Motivational Interviewing Vocab Flashcards
1
Q
Ability
A
Ability—A form of client preparatory change talk that reflects perceived personal capability of making a
change; typical words include can, could, and able.
2
Q
Absolute Worth
A
Absolute Worth—One of four aspects of acceptance as a component of MI spirit, prizing the inherent
value and potential of every human being.
3
Q
Acceptance
A
Acceptance—One of four central components of the underlying spirit of MI by which the interviewer
communicates absolute worth, accurate empathy, affirmation, and autonomy support.
4
Q
Accurate Empathy
A
Accurate Empathy—The skill of perceiving and reflecting back another person’s meaning; one of four
aspects of acceptance as a component of MI spirit.
5
Q
Activation Language—
A
Activation Language—A form of client mobilizing change talk that expresses disposition toward action,
but falls short of commitment language; typical words include ready, willing, considering.
6
Q
Affirmation
A
Affirmation—One of four aspects of acceptance as a component of MI spirit, by which the counselor
accentuates the positive, seeking and acknowledging a person’s strengths and efforts.
7
Q
Affirming
A
Affirming—An interviewer statement valuing a positive client attribute or behavior.
8
Q
Agenda Mapping
A
Agenda Mapping—A short focusing metaconversation in which you step back with the client to choose
a direction from among several options.
9
Q
Agreement with a Twist
A
Agreement with a Twist—A reflection, affirmation, or accord followed by a reframe.
10
Q
Ambivalence
A
Ambivalence—The simultaneous presence of competing motivations for and against change.
11
Q
Amplified Reflection
A
Amplified Reflection—A response in which the interviewer reflects back the client’s content with greater
intensity than the client had expressed; one form of response to client sustain talk or discord.
12
Q
Apologizing
A
Apologizing—A way of responding to discord by taking partial responsibility.
13
Q
Assessment Feedback
A
Assessment Feedback—Providing a client with personal feedback of findings from an evaluation, often
in relation to normative ranges; see Motivational Enhancement Therapy.
14
Q
Assessment Trap
A
Assessment Trap—The clinical error of beginning consultation with expert information gathering at the
cost of not listening to the client’s concerns. See also Question–Answer Trap.
15
Q
Autonomy Support
A
Autonomy Support—One of four aspects of acceptance as a component of MI spirit, by which the
interviewer accepts and confirms the client’s irrevocable right to self-determination and choice.
16
Q
Blaming Trap
A
Blaming Trap—The clinical error of focusing on blame or fault-finding rather than change.
17
Q
Bouquet
A
Bouquet—A particular kind of summary that collects and emphasizes the client’s change talk.
18
Q
Brainstorming
A
Brainstorming—Generating options without initially critiquing them.
19
Q
CATs
A
CATs—An acronym for three subtypes of client mobilizing change talk: Commitment, Activation, and
Taking Steps.
20
Q
Change Goal
A
Change Goal—A specific target for change in motivational interviewing; typically a particular behavior
change, although it may also be a broader goal (e.g., glycemic control) toward which there are
multiple avenues of approach.
21
Q
Change Plan
A
Change Plan—A specific scheme to implement a change goal.
22
Q
Change Ruler
A
Change Ruler—A rating scale, usually 0–10, used to assess a client’s motivation for a particular change;
see Confidence Ruler and Importance Ruler.
23
Q
Change Talk
A
Change Talk—Any client speech that favors movement toward a particular change goal.
24
Q
Chat Trap
A
Chat Trap—The
25
Client-centered Counseling
Client-centered Counseling—See Person-centered Counseling.
26
Closed Question
Closed Question—A question that asks for yes/no, a short answer, or specific information.
27
Coaching
Coaching—The process of helping someone to acquire skill.
28
Collaboration
Collaboration—See Partnership.
29
Collecting Summary
Collecting Summary—A special form of reflection that pulls together a series of interrelated items that
the person has offered. See also Summary.
30
Coming Alongside
Coming Alongside—A response to persistent sustain talk or discord in which the interviewer accepts
and reflects the client’s theme.
31
Commitment Language
Commitment Language—A form of client mobilizing change talk that reflects intention or disposition
to carry out change; common verbs include will, do, going to.
32
Compassion
Compassion—One of four central components of the underlying spirit of MI by which the interviewer
acts benevolently to promote the client’s welfare, giving priority to the client’s needs.
33
Complex Reflection
Complex Reflection—An interviewer reflection that adds additional or different meaning beyond what
the client has just said; a guess as to what the client may have meant.
34
Confidence Ruler
Confidence Ruler—A scale (typically 0–10) on which clients are asked to rate their level of confidence
in their ability to make a particular change.
35
Confidence Talk
Confidence Talk—Change talk that particularly bespeaks ability to change.
36
Confront
Confront—(1) as a goal: to come face to face with one’s current situation and experience; (2) as a
practice: an MI-inconsistent interviewer response such as warning, disagreeing, or arguing.
37
Continuing the Paragraph
Continuing the Paragraph—A
38
DARN
DARN—An acronym for four subtypes of client preparatory change talk: Desire, Ability, Reason, and
Need.
39
Decisional Balance
Decisional Balance—A choice-focused technique that can be used when counseling with neutrality,
devoting equal exploration to the pros and cons of change or of a specific plan.
40
Depth of Reflection
Depth of Reflection—The extent to which a reflection contains more than the literal content of what a
person has already said. See also Complex Reflection.
41
Desire
Desire—A form of client preparatory change talk that reflects a preference for change; typical verbs
include want, wish, and like.
42
Directing
Directing—A natural communication style that involves telling, leading, providing advice, information,
or instruction.
43
Direction
Direction—The extent to which an interviewer maintains in-session momentum toward a change goal.
44
Discord
Discord—Interpersonal behavior that reflects dissonance in the working relationship; sustain talk does
not in itself constitute discord; examples include arguing, interrupting, discounting, or ignoring.
45
Discrepancy
Discrepancy—The distance between the status quo and one or more client change goals.
46
Docere
Docere—(Latin verb infinitive) To inform, in the sense of installing knowledge, wisdom, insight;
etymologic root of doctrine, indoctrinate, docent, and doctor.
47
Double-Sided Reflection
Double-Sided Reflection—An interviewer reflection that includes both client sustain talk and change
talk, usually with the conjunction “and.”
48
Ducere
Ducere—(Latin verb infinitive) To elicit or draw out; a Socratic approach; etymologic root of education
(e ducere); compare with Docere.
49
Elaboration
Elaboration—An interviewer response to client change talk, asking for additional detail, clarification, or
example.
50
Elicit–provide–elicit
Elicit–provide–elicit—An information exchange process that begins and ends with exploring the client’s
own experience to frame whatever information is being provided to the client.
51
Empathy
Empathy—The extent to which an interviewer communicates accurate understanding of the client’s
perspectives and experience; most commonly manifested as reflection.
52
Emphasizing Personal Control
Emphasizing Personal Control—An interviewer statement directly expressing autonomy support,
acknowledging the client’s ability for choice and self-determination.
53
Engaging
Engaging—The first of four fundamental processes in MI, the process of establishing a mutually
trusting and respectful helping relationship.
54
Envisioning
Envisioning—Client speech that reflects the client imagining having made a change.
55
Equipoise
Equipoise—The clinician’s decision to counsel with neutrality in a way that consciously avoids guiding a
client toward one particular choice or change and instead explores the available options equally.
56
Evocation
Evocation—One of four central components of the underlying spirit of MI by which the interviewer
elicits the client’s own perspectives and motivation. See also Ducere.
57
Evocative Questions
Evocative Questions—Strategic open questions the natural answer to which is change talk.
58
Evoking
Evoking—The third of four fundamental processes of MI, which involves eliciting the person’s own
motivation for a particular change.
59
Expert Trap
Expert Trap—The clinical error of assuming and communicating that the counselor has the best
answers to the client’s problems.
60
Exploring Goals and Values
Exploring Goals and Values—A strategy for evoking change talk by having people describe their most
important life goals or values.
61
Focusing
Focusing—The second of four fundamental processes of MI, which involves clarifying a particular goal
or direction for change.
62
Following
Following—A natural communication style that involves listening to and following along with the
other’s experience without inserting one’s own material.
63
Formulation
Formulation —Developing a shared picture or hypothesis regarding the client’s situation and how it
might be addressed.
64
FRAMES
FRAMES—An acronym summarizing six components commonly found in effective brief interventions
for alcohol problems: Feedback, Responsibility, Advice, Menu of options, Empathy, and Self-
efficacy.
65
Goal Attainment Scaling
Goal Attainment Scaling—A method originally developed by Thomas Kiresuk for evaluating treatment
outcomes across a range of problem areas.
66
Goldilocks Principle
Goldilocks Principle—In order to be motivating, a discrepancy should be not too large or too small.
67
Guiding
Guiding—A natural communication style for helping others find their way, combining some elements of
both directing and following.
68
Implementation Intention
Implementation Intention—A stated intention or commitment to take a specific action.
69
Importance Ruler
Importance Ruler—A scale (typically 0–10) on which clients are asked to rate the importance of making
a particular change.
70
Integrity
Integrity—To behave in a manner that is consistent with and fulfills one’s core values.
71
Intrinsic Motivation
Intrinsic Motivation—The disposition and enactment of behavior for its consistency with personal goals
and values.
72
Key Question
Key Question—A particular form of question offered after a recapitulation at the transition from
evoking to planning, that seeks to elicit mobilizing change talk.
73
Labeling Trap
Labeling Trap—The clinical error of engaging in unproductive struggles to persuade clients to accept a
label or diagnosis.
74
Lagom
Lagom—(Swedish) Just right; not too large, not too small. See also Goldilocks Principle.
75
Linking Summary
Linking Summary—A special form of reflection that connects what the person has just said with
something you remember from prior conversation. See also Summary.
76
Looking Back
Looking Back—A strategy for evoking client change talk, exploring a better time in the past.
77
Looking Forward
Looking Forward—A strategy for evoking client change talk, exploring a possible better future that the
client hopes for or imagines, or anticipating the future consequences of not changing.
78
Menschenbild
Menschenbild (German)—One’s fundamental view of human nature.
79
MET
MET—An acronym for Motivational Enhancement Therapy.
80
MIA–STEP
MIA–STEP—A package of training materials for MI supervisors, produced by the U.S. Center for
Substance Abuse Treatment.
81
MINT
MINT—The Motivational Interviewing Network of Trainers, founded in 1997 and incorporated in
2008 (www.motivationalinterviewing.org).
82
MISC
MISC—The Motivational Interviewing Skill Code, introduced by Miller and Mount as the first system
for coding client and interviewer utterances within motivational interviewing.
83
MITI
MITI—The Motivational Interviewing Treatment Integrity coding system, simplified from the MISC
and focusing only on interviewer responses, to document fidelity in MI delivery.
84
Mobilizing Change Talk
Mobilizing Change Talk—A subtype of client change talk that expresses or implies action to change;
examples are commitment, activation language, and taking steps.
85
Motivational Enhancement Therapy (MET)
Motivational Enhancement Therapy (MET)—A combination of motivational interviewing with
assessment feedback, originally developed and tested in Project MATCH.
86
Motivational Interviewing
Motivational Interviewing—
• Lay definition: A collaborative conversation style for strengthening a person’s own motivation and
commitment to change.
• Clinical definition: A person-centered counseling style for addressing the common problem of
ambivalence about change.
• Technical definition: A collaborative, goal-oriented style of communication with particular
attention to the language of change, 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.
87
Need
Need—A form of client preparatory change talk that expresses an imperative for change without
specifying a particular reason. Common verbs include need, have to, got to, must.
88
OARS
OARS—An acronym for four basic client-centered communication skills: Open question, Affirmation,
Reflection, and Summary.
89
Open Question
Open Question—A question that offers the client broad latitude and choice in how to respond; compare
with Closed Question.
90
Orienting
Orienting—The process of finding a direction for change when the focus of consultation is unclear. See
also Focusing.
91
Overshooting
Overshooting—A reflection that adds intensity to the content or emotion expressed by a client. See also
Amplified Reflection.
92
Partnership
Partnership—One of four central components of the underlying spirit of MI by which the interviewer
functions as a partner or companion, collaborating with the client’s own expertise.
93
Path Mapping
Path Mapping—The process of choosing a change plan when there are several possible routes toward
the goal.
94
Permission
Permission—Obtaining by the interviewer of client assent before providing advice or information.
95
Person-centered Counseling
Person-centered Counseling—A therapeutic approach introduced by psychologist Carl Rogers in which
people explore their own experience within a supportive, empathic, and accepting relationship; also
called client-centered counseling.
96
Phase 1
Phase 1—A term used in prior editions of Motivational Interviewing to describe the earlier “uphill”
period of engaging, guiding, and evoking, in which the general goal is to elicit and strengthen client
motivation for change.
97
Phase 2
Phase 2—A term used in prior editions of Motivational Interviewing to describe the latter “downhill”
period of planning in which the general goal is to elicit and strengthen commitment to a change
goal and to negotiate a specific change plan.
98
Planning
Planning—The fourth fundamental process of MI, which involves developing a specific change plan that
the client is willing to implement.
99
Prefacing
Prefacing—A specific form of permission in which the interviewer does not directly ask the client’s leave
to provide information or advice, but instead precedes it with an autonomy support statement.
100
Premature Focus Trap
Premature Focus Trap—The clinical error of focusing before engaging, trying to direct before you have
established a working collaboration and negotiated common goals.
101
Preparatory Change Talk
Preparatory Change Talk—A subtype of client change talk that expresses motivations for change
without stating or implying specific intent or commitment to do it; examples are desire, ability,
reason, and need.
102
Q Sorting
Q Sorting—A technique developed by William Stephenson, a colleague of Carl Rogers, in which a
person sorts cards describing attributes into piles ranging from “not like me” to “very much like
me.”
103
Querying Extremes
Querying Extremes—A strategy for evoking change talk by asking clients to imagine best consequences
of change or worst consequences of status quo.
104
Question–Answer Trap
Question–Answer Trap —The clinical error of asking too many questions, leaving the client in the
passive role of answering them. See also Assessment Trap.
105
Reactance
Reactance—The natural human tendency to reassert one’s freedom when it appears to be threatened.
106
Readiness Ruler
Readiness Ruler—See Change Ruler.
107
Reason
Reason—A form of client preparatory change talk that describes a specific if–then motive for change.
108
Recapitulation
Recapitulation—A bouquet summary offered at the transition from evoking to planning, drawing
together the client’s change talk.
109
Reflective Listening
Reflective Listening—The skill of “active” listening whereby the counselor seeks to understand the
client’s subjective experience, offering reflections as guesses about the person’s meaning. See also
Accurate Empathy.
110
Reflection
Reflection—An interviewer statement intended to mirror meaning (explicit or implicit) of preceding
client speech. See also Simple Reflection, Complex Reflection.
111
Reframe
Reframe—An interviewer statement that invites the client to consider a different interpretation of what
has been said.
112
Resistance
Resistance—A term previously used in MI, now deconstructed into its components: sustain talk and
discord.
113
Righting Reflex
Righting Reflex—The natural desire of helpers to set things right, to prevent harm and promote client
welfare.
114
Running Head Start
Running Head Start—A strategy for eliciting client change talk in which the interviewer first explores
perceived “good things” about the status quo, in order to then query the “not-so-good things.”
115
Self-Actualization
Self-Actualization—The pursuit and realization of one’s core values—becoming what one is meant to
be. See also Telos.
116
Self-Disclosure
Self-Disclosure—Sharing something of oneself that is true when there is good reason to expect that it
will be helpful to the client.
117
Self-Efficacy
Self-Efficacy—A client’s perceived ability to successfully achieve a particular goal or perform a
particular task; term introduced by Albert Bandura.
118
Self-Esteem
Self-Esteem—A client’s general level of perceived worth.
119
Self-Motivational Statement
Self-Motivational Statement—See Change Talk.
120
Self-Regulation
Self-Regulation—The ability to develop a plan of one’s own and to implement behavior in order to carry
it out.
121
Shifting Focus
Shifting Focus—A way of responding to discord by redirecting attention and discussion to a less
contentious topic or perspective.
122
Simple Reflection
Simple Reflection—A reflection that contains little or no additional content beyond what the client has
said.
123
Smoke Alarms
Smoke Alarms—Interpersonal signals of discord in the working alliance.
124
Spirit
Spirit—The underlying set of mind and heart within which MI is practiced, including partnership,
acceptance, compassion, and evocation.
125
Stages of Change
Stages of Change—Within the transtheoretical model of change, a sequence of steps through which
people pass in the change process: precontemplation, contemplation, preparation, action, and
maintenance.
126
Status Quo
Status Quo—The current state of affairs without change.
127
Summary
Summary—A reflection that draws together content from two or more prior client statements. See also
Collecting Summary, Linking Summary, Transitional Summary.
128
Sustain Talk
Sustain Talk—Any client speech that favors status quo rather than movement toward a change goal.
129
Taking Steps
Taking Steps—A form of client mobilizing change talk that describes an action or step already taken
toward change.
130
Telos
Telos—(Greek) The natural, mature end state of an organism toward which it grows, given optimal
conditions.
131
TNT
TNT—An acronym for a Training of New Trainers in motivational interviewing; begun in 1993.
132
Transitional Summary
Transitional Summary—A special form of reflection to wrap up a task or session by pulling together
what seems important and signal a shift to something new.
133
Transtheoretical Model
Transtheoretical Model—A complex model of change developed by James Prochaska and Carlo
DiClemente, one part of which describes stages of change.
134
Undershooting
Undershooting—A reflection that diminishes or understates the intensity of the content or emotion
expressed by a client.
135
Values
Values—A person’s core goals or standards that provide meaning and direction in life.
136
Values Sorting
Values Sorting—A technique used by Milton Rokeach and others, in which a person gives priority
rankings to various values, for example, by sorting cards into piles ranging from “not at all
important” to “most important.”
137
Working Alliance
Working Alliance—The quality of the collaborative relationship between client and counselor, which
tends to predict client retention and outcome.
138
ACCEPTANCE
to be accepted as I am
139
ACCURACY
to be correct in my opinions and beliefs
140
ACHIEVEMENT
to have important accomplishments
141
ADVENTURE
to have new and exciting experiences
142
ART
to appreciate or express myself in art
143
ATTRACTIVENESS
to be physically attractive
144
AUTHORITY
to be in charge of others
145
AUTONOMY
to be self-determined and independent
146
BEAUTY
to appreciate beauty around me
147
BELONGING
to have a sense of belonging,
| being part of
148
CARING
to take care of others
149
CHALLENGE
to take on difficult tasks and problems
150
COMFORT
to have a pleasant and comfortable life
151
COMMITMENT
to make enduring, meaningful
| commitments
152
COMPASSION
to feel and act on concern for others
153
COMPLEXITY
to embrace the intricacies of life
154
COMPROMISE
to be willing to give and take in
| reaching agreements
155
CONTRIBUTION
to make a lasting contribution
| in the world
156
COOPERATION
to work collaboratively with others
157
COURAGE
to be brave and strong in the
| face of adversity
158
COURTESY
to be considerate and polite
| toward others
159
1 I -Tell me what brings you to the clinic.
2 C -My doctor said I should see you because I’ve been having
some back trouble, pain in my lower back. Sometimes it’s
hard to get out of bed in the morning.
3 I - It hurts that much.
I - + An open question (OQ)
C - A possible focus (pain management)
with change talk about pain reduction
(“having . . . trouble . . . hard to get out
of bed”).
I - + Reflecting change talk. The engaging
process usually involves open questions
and good listening.
160
4 C - Yes, it’s always worse in the morning. I get up anyhow,
but it takes me a while to straighten up. And I get these
shooting pains down my leg.
5 I - And still you get on with your day.
I - +Complex reflection (CR).
161
6 C -Yes, and that’s not easy. My whole life has changed, and
the tablets from the doctor don’t really help, and he doesn’t
want to give me stronger ones.
7 I - Sometimes you must wonder when you will ever feel better.
I - +CR
162
8 C-Exactly, it’s been going on for a few years now, and I
sometimes just burst into tear with the pain.
9 I - It gets that bad
I - +CR
163
10 C - And I can’t keep taking time off work, so I have to keep
going, and it only seems to get worse.
11 I - Like it’s taking over your life.
I - +CR
164
12 C -That’s exactly right, and I can’t keep going like this. I’m not
that old.
13 I - Something’s got to change for you.
C - Engagement is good so far, and he is
expressing change talk, but is exercise
the focus?
I - + CR of change talk.
165
14 C - Yes, so he referred me to you for help with exercise, but I
just hate exercising. It’s so incredibly boring and I get out of
breath quickly.
15 I - Exercise seems like a waste of time.
C - Focus on exercise is confirmed, and he
starts with sustain talk.
I - +CR
166
16 C - Not exactly. I mean, I can see that it’s an investment in my
own health, but I get so bored just exercising. I can’t stand
it. Besides, it hurts.
17 I - An investment in your health—yes! That’s a good way to
look at it. What kinds of exercise have you tried?
C - Change talk and sustain talk together.
I - + Reflecting the change talk;
affirmation.
Asking for elaboration.
167
18 C - I never go to a gym—weight lifting or anything like that. I
feel too self-conscious.
19 I - Why do you feel self-conscious?
I - ? OQ, but asking for elaboration of
sustain talk. The expected result would
be more sustain talk.
168
20 C - There would be all these superbuffed people working out
there. I’d feel like a loser.
21 I - There are some gyms that are designed for older people.
C -Sustain talk.
I - –[MI-inconsistent] Offering information/
advice without permission.
169
22 C - I just don’t like to exercise around other people. More sustain talk.
23 I - It’s the comparison that feels so uncomfortable—being
unfit.
C - More sustain talk.
I - +CR
170
24 C - Yeah. I’ve put on some weight here in the belly, and I don’t
look good in spandex!
25 I - And the back pain is keeping you from doing things you
enjoy. . . .
I - + CR Bringing the focus back.
171
26 C - (interrupting) Dancing, too. I used to like going dancing.
27 I - The pain limits you in doing things you enjoy like dancing.
You notice you’re getting out of breath more quickly, and
sometimes you feel self-conscious about being out of shape.
You’re also concerned about being restricted or disabled,
both now and as you getting older.
I - + A good MI summary of change talk
| offered thus far.
172
28 C - Right. The pain is really slowing me down.
29 I - How much do you already know about exercise and aging?
I - + OQ, possible beginning of an elicit–provide–elicit sequence.
173
30 C - I’ve heard that you lose muscle mass as you age if you don’t
do something to prevent it.
31 I - Yes, you’re right about that.
Do you know how to prevent it?
C - Change talk.
I - + Affirmation.
Closed question, but MI-consistent.
174
32 C - Use it or lose it, I guess. But what’s the good of living a few months longer if you’ve spent them exercising?
33 I - It’s the quality of life that matters to you.
I - + CR that is a nice reframe of sustain
| talk.
175
34 C - Yes. I mean, I’d like to live to a nice ripe old age, too, but
only if I’m healthy and able to do things.
35 I - With whatever amount of time you have, long or short.
I - + CR Continuing the paragraph.
176
36 C Right.
37 I So I asked you before what kinds of exercise you have tried.
I - + OQ.
177
38 C - I used to run some. People say that if you run long enough
you get this kind of high that keeps you going. Never
happened. I promised myself once to run every single day
for a year at a track nearby. I did it, and I hated every single
day of it.
39 I - What else have you tried?
I - + OQ.
178
40 C - I bought a stationary bicycle from a friend earlier this year,
and like I said it just bores me to death.
41 I - You bought an exercise bicycle for your home! Good for
you. What else?
Taking steps.
Sustain talk.
I - + Affirmation.
OQ.
179
42 C - That’s about it, I guess. I used to do some sit-ups sometimes
to tighten up my belly, but I can’t now.
43 I - You’re pretty self-conscious about your stomach.
I - +CR
180
44 C - Yeah, I don’t want Dunlap disease. (Laughs.)
45 I - So that’s another change you might like—to tighten up your
stomach muscles.
C - Change talk (desire). “Dunlap disease”
is a southwestern joke: “My belly done
lapped over my belt.”
I - + Adding a focus.
181
46 C - I’d look better.
47 I - What other advantages might there be for you to exercise
more?
C - Change talk (reason).
I - + OQ Shifting focus a bit to exercise.
182
48 C - My doctor told me that I have borderline diabetes, and
losing some weight would help with that.
49 I - Oh! So that’s another consideration—you don’t want to
wind up with diabetes.
C - Change talk (reason).
I - + CR.
183
50 C - It runs in my family, and I’ve seen what can happen.
51 I - You know what can happen.
C - Change talk (reason).
I - + Simple reflection.
184
52 C - My grandmother had to take insulin every day, and she
died from complications of diabetes. She was also going
blind.
53 I And you don’t want that to happen to you.
C - Change talk (reason).
I - + Reflection. Continuing the paragraph.
185
54 C - No, I don’t. I like to read, go to movies, see my family.
55 I - What else do you know can happen with diabetes?
C - Change talk (reasons).
I - + OQ (elicit).
186
56 C - I’ve heard you can lose your toes or your feet. Is that right?
57 I Yes, high blood sugar makes your blood thicker, and that
interferes with circulation. Over time it can affect your
hands and feet, and your eyes, as you said. What would
that mean for you?
C - Change talk (reason) and giving
permission.
I - + Providing information with permission
followed by eliciting.
187
58 C - Well like I said, I don’t want to be disabled.
59 I - That’s a big theme for you—to stay healthy and able to do
what you enjoy doing. That’s one reason you came here.
C - Change talk.
I - + Reflection linking to prior material.
188
60 C - Yes, I guess so.
61 I - You guess so? Well is it or isn’t it?
I - –MI-inconsistent: Confront.
189
62 C - Well mostly I came about my back.
63 I - You’re not really that concerned about the diabetes.
C - Backpedaling.
I - + Reflecting sustain talk (without any sarcasm).
190
64 C - Oh, I am. I was kind of surprised when the doctor told me
I’m getting it, and I should lose some weight.
65 I - That surprised you.
C - Change talk.
I - + Simple reflection.
191
66 C - It did. I think of myself as a pretty healthy person, and I
want to stay that way as long as I can.
67 I - And you know that there’s something you can do about
that—like you said about not losing muscle mass. What you do makes a difference in staying healthy.
C - Change talk.
I - + CR Testing the water a bit on action
planning.
192
68 C - Yes. So what do you think I should do?
69 I - I can certainly suggest some options, and together we can
figure out what might work best for you—what would fit
into your life and get you the results you want.
I - + Avoids the trap of making one
| suggestion.
193
70 C - That sounds good.
71 I - Let me just take a minute to make sure I understand what
you want, and then we can talk about options. OK?
I - + Transitional summary.
194
72 C - All right.
73 I The first thing you mentioned, what was bothering you
most, is your lower back pain that particularly slows you
down in the morning. The pain and getting out of breath
has been keeping you from doing things that you enjoy, like dancing. You wish we could just wave a magic wand and make it go away, and you also suspect that exercising more
could help. So far so good?
I - + Summary of change talk.
195
74 C - Yes.
75 I - OK. A big motivation for you is that you don’t want to become disabled as you age. You know about “use it or lose it” and you don’t want to lose it. Then there is also
this concern about diabetes, and you think there are things you could do to keep from developing it, or at least slow it down.
I - + Continuing the summary of change
| talk.
196
76 C - That’s what the doctor told me.
77 I - And that’s right, you can. So the theme that seems to run through all this is that you want to be as healthy as you
can. You know that doesn’t happen automatically, but there are things you can do to keep yourself more healthy and strong. Not only the length, but the quality of your life is
important to you. Did I miss anything?
I - + Continuing the summary of change
| talk.
197
78 C - That I don’t like exercising.
79 I - Right. That’s a real puzzle for you. You really detest
exercising, and you know that your health depends on what you do, and that’s part of why you’re here. You don’t like exercise, and you know it’s important. That’s where you’re stuck.
C - The client responds with a sustain talk
theme that is an important piece of the
puzzle.
I - + CR Double-sided reflections of
ambivalence with “and” in the middle,
placing the change talk last.
198
80 C - Well, I’m here.
81 I - Yes, you are! You’re warming up a bit to the idea of being more active. In fact, being able to stay active is one of the things you want.
I - + Affirmation. Reframe.
199
82 C - Right. It’s just so boring.
83 I - Yes—sorry, I forgot to mention that. You’ve told me several times now how boring exercise is for you sometimes. And at the same time maybe there are kinds of activity that you really enjoy. It’s just certain kinds of exercise that you hate.
I - + Apology. Reframe.
200
84 C - Uh huh. If I enjoyed it, it would be easier to do.
85 I - One key for you, then, is to find forms of exercise or
activity that you enjoy doing and that will also help you
manage your pain, maybe lose some weight, and decrease
your insulin resistance. So what do you think might make physical activity less boring and more enjoyable for you?
```
I - + Summary and OQ.
The interviewer is doing well with
reflection, but is starting to talk more
than the client. It’s time to change the
balance, and the interviewer does it with
an open question.
```
201
86 C - When I’m doing it with someone, like dancing, that’s more
fun, especially if it’s someone I like being with.
87 I - Having a friend along.
I - + Simple reflection.
202
88 C - Yeah—someone to talk to. But it doesn’t have to be with somebody else. I do like walking in the mountains by
myself. It’s peaceful and helps me relax.
89 I - That’s interesting. Sometimes activity is not boring.
I - +CR
203
90 C - In the mountains it’s not all the same. I see different things
along the way, hear sounds, feel the air. It’s not the same
every time.
91 I - It’s straight repetition that is dull. And you’re self-conscious
exercising around others, except maybe a friend.
I - +CR
204
92 C - I tried that bicycle at home, but it was so boring.
93 I - Just staying in the same place, with nothing else happening.
I - +CR
205
94 C - Right. Maybe I should get a mountain bike!
95 I - Or you could try doing something you enjoy while riding the stationary bike at home.
I - –Advice without permission; not terribly off track, but now they must discuss the
interviewer’s idea.
206
96 C - Like what?
97 I - It would have to be something that you watch or listen
to, I guess. What do you watch or listen to when you’re
relaxing?
C - Uh oh. Will the interviewer become the problem solver?
I - + The interviewer recovers with an open
question to elicit solutions from the
client.
207
98 C - I could listen to music. Or I can get reruns of TV programs
I like on my iPad.
99 I - That sounds like a good idea. How would you do it?
I - + Affirm, OQ.
208
100 C - The machine has like a music stand on it, and I can put the iPad on there, or the iPod just goes in my pocket.
101 I - So how would that work for you, to try bicycling while you enjoy reruns?
I - + OQ.
209
102 C - Or even new programs—they stream them now after the broadcast. You can get all kinds of things on line.
103 I - There’s a lot to choose from.
I - + Reflection, emphasizing choice.
210
104 C - Yeah. That might work.
105 I - You’re not sure yet.
I - + Reflecting voice tone of ambivalence.
211
106 C - Well, I like being outside more, but I could try it when the weather’s not good.
107 I - I see. When the sun’s shining you like to be outside, and you even had the idea of a mountain bike to keep your strength
and energy up. Then when that’s not convenient, you also
have the option of using your inside bicycle and watching
programs or listening to music you enjoy. It sounds like that could work for you.
C - Mobilizing change talk: Activation.
I - + Summarizing a change plan.
212
108 C - Yes, I think so.
109 I - And how do you think that might help you with the pain you’ve been having, or managing your blood sugar?
C - Change talk (ability).
I - + Eliciting instead of giving information
he may already have.
213
110 C - The doctor told me that being more active, getting more exercise can help with both of those.
111 I - Two for the price of one.
C - Change talk (reasons).
I - +CR
214
112 C - Maybe even lose some weight, too.
113 I - So are you going to do it or not?
C - Change talk (reason).
I - –[Definitely MI-inconsistent] Closed
question, and pressing for commitment
too quickly.
215
114 C - It sounds like a good idea.
115 I - Well, let me see if I understand you, then. Your doctor referred you because you’re having this lower back pain that
is slowing you down and preventing you from doing things
you like, and there is also this concern about developing
diabetes. You know that more regular exercise could help
you with both of those and also with keeping your weight
down. Since some kinds of activity are really boring for
you and you’re definitely not into going to a gym, you’ve been coming up with ways that you could get more exercise and also enjoy it. You already go walking in the mountains
sometimes, and you like that, and you’ve thought about
getting a mountain bike that could let you cover more
ground, see more scenery, and get a good workout. And you came up with a way that you could even use the stationary
bike at home and pass the time by watching programs you like.
C - Still preparatory, not mobilizing change talk.
I - + A recapitulation emphasizing the
change talk that he has offered . . .
and his own ideas for a change plan.
216
116 C - Without the commercials!
117 I - Right! You can get reruns with the commercial breaks
cut out. That gets an hour program down to about 45 or 50 minutes, which is good length of time to exercise. And
another idea you had was to be active with other people, with friends, like going dancing. So you have come up with some really good options. I suppose the challenge at this point is getting yourself to do these things. Given what you
know about yourself, what will it take?
I - + CR .
Continuing the change plan.
OQ, eliciting.
217
118 C - Well, I know if I call a friend and say let’s go dancing or walking or biking, I’m going to do it.
119 I - That’s one thing that would work for you.
C - Mobilizing change talk.
I - + CR, with an implicit “What else?”
218
120 C - And for me it’s deciding when I’m going to do it—like on what day and time.
121 I - If you schedule it, it’s more likely to happen.
I - + CR.
219
122 C - Yeah, otherwise I just have these good intentions, but never
get around to it.
123 I - So planning it for regular times and days of the week and
maybe including somebody else in the plan sometimes. That
would help you actually carry out your plan.
I - +CR
220
124 C - I think so.
125 I - Now let me ask you this. On a scale from 0 to 10, where 0
is not at all important, and 10 is extremely important, how important would you say it is for you to do this, to be more active?
I - + Importance ruler.
221
126 C - Seven maybe, or eight.
127 I - Seven or eight. That’s pretty high! Why such a high number?
I - + OQ follow-up.
222
128 C - This diabetes thing is bothering me, and I can also see that if I don’t do something different and take off some weight I’m just going to get more restricted and not be able to do things I enjoy.
129 I - OK. Now how about this? On that same 0 to 10 scale,
where 0 is not at all confident, and 10 is totally confident,
how confident are you that you can do this, increase your
activity, if you make up your mind to do it?
C - His own change talk summary.
I - + Confidence ruler.
223
130 C -Ten.
131 I - Ten! My word! No doubt about it.
I - + CR.
224
132 C - Nope.
133 I - So it’s really a matter of deciding that it’s important enough to do, and once you do that, it’s going to happen.
I - + CR.
225
134 C - That’s right. And it’s important.
135 I - You’re pretty close to making up your mind.
136 C - I am.
I - +CR
226
Now what is your hunch?
Do you think that the interviewer should try now for a firm commitment? Why
or why not?
no answer given..guess you have to decide?
