Motivational Interviewing

Miller and Rollnick gave it. They defined it as – “a collaborative, person-centred form of
guiding to elicit and strengthen motivation for change.”
2 Components
1. Relational
- Empathy
- Affirmation
- Non-judgmental
- Autonomy Supportive
2. Technical
- Elicit change talk
- Reinforce desire, ability, reason and need to change
Characteristics of MI
1. Collaborative – the therapist is not the expert; the client and the therapist work
together to find what works for the client.
2. Evoking – the interview is focused on drawing information out from the client. It can
be about their view of the problem, how they would change, their values and goals,
and ambivalence and sustained talk views.
3. Acceptance – Accepting client’s worth, showing empathy, respecting their autonomy
and affirming their views.
4. Compassion – Showing the genuine desire to help and being authentic in the
emotional response to the client’s feelings.
4 Guiding Principles
1. Resist the righting reflex – Don’t think about fixing the client; they will tell you
about their need and ability to change themselves.
2. Understand the client’s motivations – Talk about their feelings, desires, and needs to
change.
3. Listen to the client – Attentively listen and reflect on the client’s talk.
4. Empower the client – Focus more on the client’s strengths than weaknesses.
Processes of MI
1. Engage – Building a relationship with the client and making them trust you.
2. Focus – Focusing on the problem and what the client is here for. This should be based
on what the client wants and not our assessment.
3. Evoke – Talk about the client’s motivations, reasons and strengths while changing and
bring out the need for it.
4. Plan – Ensure the client's commitment and then plan to take further steps to change.
Engage
To develop a relationship, use interviewing skills to talk to the client.
1. Open-ended questions – allow the client to talk about their concerns
2. Affirmations – listen to the client validate their feelings and focus on the positives
and their strengths. Comment, reframe, or elicit information.
3. Reflections – there are 9 types of reflections that you can use to make it clear to the
client that you are listening to the client.
A. Simple Reflections
i) Repeat
ii) Rephrase
B. Complex Reflections
i) Double Sided Reflection
ii) Amplifying
iii) Metaphor
iv) Shifting Focus
v) Reframing
vi) Reflection of Feeling
vii) Emphasize Personal Choice
4. Summarise – put together a few points mentioned by the client and give them a
concise version of what has been discussed before. This can be done in the beginning,
the end, or after a topic has been completed.
Focus
This is to understand the problem and determine what the client wants attention to. This can
be done by agenda setting and asking open-ended questions about the client's concerns and
feelings.
Evoke
This is to elicit information from the client. The information can be in the form of three
‘talks’
1. Sustained Talk – This is where the client mentions how they want to stay the same
and talks about the need, desire, ability and reasons to not work on the problem
2. Change Talk – This is where the client talks about change and working on the
problem. This can again be of 2 types.
- Preparatory Change Talk – This mainly deals with the thinking part of the change.
It has 4 components.
i) Desire to change
ii) Ability to change
iii) Reasons to change
iv) Need to change
- Mobilizing Change Talk – This mainly deals with the action part of the change. It
has 3 components.
i) Commitment
ii) Activating
iii) Taking Steps
3. Ambivalence – This is where the client talks about wanting to change but also
wanting to remain the same.
The therapist can also evoke using other strategies, such as the following –
1. Readiness Ruler – Ask the questions on a scale and then ask them about their position
on the scale, the reason for it, or what it will take them to go higher. This question is
mainly used for confidence and commitment information.
2. Decisional Balance – This is a pros and cons list to reduce ambivalence and move
towards change.