down barriers to behavior change. A downloadable manual and online tutorial
on Barrier Analysis can be found at http://barrieranalysis.fhi.net. (The participants in this MI
workshop had received prior training in Barrier Analysis. If the participants in your workshop
have not had this training, questions on Barrier Analysis and key determinants may be
omitted.)
6
Motivational Interviewing Training
Part C. MI in the Context of an AIDS Prevention Program: Change, Special
Cases, and Problems
After completing Part C, you will have:
 Ordered the steps in creating a plan for change;
 Listed and examined special groups with whom your learners are likely to
work;
 Heard the specific ways in which MI can be adapted to work with special
groups;
 Reviewed common problems in using MI.
Total Estimated Training Time, Part C: 4 to 5 hours
Total Estimated Conduct Time of MI Training: 16 – 21 hours
Note that your training time may vary considerably from the estimates given here,
depending on the number of participants in the training: These estimates are offered
to help with planning your training only. If you have additional time, we recommend
adding in additional MI role-playing for practice (See Task #13).
7
Motivational Interviewing Training – Task #1
Task #1: Welcome and Introductions Exercise4
[Skipped in Global TOT Workshop, but use at country-level workshops.]
1a. Think of an object which symbolizes your work (e.g., a tree, a helping hand, etc.).
What is it, and why does it symbolize what you do? Share your symbol and
something else about yourself with a partner.
Time: 5 minutes
1b. Then we will hear everyone’s symbols as a group.
Time: 5 minutes
Facilitator Guidance:
Materials needed: None.
Anticipated Time: 10 minutes
Purpose: To introduce participants and the facilitator and to one another in a fun
way. If you have another ice-breaker exercise that you prefer to use, substitute it for
this one.
Slide Annotation: Show “Task # 1” slide.
1a. Warmly welcome the participants to the training. Ask participants to choose an
object which symbolizes their work. They should explain how this object symbolizes
what they do, and some other detail about themselves, to a partner for 5 minutes.
1b. Bring the group back together. Have each person introduce themselves to the
group, and describe their object and why it represents them for 5 minutes.
Slide Annotation: Following the warm-up and introduction exercise, you may wish to
show “Why Are We Here”, or replace it with your own slide explaining the goals of
your program. “Part A: What is Motivational Interviewing”, introducing the
Achievement-Based Objectives for Part A of the Training, should be shown
afterward. Ask participants if they have questions about the objectives before moving
on to the next task.
4
Exercise taken from “The Power of Dialogue in International Development” workshop, May 24-26, 2005, for
Food for the Hungry by Global Learning Partners.
8
Motivational Interviewing Training – Task #2
Task #2: Identifying Barriers to Change
[Use this Task only with Trainers during Training of Trainers Workshops.]
2a. The boxes show scenarios of people in different stages of change. Match the
people in the scenarios with the stages of change on the left.
2b. Based on your knowledge of Barrier Analysis, what are the determinants of
behavior change for each of these people? Write in the determinants on the right
side, next to each person’s scenario.
Time: 20 minutes
2c. We will hear a sample of your conclusions.
2d. At what stages of change5 do many development actions take place?
Time: 20 minutes
Facilitator Guidance:
NOTE: For trainers who have not been introduced to the Stages of Change
model, review that with them now using the Educational Methods and
Messages training notes. For trainers who have not been introduced to Barrier
Analysis, omit part 2.b.
Materials needed: Printed cards -- The cards should be printed using the file
provided. The cards will have the Stages of Change written on some of the cards,
and two sets of scenarios on the other cards. Use one set of these cards for each
small group of five people.
Anticipated Time: 40 minutes
Purpose: To help participants recall what they know about Prochaska’s Stages of
Change model, and tie the knowledge to Barrier Analysis, as well as to introduce MI
as an intervention that can be used when people are in the contemplation or
preparation stages of change. A small group may do this as a group activity; a large
group may split into pairs. If your participants have not trained in Barrier
Analysis, you should omit this task.
Slide Annotation: “Task 2: Identifying Barriers to Change” should be showing as you
introduce this activity.
5
Participants in the original MI training using this guide had previously been trained in Prochaska’s Stages of
Change model. If your participants have not yet had that training, you should train them using pp.12-14 of the
Barrier Analysis training manual (http://barrieranalysis.fhi.net), the online Barrier Analysis tutorial, or some
other suitable training materials. There is a wealth of information online on this model.
9
Motivational Interviewing Training – Task #2
2a. Divide participants into groups of about five people. Give each group a set of
the cards and have them arrange the stages of change in order vertically or
horizontally (depending on the size of the board or wall that you are using).
Participants should then place the various scenario boxes (Set #1) next to the
appropriate stage of change. (Correct answers are included with each scenario on
the following page.) Remind participants that they have a list of the determinants of
behavior change in the Participants’ Guide. If they have time, they can do the same
with Set #2.
2b. Using the list of behavior change determinants included, allow participants to
write in the determinants of behavior change for the person in each scenario.
Remind participants that only some scenarios have behavior change determinants –
“None” is therefore a correct answer to some scenarios.
Barrier Analysis: Determinants of Behavior Change (as shown in participants’
guide)
Perceived Susceptibility: the person believes the problem could happen to them
Perceived Severity: the person believes the problem is serious
Perceived Action Efficacy: the person believes the preventive action works
Perceived Social Acceptability: the preventive action will be acceptable to family,
friends
Perceived Self-Efficacy: the person feels they are capable of doing the preventive
action
Cues to Action: the person can remember to do the preventive action and how to do
it
Perceived Divine Will: the person believes God or the gods control the problem and
its solution, and it is beyond their personal control to prevent or mitigate it
Negative or Positive Attributes of the Behavior: the preventive action has good
aspects that may be attractive or bad aspects that may cause the person to avoid
the action
Example of activity arrangement
Pre-contemplation
Scenarios 1 - 5
Behavior Change
Determinants
Contemplation
Preparation
Action
Maintenance
2c. Ask selected participants why they chose to categorize the people in the
scenarios as they did, and why they chose the determinants of behavior change that
they wrote in (if they did that). Correct any misperceptions about which stage of
10
Motivational Interviewing Training – Task #2
change the person in each scenario is in, or which barrier to change is affecting
them. (Correct answers are included with each scenario below.)
2d. Ask participants in which stage of change most behavior change programs
target. They should mention the pre-contemplation or action stages. Ask if all
people are usually in those stages.
Explain (if they do not bring up these responses):
Many development actions specifically take place either at the pre-contemplation
stage (providing information) or at the action stage (they assume someone is ready
to change). Motivational Interviewing is most appropriate for people in the
Contemplation and Preparation stages. Before people understand the negative
aspects of a behavior, they sometimes do not have very much ambivalence about
change, or even understand the behavior that you are promoting. That means that
you will often use other methods (like consciousness raising and environmental
reevaluation6) prior to using MI.
Scenarios
Below are the scenarios for this activity. Place the scenarios below on cards and put
them on the board or wall for each group in random order for the participants to
arrange. Do not put them up in this order originally, because that would make it too
easy for participants to order them properly. There are two sets of scenarios here.
Set 1:
Benito is 17 years old. He has been having sex for the past three years, and does
not see any reason why he should stop. He says, “Yeah, I’ve heard all about getting
HIV, but if I am going to get HIV, I probably already have it by now.”
(SoC: pre-contemplator, BA: perceived action efficacy)
Jamila is 19 years old, and has been having sex with men for money in order to feed
her younger siblings since age 15. “I would like to ask each man to use a condom so
I know I am at less risk for HIV” she says, “but I do not think I could do it. Plus, I fear
he will always refuse, and maybe become angry with me and hurt me, or go to
another woman and then I will lose money.”
(SoC: contemplator, BA: negative attributes, perceived self-efficacy)
Samuel is 25 and newly married. “I have decided I must be faithful to my wife. She
and our future children mean too much to me to risk their health.”
(SoC: preparer, BA: perceived susceptibility, perceived severity)
George is 40 years old, single, and has HIV. “I have just begun using a condom
every time I have sex so that I will not infect my partners,” he says. “I hope I will be
able to remember to buy them.”
(SoC: actor, BA: cues to action)
6
Environmental reevaluation is learning how one’s actions affect one’s self/others through methods such as
guided discussions with others, testimonies, or storytelling.
11
Motivational Interviewing Training – Task #2
Prudence is 18, and single. “It is such a relief to know that I will not have to worry
about HIV. Since last month, when I made the decision to be abstinent until
marriage, my heart feels light.”
(SoC: maintainer, BA: perceived action efficacy, perceived susceptibility, perceived
severity)
Set 2:
Amina is a 35-year-old wife and mother of five children. “I haven’t heard very much
about HIV, but since I have always been faithful to my husband,” says Amina, “I
could never get HIV. Besides, when God wants someone to get the disease, they
get it, no matter what.”
(SoC: pre-contemplator, BA: perceived susceptibility, perceived divine will)
Mtume is 20 years old, and married for two years. “If I do not stop sleeping with
other women,” he says, “I am sure I will bring HIV home to my family. But what will
my friends say? Will they think I am less of a man if I am only sleeping with my
wife?”
(SoC: contemplator, BA: perceived social acceptability)
Safiya is 14 years old. “I have thought about this a lot,” she says. “I am ready to
decide to be abstinent. I just need to know what I should tell my friends.”
(SoC: preparer, BA: perceived social acceptability)
Philip is 32, and married. “I don’t want my family to experience the stigma of HIV,
even if I am not always faithful to my wife. I have decided to use a condom every
time I have sex with another woman.”
(SoC: actor, BA: perceived social acceptability)
Hasan is 24 years old. “Since I decided to be abstinent four months ago, I am happy
with my decision,” he says. “Sometimes it is hard to wait, but I will be married soon,
and my wife and I will be safe from HIV.”
(SoC: maintainer, BA: perceived action efficacy)
12
Motivational Interviewing Training – Task #3
Task #3: MI and Health Promotion: How different are they?
3a. Listen to the following role plays, acted out by your colleagues.
Time: 15 minutes
3b. With a partner, name the differences between the two methods that you hear.
Time: 5 minutes
3c. We will hear your ideas.
Time: 20 minutes
Facilitator Guidance:
Materials needed: Paper copies of the scripts to give to participants.
Anticipated Time: 40 minutes
Training Preparation: Ask for volunteers to review the scripts right after the icebreaker exercise, and send out the scripts to those who will do the roleplay.
Purpose: To highlight the differences between traditional health promotion and
motivational interviewing.
Slide Annotation: Show “Task #3”.
Have two participants read the following two scripts. You may wish to ask two
different participants to read the second script.
Ask: “What differences do you notice between traditional health promotion and
motivational interviewing in these two scenarios?”
Allow participants 20 minutes to discuss the differences in pairs, and have them write
down their thoughts. In plenary, list their responses on a flip chart.
Slide Annotation: Show “MI and Health Promotion: Some Differences” at this time,
which contains the following differences in shortened form.
Important differences to note (mention only if participants do not say these):

In the health promotion scenario, it was the promoter who set the agenda; in
the MI scenario, the health promoter asked Imani what she wanted to talk
about. The subject of HIV came up in conversation after Imani’s initial
concern – her husband’s illness – had been dealt with.

Afiya never argued with Imani in the MI scenario. There was less direct
confrontation or opposition.
13
Motivational Interviewing Training – Task #3

Afiya used strategies such as importance scales (“how important is it to you to
do this”) to draw out fine shades of detail in Imani’s responses.

She always uses the positive direction of the scale (e.g., why are you a four
and not a three) rather than asking “why aren’t you a five?”

It’s not that her technique (using health promotion) is bad in the first scenario:
it’s simply not the best tool for the situation.
14
Motivational Interviewing Training – Task #3
Task #3 Script: Afiya and Imani Talk about HIV Prevention
[Part I: Health Promotion]
[Afiya is a Health Promoter and Imani is a young married woman. Afiya has
arrived for a visit at Imani’s home.]
Afiya:
Hi, Imani. How are you doing today?
Imani:
I am doing well, but I think I will get sick soon. I have been caring for my
husband, and he has been ill. I will probably catch whatever he has.
Afiya:
Oh, I’m sorry to hear that – being sick is nothing to look forward to. What
does he have?
Imani:
I’m not sure. It came on slowly, but it has lingered. He has very bad
diarrhea on and off, an itchy rash, and a fever.
Afiya:
I am sure you have been taking good care of him – you were always very
receptive to our talks about health and hygiene. Do you have any
questions about it that I can answer?
Imani:
Well, I just want to know if it could be something more serious than just a
flu. He’s had it for a few weeks, and it doesn’t seem to be getting any
better.
Afiya:
It might be a stomach flu. You should take him to the clinic: they can help
you to figure out what it is and tell you how best to treat him. The symptoms
you describe are symptoms of many illnesses, including HIV. That is what I
am here to talk about today.
Imani:
[worried] I know what HIV is, we’ve talked about it before. That can’t have
anything to do with my husband?
Afiya:
Just to be clear, I am not telling you that he has HIV. The only way a
person can know if he or she has HIV is to be tested for it, like we
discussed in our last talk. He may very well have a stomach flu. I wonder,
have you both been tested for HIV?
Imani:
I know I never have. I have never asked him if he has or not. And anyway,
we are married. We have nothing to worry about with HIV.
Afiya:
You should go to the clinic to get tested. It would be a good idea to do this
so you will know your HIV status. Maybe you could do that when you take
him there for treatment for this illness that he has. In addition, I can tell you
some ways to prevent HIV. You can get HIV even if you are married, you
know.
Imani:
How is that possible?
15
Motivational Interviewing Training – Task #3
Afiya:
Even if you are married, if one spouse had it before the marriage, it can be
passed to the other spouse. In addition if either of you has slept with
someone else after being married, this also puts you at risk for getting HIV.
Imani:
[defensive] I would never be unfaithful to my husband! I am a good wife!
What a man does is his own business. I could never ask him if he has ever
been unfaithful to me!
Afiya:
[patiently] I think you may have misunderstood me: I am not saying that you
have ever been unfaithful, nor am I saying that your husband was unfaithful
to you. It is very important, however, for you both to talk with each other
about these sorts of things, and to be tested for HIV, so that you can be
sure you prevent yourselves from getting it. As a first step, how about
going together to be tested for HIV?
Imani:
How would I even bring up such a subject? He will think I am implying
something, and I do not need to upset him even further while he is ill!
Afiya:
Perhaps it will have to wait until he is feeling better. I can help you with
some strategies to start this conversation, so that it will be easier for you.
[Part II: Using Motivational Interviewing]
[Same day and place, but Afiya approaches it differently.]
Afiya:
Hi, Imani. How are you doing today?
Imani:
I am doing well, but I think I will get sick soon. I have been caring for my
husband, and he has been ill. I will probably catch whatever he has.
Afiya:
Oh, I’m sorry to hear that – being sick is nothing to look forward to. What
does he have?
Imani:
I’m not sure. It came on slowly, but it has lingered. He has very bad
diarrhea on and off, an itchy rash, and a fever.
Afiya:
I am sure you have been taking good care of him – you were always very
receptive to our talks about health and hygiene. You know, I am supposed
to talk with you about preventing HIV today. Is that what you would like to
talk about, or is there something more important to you that we should
discuss?
Imani:
Well, I just want to know if his illness could be something more serious than
just a flu. He’s had it for a few weeks, and it doesn’t seem to be getting any
better.
Afiya:
The symptoms you describe could be many different illnesses, most of
which are not serious. If you take him to the clinic, they can help you figure
out what it is and how best to treat him. It is probably just a stomach flu, but
16
Motivational Interviewing Training – Task #3
I can understand why you are concerned. What else do you think it could
be?
Imani:
I don’t know. I thought it was probably a stomach flu, too. It couldn’t be HIV,
could it? I thought that you could only get HIV through sex with an infected
person, or through infected blood, like something on a used needle.
Afiya:
You’re correct that the only way a person can get HIV is through sex with
an infected person or through infected blood. The only way you can know if
he has HIV is to go and have him tested for it at the clinic, like we discussed
before. Although the symptoms you describe are also symptoms of HIV, it
does not mean that he has HIV.
Imani:
We are both generally healthy people. I don’t know if we really need to be
tested for HIV.
Afiya:
How do you feel about being tested for HIV?
Imani:
[hesitant] I guess it would be nice to know for sure that we didn’t have it. I
can’t imagine that either of us could have it, though. After all, we are
married.
Afiya:
So you think you might want to get tested for HIV, just for peace of mind.
But you are pretty sure that neither one of you has HIV, since both of you
have been faithful in your marriage.
Imani:
Well…I know that I have been faithful, but what a man does is a man’s
business. I do not know if my husband has been with other women since
our marriage. If he has been unfaithful, is he at risk for HIV, though?
Afiya:
Yes, and so is anyone else that he has slept with. How important is it to
you to talk with him about being tested for HIV? Would you say it is very
important, somewhat important, a little important, or not at all important?
Imani:
[nervously] Given what you have just told me, it is quite important.
Afiya:
Why is it quite important, more than just a little?
Imani:
I don’t want to be at risk. We will have a family soon, I feel sure, and I know
that HIV can be passed from mother to child. And what would I do if my
husband died of HIV? It would be awful, knowing that I could lose him, and
that I and my children could have it too! I do not want that for my family.
Afiya:
So you feel it’s quite important to talk with him about this issue of being
tested for HIV. It’s important for you, your husband, and your future
children. How confident are you that you could talk to him about it? Let’s
use the same scale, from very confident to not at all confident
Imani:
[sadly] Ah, I do not know how I could even bring it up with him. I not very
confident I could do it. What would he think of me, if I said such things? I
17
Motivational Interviewing Training – Task #3
am afraid of what he would say if I even brought up the issue of testing.
[alarmed] Maybe he would even think that I have been unfaithful!
Afiya:
So you are worried that he might feel think you have been unfaithful, if you
brought up being tested for HIV.
Imani:
Yes, I think he would. I am sure he would wonder where I got such ideas.
Afiya:
What would need to happen for you to become more confident that you
could talk with him about it?
18
Motivational Interviewing Training – Task #4
Task #4: Evidence for the Effectiveness of MI
[Use this Task only with Trainers during Training of Trainers Workshops.]
4a. Listen to the following presentations on how Motivational Interviewing has been
used in an African context and with HIV/AIDS.
Time: 15 minutes
4b. What surprises you about the effectiveness of MI in these studies?
4c. What is different about the context of your project from how MI was used in
these studies?
4d. What about these examples makes you confident that MI could be effective in
your programs?
4e. How convinced are you of MI’s effectiveness at this point?
Time: 15 minutes
Facilitator Guidance:
NOTE: This task is most important for the trainers. For other participants trained,
you can briefly talk about the effectiveness of this method and why it is helpful for
use in HIV/AIDS prevention programs (focusing on how it works well when people
have mixed feelings about something, like faithfulness).
Materials needed: Copies of the studies (or highlights) to give to participants.
Anticipated Time: 30 minutes
Preparation: Email the studies or highlights to the participants prior to the start of the
training.
Purpose: To demonstrate that MI has been effectively used in Africa. The full text
study on MI in Zambia for water purification promotion may be found at:
http://www.cdc.gov/safewater/publications_pages/2000/thevos1_2000.pdf. The full
text of the HIV/AIDS prevention study in the United States is not available for free
online.
Slide Annotation: Show “Task #4” to introduce this exercise, before moving on to the
next slide..
4a. Briefly present findings of the Zambia study and U.S. study using PowerPoint or
other presentation materials.
19
Motivational Interviewing Training – Task #4
There are many examples of success using motivational interviewing to address
problem drinking or drug use in Western countries. However, the following study is
one of only two published studies of MI work done in a developing country, and this
is the only one we know of which was conducted in Africa (the other was a nonrandomized pilot study conducted with female sex workers in Tijuana, Mexico).
Slide Annotation: Show “Motivational Interviewing in Zambia” at this time.
In Africa, Motivational Interviewing was tested in three randomized, controlled trials
in peri-urban communities in Kitwe, Zambia. The goal of the intervention was to
increase use of household water disinfectants to prevent diarrhea, which was
identified as a major health concern in the area. The trials compared motivational
interviewing with education on water disinfection to education only.
Slide Annotation: Show “Health Promotion + MI” at this time.
Both the MI intervention and the control intervention were delivered by neighborhood
health committee volunteers in weekly sessions averaging 15-30 minutes. Only
those volunteers who were delivering the MI + education intervention were trained in
MI, although all volunteers received the same training in water disinfection
educational messages. These volunteers were trained by local nurses who had also
been trained in MI specifically for this intervention. Volunteers received 10 hours of
training over 5 days.
Slide Annotation: Show “How NHC Volunteers Were Trained” at this time.
The first field trial did not see significant differences in results between the
experiment and control groups. The researchers theorized that this was due to a flaw
in the study design in which all the volunteers were trained by the same person, and
this likely resulted in cross-contamination of MI methods in both the MI+ education
and the education-only volunteers. In the second and third field trials, the MI
educator trained only those volunteers using MI, whereas the education-only
volunteers were trained separately by a different person (although both groups
received the same water disinfection education). The second and third field trials
show significant differences between the control and MI groups, demonstrating the
effectiveness of the MI + education approach in comparison to the education only
approach.
Slide Annotation: Show “Zambia MI Study: Field Trial #2” at this time. The table this
text refers to is on the next page of this facilitator’s guide.
The table on page 11 in your participants’ guide shows results from the second field
trail. In the second field trial, the researchers said that the MI group bought 61-77%
more bottles of the disinfectant per household than the Education only group
(p<0.001). (However, it appears from the graph that they bought about three times
as many.) 94% of the difference in sales was attributable to the group to which the
person was assigned. These differences in sales (and presumably use of the water
purification liquid) continued for the eight-months of the trial. The average number of
cases of diarrheal in children was reduced, as well (unpublished data).
20
Motivational Interviewing Training – Task #4
Field Trial #2: Bottles of Disinfectant Sold per Household, MI vs. Education
Only (1998-99)
Slide Annotation: Show Slides “Field Trial #3” (5 slides) at this time. The table this
text refers to is on the next page of this facilitator’s guide.
The next four slides show information which is contained on a table in your
Participants’ Guide, on page 12. You’ll see that the table is divided into three main
columns: one for the motivational interviewing group and the other two for two
control groups in the third field trial. For each group, a measurement was taken at
baseline and at follow-up for the indicators shown on the left.
21
Motivational Interviewing Training – Task #4
In the third field trial, use of the disinfectant for water purification increased from:
• 1% to 65% in the group that received MI,
• from only 2% to 4% in one comparison group, and
• from 34% to 16% (a drop) in the second comparison group.
The proportion of people who had ever used disinfectant increased from:
• 13% to 99% in the group that received MI,
• from 18% to 34% in one comparison (control) group, and
• from 9% to 18% in the second comparison (control) group.
Knowledge on diarrhea also increased more in the MI group than in the comparison
group.7
Slide Annotation: Show “MI and HIV Prevention” at this time.
Studies have been done testing the effectiveness of motivational interviewing and
HIV prevention, although with the exception of the Mexican study, they have all been
in Western countries.
7
Notes and PowerPoint slides from study of Motivational Interviewing to improve water disinfection practice in
Zambia by Tom Davis, Food for the Hungry.
22
Motivational Interviewing Training – Task #4
The next intervention we will review aimed to reduce the risk of HIV infection among
poor, single urban women who were at high risk for HIV in the United States. Risk
factors included ever having a sexually-transmitted disease, participating in
transactional sex, having multiple partners, and drug use.
Slide Annotation: Show second “MI and HIV Prevention” at this time.
Two trials of a method using motivational interviewing were conducted, and both
showed increases in risk-reducing behavior at the end of the intervention and at a
three-month follow-up.
Slide Annotation: Show “Studies Cited” at this time.
Here are the citations for the studies I’ve just presented, in case you would like more
information. These citations may also be found in the References section at the
back of your participants’ guide.
Slide Annotation: Show “Important Limitations” at this time.
There are important limitations to these studies for our purposes in HIV prevention
programs. First and most obvious, there are very few studies conducted in a
developing country context. To date, other than the study on water disinfection in
Zambia, we have found no additional published or unpublished work on motivational
interviewing used in Africa or elsewhere in a developing country. In addition, no
published or unpublished studies exist where abstinence and faithfulness messages
were promoted in addition to condom use. Most HIV risk reduction studies which
used motivational interviewing were focused on high-risk groups, such as
commercial sex workers, men having sex with men, and injecting drug users.
Slide Annotation: Show “Why We Think MI Will be Effective” at this time.
However, there are several reasons we would might expect MI to be effective in
increasing adoption of these healthy sexual behaviors. (1) People often have high
levels of ambivalence concerning sexual behaviors like abstinence, faithfulness, and
condom use, and MI generally works well in that context. (2) people often expect to
be highly involved in decision making about their own sexual behavior, and MI
values and respects that choice. Where some more coercive behavior change
methods (e.g., fines or buzzers to increase seat belt use) can work well in reducing
behavior where personal choice is not as highly valued (and the behaviors as easily
observed), for sexual behavior, it is important to use a method that is highly
respectful of people’s free choice and that honors that choice.
Food for the Hungry will be breaking new ground using Motivational Interviewing in
promoting abstinence and being faithful in Africa as an HIV prevention strategy.
Slide Annotation: Show “Other Situations” at this time.
In addition to diarrhea prevention and HIV risk reduction, these are just a few of the
situations where MI has been used to help people change their behavior. It is most
23
Motivational Interviewing Training – Task #4
famous in the United States and Great Britain for use with people who abuse alcohol
and drugs, however, as you see, it has many other applications.
Slide Annotation: Show “Task #4” (containing 4b – 4e) at this time.
Ask:
4b. What surprises you about the effectiveness of MI in these studies?
4c. What is different about the context of your program from how MI was used in
these studies?
4d. What about this example makes you confident that MI could be effective in your
programs?
Slide Annotation: Show “4e” at this time. If you are using Elluminate, ensure the
polling buttons reflect choices A – E.
4e. How convinced are you of MI’s effectiveness at this point?
Ask several participants to comment on how convinced they are of the effectiveness
of MI, and if they are not convinced, what their reservations are. The answers to this
question will tell you whether or not your learners require further information to be
convinced MI will work for their program.
24
Motivational Interviewing Training – Task #5
Task #5: Principles of MI
5a. Read the following definition of Motivational Interviewing. Underline what strikes
you in this definition. What do you have questions about?
Time: 15 minutes
5b. Listen to the following guiding values and principles of Motivational Interviewing.
Time: 15 minutes
5c. Divide into three groups and reflect on the relationships between these
values/principles and:

Group 1: Community development work

Group 2: Your culture

Group 3: Religious teaching
What examples of other development interventions, cultural beliefs or proverbs, and
religious beliefs and passages from the religious texts are supportive of the guiding
values and principles of motivational interviewing?
Time: 20 minutes
5d. We will hear all responses.
Time: 10 minutes
Facilitator Guidance:
Materials needed: Religious scripture (e.g., Bible, Qu’ran).
Anticipated Time: 1 hour
Training Preparation: Arrange to have breakout rooms where participants can do
small group discussions. They should make notes on newsprint and bring that back
to the main training room to report out to the entire group.
Purpose: Present the key guiding values and principles of MI and to help participants
to relate them to their work, their culture, and their religious beliefs.
Slide Annotation: Show “Task #5”.
5a. Motivational Interviewing is a people-centered, directive method for increasing a
person’s inner (intrinsic) motivation to change by exploring and helping them to
resolve their mixed feelings (ambivalence) about a new behavior.
25
Motivational Interviewing Training – Task #5
Motivational Interviewing was developed by Dr. William Miller of the University of
New Mexico and Dr. Stephen Rollnick of the University of Wales, both of whom are
academics with extensive experience in counseling, particularly in health settings,
and with addictive behaviors (e.g., use of alcohol or drugs).
Ask: What strikes you when you read this definition? Underline that part. What do
you have questions about?
Answer any questions about the definition, and note down anything they find
surprising or striking on newsprint. Ask different people to offer comments on what
they found striking about the definition. If appropriate, point out where various
questions will be answered in the training (for example, “We will discuss being
directive in motivational interviewing in Part B.”)
Slide Annotation: Show Slide “Task #5 continued…” to introduce the task, then move
on to “The Guiding Values of MI”.
5b. The guiding values upon which motivational interviewing is based are:
•
Collaborating together: Honors the person’s experience and perspective. MI
does not attempt to force someone to change.
•
Bringing Forth Strength for Change (“Evocation”8 in Miller & Rollnick):
Presumes that the person already has the resources and motivation to
change, and works to enhance them. We help people to “drink from their own
wells.”
•
Free Choice (“Autonomy” in Miller & Rollnick): Respects the person’s right
to decide what is best for themselves, and helps them make an informed
decision.
Slide Annotation: Show “Express Understanding” through “Support Self-Efficacy” as
you discuss the four principles of MI.
There are four main principles which guide motivational interviewing practice:
1. Express Understanding (Express Empathy in Miller & Rollnick): You attempt
to understand the situation from the person’s point of view, realizing and
expressing that it is normal to feel ambivalent about many things. This does not
mean you must agree that they are right, or endorse their behavior. In Part B, we
will talk about and practice reflective listening, an important skill throughout the
MI process that will also help you to express understanding.
Ask: What is reflective listening?
See if anyone knows what reflective listening is: people who have extensive
experience in counseling may have practiced or used reflective listening in the past,
and could be a good resource for other trainees. Reflective listening is a way of
8
The terms “Evocation,” “Autonomy,” “Express Empathy,” etc. have been changed to make them more easily
understandable to non-English speaking trainees.
26
Motivational Interviewing Training – Task #5
responding to people by using statements that closely mirror what the person has
just said, and sometimes add to it in order to encourage continued conversation.
Ask: In your experience, what happens when you attempt to force someone to
change their behavior?
Wait for one or two participants to offer their experiences. At least one of them
should mention encountering resistance to change, particularly if it is forced. If no
one mentions this, you might ask if anyone has experienced it.
Add: People who are ambivalent about changing their behavior may respond by
actually increasing the problem behavior in response to attempts to force them to
change. This phenomenon is called “psychological reactance.” It simply means that
the person feels their personal freedom or control is being challenged, they will find
the problem behavior more attractive and begin to do it more often. This happens
even when the consequences of the behavior become more negative. Trying to
force someone to change, threaten or punish them can actually strengthen their
resolve not to change.
We want to fix things – this is particularly true of those of us who work in
development, but it is a common desire in any normal person who cares about
others. We see problems, like HIV, and we want to prevent them. But if information,
force, and threats don’t work, how then, do we get people to change their behavior?
2. Develop Difference (“Develop Discrepancy” in Miller & Rollnick): People are
motivated to change when there is a difference between their personal values
and important goals and their present behavior. Your job is to help them discover
what is truly important to them and how they can change so their behavior
reflects their values. During MI, you will not argue for change, they will express
their own arguments for change.
3. Roll with Resistance: In MI, resistance is like a red traffic signal. It tells you to
stop what you are doing and change tactics: you may be pushing the person too
far, or moving too quickly for them. We will discuss resistance and how to roll
with it more in Part B: rolling with resistance also involves reflective listening.
During MI, you don’t argue for change. Instead, you invite them to see things
from a different perspective.
4. Support Self-Efficacy: A person must believe they can change before they will
be able to change. Here we find a correlation with the concept of self-efficacy in
barrier analysis. If you believe the person can change, it will influence their
confidence. If you believe that they can not, they are less likely to change.
Slide Annotation: Show “Task #5 continued” (containing 5c – 5d).
5c. Divide participants into three groups to look at MI from three separate
perspectives: one to look at MI from the point of view of development interventions,
one from the point of view of African culture, and one from the point of view of the
participants’ religions’ teaching. If the groups need help or ideas, you can refer them
to the bulleted examples below to get them started.
27
Motivational Interviewing Training – Task #5
Group 1 should discuss times in their work when they have used other community
development interventions or tools which are based on the same values as MI or that
use similar principles to motivational interviewing.
Examples:
 Hearth Model
 Trials of Improved Practices (TIPS)
 Appreciative Inquiry
Group 2 should discuss African cultural beliefs or proverbs from their own
experience which reflect guiding values and/or principles similar to those of
motivational interviewing.
Examples9:
 A little subtleness is better than a lot of force (D.R. Congo)
 Anticipate the good so that you may enjoy it. (Ethiopia)
 He who learns, teaches (Kenya)
 Talking with one another is loving one another. (D.R. Congo)
 The fool speaks, the wise man listens (Galla, Ethiopia)
Group 3 should discuss scriptural passages (e.g., from the Bible or Qu’ran) or other
religious beliefs which are in line with the guiding values and/or principles of
motivational interviewing.10
Examples from the Bible that people may give:
 Exodus – God gives the Hebrews many chances to return to him, despite the
fact that they turn away from him many times after leaving Egypt. He
respects the autonomy of His people.
 The Bible tells the story of God putting himself in our shoes through Jesus, in
part, so He could empathize with us.
 The story of the rich man with many flocks and the poor man with one lamb,
as told to David by Nathan (2 Samuel 12:1-14) – The rich man does not wish
to kill one of his own flock to feed a guest, so he kills the poor man’s single
lamb instead. Nathan tells this story to David to make him see the
discrepancy between his values and what he has done by taking the killing
Uriah the Hittite and taking Uriah’s wife for himself.
5d. Bring all participants back together. Ask each group to present a brief summary
of their discussion to the others. After each presentation, ask members of the other
groups to add additional interventions, proverbs or beliefs.
9
10
All African proverbs from: http://www.namesite.com/searchproverb.php3
This training was originally conducted with staff of a Christian faith-based organization. If you are working with
participants of other faiths, we encourage you to provide examples from their own religious texts.
28
Motivational Interviewing Training – Review of Part A and Part B Homework
Part A Review & Synthesis
Take a moment to briefly review the exercises you completed in Part A for the entire
group – the review below mentions each in terms of the Achievement-Based
objectives cited at the beginning of Part A. Ask each question and listen to
responses from the group as a way of checking that they remembered what you
discussed.
Slide Annotation: Show “Review of Part A”.

We related the Stages of Change to Barrier Analysis and discussed where MI fits
in.
o For what stages of change is MI helpful?

We compared MI to Health Promotion.
o What differences did you notice?

We reviewed the evidence that MI can be effective in our program.

We discussed the guiding values and principles of MI, and how they relate to
development work, to African culture, and to our faith.
o Do think MI is compatible with development work, with African culture, and
our faith?
Homework Assignment
Assign this homework before beginning Part B, preferably the night before you will
begin Part B so that participants have adequate time to think of their stories.
Training preparation: You might want to have several participants write up their
stories prior to the next session. You can then paste each story in a separate slide
for display during the training.
Slide Annotation: Show “Homework: Your Stories”. These instructions can also be
found on page 15 of the participants’ guide.
Think of two stories from your life where you were conflicted (ambivalent) about
something.
The story you choose to present should meet the following criteria:
 You were trying to change your own behavior (e.g., a habit you wanted to get
rid of, change, or adopt).
 There were good reasons to change, but also good reasons not to change.
 It is okay if you did not resolve the situation.
 The story can be from any point in your life. (It does not be to recent.)
 The story should not be so personal that you would be unwilling to share it
with the other participants.
29
Motivational Interviewing Training – Review of Part A and Part B Homework

You should be able to finish telling the story in five minutes or less.
We will tell each other our stories for one of tomorrow’s exercises. (The stories will
be used in the Part B reflective listening exercise, Task #9.)
30
Motivational Interviewing Training – Task #6
Task #6: Overview of the MI Process
6a. Order the steps in the MI Process using the cards provided.
Time: 10 minutes
6b. Looking at the MI diagram, what components will enhance importance?
6c. What key determinants in Barrier Analysis affect importance the most?
6d. Thinking about the values of MI and OARS, how could you enhance confidence
by using MI?
6e. How would low confidence affect importance of making a change?
6f. How did Afiya, the health promoter in yesterday’s scenario, assess Imani’s
importance and confidence?
Time: 20 minutes
Facilitator Guidance:
Materials Needed: Colored squares of paper or cardstock, on which the various
steps in the MI process are written. (Use one set for each group if doing this in small
groups.)
Anticipated Time: 30 minutes
Training Preparation: Put the objects up on a board using tape in random order.
First, ask one participant to describe which step they think should come first. (Place
that step in the appropriate order for them, or have them place it themselves.) Then
ask a second participant to place the second step, and reorder the first step if they
think a different step should come first. Have a third participant place the third step,
reordering the first two if needed, and so on until all steps have been placed.
Purpose: to present the process of motivational interviewing in a visual way.
Slide Annotation: You may wish to show “Part B” first, and review the objectives for
Part B before beginning this activity. When you are finished reviewing objectives,
move on to “Task #6” to introduce Task 6. Use “Task #6” (with disordered graphic)
when you are ready for participants to begin the task itself.
6a. [Show the blank MI diagram on slide or draw on a sheet of newsprint, and
introduce the steps on cardstock or on the slide, to the left of the blank diagram.]
This diagram is out of order. All the steps in the process are listed. There are some
linear steps, and then there are also some which occur throughout the process,
indicated by the boxes next to the arrows with two ends. Put the diagram in the
31
Motivational Interviewing Training – Task #6
order that you think it should go. Note that the OARS step is already in the correct
place.
Give participants 5 minutes to accomplish this task. Then show the correct order (as
seen below).
Slide Annotation: Show “The MI Process: An Overview”.
Establish Rapport
Reduce Resistance
Exchange Information
Set the Agenda
Assess Importance and Confidence
Explore Importance/ Values and Build
Confidence
Open Questions
Affirmation
Reflective Listening
Summarizing
Encourage Change Talk
Enhance Motivation to Change – Move on to
Part 2, Creating a Change Plan
Explain:
Here is the correct order. The OARS – Open Questions, Affirmation, Reflection, and
Summarizing support this process and help you to ‘row your boat’ to the desired
shore: enhancing a person’s own intrinsic motivation to change. Take a moment
now to fill in the blank diagram in your participants’ guide. By filling it in yourself, you
will be able to remember it better.
Ask: What does it mean to establish rapport? (Allow a participant to give you their
definition of establishing rapport.)
MI begins with establishing rapport: this means that you spend some time getting to
know the person and trying to understand their perspective. You might do this by
asking them to describe a ‘typical day’ in their life, perhaps as it relates to the
behavior you want to discuss. If you already know them well or have an established
relationship, this step may feel irrelevant, and you may begin the conversation in
whatever way you choose. You do not need to have a lengthy opening conversation
32
Motivational Interviewing Training – Task #6
about an unrelated topic with them. In this first step, you will demonstrate listening
skills to show the person you are truly interested in what they have to say: this
means that you do not assume you know what they will want to talk about.
Ask: How do you think a person’s expectations about you will influence the rapport
you will have?
Note their responses on newsprint.
Add: particularly if the person has had many conversations about the same behavior
in the past, they will expect you to repeat the same things they have already heard,
and may expect you to lecture them or argue with them, as others have done. It is
important to remain non-judgmental, listen, and ask for their input. This is what is
meant by establishing rapport. You need to show the person that this time will be
different, that you will work with them in a very different, respectful, and collaborative
way.
The second step in the process is setting the agenda. In some cases, you may be
able to get through this step very quickly, such as when the desired topic of
conversation is known to both of you prior to your meeting, or when the subject is
obvious. In other cases, however, there may be multiple topics you could address,
and it is important that they, not you decide what you will focus on. You can, if you
wish, present a menu of options to them.
Ask: How did Afiya, the promoter in yesterday’s scenario, allow Imani to set the
agenda when she used motivational interviewing?
Afiya asked Imani what she wanted to talk about, but still noted that her purpose for
being there was to talk about HIV. She made her own agenda clear to Imani, but did
not force her to talk about it right away, respecting Imani’s obvious concern about
her husband’s illness. The subject of HIV testing, which was already introduced, then
came up later in the conversation.
Another example of agenda setting, talking with a person who is about to be married:
“There are many things we could talk about today. We could talk about what
it means to be faithful to your spouse, we could talk about some challenges to
fidelity that you may face as a married person and how you might deal with
those, but perhaps there is something else more important to you that you
would like to talk about?”
Once the agenda is set, there are two key things you need to know to find out how
ready someone is to change their behavior:
1. How important does the person feel the change is to them?
2. How much confidence does the person have concerning their ability to
change?
Slide Annotation: Show “Task #6 continued…”
[Note responses to the following questions on newsprint.]
33
Motivational Interviewing Training – Task #6
6b. Ask: Looking at the MI diagram, what MI techniques would you use to increase
someone’s feeling that it is important to change their behavior?
Add, if they do not come up with these:
Agenda setting, information exchange, and change talk can help you to enhance
importance. Agenda setting will ensure you are talking about something the person
is really interested in: remember that they will not always share your views on the
importance of subjects like HIV! Information exchange can help to increase the
importance of something, by providing them with additional benefits of change.
6c. Ask: What key determinants in Barrier Analysis affect importance the most?11
You’ll see a list of the Barrier Analysis determinants on the next page of your
participants’ guide, to help you recall them.
Add, if they do not come up with these:
Perceived severity, susceptibility, social acceptability, divine will and positive
attributes of the action are all determinants which might affect importance.
Examples:
 “If you believe that AIDS is a death sentence.”
 “If you believe that abstinence before marriage is really important to God.”
6d. Ask: Thinking about the guiding values and principles of MI, and OARS, which of
the MI techniques would you use to enhance the person’s confidence in their ability
to change?
Add, if they do not come up with these:
Affirmation, one of your OARS, will help you to enhance confidence. Affirmation
means that you are supportive of the person. Even small successes are celebrated.
Ask: What are some examples of affirming statements?
Examples:
 I see that your family is really important to you.
 You seem to be a very strong person: you have had to handle many
difficulties in your life, and yet you have managed it.
 I think that’s a very good idea.
You can also use change talk questions about previous successes in behavior
change, even if they are not related to the behavior in question.
Example: “Tell me about a time when you accomplished a difficult change in your
life. What change did you make and how did you do it? How did it make you feel?”
Helping people to remember that they do have the power to change within
themselves gives them hope for the future.
11
If your participants have not had training in Barrier Analysis, skip this question. More information on Barrier
Analysis can be found at http://barrieranalysis.fhi.net.
34
Motivational Interviewing Training – Task #6
6e. Ask: How would low confidence affect importance of making a change?
[Add, if they do not come up with these:]
A person who thinks that change is impossible will give the change a lower
importance to avoid the feeling of helplessness that comes with being unable to
change a bad situation. They will minimize the severity of the problem they are
facing.
6f. Ask: How did Afiya, the promoter in yesterday’s scenario, assess Imani’s
importance and confidence?
[Add, if they do not come up with these:]
Afiya used an importance and confidence scale exercise to figure out how important
it was to Imani to talk with her husband about HIV testing and faithfulness. These
scales are often used in Motivational Interviewing, and can be very useful to help you
understand where a person stands in terms of their importance and their confidence.
You do not need to use numbers necessarily. Always frame your responses in a the
positive sense: moving toward the desired change. This will cause the person to
give you reasons why change is important to them, or reasons why have some
confidence that they could change. Sometimes, it will be the first time the person
has ever said these things aloud, and that can have a large impact on their thinking.
Slide Annotation: Show “Importance and Confidence Scales”.
Example: “Why is it ‘slightly important’? What gives it that little bit of importance?”
(Asks why a person feels change is more important.)
Ask participants for more examples of asking positive questions related to
importance and confidence scales and note responses on newsprint.
Examples:
 What would it take for you to become a five on this scale?
 What would need to happen for this change to become more important?
 I know you said you were at a one, but that is higher than a zero. What gives
you that little bit of confidence?
 Imagine that you are now totally confident that you could do this. What has
happened to give you that confidence?
Once you have assessed importance and confidence, you will know where to go
next in the discussion, either enhancing confidence or increasing importance of
change, or both.
Whatever your goal, you are ultimately aiming to encourage change talk. “Change
talk” is, literally, talking about change – later on in Part B, we’ll discuss four
categories of change talk, and many different ways to encourage someone to talk
about change. Why is it so important that the person you are talking with talks about
change? Simply put, the more they think about it, talk about it, and imagine it, the
more likely they are to do it.
A Note About Information Exchange
35
Motivational Interviewing Training – Task #6
Using motivational interviewing does not mean that you will never provide any
information and advice. A person who is ambivalent may be ambivalent because
they do not have all the information they need to make a good decision. So how do
you exchange information while still adhering to the values of MI? Always ask
yourself the following two questions before providing information or advice:



Has the person voiced a need for information or ideas?
Have I asked the person what they think about this subject?
Is the information I am going to give important to the person’s safety, or likely
to enhance their motivation to change?
Ask permission before you give advice or information. Proceed only if the person
gives their permission (they generally will). By providing information in this manner,
you continue to communicate your respect for them, and your concern, and you are
less likely to encounter resistance.
You’ve probably noticed that the last part of the process refers to a “Part Two” which
is all about creating a plan for change. We will not discuss this part today, I want to
show you the process briefly, so you know what’s ahead.
Slide Annotation: Show “Preview of Part 2”
In the next exercise, we will begin to talk about the OARS and how these support the
MI process.
36
Motivational Interviewing Training – Task #7
Task #7: Open vs. Closed Questions
[Skipped in Global TOT Workshop, but use at country-level workshops.]
7a. Which is an open question?
What do you think about abstaining from sex before marriage?
OR
Have you and your girlfriend discussed having sex?
7b. With a partner, divide the list into open and closed questions.
Time: 5 minutes
7c. We’ll hear a sample of your responses.
Time: 10 minutes
Materials needed: none.
Anticipated Time: 15 minutes
Using PowerPoint during this task: Have participants look at the first slide in this
exercise, Slide 37 for exercise 7a, before moving on to Slide 38. The objects on
slide 39 are all separate so that they can be individually moved into two columns:
open or closed.
Purpose: to help participants distinguish between open and closed questions.
Slide Annotation: Show “Task #7: OARS – Open Questions”.
7a. Ask: which is an open question?
What do you think about abstaining from sex before marriage?
OR
Have you and your girlfriend discussed having sex?
Wait for responses, and ask participants why they chose their answer. Ask if anyone
knows the definition of an open question. The correct response is “What do you
think about abstaining from sex before marriage?
An open question is a question which does not have a simple yes/no answer. A
closed question, then, by definition, is a question with a yes/no answer, or a very
short answer. Open questions invite a long response, which is exactly what you
want in motivational interviewing. In MI, the person you are talking with should do
much more talking than you. Open questions, the first of your OARS, will ensure that
they do talk more than you, and that they will provide you with far more information
than if you asked closed questions.
37
Motivational Interviewing Training – Task #7
Slide Annotation: Show “Categorize These Questions…”
7b. Ask participants to work in pairs, dividing the following list into open and closed
questions.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Have you ever been tested for HIV?
How would being abstinent before marriage be good for you?
What are your views on faithfulness in marriage?
Do you want to stay in this relationship?
What consequences of HIV concern you most?
What would make it easier for you to be faithful?
Who decides whether or not you will use a condom, you or your partner?
Have you ever thought about being abstinent?
What do you like about being abstinent?
Don’t you think you should get tested for HIV?
Do you believe you can get HIV, even if you are married?
What are the reasons that you would want to continue having sex with your
boyfriend?
Does your girlfriend ever ask you if you have other partners?
Is this an open or a closed question?
6c. Ask participants how they classified the questions above. When all questions
have been classified by the group, show the answers if any were incorrectly
classified, and explain why they are open or closed questions.
Slide Annotation: Show “Correct Answers”.
Correct answers:
Open Question
How would being abstinent before
marriage be good for you?
Closed Question
Have you ever been tested for HIV?
Do you want to stay in this relationship?
What are your views on faithfulness in
marriage?
What consequences of HIV concern you
most?
What would make it easier for you to be
faithful?
Who decides whether or not you will use
a condom, you or your partner?
Have you ever thought about being
abstinent?
Don’t you think you should get tested for
HIV?
What do you like about being abstinent?
What are the reasons that you would
want to continue having sex with your
boyfriend?
Do you believe you can get HIV, even if
you are married?
Does your girlfriend ever ask you if you
have other partners?
38
Motivational Interviewing Training – Task #7
Open Question
Closed Question
Is this an open or a closed question?
It is not always wrong to use closed questions in motivational interviewing – at times,
it may be unavoidable. However, the more open questions you ask, the more
answers you will hear.
Optional: View the MI Training DVD #1, Title III, Chapter 8, Examples of Open
Questions.
39
Motivational Interviewing Training – Task #8
Task #8: Recognizing OARS
8a. Listen to the following dialogue, which shows the use of open questions,
affirming, reflective listening, and summarizing in developing discrepancy.
8b. Circle or mark the following in your (paper copy) of the dialogue:
 Two examples of reflective listening
 An open question
 One example of resistance
 One example of affirmation
 One example of summarizing
8c. We will hear all responses.
Time: 1 hour
Facilitator Guidance:
Materials needed: copies of dialogue scripts for participants to read and follow along.
Anticipated Time: 1 hour
Purpose: to illustrate some key OARS techniques: reflective listening, summarizing,
and affirming and how they can help develop discrepancy.
Slide Annotation: Show “Task #8”.
Ask for a volunteer to read the part of James in the script below (which is in the
Participant’s Guide). Read the part of Afiya, the health promoter, yourself. Set the
scene by reading the following paragraph to the group before the script is read.
The following role-play will demonstrate important OARS: reflective listening,
summarizing, and affirming. Without having heard their specific motivational
interviewing definitions, see which OARS you can identify just by reading and
hearing them. After that, we will talk in more detail about what the person using MI
did, for example, what type of reflective listening was used.
Afiya, our health promoter, is talking with James, a married truck driver who has just
returned home from a recent delivery. James is fully aware that sleeping with other
women while he is away from home may infect him and his wife with HIV. Afiya is
continuing her health promotion messages about being faithful as HIV prevention.
Read the role play between Afiya and James. Give participants about 5 minutes to
mark their examples. You may wish to read the dialogue a second time.
Ask: What did you choose for reflective listening? For affirmation? For summarizing?
Which was the open question?
40
Motivational Interviewing Training – Task #8
Listen to their ideas and correct any incorrect identifications of reflection,
summarizing, open questions, and affirming.
Slide Annotation: Show “Affirmation.”
After reading the slide describing Affirmation, ask three different participants to
respond with an affirmation as you read these three statements aloud to them.
1. I told my friend I would be around to talk with her whenever she wanted. I
mean, she was really feeling badly about breaking up with her boyfriend, and I
knew that if she didn’t talk about it with someone, she would only be more
miserable.
2. Since I lost my job six months ago, it’s been a struggle just to feed everyone.
I go and look for work every day, but I rarely find anything. I feel so
discouraged.
3. This little girl was wandering around last week. Her sister had just dropped
her off and left, without making sure she went to the apartment she was
supposed to go to. She didn’t even know the last name of the other little girl
she had come to play with!
Optional: View the MI Training DVD #1, Title III, Chapter 15/16, Examples of
Affirming.
Slide Annotation: Show “Simple Reflections.”
In reflective listening, you are not asking questions. Open questions can help you get
the conversation started and keep it moving. With reflective listening, you are simply
repeating back what the other person has said very succinctly, staying as close to
their meaning and their words as you can. You can also reflect their emotions, even
if they don’t state them directly. If you’re not sure what they meant, they will often
correct you and provide clarification when you briefly repeat their words to them.
Reflections can also move the conversation along if you add something: take a
guess as to what else might be going on based on what they said thus far in the
conversation. If you’re not correct, they will let you know. If you are, they may go on
to describe something you otherwise wouldn’t have discussed.
After reading the slide describing Simple Reflections, ask three different participants
to respond to you with an simple reflection after you read these three statements
aloud to them.
1. After we said such terrible things to each other during the argument, I didn’t
know what to do. My mother left very upset, and the next time I saw her, she
wouldn’t speak to me. She acted like I wasn’t even there.
2. My friends and I meet every day now to play football in the afternoon. It has
filled up the time we used to spend getting into trouble, and we are all feeling
very fit – it was a great idea to start those afternoon football games.
41
Motivational Interviewing Training – Task #8
[Ex: You’re happy with that decision to play football instead of getting into
trouble.]
3. The other day at school a boy approached me and said something very rude.
I thought at first he was kidding and just had a weird sense of humor. But
then he wouldn’t leave me alone and I knew he was serious.
[Ex: So you realized that he was serious about what he said and that affected
you.]
Optional: View the MI Training DVD #1, Title V, Chapter 3, Examples of Simple
Reflections.
Slide Annotation: Show “Amplified Reflections.”
One of Afiya’s reflections strengthened what a James said beyond what he meant
(“So even if you got AIDS, it wouldn’t matter” - amplified reflection). This causes
him to disagree and say that it does in fact matter if he has AIDS or not, because his
family will suffer. Notice that Afiya has discovered a discrepancy between James’
behavior and his values: it does matter to James if he has AIDS or not because he
does not want the community to shun them if he becomes ill. James has also made
a motivating statement for change, expressing his concern that his family’s
reputation would be harmed if he became sick with AIDS.
After reading the slide describing Amplified Reflections, ask three different
participants to respond to you with an amplified reflection after you read these three
statements aloud to them.
1. I don’t think he would ever cheat on me. He has never given me any reason
to doubt him before, no matter what my friend says she saw.
[You are certain that he has always been faithful.]
2. It doesn’t matter if we have sex or not. Who’s going to find out? And no one
cares these days anyway if you’re a virgin when you’re married – it’s just not a
big deal like it used to be.
[So there’s really no reason whatsoever to wait until marriage to have sex.]
3. Some friends told me my little brother went to a party the other day, and got
really drunk. Who knows what he did – I’m sure he wasn’t himself. He’s
going to get himself into trouble if he carries on like that. It was a bad deal for
me when I was his age, too. But it’s his life. He’s got to find out for himself.
Optional: View the MI Training DVD #1, Title V, Chapter 4/5, Examples of Amplified
Reflections.
Slide Annotation: Show “Double-sided Reflections.”
In her final summary, Afiya presents both sides of the argument (double-sided
reflection), summarizing both the reasons he’s presented for change, and the
reasons against it. Summarizing and double-sided reflection are not always very
42
Motivational Interviewing Training – Task #8
different. You can present a summary without presenting two sides of an argument,
but you can not do that with a double-sided reflection: the two sides must be present.
After reading the slide describing Double-Sided Reflections, ask three different
participants to respond to you with a double-sided reflection after you read these
three statements aloud to them.
1. My mother says “Never see that boy again,” but I really like him. He seems
so caring, and he’s always doing nice things for me.
[So your mother doesn’t want you to see him and you like how he treats you.]
2. I saw this girl the other day who was so attractive – I would really like to get to
know her better. She noticed me, I’m sure of it. But I was too scared to even
ask her name. What if she turned out to have AIDS? You never know – you
can’t tell just by looking at a person.
[So you want to get to know her but think that she could have AIDS.]
3. It is so stupid the way she tries to control me! I am totally capable of making
my own decisions, but I get treated like a child. Just because my sister
doesn’t like some of the things I do, she thinks I might go out and get myself
hurt and she never lets me out of her sight.
[You feel like she is treating you like a child even though you can make your
own decisions.]
Optional: View the MI Training DVD #1, Title V, Chapter 7/8, Examples of Doublesided Reflections.
Slide Annotation: Show “Summarizing.”
After reading the slide describing Summarizing, ask three different participants to
respond to you with summary after you read these three statements aloud to them.
1. I think I’m going to have to drop out of school. My dad needs me at home,
there are just too many chores and too many other people to feed since mom
died. He figures maybe I can work a little too, to earn some extra money, but
I just don’t know how I am going to do it all. Besides, who would hire me? I’m
too young and I don’t have an education.
2. My mother seems so exhausted now. She used to be so energetic and full of
life, but these days it is a struggle for her just to get out of bed. I don’t know
how we are coping with it all. There are all these rumors flying around that
she has AIDS, and no one in the village wants to come and help us because
they are all afraid of getting it from her.
3. Who would want to be around a person who has AIDS? I never knew it, but
my brother must be one of those awful people who do bad things. That’s why
they get those kinds of diseases. Good people never seem to get them, you
know? AIDS is God’s punishment on the wicked – they are best left to suffer
their fate alone, and then maybe they will repent.
43
Motivational Interviewing Training – Task #8
Optional: View the MI Training DVD #1, Title III, Chapter 13/14, Examples of
Simple Reflections.
Slide Annotation: Show “Being Directive.”
Note how Afiya’s reflection is directive. There are many things in James’ responses
that she could’ve chosen to focus on: for example, she might have decided to ask
him how he thinks his family would hide his illness if he got AIDS. However, she
chooses to focus on the statement of change: the fact that he’s just said it would
matter if he got AIDS because of his family’s reputation.
44
Motivational Interviewing Training – Task #8
Task #8 Script: Interview with James12, a married truck driver
Afiya: [calmly] Let me make sure I understood what you meant, James. You told me
that you feel that not having sex with other women when you are on the road is
different from not drinking beer or stopping other behaviors which you know could
harm you. [summarizing, checking for understanding]
James: That’s right. I am a man, and men must have sex. It is like breathing – one
can not go without it for very long. [chuckles] Now I suppose you are going to tell me
I have to stop? But I tell you, we will all die someday, whether it’s from AIDS or
something else. Why shouldn’t I enjoy myself while I am alive? [resistance]
Afiya: [still calmly] So even if you got AIDS, it wouldn’t matter. [amplified
reflection] You will die someday anyway and you want to enjoy your life to the
fullest. [simple reflection]
James: Well, it’s not that it wouldn’t matter if I had AIDS. I suppose we would have
to keep it quiet. I would not want my family to suffer, and if people here thought I
had AIDS, they would shun them. [argument for change]
Afiya: So your family’s reputation is important to you. You wouldn’t want them to be
shunned by the community if you got AIDS and became ill. [simple reflection] You
obviously have their best interests at heart. [affirming]
James: Yes, and that happened to our neighbor, too – he was an old truck driver
too, and his wife always had a wandering eye when he was away. But when his wife
came down so ill, everyone whispered that it was AIDS. No one would help him care
for her, not even his children, and then he got sick.
Afiya: So on the one hand, you want to have sex while you’re out on the road – you
want to enjoy yourself when you’re away from your wife, and on the other hand, if
you got AIDS, your family would have to hide your illness somehow to make sure
they are still welcome in the community. If they could not hide your illness, there
would be terrible consequences: the community would shun them. [double-sided
reflection: summarizing]
James: Yes, I guess so.
Afiya: So where does all of this leave you?
12
The character of James is based on Louis Chikoka, a Botswanan truck driver interviewed by
Johanna McGeary for Time Magazine’s feature report “Death Stalks a Continent.” Feb. 12, 2001.
45
Motivational Interviewing Training – Task #9
Task #9: Using the OARS
9a. Divide into groups of three
 Storyteller: tell one of the stories you came up with for homework
 Reflective Listener: listen reflectively as they tell their story, using all the
OARS
 Coach: observe the conversation and take notes on the reflective listener:
make notes of both good technique and areas for improvement.
o You may use the Quality Checklist in your Participants’ Guide to help
you. Two copies are provided.
Storyteller: Pause after every 2-3 statements to give the other person a chance to
listen reflectively.
9b. After the story is complete, the storyteller and the listener provide feedback to
the reflective listener. (5 minutes)
9c. Switch positions and repeat until everyone has had an opportunity to listen
reflectively at least once.
Time: 1 hour
If you have extra time, tell your 2nd story!
Facilitator Guidance:
Materials needed: pens and paper for participants to write on, paper copies of the
OARS Quality Checklist found in Annex 2 of this facilitator guide, and on page 19 of
the participants’ guide.
Anticipated Time: 1 hour
The instruction to pause after every 2-3 sentences should be emphasized for
storytelling participants to make sure they allow for time for the person practicing
their reflective listening to reflect. Otherwise, it can be difficult for the person using
MI to come up with a response at the appropriate time.
Slide Annotation: Show “Task #9: Using the OARS.”
Purpose: to allow participants to practice the reflective listening skills they have
learned.
To start this exercise, it can be extremely helpful to participate in the exercise
by using the OARS yourself while listening to one participant’s story. Other
participants should listen and even use the checklists to mark off the various
OARS you demonstrate. If participants hear you do it first, it will be easier for
them to understand what you expect them to do in this exercise.
46
Motivational Interviewing Training – Task #9
In this exercise, participants should practice their reflective listening skills only. They
are not meant to attempt to help the storyteller resolve whatever conflicts are
presented in their story, they are merely to practice the OARS.
Remind your coaches to provide constructive feedback that the reflective listener can
actually do something about. Visit each group in turn and observe what is going on,
offer advice where needed, but attempt to allow participants to work things out on
their own.
Slide Annotation: Show “Task #9 continued…” when ready to end the exercise.
At the end of the exercise, gather all groups back together and ask:



How did you feel when you were ‘reflectively listened to’?
What were some good tips you got from your coach and storyteller?
What did you notice about reflective listening when you were observing it?
Write all helpful suggestions on newsprint.
47
Motivational Interviewing Training – Task #10
Task #10: Recognizing resistance to behavior change
10a. You will see examples of different responses to a single open question. Vote
on whether the responses are examples of resistance or not.


Yes, it is resistance.
No, it is not resistance.
10b. What skills have you already learned which might help you roll with resistance?
10c. What resistance to abstinence and faithfulness might you expect to hear from
participants in the BH and ABY projects?
Time: 15 minutes
Facilitator Guidance:
Materials needed: sheets on which the question and various examples of resistance
are written so that participants can see them, if you are not using the Facilitator’s
PowerPoint in Annex 1.
Anticipated Time: 15 minutes
Purpose: to provide participants with examples of resistance – some obvious and
others not necessarily obvious, and to give them practice in recognizing it. It will also
provide examples of how to deal with resistance.
Slide Annotation: Show “Change Talk and Resistance in MI” and briefly introduce
this section on change talk and resistance, then show “Task #10” when you are
ready to introduce Task 10.
This exercise provides responses to a single question. All responses are examples
of resistance.
Slide Annotation: Show “Task #10: Is it Resistance?” (4 slides) as you go through
each question.
Question: “So what do you think about abstinence before marriage?”
Response 1: “I don’t think it really matters if you’re abstinent or not. That’s a
very old-fashioned view.”
Response 2: “Well, sometimes it’s just not that easy.”
Response 3: “...Nothing, really.”
Question: “Let’s talk a little more about abstinence. So what do you think
about-”
48
Motivational Interviewing Training – Task #10
Response 4: [interrupts] “I’d rather talk about my boyfriend.”
Ask participants to vote (Thumbs up / Thumbs down) on which are examples of
resistance. Go slowly enough to give people time to think.
Slide Annotation: Show “Task #10: Is it Resistance?” (answer slide) after voting is
completed. Reveal that all were examples of resistance.
Resistance is not always outright challenge or argument. Sometimes, it can be very
subtle. The way to deal with resistance in MI is not to argue with the person, but
rather to roll with resistance by acknowledging it for what it is: a sign of ambivalence.
Rolling with resistance will have the effect of reducing resistance rather than
increasing it.
Slide Annotation: Show “Task #10 Continued…”.
10b. Ask: What skills have you already learned which might help you roll with
resistance?
They should mention reflective listening skills: simple reflection, amplified reflection,
double-sided reflection.
10c. Ask: What resistance to abstinence and faithfulness might you expect to hear
from participants in the BH and ABY projects?
Some possible examples:
 No one is abstinent until marriage these days. That’s old-fashioned.
 I can’t see myself stopping now that I’ve started: that would be too hard.
 You can’t expect everyone to be faithful.
Note examples on newsprint, you will use them in Task 11b.
Slide Annotation: Show Slides “Shifting Focus” through “Coming Alongside” as you
go through each example of Rolling with Resistance.
There are some other ways involving reflective listening skills which can help you to
roll with resistance. We’ll go through each of these in turn in response to a resistant
statement.
Resistant Statement:
“I suppose now you are going to tell me I can never have sex again until I am
married.”
The first way to handle resistance is Shifting Focus: if you find a barrier in the road, it
may be easier to go around it rather than trying to go over it. This is the idea behind
shifting focus.
Example: “We’ve only just begun to discuss this, and you are right - we should not
jump to any conclusions about what you’ll want to do.”
49
Motivational Interviewing Training – Task #10
Optional: View the MI Training DVD #1, Title V, Chapter 8-9, Examples of Shifting
Focus.
Another option is Reframing, you acknowledge the truth in the statement, but
interpret the situation differently, in a way that also acknowledges the possibility of
change.
Example: “It’s hard to imagine going without something like sex for what could be a
long time, you’re right. There are benefits to sex, definitely, and there are also
benefits to abstinence: you can protect yourself and your future spouse from HIV.
 Notice that rather than saying “but there are also benefits to abstinence” the
response is “and there are also benefits to abstinence.” By using “and” rather
than “but” you avoid sounding even slightly argumentative. This is akin to a
double-sided reflection.
Optional: View the MI Training DVD #1, Title V, Chapter 10-11, Examples of
Reframing.
Very similar to Reframing is the strategy of agreeing with a twist: reflect what’s been
said, and then reframe the discussion.
Example: “You’re wondering how difficult it would be for you to abstain from
something that’s really fun, even if it would protect you from AIDS.”
Optional: View the MI Training DVD #1, Title V, Chapter 12-13, Examples of
Agreeing with a Twist.
In keeping with the autonomous spirit of MI, you can also emphasize personal
control. This can be very effective with people who are upset or arguing fiercely.
Example: “This is your decision. Even if I wanted to, I could not make it for you.”
Optional: View the MI Training DVD #1, Title V, Chapter 14/15, Examples of
Emphasizing Personal Control.
Finally, you can do what’s called “coming alongside” the person: this means you take
on the anti-change point of view and may even argue for it.
Example: “AIDS really isn’t that serious. It’s worth the risk to continue having sex.”
 Use with caution: you can not trick someone into changing, and you should
not want to in keeping with the values of MI. You may set it up deliberately
and be very open about what you are doing.
 For example: “Sometimes it’s helpful to see all the reasons for and against
being abstinent – you undoubtedly have some very good reasons why you
might not decide to be abstinent, and you have already expressed some of
them. Let’s debate them: I’ll take the position that I don’t need to be
abstinent. Your job is to convince me that I should.”
Coming alongside can also lead to what’s called a “decisional balance sheet” in MI.
That is simply a list of the good things and bad things about a particular behavior,
written out, to allow the person to see all the arguments for and against change. You
write the arguments against change on one side, and the arguments for change on
50
Motivational Interviewing Training – Task #10
the other and compare the them. Use this activity only if you think it would be helpful
for the person to whom you are talking – it is not necessary in MI.
Optional: View the MI Training DVD #1, Title V, Chapter 16/17, Examples of
Coming Alongside (aka “Siding with the Negative”).
51
Motivational Interviewing Training – Task #11
Task #11: Practice Rolling with Resistance
11a. Using the examples of resistance that you developed in the last exercise, write
two responses using the methods of rolling with resistance that we just discussed.

Use a different method of rolling with resistance for each of your responses.
Time: 10 minutes
11b. We will hear all responses.
Time: 5 minutes
Facilitator Guidance:
Materials needed: paper and pens for participants. You may also wish to provide
handouts with the examples of different types of responses to resistance (e.g.,
Shifting Focus).
Anticipated Time: 15 minutes
Purpose: to provide an opportunity for participants to think about how they would use
the various ways of rolling with resistance in response to a realistic situation that they
came up with themselves.
Slide Annotation: Show “Task #11.”
Give participants about 10 minutes to write their responses, then come back together
in a large group to hear each response. Provide hints and additional examples if
needed.
Optional: View the MI Training DVD #1, Title V, Chapters 18-31, Case Examples of
Responding to Resistance with Dr. Theresa Moyers and Dr. Carolina Yahne.
52
Motivational Interviewing Training – Task #12
Task #12: Listening for Change Talk
12a. Listen to the following conversations. Count the number of times you hear
change talk.
Time: 5 minutes
12b. How might you use the importance/confidence ruler to encourage change talk?
12c. What other ways might you encourage change talk? Write down three
examples.
Time: 15 minutes
12d. We will hear all your examples.
Time: 10 minutes
Facilitator Guidance:
Materials needed: Use a tape player or DVD to play an audio clip of change talk.
For environments where it would not be possible to use a computer or tape player,
use typed out scripts and read them.
Anticipated Time: 30 minutes
Purpose: to give participants practice in recognizing examples of change talk, and
help them come up with ideas for encouraging change talk.
Slide Annotation: Show “Change Talk in MI”.
Now we’re going to talk about the opposite to resistance: change talk. Change talk
is a sign that you are moving in the right direction in the conversation, that change is
coming closer. It can also become a self-fulfilling prophecy, just as your belief in the
person’s ability to change can encourage change. If a person is able to express their
own reasons for change and hope that they can change, they will be more likely to
do it. Change talk may occur naturally as a part of the conversation, or you might do
certain things to elicit it. We’ll practice both recognizing and eliciting change talk.
Slide Annotation: Show “4 Kinds of Change Talk.”
There are four kinds of change talk (though you may hear others, these general
categories will help you to recognize change talk when you hear it):
53
Motivational Interviewing Training – Task #12
Disadvantages of the Behavior
 “When I am unfaithful, my wife suspects it, becomes angry, and then we
argue.”
Advantages of Change
 “My parents won’t worry about me as much if they know that I have committed
to abstinence.”
Optimism about Change
 “It would be wonderful to be married and know for sure that my wife and I will
not have HIV.”
Intention to Change
 “I think I might be able to try abstinence if my friends would try it too.”
Slide Annotation: Show “Task #12: Encouraging Change Talk.”
12a. Listen to the following short audio clips [or scripts] now. Count each time you
hear one of the kinds of change talk we’ve just discussed.
Play the audio clip or read scripts. Ask participants to count each time they hear one
of the four types of change talk, and write down the number of times they hear it.
You may wish to play them more than once, first by asking participants just to listen,
second asking them to count the examples of change talk.
Note that the script below is a paraphrase of the audio clips taken from the Change
Talk sections of the Motivational Interviewing Training DVDs.13
Script [Use if Needed]:
(Optional: Use MI Training DVD #1, Title III, Chapter 18 [advantages of change,
disadvantages of status quo], 20 [disadvantages / expressing concern about
situation], 22 [intention to change], 24 [optimism for change] has examples of
Change Talk).
Woman 1 – a prostitute [to Motivational Interviewer]: Well, I’ve been a prostitute
for a lot of years….and, it’s not very safe for me to do that anymore, so I feel like I
need to get some kind of a career. [change talk: disadvantages of status quo]
Man 1 – has an alcohol problem [to Motivational Interviewer]: We’re having a lot
of problems. She has threatened to leave me several times. [change talk:
disadvantages of the status quo]. She’s really happy that I got arrested, because
now I have to come here, and talk to you.
Motivational Interviewer: You mentioned that your relationship with her is really
important to you.
13
Miller, W. and Rollnick, S., and Moyers, T. Motivational Interviewing Professional Training DVD.
1998. The University of New Mexico: Albuquerque.
54
Motivational Interviewing Training – Task #12
Man 1: Yeah, well, I have a kid with her, and I want to be a good father to my kid, so
it is really important to me that she and I have a good relationship. [change talk:
advantages of change]
Motivational interviewer (to Woman 1): Your friend and your sister both believe in
your ability to accomplish this change. Why do you think they believe in you?
Woman 1: I don’t know…I don’t know. Maybe…they see something in me that I
don’t?
Motivational Interviewer: What do you think they see?
Woman 1: Maybe…well, that I am strong.
Motivational Interviewer: Now, by strong, do you mean, you can lift heavy
weights?
Woman 1: No…no…I mean that I’m…determined. Is that a good word for it?
[change talk: optimism or confidence about change]
12b. Ask: How might you use the importance/confidence ruler to encourage change
talk?
Add, if they do not come up with this themselves:
Remember that Afiya, our health promoter, used the importance scale with Imani to
elicit change statements about the advantages of talking to her husband about HIV
testing. Asking, in the positive, “Why is it more important to you to do this?” or “Why
are you more confident that you can accomplish this?” can elicit talk about the
person’s ability to change and the advantages of change. This can be done even if
the person is only a 1 on a scale of 5. Why are they a 1 and not a 0? What gives
them that little bit of hope or desire for change?
12c. Ask: What other ways might you encourage change talk? Write down three
examples. Give them about 15 minutes to complete this task.
12d. Ask all participants to read their examples aloud. Add in the following, and
show on the appropriate slide or newsprint.
Slide Annotation: Show Slides “Eliciting Change Talk” (6 slides) while going through
the rest of the strategies.
Here are some more ideas. Remember, these are just different strategies you can
use: you do not have to use all of them or any of them! You may come up with
others on your own that work just as well.
Ask open questions:
Examples:
 What worries you about having sex with your girlfriend now?
 If you did decide to be abstinent, what would be good about it?
 If you resolved to be faithful to your spouse, what about you makes you think
you could be successful?
 So what are you thinking about abstinence at this point?
55
Motivational Interviewing Training – Task #12
Optional: View the MI Training DVD #1, Title IV, Chapter 2, Examples of Evocative
Questions
Asking for more details (that elicit change talk):
Examples:
 In what ways do you think your friends would support your decision to be
abstinent?
 You mentioned there was a time when you were tempted to sleep with
someone else, but you didn’t. Tell me more about that time, and your reasons
for avoiding infidelity.
 What other difficult decisions have you made in your life? How did you make
them?
Optional: View the MI Training DVD #1, Title IV, Chapter 6, Examples of Asking for
Elaboration
Ask about extreme situations:
Examples:
 What is your biggest concern about AIDS in the long run?
 What consequences of having sex with many partners do you know of, even if
you don’t think they could happen to you?
 If you were completely successful at being abstinent until marriage, what
positive things would happen?
Optional: View the MI Training DVD #1, Title IV, Chapter 8, Examples of Imagining
Extremes
Explore the past and the future
Examples:
 Before you had these worries about HIV, what was your life like?
 If you continue on as you are now, what do you think will happen? Tell me
what life will be like for you in ten years.
 Think back to when you were first married. How did you feel about your
marriage and your spouse?
 How would you like things to be in your future? Tell me about the best
possible future you can imagine.
Optional: View the MI Training DVD #1, Title IV, Chapter 10 & 12, Examples of
Looking Forward and Looking Back
56
Motivational Interviewing Training – Task #12
Goals and Values
Examples:
 What is most important to you in your marriage?
 What do you think people should do about sex before marriage?
 What do you think God wants people to do about their sexuality within
marriage?
 What do you value in a spouse? What are the qualities that you would want
for yourself?
 What do you think is the right thing to do about faithfulness in marriage?
The OARS will always be helpful here, too:
 Ask open questions about change
 Affirm change talk
 Reflect change talk
 Summarize reasons for change.
57
Motivational Interviewing Training – Task #13
Task #13: Practice Motivational Interviewing!
13a. In pairs, practice your motivational interviewing skills.
One: Assume a character who is being motivationally interviewed: you will be given
information about your character, or you may make up your own.
Two: Practice the motivational interviewing skills we have been learning.
Take 25 minutes for your first conversation, then take about five minutes to discuss
how the first session went, and switch roles.
Facilitator Guidance:
Materials needed: copies of character sheets (see Annex 3) for participants (in
participant guide). Optional: MI Coaching cards.
Anticipated Time: 2 hours
Emphasize the importance of pausing to the participant playing the person being
motivationally interviewed. They should have practiced this skill already in Part B,
during the reflective listening exercise.
Purpose: to give participants practice in using motivational interviewing skills.
Conduct Round 1 in break-out rooms (to increase safety/confidentiality), debrief in
the large group, and hold Round 2 in a ‘fishbowl’: this means that two people
participate in the exercise while the others listen in. (This is where you will hold up
the MI Coaching Cards to help the person know what to do.) You may also take
extra time at the end of the training for more practice.
During the exercise, move around the room, observing the different pairs. Use the
Motivational Interviewing Quality Checklist (Annex 4) to evaluate each motivational
interviewer.
Slide Annotation: Show “A Little Motivation,” which contains a motivational statement
to help allay anyone’s fears about actually doing MI. When you are ready to
introduce the activity, show “Task #13.”
You may wish to hand out character sheets the night before this exercise and allow
people to read through them or develop their own characters as homework.
Slide Annotation: Show “Task #13 Guidance.”
Emphasize the following for all participants:
58
Motivational Interviewing Training – Task #13
If you are playing a character:
 Do not be SO resistant that your motivational interviewer has no chance to
even discuss change with you: remember that you are ambivalent about
changing. This means that you have some reasons you might want to change
in addition to reasons that you might not want to change.
 Do no be too easy on your interviewer either: feel free to act a little! Think
about what you want to get out of this practice: what skills would you like to
work on when it is your turn to motivationally interview them? Respond to
your interviewer in a way that will give them an opportunity to practice their
skills.
If you are a motivational interviewer:
 Do not expect to resolve this person’s problem and make a change plan in
your first, 30-minute session. This is a meeting just like one you might have in
real life, so it may take several conversations before you get to the point of
making a change plan. Expect this, listen to your partner, and respond
accordingly.
As the facilitator (and for others that may help you coach each group), either (1) sit
behind the person being counseled, and hold up MI coaching cards to give the
person hints as to what to do, or (2) sit behind the MI counselor and whisper to them
things that they should consider when they get “stuck.” With either method, try not to
intervene too often.
We’ll take as much time as we have left today, but no more than two hours, for this
exercise. If we run out of time, we’ll begin with more practice tomorrow.
59
Motivational Interviewing Training – Review of Part B
Part B Review and Synthesis
Take a moment to briefly review the exercises you completed in Part B for the entire
group – the review below mentions each in terms of the Achievement-Based
objectives cited at the beginning of Part B. Ask each question and listen to
responses from the group as a way of checking that they remembered what you
discussed, and that they are feeling comfortable with what they have learned.
Slide Annotation: Show “Review of Part B” (5 slides, through “Review: Principles of
MI”).

We examined an outline of the practice of Motivational Interviewing.
o What is the most difficult part of the process, in your opinion?

We distinguished between open and closed questions.
o What is an open question?
o Correct Answer:
 A question which requires a detailed response, greater than
yes/no.

We assessed how reflective listening skills can help develop discrepancy
between current behavior and personal values.
o What does the acronym OARS stand for?
o Correct Answer:
 Open Questions, Affirmation, Reflective Listening, Summarizing
We also looked the beginning part of a process for Motivational Interviewing. [Show
process slide.] Here it is again just for review.

We experienced, heard, and practiced reflective listening.
o Name one kind of reflection that we talked about.
o Correct Answers:
 Simple reflection
 Double-sided reflection
 Amplified reflection

We compared resistance and change talk as indicators of how the
conversation is going.
o What are the four kinds of change talk?
o Correct Answers:
 Disadvantages of the Current Behavior
 Advantages of Change
 Optimism about Change
 Intention to Change

We practiced using motivational interviewing skills in role-playing situations.
o How confident do you feel in your ability to motivationally interview
someone?
Let’s also take a moment to review the guiding values and principles of MI.
60
Motivational Interviewing Training – Review of Part B
•
Collaborating together: Honors the person’s experience and perspective. MI
does not attempt to force someone to change.
•
Bringing Forth Strength for Change: Presumes that the person already has
the resources and motivation to change, and works to enhance them. We help
people to “drink from their own wells.”
•
Free Choice (“Autonomy” in Miller & Rollnick): Respects the person’s right
to decide what is best for themselves, and helps them make an informed
decision.


Express Understanding: Ambivalence is normal
Develop Difference: Explore differences between personal values, goals and
current behavior
Roll with Resistance: Avoid arguing with the person
o Name a method of rolling with resistance
o Correct answers: shifting focus, reframing, agreeing with a twist,
coming alongside, OARS
Support Self-Efficacy: A person must believe they can change before
change is possible


What are your questions?
Optional: View the MI Training DVD #1, Title IV, Chapters 13-28, Case Example
Opening Session with Dr. Miller and Title V, Chapters 18-31 if those have not been
reviewed earlier (on Responding to Resistance). You can also view the MI Training
DVD #2, Title II, Chapters 4-23, Case Example: Giving Feedback.
61
Motivational Interviewing Training – Task #14
Task #14: Recognizing Readiness for Change
14a. Look at this list of behaviors. Identify those which may be an indication of
readiness for change.
Time: 5 minutes
14b. We will hear examples of your choices.
14c. Which ones surprise you?
Time: 10 minutes
Facilitator Guidance:
Materials needed: None.
Anticipated Time: 15 minutes
Purpose: to give participants practice in recognizing readiness for change. You may
begin by going over the Achievement-Based Objectives for Part C before starting
this task.
Slide Annotation: Show “Part C: Special Cases…” to review the Achievement-Based
Objectives for Part C. When you are ready to begin the task, move on to “Task #14.”
At a certain time in motivational interviewing, the person you are talking with will
become more ready to make a change. How do you recognize this shift in attitude?
Miller and Rollnick describe this as a ‘window,’ not just one moment. In this
exercise, we are going to look at behaviors you might see when a person is more
open to change.
14a. Look at the following list of behaviors, and circle in your participant’s guide
those which you think represent signs that a person is ready for change. I will give
you a about five minutes to do that.
Slide Annotation: Show “Task #14: Which Ones Indicate a Person is Ready to
Change?”.
Give participants five minutes to circle their responses. Those in bold in the list below
are signals of change – the bulleted examples are included as unusual or unlookedfor signals of change, and are intended to surprise participants and challenge their
assumptions.
Which Ones Indicate a Person is Ready to Change?
Asking about change
Trying out a change behavior
62
Motivational Interviewing Training – Task #14
Arguing against change
 Feeling a sense of loss and resignation
Increased talk about the problem
Feeling peaceful and calm
 Imagining a difficulties if a change were made
Blaming others for the problem
Discussing the advantages of change
Expressing hope for the future
Minimizing the problem
14b. Ask participants to explain some of their choices, particularly if they chose
either of the two bulleted examples. They should mention how most examples
(except the bulleted ones) reflect the types of change talk. Correct any
misperceptions. Arguing against change, increased talk about the problem behavior,
blaming others, and minimizing the problem are all indications that the person is not
ready to make a change and continued work enhancing importance and confidence
needs to be done.
If participants do not mention the two bulleted examples, save explanations of them
for 14c.
Slide Annotation: Show “Task #14: Which Ones Indicate a Person is Ready to
Change?” (with circled answers)..
14c. Reveal the slide with the circled correct answers, or circle the correct answers
yourself. Ask participants which ones surprise them.
If you have not already discussed the two bulleted examples, explain:
People who are ambivalent may feel a sense of loss, or seem resigned when they
are close to making a decision to change their behavior – that is only natural, as they
are giving up something they had positive as well as negative feelings about.
You might also hear some discussion of how things would be more difficult if a
change were made, but this is not necessarily the resistance that you might think it
is. It can also be an indication that the person is imagining what change would be
like.
Ask: How can you tell the difference? How would you know if discussion of the
difficulties associated with change is resistance or an indication of readiness to
change?
They should look for other indications that the person is ready for change, such as
other kinds of change talk. They should also have a sense of readiness to move on
to the next stage.
63
Motivational Interviewing Training – Task #15
Task #15: Creating a Plan for Change
15a. Order the steps in creating a plan for change.
Time: 15 minutes
15b. We will hear your ideas.
15c. Write two examples of key questions.
15d. We will hear your questions.
Time: 15 minutes
15e. Listen to the following role-play demonstrating all the steps in Part 2 of MI.
Time: 10 minutes
Facilitator Guidance:
Materials needed: Colored sheets of paper or cardstock on which the steps in
creating a change plan are written for participants to order. Participants should be
able to order these (vertically or horizontally, depending on your space) on a wall or
piece of newsprint.
Anticipated Time: 40 minutes
Purpose: To present the steps in Stage 2 of Motivational Interviewing.
Slide Annotation: Show “Task #15: Creating a Plan for Change” to introduce the
exercise. When you are ready to begin the exercise, show “Task #15: How would
you order these steps…”.
15a. Ask participants to arrange these steps in the order that makes the most sense
to them. A small group may do this activity together with the facilitator. Alternately,
the facilitator can give each group a copy of the steps on cards and have them work
to arrange them. Give them 10 minutes to complete the task before bringing them
back together.
15b. Ask participants for examples of how they ordered the steps, and ask for an
explanation of why certain steps were put in various places.
Slide Annotation: Show “Task #15: Creating a Plan for Change” (graphic) or draw the
diagram as ordered, below.
64
Motivational Interviewing Training – Task #15
Summarize arguments for
change/acknowledge reluctance
Ask a key question, like “What
do you think you will do now?”
Provide
information
and advice
Set Goals
Consider change options
Make a plan
Elicit Commitment to the Plan
Support Commitment to the Plan
Review and Revise Plan, If Needed
This is a suggestion of the order in which you might create a change plan. There
may be other ways to do this, however, this order has been used successfully in
Motivational Interviewing. Note that an additional box, on advice and information,
has been added. We will address this part of the process after talking about the
others. Take a moment now to fill out the blank diagram in your Participants’ Guide,
to help you remember the steps.
Give them a few minutes to fill in the diagram.
Slide Annotation: Show “Summarizing Arguments for Change.”
Summarizing reasons for change and acknowledging reluctance
Summarizing reasons for change, while acknowledging the person’s ambivalence, is
a good way to begin your transition from talking about change to planning for it. Your
summary should include:
1. The person’s own perceptions of the problem behavior, reflected in their
change talk (disadvantages of status quo)
2. Acknowledgement of what remains attractive about the behavior
3. Review of any objective evidence that is relevant to the importance of change
4. A restatement of any change talk about intention to change, and confidence in
his or her ability to change
5. Your own assessment of the person’s situation, especially when it is similar to
their own.
You are tying together all of the reasons for change that the person has stated, but
still acknowledging any remaining reluctance or ambivalence. Just because you
65
Motivational Interviewing Training – Task #15
have reached a phase where it is possible to think about changing, this does not
mean that all ambivalence is completely resolved, nor that ambivalence will not
reappear in the future.
Slide Annotation: Show “Task #15” (with 15c and 15d).
Ask a Key Question
The key question is the transition point where you begin to work with the person to
make a plan for change. It is always an open question.
15c. Write two examples of key questions.
You may wish to repeat the key question in the change plan example for
participants.
15d. Give participants five minutes to write their examples then ask each in turn to
read them aloud.
Slide Annotation: Show “Ask a Key Question.”
Here are some more ideas of key questions:14





Where does this leave you?
What is your next step? What are your options?
How do you want things to be for you in the future?
Of the things we have talked about, what concerns you most? What do you
want to do?
It sounds like things can not stay the way they are now. What do you think
you might do?
Using your OARS, you will continue to move toward a plan for change as the person
responds. Emphasize the person’s freedom to choose and their personal
responsibility for the change, if needed, reducing resistance and reinforcing change
talk.
Slide Annotation: Show “Set Goals for Change” through “Giving Advice…” while
discussing the rest of the change plan.
Set Goals
Think about the questions you used to encourage change talk, and your key
questions: these same questions will help you together to set goals that the person
can meet. Remember these goals are the choice of the person who must fulfill them:
if you attempt to set goals for them, or enforce your idea of what goals they should
set, you are likely to meet with resistance and they are less likely to change. You
may suggest additional goals, after asking for permission to do so. Asking
permission emphasizes personal choice and the person’s control over the goals they
will set for themselves, and is consistent with the values of motivational interviewing.
14
From Miller, W. and Rollnick, S. Motivational Interviewing.
66
Motivational Interviewing Training – Task #15
If the person has multiple goals in mind, you may need to prioritize them together.
They can set ‘milestones’ on the way to achieving their goals, particularly if they
must make big changes: milestones can be helpful if a person feels overwhelmed by
the magnitude of change they must make. Also consider that some people may not
set goals which are realistic for themselves. If you feel the person you are talking
with is in this situation, you can check by asking them to rate their confidence in their
ability to achieve the goal. You might also ask them to consider what the
consequences of a particular course of action might be.
Consider Change Options
How will this person achieve the goals they have set for themselves? Only they know
how they will accomplish their goals, and yet, sometimes they can feel overwhelmed
by the changes they want to make, or unsure as to what to tackle first.
Here is where a ‘menu’ can be very helpful. Help them, by using your OARS, to
develop multiple ways in which they might change, and create a menu of options.
You may discuss ways in which other people have made the change, but once
again, be careful not to impose your own views, or others’ views about how to
change on the person. Add these ways that other people have changed to the
menu, and let them select the option that works the best for them.
Make a plan for change
The person should voice the various steps in the plan as much as possible – much
like verbalizing the reasons for change can increase a person’s desire to change,
talking through a change plan makes it more likely to occur. Some people find it
helpful to write down their plan, however, use this option only if it seems appropriate
for the person you are working with.
You may also suggest a ‘trial run’ of the plan (just as people do in “Trials of Improved
Practices” – TIPS)15. The person can try out new behaviors for a short period of time,
to see how they feel, without making a full commitment. This can also lead to a
realistic assessment of how it would be to make the changes.
Summarize the plan in its entirety, once you have discussed it.
Elicit commitment to the plan
All your conversations have lead up to this moment. You have just summarized the
person’s plan for change, and now you come to the final key question:
“Is this what you want to do?”
You hope they will say “Yes.” Verbalizing, as we have already heard, is very
important to eliciting commitment. If they seem reluctant or unsure, you may have
more confidence building work to do, or it may be an indication that they have been
rushed into a decision somewhere along the way. Do not push them into saying yes.
You may ask them to think about it until your next meeting with them, emphasizing
personal choice again.
15
More information on TIPS can be found at
http://www.changeproject.org/tools/xchangetools/tx_tips.htm.
67
Motivational Interviewing Training – Task #15
Give information and advice
A new piece of the process has been added here: giving information and advice.
You may have been doing this all along, as a part of information exchange.
However, remember the two guidelines for giving information and advice, which fit
the values of motivational interviewing:


Have I asked the person what they think about the subject?
Is the information I am going to give important to the person’s safety, or likely
to enhance their motivation to change?
Ask permission before you give advice or information. Proceed only if the person
gives their permission.
Slide Annotation: Show “Task #15” (with 15e).
Read the role-play on the following pages, or ask two participants to read it through
with for you.
68
Motivational Interviewing Training – Review of Part B
Task #15 Script: Motivational Interviewing - Creating a Plan for Change In
Practice
The following script is an abbreviated version of creating a change plan, meant to
demonstrate how all the steps in Part 2 of Motivational Interviewing might fit
together. The length of this conversation is not necessarily realistic, but has been
abbreviated for the sake of time.
[This script is a conversation between James, a youth group leader, and
Joseph, a member of a youth group. James and Joseph have been meeting
individually over a period of several months to discuss a decision to be
abstinent before marriage. This conversation begins in the middle of one of
their meetings.]
James:
Let me just see if I can put everything we’ve talked about so far together.
You have been thinking about being abstinent before marriage for a month
or so now, ever since your girlfriend, whom you wish to marry, brought it
up. She told you how she felt pressured to have sex with you, even if she
didn’t want to, and felt that she couldn’t say no to you. She wasn’t angry
with you, but it upset you to hear this from her because you certainly never
wanted her to feel forced. She wanted you to know that she felt this way,
and because you expressed a desire to marry her she felt it was important
to tell you before you were married. You love her very much, and are very
attracted to her, so it is hard to think about returning to abstinence (that is,
being secondarily abstinent) now that you have already started having sex.
But you are worried that if you continue to have sex, she will get pregnant
and it will rush you into marriage before she can finish school, which you
both feel is important. Worse yet, if she becomes pregnant, her parents
will not approve of you, which will put you at a disadvantage in proposing
marriage. Even though you’re both sleeping only with each other, and you
both know that you do not have HIV because you have been tested, you
also want to set a good example for your younger siblings by practicing
abstinence, to help strengthen their resolve to be abstinent also and
protect themselves from HIV. [summarizing, checking for
understanding] Did I get all of it?
Joseph: Yeah, I felt terrible – I had no idea she felt that way. [change talk:
disadvantage of current situation.]
James:
What are you thinking about doing? [asking a key question]
Joseph: I really think we should be abstinent. If I can ask her parents’ permission
to marry her in the next month or two, then it will be settled and we won’t
have that long to wait anyway. But man, it will feel like forever! And I want
to talk to my little brother too: I want him to know what I am doing and why,
so that he remains safe.
James:
You have a lot on your mind: I can see it will not be easy, but you really
want to do the right thing by your future wife and by your brother, and that
is a sign that you are no longer a boy. You are taking on responsibility like
69
Motivational Interviewing Training – Review of Part B
a man. [affirming and adding a personal assessment of the situation]
You listed a lot of different things there. Where do you want to begin?
Joseph: I don’t know. I think it might be quite tough, you know? I can’t wait too
long to ask her parents, so maybe I should do that first. But then there’s
the whole matter of telling others about this decision to be abstinent. I
think she would support it, but maybe my friends would think I’m less of a
man for giving in to her. [ambivalence returns]
James:
You certainly want your future wife’s respect, but your friends’ opinions are
also important to you. [simple reflection] Can I suggest something?
[asking permission to provide advice]
Joseph: Okay.
James:
How about just trying abstinence for a short time? You don’t have to
commit to it until marriage today. Try it for a set period of time (like a
month) and see how it feels to both of you. If you are strong enough, you
can stick with it, and if you aren’t, you can talk to your girlfriend and
reconsider. [providing an option, helping with setting goals]
Joseph: Umm…okay, but what do I tell my friends? [subtle resistance to change]
James:
That’s your decision of course. What would happen if you just didn’t say
anything?
Joseph: Maybe nothing. It’s not something that we really talk about anymore – it’s
old news. But I think I would have to say something eventually. I mean,
she’s going to tell her friends if I decide to be abstinent, even for a little
while. That will be big news to them. And then it might get around, you
know.
James:
This is a tough situation for you, and only you know what the right decision
will be. [expressing understanding, and emphasizing personal control
again] Just imagine for a second, if word did get around to your friends, is
there anything positive that could result from that? [eliciting change talk:
imagining the future]
Joseph: I think some of them would think less of me, but a few others might
reconsider their own situations with their girlfriends. I think I could argue
that being abstinent is a good decision though, especially because they
are putting themselves at risk for HIV. [change talk: confidence in his
ability to convince his friends he’s made a good decision]
James:
So you think you might have some friends who would support you, or at
least might come around to your way of thinking, if you told them more
about it. [simple reflection] Try it out on me. What could you say to
them?
70
Motivational Interviewing Training – Review of Part B
Joseph: Maybe I would say something like “If I become abstinent, I know that I will
not get HIV, and my wife and children will not get HIV. My family will thrive
if I am strong. That alone is worth a little self-denial. And I am strong
enough to do this.” [more change talk]
James:
That was convincing to me. What are some other ways to tell them?
[developing a menu of options]
Joseph: I could say that “Only a fool treads loudly when his wife is sleeping.” They
know I want to marry her. But I think the best argument is talking about
HIV. If there’s one thing that stops them talking and makes them listen, it’s
the idea of getting HIV.
James:
Perhaps you will even help your friends to avoid HIV by talking about it
with them. [affirming] You feel like you can do it, and that some will be
convinced to reexamine their own situations, even if a few will think you
are not manly. [reflecting change talk] Do you want to start by telling
your friends, or should another step come first? [back to goal setting]
Joseph: No, first I have to tell my girlfriend. That is the right thing to do. Then, if it
comes up, I’ll tell my friends why I made the decision that I did.
James:
What comes next?
Joseph: I want to ask her parents’ permission to marry her. I think they want her to
marry soon after she finishes school, so I should ask soon, probably by the
end of next month. [Sets a goal for himself!]
James:
You also said that talking to your little brother about your decision was
important to you. What do you want to say to him?
Joseph: Well, I don’t want to go talking to him about abstinence if I can’t do it
myself, you know? That will probably make him less likely to do it, if he
sees that I can’t.
James:
He really looks up to you. [simple reflection]
Joseph: Yeah, he does. Maybe I should just do what you suggested and try out
abstinence for a month. We can see how it goes. Then if I decide to
continue, I can tell my little brother all about it.
James:
(Looking at notes) So you’ve decided to be abstinent for a month, just to
try it out. You’ll tell your girlfriend first, and you will explain it to your friends
if they ask you. By the end of next month, you want to ask your girlfriend’s
parents for permission to marry her. By that point, you will have tried
abstinence for a month, and you will have considered whether or not you
want to continue with it afterward, after talking with your girlfriend about it.
If it works for you, you want to tell your little brother about it.
[summarizing the plan] [takes a deep breath] Is that what you want to
do? [elicits commitment to the plan]
71
Motivational Interviewing Training – Review of Part B
Joseph: Yes, that’s what I want to do.
James:
[concealing a big sigh of relief] Great! I think you have a lot of personal
qualities that will make you successful at secondary abstinence. Tell me
how it’s going the next time we meet.
72
Motivational Interviewing Training – Task #16
Task #16: Working with Special Groups
[Use this Task only with Trainers during Training of Trainers Workshops.]
16a. Look at the following list of special groups with whom you and your motivational
interviewing trainees are likely to work. These came from the survey you answered
prior to the training.
16b. In groups of three, list other groups you know your trainees will work with that
you do not see here.
Time: 15 minutes
16c. Based on your own experience, what other tips do you have for using
motivational interviewing with the special groups we have identified?
Materials needed: None.
Anticipated Time: 20 minutes
Purpose: To allow participants an opportunity to consider motivational interviewing
not only in the context of their own job, but also in the context in which their trainees
will be working.
Slide Annotation: Show “Task #16” to introduce the task, and move on to “Task #16:
Who Will You Work With?” when ready to begin the task.
16a. Show the list of groups whom participants and their trainees will work with from
the learning assessment done prior to the training, either on a slide or on newsprint.
16b. Ask participants to divide themselves into groups of three, and brainstorm
others with whom they or their trainees might work using MI. Give them about 5
minutes for this task, then ask them to present the results of their discussions. Add
additional groups to the list.
Not much research has been done with working with many of these types of people
to guide us as to their special needs and considerations in motivational interviewing.
Much of what we know about the effectiveness of motivational interviewing comes
from work done with adults in individual meetings. What can the few studies which
have been done with MI in youth, in groups, and with couples tell us?
Slide Annotation: Show “Tips for Working with Youth.”
Youth
Little research has been done with motivationally interviewing adolescents and
groups; even less research exists with MI and youth who have already initiated risky
behavior. Yet, this is one of the primary groups we will work with.
73
Motivational Interviewing Training – Task #16
Youth who have already begun a risky behavior or who are engaged in multiple risky
behaviors (such as transactional sex and drug use) may have had negative
experiences with adults which may cause them to be more resistant to considering
change, particularly when the person working with them is an adult or authority
figure. It is important to take the time needed to form an alliance with the person and
not rush to setting an agenda. Particularly if you are an authority figure, you must
demonstrate that you are different from other adults and authority figures they have
encountered in the past. As in all motivational interviewing, but particularly with
youth, it is important not to give advice without first asking permission.
Ask: How might you ask a young person’s permission to give advice?
Examples:
 “I have an idea that might be helpful. Do you want to hear it?”

“This may or may not affect how you are thinking, but there are a few things I
think it is important for you to know. Maybe you have already heard these
things, but I want to be sure. Would it be alright with you if I talked to you
about those things?”
Slide Annotation: Show “Tips for Working with Groups.”
Groups
Groups tend to amplify the responses of some of their members: people who are
normally quiet may fade into the background entirely. People who are normally loud
and the center of attention may become even more so.
There is also something called the “Risky Shift” which is based on research by Kurt
Lewin’s – people who normally value risk taking will take more risks if they are in a
group. People from cultures that value being conservative and not taking risks tend
to take less risk in groups. People may take extreme positions on an issue, or not
voice their opinion at all, just because they are among a group of peers.
Particularly because we are dealing with personal subjects like sex and marriage, it
is important that group members feel as safe as possible. You may wish to lay some
ground-rules before beginning any group discussion, to remind participants to
respect one another’s differences.
Some members of the group may also be ‘fixers’. They may make inappropriate
comments to others in the group, chiding or telling them how to change. It is
important to respond to these comments by reframing them, and to head off any
potential resistance by emphasizing the person’s personal control and choice.
If you are seen as an authority figure, groups may also attempt to ‘prove you wrong.’
Use such demands for answers as an opportunity for group reflection: ask the group
what they think should be done instead. Solutions emerge from the group, not the
facilitator. This both eases the tension of an authoritative relationship and respects
group members’ own experiences.
74
Motivational Interviewing Training – Task #16
Slide Annotation: Show “Group Construction: Some Tips.”
Other tips, based on researchers’ experiences with Group MI, are:
 10-20 people per homogenous group seems ideal
 With more people, there is a lot to do - consider two group leaders:
o Discuss how you will work together
o You might divide tasks: e.g., rolling with resistance and expressing
empathy
o May facilitate breaking up into smaller groups
 If possible, don’t overload the group with people who are not considering change
o Try an exercise to see who is thinking about change and who isn’t
o Use your own judgment when forming groups: would it be advantageous
to include some people who have successfully changed?
Slide Annotation: Show “Tips for Working with Couples.”
Couples
Ask: If you were to use MI with couples in the context of preventing HIV and
encouraging faithfulness, what do you think would be some things you should keep
in mind?
There is no research available in which motivational interviewing was used with
couples in the context of encouraging faithfulness. The published research which
has been done in HIV/AIDS prevention did not involve the partners of the people
studied in the MI sessions. However, motivational interviewing has been used with
couples for other behaviors, such as excessive drinking, smoking, and other health
concerns.
There are obviously many important considerations if you plan to motivationally
interview couples together about the issue of faithfulness in marriage, particularly if
one or both spouses have been unfaithful, and the other partner is unaware of the
infidelity. In other contexts, such as alcohol abuse, motivational interviewers found it
helpful to include a person’s spouse when the partner’s behavior would not hinder
change and where the partner was supportive of change.
It would be better to motivationally interview partners separately when discussion or
revelation of one partner’s unfaithfulness would cause a threat to that person’s
physical safety. The revelation of unfaithfulness in marriage could undoubtedly be
very painful emotionally as well: care for each individual’s emotional and physical
well-being should always be your highest concern. Even in situations where the
couple is merely being counseled in preparation for marriage, care should be taken
to ask the person for their permission to include their partner in any discussion.
In the case of argumentative couples, they can be taught to use motivational
interviewing skills (example: OARS) with each other to overcome difficulties in
communicating.
Slide Annotation: Show Slide 89.
75
Motivational Interviewing Training – Task #16
16c. Ask: Based on your own experience working with these groups or types of
people on other projects, what advice do you think might be helpful for using
motivational interviewing with them?
Note their responses.
76
Motivational Interviewing Training – Task #17
Task # 17: Who’s thinking about change?
17a. Imagine that you are a youth group leader using MI techniques to discuss
abstinence.
In groups of five, design an activity that would tell you how many people in a group
are considering abstinence before marriage, and how many are not. Your activity
should take no more than 5 minutes to complete.
Time: 15 minutes
17b. We will participate in your activities!
Time: 30 minutes
Materials needed: Paper and pens for participants to write their ideas on.
Anticipated Time: 45 minutes
Purpose: to place participants in the context of their activities, and to get them to
think creatively about using MI in groups, applying what they have learned in the
previous activity about having many pre-contemplators in the same group. If your
participants will be working with pastors who will instead counsel couples, you may
wish to alter this exercise to fit your trainees.
Slide Annotation: Show “Task 17.”
Allow participants 15 minutes of design time. Then all other participants should
participate in each group’s activity as though they were members of a youth group.
After each activity, ask the participants to provide feedback and suggestions for
improvement to each other on the exercises.
77
Motivational Interviewing Training – Task #18
Task #18: Review - Avoiding the traps!
18a. You will hear examples of what not to do in motivational interviewing!
Time: 10 minutes
Materials needed: None.
Anticipated Time: 10 minutes
Purpose: To introduce a few ‘traps’ in motivational interviewing.
Slide Annotation: Show “Task #18.”
I’m going to introduce a few ‘traps’ in motivational interviewing: things which can
happen naturally because of our human desire to fix things or to encourage change,
but that will have a negative effect on the conversation.
Slide Annotation: Show “Early Traps: Labeling.”
Early Traps: Labeling
Raina (Counselor): So you have been prostituting yourself.
Sophie: He just pays my school fees. It’s not the same.
Labels like “prostitute” and “promiscuous” may increase resistance, and decrease
desire to talk about the behavior in question. There is no reason to use them. If,
however, a person labels themselves, there is no reason to avoid the label. Labels,
however, are simply unimportant: it is the behaviors that matter.
Slide Annotation: Show “Early Traps: Blaming.”
Early Traps: Blaming
Emerson (Counselor): Even if your wife doesn’t seem interested, is it permissible to
sleep with others?
Jacob: So it’s all my fault. She has nothing to do with it.
Blaming serves no purpose in motivational interviewing, and often increases
resistance, no matter who is being blamed.
Slide Annotation: Show “Early Traps: Question / Answer Trap”
78
Motivational Interviewing Training – Task #18
Question / Answer Trap
Emerson (Counselor): Do you want to avoid getting AIDS?
Jacob: Yes.
Emerson: So you realize that you need to do something to avoid AIDS?
Jacob: Yes.
Emerson: So why not give abstinence a try?
Jacob: Well, that’s one option I’ve considered.
Emerson: So let me tell you about why this would be a good decision for you.
This trap is where you ask the questions as the counselor and the counselee just
responds to your question. You want the other person to be doing a lot of the
talking. You are not the expert in this. Behavior Change is not just about information
exchange. Even if you have information and education, that does not mean that you
can use that information to get the other person to change. The solution is behavior
change, and the person has to make their own choices there. They need to do a lot
of the talking and thinking through of information. This is a big shift to make for
many counselors who are used to giving people information.
We do give information in HIV/AIDS prevention programs (e.g., in AB Awareness
Campaigns, PSAs, use of curricula), but this method is for people who do not
change after receiving that information. It requires a different approach.
Slide Annotation: Show “More Traps: Gloom for Two.”
Confidence Traps: Gloom for Two
Sophie: What can I do? I have to sleep with him – my family has no money, certainly
none for school fees. This is the only way I can go to school. Besides, my parents
are happy with this arrangement: they think I am a connection with someone
influential.
Raina (Counselor): Wow, that’s awful. [really depressed]
At least one of you has to have hope! The issues we are discussing and the
situations people are in can be very sad, and may seem impossible to overcome.
Our faith traditions teach us, however, that there is always hope. Be empathetic and
use your faith to lend hope to the other person. This does not mean you must be
unrealistically cheerful or minimize the situation.
View the MI Training DVD #1, Title III, Chapters 1-6. Traps.
79
Motivational Interviewing Training – Task #19
Task # 19: Outlining a Community-level MI Training
[Use this Task only with Trainers during Training of Trainers Workshops.]
19a. Identify Groups and Develop an MI Training Outline for Use at the Community Level
Time: 1 hour
19b. Present your outline on a flip chart to the group!
Time: 1 hour
19c. As a group, we will compile a single training outline to use at the community level.
Time: 30 minutes
Materials needed: Pens or markers and flip charts for participants to write their ideas on.
Anticipated Time: 2 hours
Purpose: to give participants an opportunity to start designing the trainings they will conduct
at the community level..
Slide Annotation: Begin with the Slide,“Task #19: Develop an Outline of Your Training.”
Read through tasks.
Slide Annotation: Identify Groups & Develop an MI Training Outline
19a. Think about the types of individuals or groups your trainees will work with at the
community level, and the list of skills you just completed. With one or more partners, use
these two things to develop an outline of your own MI training for use at the community
level. (If possible, work with the people who will conduct the training with you. You may
also work with people who will give a similar training to yours, so you can share ideas.)
Your outline should include:
 the group that you are training (corresponding to this outline, such as Community
Leaders, Pastors, Youth Leaders);
 5 - 10 learning objectives you want your trainees to achieve (the objectives should
relate to the people your trainees will work with and the skills you think they need);
 the order in which you will teach MI Skills;
 additional information that you need to complete your training;
 the exercises that will need to be adapted (from the TOT training notes) for lowliteracy groups and for use where electricity or project equipment is not available;
 the length of the training
Use these training notes as a starting point and decide what needs to be added and what
can be left out.
Allow participants 1 hour of design time. Emphasize that if possible, participants should
work with any other trainers who will conduct the MI workshops with them to develop the
80
Motivational Interviewing Training – Task #19
training outlines. Participants whose trainees will work with similar groups may also work
together and share ideas. If possible, have participants write their final outlines on flip
charts so that the others may see them. Depending on how many groups you have, you might
also wish to give a time limit for the presentations, so that they do not run too long.
When participants have completed their outlines and reassembled in a large group, remind
them of the importance of giving constructive feedback.
Slide Annotation: Show “Providing Respectful Feedback”
After each group presents their training outline, those who watched the presentation should
mention at least two good things about the outline, and two suggestions for improvement.
When you provide this feedback, please remember to give it respectfully. This means:




The feedback should be directly related to the training outline the group has presented
Feedback should focus on how to make the training better (please do not give
feedback on any personal qualities of the people presenting)
Your suggestions should be things that the presenting group can do something about
Be specific, both in your description of what is good, and your suggestions for
improvement
Provide your own respectful feedback to each group as well, but ask for the other
participants’ to give their feedback first. Ensure that all have had a chance to speak before
you provide your own feedback.
After all feedback has been given, ask participants to take a few minutes to look at the
training outlines, and think about combining them into one. Work with participants as a
group to develop a single training outline, based on their ideas and suggestions. You may
have an alternative order and objectives for a few points on the outline, if some people feel
strongly about certain training segments.
81
Motivational Interviewing Training – Review of Part C
Part C Review and Synthesis
Take a moment to briefly review the exercises you completed in Part C for the entire
group – the review below mentions each in terms of the Achievement-Based
objectives cited at the beginning of Part C. Ask each question and listen to
responses from the group as a way of checking that they remembered what you
discussed, and that they are feeling comfortable with what they have learned.
Slide Annotation: Show “Review of Part C.”

We ordered the steps in creating a plan for change;
o List the steps in creating a change plan.

We listed and examined special groups with whom your learners are likely to
work;

We heard the specific ways in which MI can be adapted to work with special
groups;
o What are some tips for using MI with the groups we discussed?

We reviewed common problems in using MI.
o What are the three traps we reviewed?
What are your questions?
This is the end of Part C of the training. You may wish to continue with additional
role-plays for another hour or two to give participants more practice at change plan
negotiation.
Slide Annotation: Show “The Final Quiz.”
An end quiz used to test knowledge and skills acquisition at the end of this training is
included for you as Annex 5.
It includes the following (you may wish to share these with participants):
a. Questions which ask you to identify a component of motivational interviewing, or to
describe it. (multiple choice and short answer)
b. Questions which present a short MI conversation and ask you: “What is happening
here which should not happen in MI?” (multiple choice)
c. Questions which ask you to recover from a mistake made by a motivational
interviewer (e.g., arguing with the person they are interviewing): “How would you
respond?” (short answer) – Remember that there may be more than one correct way
to respond.
d. Questions which ask you to demonstrate how to respond to a person using
motivational interviewing: “How would you respond?” (short answer) – Remember
that there may be more than one correct way to respond.
End of Training
82
Motivational Interviewing Training - References
REFERENCES
Carey, M. and Lewis, B. “Motivational Strategies Can Enhance HIV Risk Reduction
Programs.” AIDS and Behavior. 1999; 3(4): 269 – 276.
Davis, T. Barrier Analysis Facilitator’s Guide: A Tool for Improving Behavior Change
Communication in Child Survival and Community Development Programs. 2004.
Food for the Hungry.
McGeary, J. “Death Stalks a Continent.” Time. 12 Feb, 2001. 157(6).
Miller, W. and Rollnick, S. Motivational Interviewing: Preparing People for Change.
2002. 2nd Ed. The Guilford Press: New York.
Miller, W. and Rollnick, S., and Moyers, T. Motivational Interviewing Professional
Training DVD. 1998. The University of New Mexico: Albuquerque.
Patterson, T. L., Semple, S. J., Fraga, M., Bucardo, J., Davila-Fraga, W., &
Strathdee, S. A. “An HIV Prevention-Intervention for Sex Workers in Tijuana, Mexico:
A Pilot Study.” Hispanic Journal of Behavioral Science. 2005; 27(1): 82-100.
Rollnick, S., Mason, P., and Butler, C. Health Behavior Change: A Guide for
Practitioners. 1999. Churchill Livingstone: Edinburgh.
Thevos, A.K., Kaona, F. A. D., Siajunza, M.T., & Quick, R.E. “Adoption of safe water
behaviors in Zambia: Comparing educational and motivational approaches.”
Education for Health. (2000); 13(3): 366 - 376.
Thevos A, Quick R, and Yanduli V. “Motivational Interviewing enhances the
adoption of water disinfection practices in Zambia.” Health Promotion International.
2000; 15(3): 207-214.
83
Motivational Interviewing Training – Annex 1
ANNEX 1: FACILITATOR’S POWERPOINT SLIDES
(See separate file)
84
Motivational Interviewing Training – Annex 2
ANNEX 2: TASK 9 QUALITY CHECKLIST
Name of Interviewer:_________________ Evaluator:______________________
YES
NO
Opening Methods
1. Did the Interviewer ask open-ended questions? .....................................................  
2. Did the Interviewer encourage the interviewee to talk by nodding, smiling, or
other actions that show that s/he was listening? ......................................................  
3. Did the Interviewer use affirmations? ......................................................................  
4. Did the Interviewer listen reflectively? .....................................................................  
5. If yes, what types of reflective listening were used? (Check all that apply.)
 Simple reflection  Double-sided reflection  Amplified reflection
6. Did the Interviewer make summary statements?......................................................  
7. Was the Interviewer directive in their reflective listening? ........................................  
Final Observations
8. Did the person (interviewee) talk more than the Interviewer? .....................................  
9. Overall assessment of the Interviewer’s performance:
1 2
Poor
3
4
5
6
7
8
9 10
Excellent
Comments:
___________________________________________________________________
___________________________________________________________________
85
Motivational Interviewing Training – Annex 3
Task 13 Character Sheet:
You are not limited to this information, and may also make up information on the spot as you respond
to your interviewer.
ANNEX 3: CHARACTER SHEETS FOR TASK 13 ROLE-PLAYS
Worksheet for Motivational Interview Role-play Characters
If you have decided to make up your own character for the role-play exercise (Task
#13), use this sheet to develop your character. Take a few moments to fill in
answers to the questions below to help you respond to your partner during the role
play.
Name of character:
Age:
Gender:
Married or single?
What is this person’s background (where they are from, family, education, etc.)?
What does this person know about HIV?
What is this person ambivalent about? [We suggest that the ambivalence center
around abstinence before marriage, faithfulness in marriage, or another HIV-related
behavior.]
What are the person’s arguments against change?
What are the person’s arguments for change?
Rate this person on a scale of 1 to 10 in confidence and importance.
Importance of change:
1
2
3
Not important
4
5
6
7
8
9
10
Very important
6
7
8
9
10
Very important
Confidence in ability to change:
1
2
3
Not important
4
5
86
Character Sheet: Benito
You are not limited to this information, and may also make up information on the spot as you respond
to your interviewer.
Name of character: Benito
Age: 17
Gender: male
Married or single? single
What is this person’s background (where they are from, family, education, etc.)?
Benito is from Maputo, Mozambique, where he grew up. He’s a ‘city kid’ and considers
himself very worldly. Benito is a laborer, and has a job at a flour mill near the port of
Maputo.
What is this person ambivalent about?
Benito is ambivalent about abstinence from sexual activity marriage. He has been having
sex for three years.
What does this person know about HIV?
Benito has heard many factually correct messages about HIV prevention, including
abstinence and condom use, but he doesn’t want to use condoms because he thinks they
are not ‘manly’. Benito has never been tested for HIV because he is afraid of finding out that
he has HIV.
What are the person’s arguments against change?
 Benito figures that since he is already having sex, and has not been using condoms
regularly, it is already too late for him to begin to worry about HIV now.
 Benito and some of his friends go out to clubs to meet women often, and he enjoys
meeting different girls and having sex with them – it makes him feel attractive and
powerful. He is also worried about what his friends will think of him if he no longer
goes out to clubs with them.
What are the person’s arguments for change?
 Benito’s mother recently introduced him to a girl who is a prospective bride. His
mother is pushing him to get married. Benito likes the girl and thinks he might want
to marry her, but he is afraid that if he has HIV, he will give it to her if they marry.
 An older man who Benito works with at the mill told Benito that he has HIV. He has
been encouraging Benito to make better choices than he made so that he will not get
HIV, such as protecting himself and staying away from prostitutes. Benito likes the
man, and helps to care for him when he is ill.
 Benito recently started going to a church with one of his friends, who has decided to
abstain from sex before marriage. This friend has been encouraging Benito to do the
same thing.
Importance of changing to be abstinent to Benito:
1
2
3
Not important
4
5
6
7
8
9
10
Very important
Benito’s confidence in his ability to change and be abstinent:
1
2
3
Not confident
4
5
6
7
8
9
10
Very confident
87
Character Sheet: Jamila
You are not limited to this information, and may also make up information on the spot as you respond
to your interviewer.
Name of character: Jamila
Age: 19
Gender: female
Married or single? Single
What is this person’s background (where they are from, family, education, etc.)?
Jamila is from a small village north of Dar es Salaam. She was orphaned at 15, and
supports her three younger siblings by having sex for money. She did not complete
secondary school, dropping out after her parents died.
What is this person ambivalent about?
Jamila is ambivalent about condom use. As she feels a responsibility to support her
younger brothers and sisters, she does not feel that she can become abstinent
because she does not see another way to support herself and them.
What does this person know about HIV?
She has heard much about HIV prevention, including condoms, various folk
remedies, and abstinence. She understands that she is at risk for HIV. She was
tested six months ago and tested negative.
What are the person’s arguments against change?
 Jamila fears that her customers will take their business elsewhere if she
insists on condom use, and she will not have enough money for food.
 Jamila is afraid of that her customers might hurt her if she asks them to use
condoms.
What are the person’s arguments for change?
 Jamila worries about how her younger brothers and sisters would manage if
she were to get HIV.
 Jamila herself would like to complete her schooling, leave prostitution, and get
a job. If she becomes ill with HIV, she believes these dreams will not be
attainable.
 Many of Jamila’s friends who also work as prostitutes have become ill, she
thinks with HIV. She does not want to follow in their footsteps.
Importance of using condoms to Jamila:
1
2
3
Not important
4
5
6
7
8
9
10
Very important
Jamila’s confidence in her ability to ask customers to use condoms:
1
2
3
Not confident
4
5
6
7
8
9
10
Very confident
88
Character Sheet: Safiya
You are not limited to this information, and may also make up information on the spot as you respond
to your interviewer.
Name of character: Safiya
Age: 14
Gender: female
Married or single? single
What is this person’s background (where they are from, family, education, etc.)?
Safiya is from a relatively prosperous family in her village in Uganda. She expects to
finish secondary school and then get married and start her family.
What is this person ambivalent about?
Safiya is somewhat ambivalent about being abstinent before marriage, although she
is leaning toward abstinence.
What does this person know about HIV?
Safiya understands how people get HIV, and she knows that it is undesirable to have
it. She knows that being abstinent until marriage will prevent HIV. She does not
know much about the consequences of the disease, what it feels like, etc. She only
knows that people with HIV who can not afford the drugs do not live long.
What are the person’s arguments against change?
 Safiya doesn’t really think that HIV would affect her if she got it – her family is
wealthy and one of the few in the area who could afford anti-retroviral
medicines.
 Sex seems to be a kind of glamorous and grown-up thing to do.
What are the person’s arguments for change?
 Safiya’s family and her religion approve of abstinence before marriage.
 She would not have to worry about getting any other kinds of sexuallytransmitted infections in addition to HIV.
 Safiya thinks her future husband would like her to be a virgin.
Importance of being abstinent to Safiya:
1
2
3
Not important
4
5
6
7
8
9
10
Very important
9
10
Very confident
Safiya’s confidence in her ability to be abstinent:
1
2
3
Not confident
4
5
6
7
8
89
Character Sheet: Philip
You are not limited to this information, and may also make up information on the spot as you respond
to your interviewer.
Name of character: Philip
Age: 28
Gender: Male
Married or single? Married
What is this person’s background (where they are from, family, education, etc.)?
Philip is a farmer from Kenya. He and his wife, Fatima, have been married for eight
years and have four children, ranging in age from two to seven years old.
What is this person ambivalent about?
Philip is ambivalent about participating in a ritual sexual cleansing. His older brother
is extremely ill, and the family expects his death soon. Anticipating the brother’s
death, Philip has been asked to ‘cleanse’ his brother’s wife by sleeping with her.
What does this person know about HIV?
Philip knows that his brother probably has HIV, although he has not been tested.
Philip understands how HIV is transmitted, and that he might get HIV from sleeping
with his brother’s wife after his brother’s death, although at this point, it is not clear
whether or not she also has the disease. Philip does not know his own HIV status.
What are the person’s arguments against change?
 Philip fears the curse that is said to impact the clan of a woman who is not
‘cleansed’ after the death of her husband. He fears that if he does not
participate and the clan is cursed, it will be his fault.
 Philip is also receiving a lot of pressure from people in his village to participate
in the ritual.
What are the person’s arguments for change?
 The headman in Philip’s village says it is Philip’s choice to participate in the
ritual or not – he will not force Philip to participate.
 Philip’s wife is very much against the cleansing, as is Philip’s sister-in-law –
both cite the possibility that AIDS will spread if the ritual is not stopped. This
is a source of argument between Philip and Fatima, as some people in the
village have accused Fatima of wishing to curse the clan because of her
outspoken opposition to the ritual.
Importance of not participating in the ritual to Philip:
1
2
3
Not important
4
5
6
7
8
9
10
Very important
Philip’s confidence in his ability to refuse to participate in the ritual:
1
2
3
Not confident
4
5
6
7
8
9
10
Very confident
90
Character Sheet: Charity
You are not limited to this information, and may also make up information on the spot as you respond
to your interviewer.
Name of character: Charity
Age: 36
Gender: Female
Married or single? Married
What is this person’s background (where they are from, family, education, etc.)?
Charity has been married for 15 years to her husband, Sam. Sam is a trader who
travels frequently, while Charity stays at home with their six children, who are
between the ages of eight and thirteen.
What is this person ambivalent about?
Charity is ambivalent about talking to her husband about faithfulness in marriage.
She suspects that he is unfaithful to her when he is away on business because a
friend’s husband saw him with another woman while he was traveling. She has been
unfaithful to him once, as well, but broke it off because she felt guilty. She is worried
that she and her husband are both at risk for HIV because they have slept with
others.
What does this person know about HIV?
The man that Charity slept with has fallen ill with HIV-like symptoms. Charity knows
that because she slept with him, she is at risk for HIV. She also knows that if her
husband has been unfaithful, they both are at additional risk. She knows that there
is a test for HIV, but she does not know where to get such a test, or if she could
afford it.
What are the person’s arguments against change?
 Charity is afraid of bringing this subject up with her husband for fear that:
o He will suspect she has been unfaithful
o He will be offended that she suspects he is unfaithful
What are the person’s arguments for change?
 Charity is worried that if they do not already have AIDS, they will have it if they
are not faithful to each other.
 Charity is strongly afraid of what would happen to her children if she and her
husband died.
Importance of talking with her husband about faithfulness to Charity:
1
2
3
Not important
4
5
6
7
8
9
10
Very important
Charity’s confidence in her ability to talk with her husband about faithfulness:
1
2
3
Not confident
4
5
6
7
8
9
10
Very confident
91
Character Sheet: ??
You are not limited to this information, and may also make up information on the spot as you respond
to your interviewer.
Name of character:
Age:
Gender:
Married or single?
What is this person’s background (where they are from, family, education, etc.)?
What is this person ambivalent about?
What does this person know about HIV?
What are the person’s arguments against change?
What are the person’s arguments for change?
Importance of change to this person:
1
2
3
Not important
4
5
6
7
8
9
10
Very important
8
9
10
Very confident
Person’s confidence in their ability to change:
1
2
3
Not confident
4
5
6
7
92
Motivational Interviewing Training – Annex 4
ANNEX 4: QUALITY CHECKLIST FOR MOTIVATIONAL INTERVIEWING
TRAINING TASK # 13 AND SUBSEQUENT PRACTICE
Name of Interviewer:_________________ Evaluator:______________________
Evaluating (check one): Task 13 Practice: ____ Post-Training Practice:
_____
Skip questions which are not relevant to the MI conversation you are observing. Do
not count skipped questions in the final score.
YES
NO
Opening Methods
1. Did the Interviewer establish rapport with the person? ............................................  
2. Did the Interviewer allow the person to set the agenda, if it was not already
clear? ........................................................................................................................  
3. Did the Interviewer ask open-ended questions? .....................................................  
4. Did the Interviewer use affirmations? ......................................................................  
5. Did the Interviewer listen reflectively? .....................................................................  
6. Did the Interviewer use simple reflections? ...............................................................  
7. Did the Interviewer use double-sided reflections? .....................................................  
8. Did the interviewer use amplified reflections?............................................................  
9. Did the Interviewer make summary statements?......................................................  
10. Did the Interviewer assess the degree to which the person felt that change
was important? ........................................................................................................  
11. Did the Interviewer assess the person’s confidence that they could change? .....  
12. Was the Interviewer directive in their reflective listening? ........................................  
13. Did the Interviewer encourage change talk?............................................................  
14. Did the Interviewer use OARS to encourage change talk? ...................................  
15. Did the Interviewer ask for description of change talk? .....................................  
93
Motivational Interviewing Training – Annex 4
YES NO
16. Did the Interviewer ask about extremes to encourage change talk? ...................  
17. Did the Interviewer ask about the past or future to encourage change talk? .....  
18. Did the Interviewer ask about the Interviewee’s goals or values to
encourage change talk? .......................................................................................  
Providing Information (Optional – use only if information was provided)
19. Did the Interviewer ask permission before providing any
unsolicited information? .........................................................................................  
20. Did the Interviewer provide information neutrally? .................................................  
21. Did the Interviewer provide factually correct information? ....................................  
Rolling with Resistance (Optional - use only if resistance occurs)
22. Did the Interviewer always avoid arguing with the person? ......................................  
23. Did the Interviewer roll with resistance using an MI method? ..............................  
24. Did the Interviewer handle resistance by shifting focus? ....................................  
25. Did the Interviewer handle resistance by reframing? ...........................................  
26. Did the Interviewer handle resistance by agreeing with a Twist .........................  
27. Did the Interviewer handle resistance by emphasizing personal control?.........  
Creating a Change Plan (Optional - use only if evaluating post-training
practice)
28. Did the Interviewer summarize arguments for change, recognizing
ambivalence? ..........................................................................................................  
29. Did the Interviewer ask a key question before beginning planning? ....................  
30. Did the Interviewer help the person to set goals for change? ..................................  
31. Did the Interviewer help the person come up with a menu of options for
change? ....................................................................................................................  
94
Motivational Interviewing Training – Annex 4
YES NO
32. Did the Interviewer help the person make a plan to change? ..................................  
33. Did the Interviewer elicit commitment to the plan from the person? .......................  
34. If the person was reluctant about the plan, did the Interviewer notice? ...................  
35. Did the Interviewer always avoid pushing the person toward any
particular solution? ...................................................................................................  
Final Observations
36. Did the person (interviewee) talk more than the Interviewer? ...................................  
37. Overall assessment of the Interviewer’s performance:
1 2
Poor
3
4
5
6
7
8
9 10
Excellent
Comments:
___________________________________________________________________
___________________________________________________________________
95
Motivational Interviewing Training - Annex 5
ANNEX 5: FINAL QUIZ
1. Which one of these is NOT a value of motivational interviewing?
a.
b.
c.
d.
Free choice
Collaborating together
Bringing forth strength for change
Giving information
2. What's happening in this conversation that should not happen in MI?
Pastor: So do you feel that husbands should be faithful to their wives?
Person: Yes.
Pastor: And do you feel that wives should be faithful to their husbands?
Person: Yes, of course, I do.
Pastor: Have you been faithful to your spouse?
Person: Usually.
a.
b.
c.
d.
The pastor is asking questions that are too sensitive.
The pastor is not asking open questions.
Nothing is wrong. This conversation is a good example of MI.
The pastor is focusing on too many different things.
3. What does the acronym OARS stand for?
a.
b.
c.
d.
Old ideas, Add new ones, Return to values, Stop arguing
Open questions, Affirmation, Reflective listening, Summarizing
Open questions, Avoid arguments, Reflective listening, Summarizing
Open questions, Affirmation, Reflective listening, Share information
4. What is happening in this conversation that should not happen in MI?
Youth group leader: It is obvious to me that you are really putting yourself at risk
for HIV by behaving like this.
Person: What do you mean?
Youth group leader: Well, you have already had a sexually transmitted infection,
and you are still having sex with many different people, and no condoms!
Person: It really isn’t that serious.
Youth group leader: Not serious… What if you got HIV? You would not be able
to work! What would your family do? They rely on your income!
Person: But I feel healthy. I had my test and it was negative. I don’t have HIV.
a. The youth group leader is lecturing and arguing for a particular point of
view.
b. The youth group leader is not promoting condoms to this person.
c. The youth group leader is not affirming enough.
d. Nothing is wrong. This conversation is a good example of MI.
96
Motivational Interviewing Training - Annex 5
5. One of the four main principles of MI is "Develop Difference
(discrepancy)." What does this mean? (Write a short answer below.)
6. What's happening in this conversation that should not happen in MI?
Imani: I just don’t know what to do. What if my husband has been unfaithful?
What if he has put me at risk for HIV?
Afiya (Counselor): You must first go to the clinic for an HIV test right away. That
is the best way to find out if you have HIV.
Imani: So I have to go for an HIV test. How will I explain that to my husband?
a. Afiya has given factually incorrect information to Imani concerning HIV
testing.
b. Nothing is wrong. This conversation is a good example of MI.
c. Afiya is telling Imani what she should do before exploring Imani's own
ideas about change.
d. Afiya is not giving Imani enough information about HIV testing.
7. Which of these is NOT one of the four principles of motivational
interviewing?
a.
b.
c.
d.
Roll with resistance
Repeat key messages
Develop difference (discrepancy)
Support self-efficacy
8. What is happening in this conversation that should not happen in MI?
Emerson (Counselor): You've said that in a typical day you might encounter two
or three women on the road that are willing to have sex with you for money. You
have the money, and you have the opportunity. Your friends think it’s a great
situation; they envy you. Your wife would probably never know, and she hasn’t
seemed interested in sex since your last child was born.
Jacob: Right. You see why I think it would be difficult to resist.
Emerson: So it would be impossible to be faithful.
Jacob: Not impossible, but difficult. Too difficult for me.
Emerson: Who among your friends would support you if you decided to be
faithful?
97
Motivational Interviewing Training - Annex 5
a. Emerson's summary is not very good.
b. Emerson's amplified reflection is too strong: he should not say that being
faithful would be impossible for Jacob.
c. Emerson has focused on Jacob's friends before asking if they were his
biggest concern.
d. Nothing is wrong. This conversation is a good example of MI.
9. Imagine you are the pastor. What would you say to recover, using MI?
Write your response below.
Pastor: So do you feel that husbands should be faithful to their wives?
Person: Yes.
Pastor: [What would you say?]
10. Name TWO of the three kinds of reflective listening in motivational
interviewing.
11. Imagine you are the youth group leader. What would you say to recover,
using MI? Write your answer below.
Person: It really isn’t that serious.
Youth group leader: Not serious! What if you got HIV? You would not be able to
work! What would your family do? They rely on your income!
Person: But I feel healthy. I had my test and it was negative. I don’t have HIV!
You don't know what you are talking about!
Youth group leader: [What would you say?]
12. Which one of these is NOT a method of rolling with resistance?
a.
b.
c.
d.
Coming alongside
Emphasizing personal control
Reframing
Telling the person what they should do
98
Motivational Interviewing Training - Annex 5
13. Imagine you are Emerson. How would you respond, using MI? Type
your answer below.
Emerson (Counselor): You've said that in a typical day you might encounter two
or three women on the road that are willing to have sex with you for money. You
have the money, and you have the opportunity. Your friends think it’s a great
situation; they envy you. Your wife would probably never know, and she hasn’t
seemed interested in sex since your last child was born.
Jacob: Right. You see why I think it would be difficult to resist.
Emerson: So it would be impossible to be faithful.
Jacob: Not impossible, but difficult. Too difficult for me.
Emerson: [What would you say?]
14. What is happening in this conversation that should not happen in MI?
Imani: I want to approach my husband about this issue, but I just don’t think I can
do it. He will be angry with me.
Afiya: Why don’t we just invite him to discuss this with us? I’ll be here and I can
help you bring it up.
Imani: Yes, but, what happens when you leave?
a. Nothing is wrong. This conversation is a good example of MI.
b. Afiya should not have offered to invite Imani's husband - this conversation
between Imani and her husband should be private.
c. Afiya is not urging Imani to accept her advice.
d. Afiya has prescribed a solution without asking permission to give advice.
15. Which one of these is NOT a type of change talk?
a.
b.
c.
d.
Expressing optimism about changing behavior
Eagerness to end the conversation
Describing disadvantages of the current behavior
Describing advantages of change behavior
16. Imagine you are Afiya. How would you respond, using MI? Type your
response below.
Imani: I want to approach my husband about this issue of HIV testing, but I just
don’t think I can do it. He will be angry with me.
Afiya (Counselor): [What would you say?]
99
Motivational Interviewing Training - Annex 5
17. What is happening in this conversation that should not happen in MI?
Imani: What can I do now?
Afiya (Counselor): What do you think you should do?
Imani: I've thought about it, but I have no idea. How could I begin this
conversation?
Afiya: What are your ideas?
a. Nothing is wrong. This conversation is a good example of MI.
b. Afiya is not building up Imani's confidence.
c. Afiya is not offering any information, even though Imani is asking for
information.
d. Afiya's is not reflecting Imani's concern.
18. Which one of these is NOT one of the steps in creating a plan for
change?
a.
b.
c.
d.
Set goals
Ask a key question
Elicit commitment to the plan
Establish rapport
19. Imagine you are Emerson. How would you respond using MI? Type
your response below.
Jacob: I think I really need to speak to my wife about why she is no longer
interested in sex, you know? Find out what’s going on.
Emerson (Counselor): [What would you say?]
20. Imagine you are Raina. How would you respond using MI? Type your
response below.
Raina: So where does all of this leave you?
Sophie: I don’t think I can go on like this. It’s just too risky. I care too much about
my future to take a chance of getting AIDS.
Raina: [What would you say?]
21. What's happening in this conversation that should not happen in MI?
100
Motivational Interviewing Training - Annex 5
James: You've really been thinking about this very hard over the last few months.
It has not been easy for you to consider being abstinent, especially since you had
already started having sex, but you decided to try abstinence for a short while.
Joseph: Yes, I have struggled many times, but I feel better about myself now,
after my decision to be abstinent for a month.
James: So what did your girlfriend say when you told her? I know you were
worried about that.
Joseph: At first she was shocked, but when I told her my reasons, she
understood. In fact, I think she was happy about it - she told her best friend and
her sister the next day, and they both came up to me and complimented me on
my strength and my wisdom. That is a great thing to hear from your future sisterin-law and your future wife's best friend!
James: It is indeed! So now that you've tried it for a while, what will you do in the
future?
a.
b.
c.
d.
James is being too positive.
James is not affirming Joseph enough.
James should have pushed Joseph to remain abstinent.
Nothing is wrong. This conversation is a good example of MI.
101
Motivational Interviewing Training - Annex 5
Answers to the Final Quiz
When grading the participants’ answers to short-answer questions asking “What
would you say?”, keep in mind that their answers do not need to reflect exactly
those in the answer key. Answers to short-answer questions are correct as long
as they are logical, reflect the values and principles of MI, and demonstrate
effective use of MI skills.
1. d
2. b
3. b
4. a
5. Develop Difference means that you help the person discover any
discrepancy between their current behavior and their goals or values in
life.
6. c
7. b
8. c
9. There are many correct responses, all could involve some kind of open
question or reflective response. Here are a few examples:
Example: Tell me more about your own marriage.
Example: What would you like to happen in your own marriage?
10. Participants could name any two of these: simple reflections, amplified
reflections, double-sided reflections
11. The youth group leader here has burst out with an opinion, and begun to
argue for it. To recover, roll with the resistance which has inevitably
followed:
Example: Because you feel healthy and your HIV test was negative, you
know you will never get HIV.
Example: Having HIV would not be a serious problem for you. It would not
change anything.
12. d
102
Motivational Interviewing Training - Annex 5
13. There are many correct ways that this discussion could continue. Emerson
could ask Jacob for more information about how change could occur, or to
state which of those things make it most difficult for him to be faithful to his
wife.
Example: Of all those things I just mentioned, which ones make it hardest
for you to resist? Why do you feel it's too difficult?
Example: Suppose suddenly it was not too difficult for you to be faithful.
What would have changed in the situation we've just described to make it
easier?
14. d
15. b
16. There are many ways Afiya could respond to this question, but all of them
could involve boosting Imani's confidence, either by helping her to recall
past successes in talking with her husband about difficult subjects, or by
asking her what would need to happen to increase her confidence. This
could involve offering advice, but Afiya should ask permission first.
Example: Think of a time when you had to discuss something else very
difficult with your husband, something you thought would make him angry.
Tell me more about that. How did you do it?
Example: I can tell you some ways in which other people have done it.
Would you like to hear about them?
17. c
18. d
19. Emerson might approach this by talking with Jacob about how to speak to
his wife. He could help Jacob develop different ways to talk to his wife.
Example: How do you think you might go about it?
Example: OK. Let's think of some different ways you could approach her.
20. Sophie says she wants to change. But how? Raina needs to find out
what Sophie is thinking about doing. The best way to do this is to ask her!
Example: What do you want to do?
Example: Going on like this is too risky, and your future is very important
to you. How will you protect yourself from getting AIDS?
21. d
103
Motivational Interviewing Training - Annex 6
ANNEX 6: MI COACHING CARDS
Use an Open-ended
Question
Explore
Importance/Values
Affirm the Person
104
Motivational Interviewing Training - Annex 6
Support Self-efficacy
(Build Confidence)
x
Assess Importance
Assess Confidence
105
Motivational Interviewing Training - Annex 6
Encourage Change Talk:
Advantages of Change
Encourage Change Talk:
Disadvantages of
Staying the Same
Summarize
106
Motivational Interviewing Training - Annex 6
Use a Simple Reflection
Use an Amplified
Reflection
Use a Double-sided
Reflection
107
Motivational Interviewing Training - Annex 6
Encourage Change Talk:
Intention to Change
Encourage Change Talk:
Optimism for Change
Roll with Resistance
108
Motivational Interviewing Training - Annex 6
Develop Discrepancy
Express Empathy
Summarize Arguments
for Change
109
Motivational Interviewing Training - Annex 6
Shift Focus
Come Alongside
Agree with a Twist
110
Motivational Interviewing Training - Annex 6
Emphasize Personal
Control
Consider Change
Options
Give Information
111
Motivational Interviewing Training - Annex 6
Set Goals
Shift Focus
Get Commitment to the
Plan
112