Key Concepts of Motivational Interviewing

Question 1

Motivational Interviewing

Answer 1

a collaborative conversation style for strengthening a person’s own motivation and commitment to change.

a way of helping people talk themselves into changing.

Motivational Interviewing (MI) is a way of talking with people about change related to things we often have mixed feelings about—exercise, diet, alcohol and other drug use, relationship issues, risky sexual behaviors, school- and job-related concerns, spiritual practices, certain attitudes, and other issues we face in our lives.

Question 2

Who started MI and why?

Answer 2

William R Miller, with problem drinkers. It explained how to talk with people about their alcohol and drug use in ways that respected their ability to decide for themselves whether they wanted to change. In the book, the authors described the spirit (core attitudes and beliefs) of this approach and the specific skills and strategies of MI.

Question 3

What is the mindset and heart-set of conversations that make a difference?

Answer 3

Partnership
Acceptance
Compassion
Evocation

Question 4

Conversations that make a difference - PACE, describe P

Answer 4

Partnership -
Collaborative style

Demonstrating genuine respect for the other person

Inviting and placing a premium on the other’s knowledge, experience and wisdom.

Sharing your own expertise when useful

Dancing rather than wrestling.

Question 5

Conversations that make a difference - PACE, describe A

Answer 5

Acceptance
Meeting people where they are at without judging

Seeking to understand the backstory and conveying genuine empathy
believing in others intrinsic values and worth

Believing in the other person
shining a light on strengths, not just deficits

Acknowledging and honoring people’s right to self determination

Question 6

What are the 4 processes the guide motivational conversations

Answer 6

Engaging - the process of establishing a mutually trusting and respectful 
 helping relationship
• Goes beyond informal chat
• Includes being welcoming
• avoids traps that promote disengagement

Focusing - clarifying a particular goal or direction for change
• Focus can arise from the individual, the external context, or the practitioner
• Three basic scenarios: 1) focus is already clear; 2) several options exist from which to choose; or 3) focus is unclear and there’s a need to explore
• Three styles of focusing: directing, following, guiding

Evoking - eliciting the person’s own motivation for a particular change
• Intended to help resolve ambivalence in the direction of change
• Emphasis on recognizing and evoking change talk
• Goal is to elicit preparatory and mobilizing change talk

Planning– developing a specific change plan that the person is willing to implement
• Includes looking for signals of readiness from the individual
• Developing a plan is not a final but a beginning step
• Implementation requires a specific plan and intention or commitment to carry it out

Question 7

What are Four Conversational Skills

Answer 7

OARS
Open - asking evocative questions
Affirming - affirming strengths
Reflective - offering reflective statements to convey empathy, highlight ambivalence, or shine a light on change talk
Summaries - providing summaries to clarify what has been said and draw ideas together

Question 8

Example questions to explore ambivalence and strengthen motivation

Answer 8

• Regarding this issue/dilemma, what’s okay about how things are now? … And what’s not okay? What concerns do you have?
• If you choose not to do anything about it, what would be at stake?
• If you were to make a change, what would be your reasons for doing so?
• Of the reasons you just gave, what would you consider to be your best reason?
• If you were to make this change, how would you go about it to be successful? (e.g., What do you think would work for you?)

• Looking at your life currently, how important or urgent is it for you to make this change?
For example, on a scale of 0–10 (0 = not at all important; 10 = totally important), where would you place yourself?
What makes it already a ___ and not a ___ (several numbers lower)?
What would it take to move from a ___ to a ___ (next higher number)?
How might I or others help you with that?

• If you did decide to make this change, how confident are you that you could be successful in doing so? (Scaling questions work well here too.)
• Who or what could be helpful to you in supporting this change?

• What, if anything, do you think you might do as a very next step to move towards this
change?

Question 9

Should you provide information and advice?

Answer 9

It’s ok to express concerns
There are many pathways to change; your way may not be the way of another
focus on helping the person evaluate options
Other information and advice, don’t impose it

Question 10

What is a method of providing information and advice?

Answer 10

Method: Elicit–Provide–Elicit 
• Elicit
◦ Ask what the person already knows
◦ Ask what the person would like to know
◦ Ask permission to provide information/advice

• Provide
◦ Prioritize what the person most wants to know
◦ Be clear; use everyday language
◦ Offer small amounts of information with time to reflect
◦ Acknowledge freedom to disagree or ignore

• Elicit
◦ Ask for person’s response, interpretation, understanding