Motivational Interviewing: Techniques and Examples

Motivational interviewing (MI) is an evidence-based method for helping people change their behavior.

Motivational interviewing techniques aim to enhance a person’s motivation to change by exploring and resolving ambivalence.

Motivational interviewing has demonstrated significant success in behavior change. Research published in the “Motivational interviewing: a systematic review and meta-analysis” by the British Journal of General Practice found that psychologists and physicians achieved positive outcomes in 80% of studies using MI, highlighting its effectiveness when applied by trained professionals.

What is Motivational Interviewing?

Motivational interviewing (MI) is a counseling approach that helps people change behaviors by exploring and resolving ambivalence. It focuses on empathy, active listening, and guiding clients toward their own solutions.

Motivational interviewing is a collaborative conversation style aimed at strengthening a person’s motivation and commitment to change.

The Spirit of Motivational Interviewing

The spirit of motivational interviewing rests on four main pillars: 

• Collaboration involves working with clients as equals.
• Acceptance means respecting client autonomy and validating their experiences.
• Compassion drives a genuine desire to promote client wellbeing.
• Evocation focuses on drawing out clients’ own motivations for change.

In their 1995 article titled “What is Motivational Interviewing?” published in the Behavioural and Cognitive Psychotherapy journal, Rollnick and Miller emphasized that the foundational spirit of Motivational Interviewing is a key factor in its effectiveness. They highlighted that Motivational Interviewing is characterized primarily by its underlying spirit rather than specific techniques.

The spirit of motivational interviewing promotes client autonomy by emphasizing personal choice and control.

Practitioners avoid lecturing or pressuring clients. Instead, they ask open-ended questions and reflect on clients’ statements.

By honoring autonomy, motivational interviewing taps into clients’ intrinsic motivation. It avoids creating resistance. Clients feel heard and respected, which increases engagement in the change process.

What are the Benefits of Motivational Interviewing?

Benefits of Motivational Interviewing include:

• Enhances intrinsic motivation for change
• Improves client-practitioner relationship
• Resolves ambivalence about behavior change
• Adaptable to various settings and issues
• Time-efficient approach
• Empowers clients in their change process
• Promotes long-term success

Who Created Motivational Interviewing, and Where Did It Originate?

Motivational interviewing was developed in the 1980s by William R. Miller and Stephen Rollnick. Miller first described the approach in a 1983 article based on his experiences treating problem drinkers.

The method originated from Miller’s observations that empathetic counseling styles led to better outcomes. He noticed that pushing clients to change often increased resistance.

Rollnick joined Miller in the early 1990s to further develop and refine the approach. Together, they published the first textbook on motivational interviewing in 1991.

Since its inception, motivational interviewing has been applied to various fields beyond addiction treatment. It’s now used in healthcare, criminal justice, and education settings worldwide.

What Are Motivational Interviewing Techniques?

Motivational interviewing uses specific techniques to help people change their behaviors. These methods focus on exploring a person’s reasons for change and boosting their commitment to making positive shifts in their lives.

5 Principles of Motivational Interviewing

There are 5 Motivational interviewing techniques that guide its practice. These are 5 principles that shape how practitioners interact with clients to help them change behaviors.

The 5 main principles are:

1. Express Empathy

Expressing empathy involves actively understanding and validating the individual’s feelings and perspective to create a supportive and collaborative environment. It helps build trust, reduce defensiveness, and encourage open communication.

• How it works: Use reflective listening to acknowledge emotions, validate experiences, and show genuine understanding.
• Example: Client: “I just don’t think I have the energy to make these changes right now.”
  Practitioner: “It sounds like you’re feeling overwhelmed and unsure about where to start.”

2. Developing Discrepancy

This technique helps individuals recognize the gap between their current behavior and their personal goals or values. Highlighting this discrepancy can create internal motivation to change.

• How it works: Ask questions or reflect statements that help individuals explore how their actions align or conflict with their values.
• Example: “You mentioned that spending more time with your family is important to you. How do you feel your current schedule fits with that goal?”

3. Avoid Argumentation

Avoiding argumentation means steering clear of debates or trying to convince an individual to change. Instead, focus on maintaining a collaborative, respectful dialogue that encourages self-reflection and exploration of their ambivalence.

• How it works: Acknowledge the individual’s perspective without judgment, avoid pushing back, and use reflective listening to keep the conversation constructive.
• Example: Client: “There’s no point in trying. This is just how I am.”
  Practitioner: “It sounds like you’re feeling stuck and uncertain about whether change is possible. Can we talk about what’s worked for you in the past?”

4. Rolling with Resistance

Instead of confronting resistance directly, MI practitioners use a collaborative approach to explore and address it. This avoids power struggles and keeps the individual engaged.

• How it works: Reframe resistance as a signal to explore underlying concerns or ambivalence.
• Example: “It sounds like you’re feeling pressured to make this change. Can we talk more about what feels uncomfortable about it?”

5. Supporting Self-Efficacy

MI emphasizes the individual’s autonomy and control over their decisions. This reduces defensiveness and increases their sense of ownership over the change process.

• How it works: Explicitly acknowledge their right to choose and emphasize their role as the decision-maker.
• Example: “Ultimately, this is your decision. I’m here to support you in whatever direction you choose.”

OARS

Motivational Interviewing relies on 4 foundational techniques, collectively referred to as OARS, to facilitate meaningful conversations and encourage personal growth.  Each technique plays a critical role in helping practitioners engage clients, explore their motivations, and build a supportive environment for positive behavioral change.

1. Open-Ended Questions

Open-ended questions encourage individuals to explore their thoughts and feelings without restriction. Instead of yes-or-no answers, these questions invite deeper reflection.

• How it works: Ask questions that allow individuals to share their thoughts freely, encouraging deeper exploration of their motivations and challenges.
• Example: “What makes you feel ready to take the next step toward your goal?”

2. Affirmations

Affirmations acknowledge an individual’s strengths and efforts, helping to build their confidence and self-efficacy.

• How it works: Highlight specific positive traits, efforts, or accomplishments to reinforce their belief in their ability to change.
• Example: “You’ve taken a lot of initiative by seeking help. That’s a big step.”

3. Reflective Listening

Reflective listening involves paraphrasing or summarizing what the person has said, showing empathy and understanding. This helps clarify thoughts and demonstrates active listening.

• How it works: Repeat or rephrase what the individual has said, focusing on both their words and the emotions underlying them.
• Example: Client: “I want to change, but it feels overwhelming.”
  Practitioner: “It sounds like you’re ready to make a change but are unsure where to start.”

4. Summarizing

Summarizing ties together key points of a conversation, reinforcing the person’s motivations and goals.

• How it works: Reflect on the main points discussed, ensuring understanding and reinforcing progress or goals.
• Example: “So far, we’ve talked about your desire to quit smoking, the challenges you’ve faced, and how your health is motivating you. Did I capture that correctly?”

Complex Reflections

Complex reflections go beyond simple repetition. They add meaning to what clients say. This helps clients feel understood and explore their thoughts more deeply.

Types of complex reflections include:

Amplified Reflection

Amplified reflection restates the individual’s statement in a slightly exaggerated way to encourage further exploration or reconsideration.

• How it works: Reflect their words with added intensity, prompting clarification or deeper thought.
• Example: Client: “I don’t see how quitting smoking will make any difference in my life.”
  Practitioner: “So you believe quitting smoking wouldn’t help you at all.”

Double-Sided Reflection

This technique acknowledges the individual’s ambivalence by reflecting both sides of their perspective—the reasons for change and the reasons against it. It helps them see the conflict without feeling judged.

• How it works: Reflect both the sustain talk and the change talk in a single statement.
• Example: “On one hand, you feel stressed about managing your time. On the other hand, you’ve been thinking about how organizing your schedule could reduce that stress.”

Metaphor Reflections

Metaphor reflections use imagery to represent an individual’s thoughts or feelings, helping simplify complex emotions and encourage deeper reflection.

• How it works: Identify underlying themes and create a metaphor that resonates with the individual’s experience.
• Example: Client: “I feel like I’m carrying so much weight, and it’s impossible to keep going.”
  Practitioner: “It’s like you’re carrying a heavy backpack that’s hard to put down.”

Sustain Talk, Ambivalence, and Change Talk

What Is Sustain Talk?

Sustain talk refers to client statements that favor maintaining current behaviors rather than changing them. Understanding sustain talk helps practitioners guide clients towards positive change.

Sustain talk represents verbal expressions favoring the status quo in motivational interviewing. It includes reasons, desires, or commitments to continue a problematic behavior. For example, a client might say, “I enjoy drinking and don’t want to stop.”

Sustain talk is significant because it indicates resistance to change. It also helps practitioners gauge a client’s readiness to change.

Recognizing these statements allows practitioners to address barriers to change directly.

The goal is to get a client from sustain talk to change talk.

What Is Change Talk?

Change talk shows a person’s thoughts about making positive changes in their life. Change talk helps practitioners guide clients toward better choices.

Change talk is when a client talks about wanting to change. It can be words about desire, ability, reasons, or need to change. For example, “I want to quit smoking” or “I can exercise more.”

Change talk is important because it predicts real behavior change.

A 2010 study titled “The Route to Change,” published in the Journal of Substance Abuse Treatment, found that client change talk during alcohol-focused motivational interviews significantly increases the likelihood of committing to and completing a Change Plan.

This highlights the power of change talk in motivating individuals to take actionable steps toward positive change.

Practitioners try to get clients to use change talk often.

Types of change talk include:

• Desire: “I wish I could stop drinking.”
• Ability: “I could cut back if I tried.”
• Reasons: “My health would improve if I quit.”
• Need: “I have to make a change.”

How Does Change Talk Differ from Sustain Talk in Motivational Interviewing?

Change talk aims for positive change. Sustain talk, on the other hand, resists change. They are two separate things, not opposites. A person might say both in one session.

Change talk examples:

• “I want to eat healthier.”
• “I can save money by quitting smoking.”

Sustain talk examples:

• “I enjoy drinking too much to stop.”
• “Exercising is too hard for me.”

Pracitioners try to increase change talk and decrease sustain talk. They might ask questions to bring out more change talk. Or they might reflect back change talk to strengthen it. The goal is to tip the balance toward change.

What Is Ambivalence?

Ambivalence refers to having mixed feelings about changing a behavior. People often want to change but also have reasons to stay the same.

Ambivalence is normal when considering behavior change. Motivational interviewing (MI) explores ambivalence as a core part of the process. It recognizes that people usually have reasons both for and against changing.

For example, someone might want to quit smoking but worry about weight gain. Or they may wish to exercise more but fear it will be too hard. MI helps people talk through these conflicting feelings.

By focusing on ambivalence, MI avoids pushing for change too soon. This reduces defensiveness. Instead, it guides people to resolve their own mixed feelings about change.

What MI Techniques Address Sustain Talk and Ambivalence to Promote Change Talk?

Practitioners can use several techniques to address sustain talk:

1. Reflective listening: Pracitioners repeat or rephrase sustain talk to show understanding.
2. Exploring ambivalence: They help clients examine pros and cons of change.
3. Amplified reflection: Practitioners exaggerate sustain talk slightly to prompt reconsideration.
4. Shifting focus: They redirect conversations to more positive topics.
5. Open-Ended Questions: Open-ended questions encourage people to talk about their motivations.
6. Support autonomy: Support client’s autonomy to make their own choices.

Evoking change talk is crucial. Practitioners ask open-ended questions about reasons for change. They affirm client strengths and reinforce positive statements about change.

A 2018 study titled “Meta-Analysis of Motivational Interviewing Process: Technical, Relational, and Conditional Process Models of Change,” published in J Consult Clin Psychol. indicated that skilled use of MI techniques can shift the balance towards more change talk relative to sustain talk.

This increases the likelihood of successful behavior change.

Practical Steps for Implementing MI Techniques

Motivational interviewing follows four key steps, often referred to as the Four Processes of MI, to help people change. These processes work together as techniques to guide conversations and promote positive behavior change.

4 Processes of Motivational Interviewing

1. Engaging: Building Connection and Trust

Engaging is the process of establishing a collaborative and trusting relationship with the individual. It sets the foundation for meaningful and productive conversations.

• How it works: Use open-ended questions, reflective listening, and affirmations to create a safe and supportive environment where the individual feels heard and valued.
• Example:
  Practitioner: “What brought you here today? I’d love to hear more about what’s on your mind.”

2. Focusing: Identifying Direction and Goals

Focusing involves narrowing the conversation to a specific goal or area of change that is meaningful to the individual. This ensures the discussion is purposeful and relevant.

• How it works: Collaborate with the individual to clarify their priorities and explore what matters most to them. Reflect their goals to confirm understanding.
• Example:
  Practitioner: “It sounds like improving your energy levels is really important to you. Would you like to focus on that today?”

3. Evoking: Eliciting Motivation for Change

Evoking is the process of drawing out the individual’s own reasons, desires, and motivations for change. This is where change talk is actively encouraged and reinforced.

• How it works: Ask open-ended questions about values, hopes, and reasons for change. Use reflective listening to amplify change talk when it arises.
• Example:
  Practitioner: “What would be different in your life if you made this change?”

4. Planning: Turning Motivation Into Action

Planning involves helping the individual translate their motivation and goals into actionable steps. It solidifies commitment and lays out a clear path forward.

• How it works: Work collaboratively to set specific, achievable goals and address potential barriers. Summarize the plan to ensure clarity and agreement.
• Example:
  Practitioner: “What’s the first step you feel ready to take? Let’s figure out how to make that happen.”

How to Measure Success

Measuring success in motivational interviewing involves tracking client progress and using specific tools aligned with MI principles. Effective evaluation helps practitioners gauge the impact of their interventions and make necessary adjustments.

How Can Practitioners Track Progress and Success in MI?

Practitioners can track progress by measuring change talk during sessions. This involves counting positive statements about change made by clients. For example, a practitioner might tally phrases like “I want to quit smoking” or “I can cut back on drinking.”

Another method is to assess client engagement. This can be done by tracking attendance, participation in sessions, and completion of agreed-upon tasks between meetings. A simple rating scale (1-5) can be used to score engagement levels.

Outcome measures specific to the client’s goals are also crucial. For instance, if the goal is weight loss, regular weigh-ins can be used. For substance abuse, practitioners might track days of abstinence or reduced use.

What Tools and Metrics Align with MI Principles?

The Motivational Interviewing Treatment Integrity (MITI) scale is a widely used tool. It assesses practitioner adherence to MI principles and techniques. The scale evaluates factors such as empathy, collaboration, and evocation of change talk.

Client feedback tools like the Session Rating Scale (SRS) align well with MI’s collaborative approach. These brief questionnaires ask clients to rate the session’s effectiveness and their relationship with the practitioner.

The Readiness to Change Questionnaire measures a client’s stage of change. This aligns with MI’s focus on enhancing motivation. Practitioners can use it to track shifts in client readiness over time.

Quantitative measures, such as blood alcohol levels or nicotine metabolite tests, can provide objective data for substance use goals. These should be used in conjunction with client self-reports and other qualitative measures.

Conclusion

Motivational interviewing is a powerful tool for facilitating behavior change. It relies on key techniques and principles to help individuals find their own motivation for positive change.

The core techniques include expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy.

These skills help practitioners guide clients toward their own solutions. For example, open-ended questions encourage deeper reflection. Reflective listening demonstrates understanding and builds rapport.

MI principles emphasize collaboration over confrontation. This approach respects client autonomy and enhances motivation for change.

Apodaca and Longabaugh, in their 2009 study titled “Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidence,” indicated that practitioners’ behaviors that are inconsistent with Motivational Interviewing principles were associated with poorer treatment outcomes, reinforcing the need to adhere to MI techniques.