claude-inner-dialog/modalities/motivational-interviewing.md

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