## Motivational Interviewing (MI) **Core principle:** People are more likely to change when they talk themselves into it than when someone else tries to convince them. Motivational Interviewing is a collaborative conversation style that strengthens a person's own motivation and commitment to change by exploring and resolving ambivalence. ### The Spirit of MI Four elements that define the approach: - **Partnership** — Working with, not on, the person. They are the expert on their own life. - **Acceptance** — Honoring autonomy, affirming strengths, expressing empathy, supporting their right to choose. - **Compassion** — Prioritizing the person's welfare and best interests. - **Evocation** — Drawing out what's already there, rather than installing what's missing. ### OARS: Core Skills **Open Questions** - Questions that invite reflection and elaboration - "What concerns you about this?" vs. "Are you concerned?" - "How would you like things to be different?" **Affirmations** - Genuine recognition of strengths, effort, and values - Not praise ("Good job!") but reflection of character ("That took courage") - "You care deeply about your kids—that comes through clearly" **Reflections** - The most important MI skill—listening and giving back what you hear - Simple: repeating or rephrasing ("You're frustrated") - Complex: reflecting meaning, feeling, or what's unsaid ("Part of you really wants this, and part of you is scared of what it would mean") **Summaries** - Collecting what's been said, linking ideas together - Especially useful for gathering change talk into one place - "So on one hand... and on the other hand... and what matters most to you is..." ### Change Talk vs. Sustain Talk **Change Talk** — Language that moves toward change: - Desire: "I want to..." - Ability: "I could..." - Reasons: "I'd be healthier if..." - Need: "I have to..." - Commitment: "I will..." - Taking steps: "I actually started..." **Sustain Talk** — Language that favors the status quo: - "I can't see myself doing that" - "It's not that bad" - "I've tried before and it didn't work" The goal is not to eliminate sustain talk but to gently tip the balance toward change talk. ### Key Concepts **Ambivalence** — Wanting and not wanting to change at the same time. This is normal, not resistance. MI works with ambivalence rather than against it. **The Righting Reflex** — The helper's instinct to fix, advise, or argue for change. Paradoxically, this often increases resistance. MI resists the righting reflex. **Readiness Rulers** — "On a scale of 0-10, how important is this change to you?" followed by "Why a 5 and not a 2?" (elicits change talk, not deficit). ### Key Questions - "What would you like to be different?" - "What's the best thing about the current situation? And the not-so-good things?" - "If you did decide to make a change, what would be your first step?" - "You rated importance at a 7—tell me about that." - "Where does this leave you?" ### When to Use MI - Ambivalence about change (health, relationships, habits, career) - Addictive behaviors or harm reduction - Health behavior change (exercise, medication adherence, diet) - When advice-giving or persuasion has failed or backfired - Early stages of change (pre-contemplation, contemplation) - Any situation where autonomy and self-direction matter ### MI Exercises - Decisional balance: exploring pros and cons of change and status quo - Readiness ruler with follow-up (why not lower?) - "A day in the life" of the changed future - Values card sort connecting values to desired change - Noticing and reinforcing change talk in conversation