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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