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Motivational interviewing is a powerful counseling style, focused on helping someone gain motivation toward a valued direction in their life. The technique was first developed in the addiction field and is now being used broadly within healthcare settings.
As an addiction counselor, I have attended several workshops on motivational interviewing and noticed a wide range in the quality of instruction. I’ve witnessed persons leaving these workshops with a shallow understanding of the approach, feeling confused, or deciding to give up on the approach altogether.
Since I am passionate about motivational interviewing and love sharing complex ideas in accessible language, I was inspired to create a practical in-depth summary of this powerful approach.
These are the four processes of Motivational Interviewing (MI), a scientifically validated approach to helping someone change:
- Engage them through reflective listening
- Focus on the main issue they are facing
- Evoke their reasons for change
- Collaborate on a plan for change
In this article, I delve into each of these four motivational interviewing processes, translating the most practical elements into simple language. Whether you work in mental health, addictions, other areas of healthcare, or are just trying to help a friend or family member, I hope this powerful approach can help.
What is motivational interviewing?
According to Dr. William Miller, the founder of Motivational interviewing:
“Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.”
Rather than merely a set of techniques, it is fundamentally a way of being with people. It is tempting to simply try to give people the psychological tools as if simply explaining it to them clear enough will make them change. This is an antiquated learning model, based on the idea that persons are empty receptacles, needing to be filled with knowledge.
As a university course instructor, I quickly learned that merely lecturing people is a highly ineffective way to facilitate meaningful learning. This lesson was reinforced in my work doing problem gambling prevention. Although some people are naturally curious and want to learn more, most people shut down as soon as they feel like someone is giving them advice.
As Peter M. Senge says:
“People don’t resist change. They resist being changed.”
Resistance to change is not personal. Persons are coping with underlying pain, the best way they currently know how. Attempts to change someone are met with resistance since they take away someone’s need for control.
Deep down, people who seem to have no motivation do want to change. Getting to that kernel of desire is the goal of motivational interviewing, and this starts with considering our way of being with them. This entails actually being there with them.
How to be with a person
This is also referred to as the “spirit of motivational interviewing”. It is a way of being that entails partnership, acceptance, compassion, and evocation, forming the acronym, PACE. Keeping PACE with others means meeting them where they are at.
Let’s start by delving into acceptance since it has several aspects.
Accepting another person as they are, while also supporting their growth, is foundational. Although acceptance sounds like a simple word, there are four aspects of acceptance: absolute worth, empathy, autonomy, and affirmation.
This means maintaining a nonjudgmental attitude toward people who are presenting difficulties.
When we hear anger or frustration, it is useful to consider what pain might be causing the person to react the way they do. Slow down and see their humanity, despite the challenges on the surface.
This aspect of acceptance from Carl Rogers’ concept of “unconditional positive regard.” It requires setting aside one’s judgments about another individual, empathizing with them, and genuinely wanting the best of them.
When someone irritates us, it can be challenging to have unconditional positive regard, but when we start with empathy, we can understand the context of their behaviors, not taking it personally, and not blaming them for being ‘bad’, ‘lazy’, or ‘stupid’. We can see them as an imperfect individual, like ourselves, striving to live a ‘good’ life. When we have unconditional positive regard, we empower individuals to see the best in themselves, inspiring them to act accordingly.
This means actively attempting to understand the other person’s point of view.
We can start by becoming curious about the other person’s inner world. This curiosity allows us to take a step back from our own biases and assumptions, facilitating mutual understanding and respect.
This entails facilitating the other person’s sense of control and independence.
We can’t make people change. We can only help spark their own desire to change. Supporting their autonomy means knowing when to slow down and simply hold space.
This means acknowledging the other person’s strengths and efforts.
We are often quick to latch on to the negative traits a person displays, overlooking their unique strengths, abilities, or efforts. Recognizing someone’s strengths helps us maintain respect for them as an individual.
Compassion requires us to actively promote a person’s welfare based on their own needs.
We often feel compelled to judge what will be best for another person. This causes us to direct the focus, assuming we know what they need to prioritize. As we take the reins, we disempower the other person, putting them into a passive role in the process.
This aspect of motivational interviewing was added when the founders, Rollnick and Miller, noticed that their method was being advertised by an “influence coach” selling his book on “How to Get Anyone to Do Anything — Fast!”.
Getting “anyone to do anything” does not require compassion since it does not consider their best interests first. Rollnick and Miller wanted to be clear that their technique is intended to be used with and for the other person, not simply for the interviewer’s personal benefit.
Evocation requires us to actively elicit the person’s own reasons for change.
We often feel compelled to make arguments for why someone needs to change. Usually, the arguments for and against change already reside within the other person. It is our job to evoke their own arguments for change, thereby increasing their intrinsic motivation.
This is the opposite of those all too common “should” statements. Has anyone ever said you should do something? How do you feel after someone tells you this? Evocation elicits the person’s own arguments for change, bypassing this resistance.
Partnership requires us to collaborate with the other person to form a plan.
We may feel compelled to dictate what we may consider a strong action-plan, pacifying the other person, leaving them feeling like they have “homework” rather than having a collaboratively constructed plan of action. Partnering with the other person inspires intrinsic motivation to change becuse they feel in control of the process.
This is the foundation of motivational interviewing. Without being with people in this open, accepting, compassionate way, the technical skill will generally be ineffective.
Now that the foundation has been laid, let’s consider the four processes listed in the intro:
These may occur in the order listed, or the conversation may go back and forth, depending on the situation’s requirements. Let’s take a closer look at each of these processes and how they work.
Engage them through reflective listening
This means establishing a trusting and mutually respectful relationship. In practical terms, it’s how we help people feel like we are someone they can trust and with whom they can share their personal experiences. Engagement can happen instantly, or it can take a while.
The best way to develop engagement is through reflective listening. Reflections consist of responding with a summary of what the person is sharing with you. Our natural tendency when listening is to ask questions continually. Reflective listening is different since it means limiting the number of questions you need to ask.
Reflections are more engaging than questions, helping facilitate empathy and a sense of understanding. To be optimally effective, try to use at least three reflections per open-ended question. For example:
Person: “I can’t believe I relapsed!”
You: “This (situation) really frustrates you” (reflection 1).
Person: “Yeah… I was doing so well… I hate when this happens!”
You: “And you want to gain more control over your drinking.” (reflection 2).
Person: “Yeah… I’ve been trying a few different things but I don’t know if I should go to treatment.”
You: “And you are still not sure if treatment is a good fit for you.” (reflection 3).
Person: “That’s right… I feel like I have a lot of support.”
You: What do you feel you need right now? (open-ended question).
Notice how reflective listening builds rapport while delving into the person’s underlying needs. Asking too many questions risks maintaining a surface-level conversation. Reflective listening delves into the other person’s experience while using infrequent open-ended questions to guide the conversation gently.
Since there are several different types of reflections, here is a brief definition and example for each:
This consists of reflecting the exact words or phrases used by the individual.
Person: “I feel guilty about my drinking because I often drink too much.”
You: “You feel guilty…”
When using a simple reflection, be careful not to sound like you are simply parroting the other person’s words. If done without a spirit of empathy, it can appear cold and mechanical.
FBI hostage negotiator, Chris Voss, shares he often used this kind of reflective listening by merely repeating the last two words the person said. Although I don’t personally recommend this when helping others, it can be a simple, fun exercise to practice reflection in everyday conversation.
This consists of finishing the other person’s sentences or paragraphs by guessing what they mean. It is also one of the most powerful forms of reflection. The key to this technique is that the dialogue should flow as if it were a single person speaking.
Person: “When I comes to drinking, I find it difficult to control myself.”
You: “…and you’re looking to gain back some control.”
Person: “yeah… I miss the way things were before I started drinking.”
You: “… spending quality time with the ones that matter.”
Note that you need to sometimes go out on a limb and take a guess at what phrase may accurately represent the other person’s experience. If you are not on the mark, the other person will correct you. If they correct you, adjust your reflection to fit their experience, maintaining a spirit of empathetic concern or curiosity.
Summaries are reflections that consist of paraphrasing two or more items someone has shared.
Person: “I tried going to a therapist to deal with my gambling because my partner was frustrated with my spending and told me I had to go, but I don’t think it helped because I keep wanting to gamble, but I also don’t want to upset my partner. I just feel lost and overwhelmed because my relationship is very important to me.
You: “So you’re feeling lost and overwhelmed because you enjoy gambling, but your partner thinks you are spending too much and wants you to get help. You value your relationship so you sought help, but you feel that it was not helpful for you.”
Summaries are most useful at the end of conversations or immediately after someone shared many concerns.
In summary, reflection builds connection and increases motivation by encouraging the other person to continue talking about their reasons for change. Rather than simply listening, asking questions, and offering feedback, incorporating a large dose of reflection into your conversations will help you better connect with others, in addition to increasing their likelihood of making a change.
Focus on the main issue
This consists of seeking and maintaining direction in the conversation. In practical terms, it’s how we help people share their most important concern.
Rather than making assumptions about what they need, focusing is a collaborative process, revealing what is best for them.
Focusing is tricky because we could take the conversation in so many places. How do you focus on one particular aspect of a person’s complex experience and list of challenges?
Open-ended questions are the most useful tools for this process. Some examples might include questions like “What is the most important issue for you right now?” and “What issue is your main priority right now?”
The key to focusing is to never make assumptions. The problem may seem “obvious” in the beginning, but this may or may not be the real issue. Guiding the focus of the conversation through open-ended questions ensures you are focusing on the most relevant aspects of their situation.
So how do you know when you’ve focused enough? Here are some quick tips:
Not yet Focused
- The person jumps around between ideas and topics
- The person reverts to small talk after disclosing an area of potential focus
- The person is still sharing important background information
- Person has directly identified a top area of priority
- You have confirmed the focus with the other person.
Evoke their reasons for change
This consists of increasing motivation by evoking the other person’s own arguments for change.
In simple terms, it’s how we help people increase motivation and maintain their commitment to change.
The best map is useless if they’re not ready to take the voyage.
Talking about our why is the fastest way to build motivational momentum. Clinical studies on this technique demonstrate that getting the other person to talk about their own reasons for change correlates with increased successful outcomes. Miller and Rollnick call this “change talk.”
Studies looking at this technique’s effectiveness show change talk is one of the significant predictors of change.
So how do you get the individual to state their own reasons for change? Listen carefully for a reason, and then reflect that reason back to them in your own words, encouraging them to continue talking about it.
Here is a simple example:
Person: “I guess if I stop coming to the casino so often, I could take better care of my elderly mother.”
You: “It looks like your mother means a lot to you…”
Person: “Yeah… she was always there for me, so I really want to be there for her.”
Whatever you reflect, you will hear more. Therefore, reflecting change talk gets you more change talk. Note that this also works in reverse. If you are not selective in your reflections, you may be encouraging more counter-change talk, keeping the person entrenched in past behaviors.
To unlock motivation, keep your ears on alert for change talk, focus your reflections, and encourage the other person to continue talking about their own reasons for change.
The purpose of evoking change talk is to increase intrinsic motivation, reducing ambivalence.
Those seeking change look toward a huge mountain ahead, ambivalent to whether they should make the trek. They want to get to the top, but also have reasons not to take the risk. Torn between these two competing desires, they are stuck.
When someone comes to us for help, it is tempting to start planning for change immediately. Before doing so, we need to take a step back, inquiring into the other person’s reasons for change. Evoking change-talk helps the other person build intrinsic motivation, a key indicator of successful long-term growth.
Special Evoking Technique: The Readiness Ruler
- Simply ask the person about their readiness to change on a scale from one to ten.
- Ask what made them choose that number instead of a one or two.
- Ask what it would take to get them to a number or two higher than the one they chose.
The readiness ruler is not a measurement tool. Rather, it is a technique designed to evoke change talk. Each step is designed for this purpose. It does not necessarily matter what number they say. What matters is how you engage the person relative to the number they chose.
Step number two might seem counter-intuitive. Why would you ask someone about their reasons for not being less motivated?
When asked about their reasons for not being less motivated (a 1-2 on the scale), they will need to respond with reasons why they are motivated. The question necessarily frames them as having some motivation, guiding them to elaborate on it. This elaboration is the essence of change talk. Using continued reflective listening is crucial to this step.
Question number two is focused on evoking, while question number three starts the initial planning phase. Strong change talk goes beyond vague desires, delving into someone’s reasons and deep internal need to change. Turning this desire into commitment and action involves collaborating on a plan.
Collaborate on a plan for change
Collaboration is like a dance. We give and take, meeting the person where they are, guiding the flow of the dance while remaining in harmony with one another. The goal is to guide them toward action, not force them into submission.
To use another metaphor, we must be like travel agents of change. We may be experts on the matter, but we can never really know what kind of trip will be best for the individual until we collaborate with them. Even when the plans are set, and the trip is booked, it is not our job to go on the trip with them. If things get rocky on the trip, they can call us for support, but it is not our responsibility to fly out and rescue them.
People need space to feel empowered when making changes. When we become confrontational experts, we disempower people, making them feel incompetent. When we collaborate with them, guiding the change-process, we empower them to take responsibility for changing, giving them the ability to see small rewards accumulate by their own volition. As these rewards start to accumulate, motivational momentum snowballs into committed action.
Collaboration solves underlying motivational issues by encouraging an active mindset rather than spurring temporary action driven by the desire to avoid criticism.
When helping people change, we are often tempted to take the lead. We want to direct them on making the change, telling them what they need to do, and perhaps even begin doing some of it for them. We may find ourselves working harder than the other person, wondering why they won’t take control over their life. If we find ourselves in this situation, it may feel like we are helping, but we have actually become part of the problem.
Special Planning Technique: Elicit-Provide-Elicit
Our contributions to a plan are better received when delivered in an elicit-provide-elicit sandwich.
This requires asking what they know about an area, providing relevant information (with permission), then asking their thoughts on the information. This technique helps bypass resistance when planning, allowing you to offer feedback without sacrificing collaboration:
You: “What do you think about counselling?” (elicit)
Person: “I think it would help me out a lot right now.”
You: “Can I tell you more about local services? (asking permission to provide)
You: “X is a great local resource…” (provide)
You: “What are your thoughts?” (elicit)
Common traps and roadblocks
Sometimes our interactions are smooth sailing. Other times, they feel heavy and difficult. You may be getting yes or no answers, “yeah buts…”, no eye contact, or the person may have difficulty opening up. Here are some common ways you might be caught in a communication trap.
The Expert Trap
This occurs when you present yourself as an expert on how the other person should be living. Being too directive creates a power-dynamic where the other person loses a sense of control over the process, decreasing motivation.
The expert trap might be tempting since it is easy to believe we know what’s best for someone. We may feel like we have access to all of the right tools and techniques, knowing exactly what the person needs to do.
The issue with jumping to solutions is that it does not work. How many people follow their family doctor’s expert advice, after being told they need to eat healthier and exercise more often?
Being an expert and presenting yourself as an expert are two different things. The founders of motivational interviewing, Rollnick and Miller, state that a true expert is invisible to the untrained eye.
Rather than creating a power dynamic where you are the expert, and the other person is a passive recipient of knowledge, it is more effective to see both of you as different types of experts. You may have expertise in psychological processes and coping skills, but the other person is an expert on the details of their own lives. As stated in the research here:
“The alliance between you and your client is a collaborative partnership to which you each bring important expertise.”
The Assessment Trap
Similar to the expert trap, putting too much emphasis on assessment places the other person in a passive role, similar to the doctor-patient dynamic. This can be a useful dynamic in many areas of physical health, but it can be a barrier to connection when helping someone with mental health and addiction issues.
Asking too many questions can intimidate and bombards the other person. Rather, it is more effective to evoke their experience through reflective listening. Luckily, process-based approaches such as Acceptance and Commitment Therapy (ACT) have moved away from diagnostic assessments, preferring a functional analysis of the thoughts, emotions, and behaviors, instead. You can learn more about ACT in my article here.
The premature focus trap
This entails trying to immediately solve the person’s problem, jumping to the solution rather than simply listening to build engagement and trust.
There may be times when you want to steer the conversation in a particular direction prematurely. Although we may feel like we have the answer, it is most effective to focus on areas that are right for the other person.
Ask yourself: Whose need am I meeting right now? Am I trying to meet my own need to provide information? Am I trying to gain a sense of importance by fixing the other person? Am I engaging with a spirit of compassion?
The Chat Trap
Although small talk can be engaging, the chat trap prolongs shallow conversation, neglecting focus and direction.
The chat trap lingers between engaging and focusing. The person may be engaged, but you may find yourself in a conversational tailspin, focusing on surface-level content.
This is perhaps most relevant when it comes to conversations with individuals we are highly familiar with. They are successfully engaged and comfortable chatting, so stepping out of this comfort zone takes a bit of courage from both yourself and the other person.
Motivational Interviewing is a powerful approach to helping people change. It starts by engaging the person through reflective listening, then focusing the conversation. It then consists of evoking their reasons for change and collaboratively planning for the change.
The acronym RULE can summarize motivational interviewing:
Resist the righting-reflex: Avoid trying to correct them or convince them.
Understand their motivation: Seek to understand their values, needs, and abilities.
Listen with empathy: Listen to their motives and potential barriers.
Empower them: Collaborate with them to build a realistic plan.
Reflective listening is a major aspect of motivational interviewing, so gaining comfort with this skill is one of the best things you can do to help sharpen your abilities. Below, you will find a list of resources focused on helping you delve deeper into the practice of motivational interviewing.
If you are curious about the psychological processes behind motivational interviewing, check out my article, “How Does Motivational Interviewing Work?” where I break down the various aspects of intrinsic motivation in plain language.
For free video demonstrations on how to do Motivational Interviewing, check out these great online modules by the British Medical Journal, here. I highly recommend it!
For the most comprehensive overview of Motivational Interviewing, by the founders themselves, check out the following book: Motivational Interviewing: Helping People Change.
If you are interested in Motivational interviewing training and events, check out the Motivational Interviewing Network of Trainers.
Lastly, if you want to connect with others interested in motivational interviewing, you can check out the Motivational Interviewing Practice Community on Facebook.