A pocket guide to

Motivational
Interviewing
Developing competency in Motivational Interviewing
(MI) takes practice. The best way to learn MI is with
practice with feedback. This tool will not replace
that!
Have someone competent in MI observe a session
(or recorded session with permission) and give you
feedback on their observations.
What this guide will do is help you after training
plan and review sessions using MI.
What is Motivational Interviewing?
Motivational Interviewing is a collaborative, goal
orientated style of communication with particular
attention to the language of change. It is designed to
strengthen personal motivation for and commitment
to a specific goal by eliciting and exploring the
person’s own reasons for change within an
atmosphere of acceptance and compassion.
(Miller and Rollnick 2013)

The essence of MI is that it is the client rather than

the worker who makes the argument for change. It
is not a collection of techniques but a way to guide
conversation to activate a person’s own motivation
and resources for change.
The way in which you talk with people
can substantially influence their personal
motivation for behaviour change.
Deep roots and a strong trunk helps
produce fruit you are working toward

‘OARS’
Listen till you
understand
strategies
Processes
Principles

Spirit

The Spirit of MI Principles (RULE)

Partnership Avoid the righting reflex
Acceptance Understand
Compassion Listen
Evoking Empower

There is something in human nature that resists

being coerced and told what to do. Ironically, it is
acknowledging their freedom to choose and not change
that sometimes makes change possible.

What will you do to stay consistent with the

spirit and principals of MI?
 The core skills of MI

O: Open questions: to explore concerns,

promote collaboration, and understand the
client’s perspective.
A: Affirmations: to support strengths, convey
respect.
R: Reflective listening: to explore deeper,
convey understanding, deflect discord, elicit
change talk.
S: Summarise: to organise discussion, clarify
motivation, provide contrast, focus the
session and highlight change talk.

Reflect with each question if possible:-

Encouraging the other person to
elaborate, amplify, confirm, or correct.
• A Simple Reflection may use different
words but stays at the same meaning
• A complex reflection makes a guess
about what the person means.
It adds something that deepens
understanding and encourages
further exploration.
Use variety in your reflections:-
Sounds like…
What I’m hearing is…
So you’re saying that…
You’re feeling like…
For you, it’s a matter of….
From your point of view,…
You are…
I would imagine you…
Must be…
Through your eyes,…
Your belief is that…
Your concern is that…
It seems to you that…
You’re not terribly excited about…
You’re not much concerned about…
The thing that bothers you is…
The important thing as you see it is…

You can get as much from reflections, even

more than relying on questions.

Your clients will teach you how effective your

reflections are. They keep talking.
 The processes of MI
Engaging Planning
• Allow time to develop a Evoking
trusting relationship Focusing
• Listen, understand, Avoid Engaging
traps
- How comfortable is
this person in talking to me?
- Do I understand this person’s perspective/
concerns?
Focusing
• Help client to prioritise areas of change.
- An agenda map helps support focusing.
- What goals for change does this person
really have?
- Do I have a clear sense of where we are
going?
- Do I have different aspirations for change
for this person?
- Does this feel more like dancing or
wrestling?
- Does it feel like we are moving together,
not in different directions?
Evoking
• Elicit the person’s own reasons for change.
- Explore readiness, willingness and ability
to change.
- Am I steering too far or too fast in a
particular direction?
- Is any reluctance more about confidence
or importance of change?
- Elicit and respond to change talk.
Planning
• If ready help the person establish a change plan
- What would be a reasonable next step
toward change?
- Am I remembering to evoke rather than
prescribe a plan?
- Am I offering needed information or advice
with permission?

Some tools in A Nudge in the Right Direction may

be useful.
http://www.setrust.hscni.net/pdf/A_nudge_in_
the_right_direction_(4).pdf

What processes did your

session focus on?
 Traps to avoid
When working with people in a helping capacity it is
easy to fall into certain traps that are less helpful.
• The assessment trap - bombarding the person
with questions
• The expert trap - communicating I have all the
answers
• The premature focus trap - talking about
change too early
• The labelling trap - calling a problem by name
• The blaming trap
• The chat trap.
 Change talk

The MI Hill
Preparatory change talk Mobilising change talk

(pre)contemplation preparation action

Change talk is the client making statements that

are in favour of change. Forms of change talk -
DARN CAT.
Preparatory Change Talk (Darn)
D = Desire statements.
Statements indicating a desire to make a change.
A = Ability statements.
The client’s self-efficacy or belief in their ability to
make changes.
R = Reasons statements.
Statements that reflect the reasons the client gives
for considering a change. “I have to quit smoking
because of my asthma.”
N = Need statements.
Statements that indicate a need for change. The
emphasis is more emotional rather than a more
cognitive reason.
Mobilizing Change Talk (CAT)
C = Commitment. Statements that are linchpins
in the change talk and critical predictors of change
occurring.
“I am going to..” “I intend to…” “I will …”.
A = Activation. This indicates movement toward
action, yet hasn’t been done. “I’m ready to…” “I am
prepared to” .
T = Taking steps. This indicates that the person
has already begun changing.

Evoking change talk - Your goal is to

strengthen change talk and/or commitment
language.

Explore a typical day

Asking evocative questions
Using the importance ruler
Querying extremes
Looking back
Looking forward
Exploring goals and values
 Using scaling questions in an MI Style
1. On a scale of 0 - 10, 0 being not important
at all, and 10 most important, what number
would you pick for yourself as to where you
are with importance on this change?
2. Why are you at a ____, and not a zero?
3. What are the 3 main reasons you want to
make this change?
4. What ideas do you have about making these
changes?
5. What would it take to get you from That
Number to One Number Higher
6. What will you do next?

Responding to change talk

When you hear change talk, respond by…

• Elaboration or details, “In what ways?” “How are
you going to do that?” Ask for specific examples
• Affirm change talk through reinforcement,
encouragement
• Reflect what the person is saying
• Summarise. It is like collecting flowers into a
bouquet. (only pick the fresh ones).
 Responding to sustain talk and discord
Sustain talk is about the behaviour
Discord is about your relationship with the client

Reflective responses to sustain talk

• Straight reflection
• Amplified reflections
• Double sided reflection.
Strategic responses
• Emphasising autonomy
• Reframing
• Agreeing with a twist
• Listening to the cons of change
• Coming along side.
Spotting discord
• Defending
• Squaring off
• Interrupting
• Disengagement.
Responding to discord
• Apologising
• Shifting focus.
 Building Confidence
• Evoke confidence talk
• Confidence ruler
• Give information and advice (with permission)
• Identify and affirm strengths
• Review past success
• Brainstorm ways to change
• Reframing
• Hypothetical thinking.

To exchange information

Always ask permissions to given information

Use Elicit-Provide-Elicit
Elicit they want it/ are ready for it, provide it
neutrally, elicit again. (Ask / provided / ask)
Ask: What do they already know.
Provide: Seek permission to add to current
understanding, correct misinformation using what
research tells us or what others have found useful.
Ask: Follow-up: How does what I told you fit into
your thinking/situation? Sit back and listen.
 Are they ready: signs of readiness

• Decreased ambivalence
• Decreased discussion about the problem
• Resolve. The client appears to have
reached some resolution
• Change talk. You are hearing more
DARN-CAT statements
• Questions about change. Clients may
begin to ask what they could do about the
problem, how other people do it
• Envisioning. The client may talk about
how life might be after a change. They look
ahead and can see difficulties or positives if
a change were made
• Experimenting. The client may have begun
experimenting with change since the last
session.

What do I do now?
Move to planning. If you have misjudged
readiness the person will let you know.
Remember our clients will teach us MI!
 Reviewing a session - how did I do?

• Did it feel like I was wrestling or

dancing?
• Did I seek to understand this person and
their world?
• What was my ratio of questions versus
reflections like?
• Did I reassure this person that
ambivalence to change is normal?
• Did I encourage this person to talk about
his/her reasons for not changing?
• What did I do with change talk?
• Did I ask permission to give information
or feedback?
• What did I do with sustain talk or
discord?
• Whose change is it? Did I keep the
righting reflex at bay.

What did I do well in this session that was

consistent with MI?
Anything I would like to do differently?
Content for this pocket guide including The MI hill is from Miller,
W. R., & Rollnick, S. (2013). Motivational interviewing: Helping
People Change (3rd Ed.). New York: Guilford Press and from
other members of the Motivational Interviewing Network of
Trainers (MINT).
For further information look to www.motivationalinterviewing.org
Compiled by Ed Sipler, Health Development
South Eastern Trust with support from other MINT members
in Northern Ireland - Kathy Goumas, Briege Quinn, Glenn Hinds

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