Motivational Interviewing Vocab

Question 1

Ability

Answer 1

Ability—A form of client preparatory change talk that reflects perceived personal capability of making a
change; typical words include can, could, and able.

Question 2

Absolute Worth

Answer 2

Absolute Worth—One of four aspects of acceptance as a component of MI spirit, prizing the inherent
value and potential of every human being.

Question 3

Acceptance

Answer 3

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.

Question 4

Accurate Empathy

Answer 4

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.

Question 5

Activation Language—

Answer 5

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.

Question 6

Affirmation

Answer 6

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.

Question 7

Affirming

Answer 7

Affirming—An interviewer statement valuing a positive client attribute or behavior.

Question 8

Agenda Mapping

Answer 8

Agenda Mapping—A short focusing metaconversation in which you step back with the client to choose
a direction from among several options.

Question 9

Agreement with a Twist

Answer 9

Agreement with a Twist—A reflection, affirmation, or accord followed by a reframe.

Question 10

Ambivalence

Answer 10

Ambivalence—The simultaneous presence of competing motivations for and against change.

Question 11

Amplified Reflection

Answer 11

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.

Question 12

Apologizing

Answer 12

Apologizing—A way of responding to discord by taking partial responsibility.

Question 13

Assessment Feedback

Answer 13

Assessment Feedback—Providing a client with personal feedback of findings from an evaluation, often
in relation to normative ranges; see Motivational Enhancement Therapy.

Question 14

Assessment Trap

Answer 14

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.

Question 15

Autonomy Support

Answer 15

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.

Question 16

Blaming Trap

Answer 16

Blaming Trap—The clinical error of focusing on blame or fault-finding rather than change.

Question 17

Bouquet

Answer 17

Bouquet—A particular kind of summary that collects and emphasizes the client’s change talk.

Question 18

Brainstorming

Answer 18

Brainstorming—Generating options without initially critiquing them.

Question 19

CATs

Answer 19

CATs—An acronym for three subtypes of client mobilizing change talk: Commitment, Activation, and
Taking Steps.

Question 20

Change Goal

Answer 20

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.

Question 21

Change Plan

Answer 21

Change Plan—A specific scheme to implement a change goal.

Question 22

Change Ruler

Answer 22

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.

Question 23

Change Talk

Answer 23

Change Talk—Any client speech that favors movement toward a particular change goal.

Question 24

Chat Trap

Answer 24

Chat Trap—The

Question 25

Client-centered Counseling

Answer 25

Client-centered Counseling—See Person-centered Counseling.

Question 26

Closed Question

Answer 26

Closed Question—A question that asks for yes/no, a short answer, or specific information.

Question 27

Coaching

Answer 27

Coaching—The process of helping someone to acquire skill.

Question 28

Collaboration

Answer 28

Collaboration—See Partnership.

Question 29

Collecting Summary

Answer 29

Collecting Summary—A special form of reflection that pulls together a series of interrelated items that
the person has offered. See also Summary.

Question 30

Coming Alongside

Answer 30

Coming Alongside—A response to persistent sustain talk or discord in which the interviewer accepts
and reflects the client’s theme.

Question 31

Commitment Language

Answer 31

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.

Question 32

Compassion

Answer 32

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.

Question 33

Complex Reflection

Answer 33

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.

Question 34

Confidence Ruler

Answer 34

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.

Question 35

Confidence Talk

Answer 35

Confidence Talk—Change talk that particularly bespeaks ability to change.

Question 36

Confront

Answer 36

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.

Question 37

Continuing the Paragraph

Answer 37

Continuing the Paragraph—A

Question 38

DARN

Answer 38

DARN—An acronym for four subtypes of client preparatory change talk: Desire, Ability, Reason, and
Need.

Question 39

Decisional Balance

Answer 39

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.

Question 40

Depth of Reflection

Answer 40

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.

Question 41

Desire

Answer 41

Desire—A form of client preparatory change talk that reflects a preference for change; typical verbs
include want, wish, and like.

Question 42

Directing

Answer 42

Directing—A natural communication style that involves telling, leading, providing advice, information,
or instruction.

Question 43

Direction

Answer 43

Direction—The extent to which an interviewer maintains in-session momentum toward a change goal.

Question 44

Discord

Answer 44

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.

Question 45

Discrepancy

Answer 45

Discrepancy—The distance between the status quo and one or more client change goals.

Question 46

Docere

Answer 46

Docere—(Latin verb infinitive) To inform, in the sense of installing knowledge, wisdom, insight;
etymologic root of doctrine, indoctrinate, docent, and doctor.

Question 47

Double-Sided Reflection

Answer 47

Double-Sided Reflection—An interviewer reflection that includes both client sustain talk and change
talk, usually with the conjunction “and.”

Question 48

Ducere

Answer 48

Ducere—(Latin verb infinitive) To elicit or draw out; a Socratic approach; etymologic root of education
(e ducere); compare with Docere.

Question 49

Elaboration

Answer 49

Elaboration—An interviewer response to client change talk, asking for additional detail, clarification, or
example.

Question 50

Elicit–provide–elicit

Answer 50

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.

Question 51

Empathy

Answer 51

Empathy—The extent to which an interviewer communicates accurate understanding of the client’s
perspectives and experience; most commonly manifested as reflection.

Question 52

Emphasizing Personal Control

Answer 52

Emphasizing Personal Control—An interviewer statement directly expressing autonomy support,
acknowledging the client’s ability for choice and self-determination.

Question 53

Engaging

Answer 53

Engaging—The first of four fundamental processes in MI, the process of establishing a mutually
trusting and respectful helping relationship.

Question 54

Envisioning

Answer 54

Envisioning—Client speech that reflects the client imagining having made a change.

Question 55

Equipoise

Answer 55

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.

Question 56

Evocation

Answer 56

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.

Question 57

Evocative Questions

Answer 57

Evocative Questions—Strategic open questions the natural answer to which is change talk.

Question 58

Evoking

Answer 58

Evoking—The third of four fundamental processes of MI, which involves eliciting the person’s own
motivation for a particular change.

Question 59

Expert Trap

Answer 59

Expert Trap—The clinical error of assuming and communicating that the counselor has the best
answers to the client’s problems.

Question 60

Exploring Goals and Values

Answer 60

Exploring Goals and Values—A strategy for evoking change talk by having people describe their most
important life goals or values.

Question 61

Focusing

Answer 61

Focusing—The second of four fundamental processes of MI, which involves clarifying a particular goal
or direction for change.

Question 62

Following

Answer 62

Following—A natural communication style that involves listening to and following along with the
other’s experience without inserting one’s own material.

Question 63

Formulation

Answer 63

Formulation —Developing a shared picture or hypothesis regarding the client’s situation and how it
might be addressed.

Question 64

FRAMES

Answer 64

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.

Question 65

Goal Attainment Scaling

Answer 65

Goal Attainment Scaling—A method originally developed by Thomas Kiresuk for evaluating treatment
outcomes across a range of problem areas.

Question 66

Goldilocks Principle

Answer 66

Goldilocks Principle—In order to be motivating, a discrepancy should be not too large or too small.

Question 67

Guiding

Answer 67

Guiding—A natural communication style for helping others find their way, combining some elements of
both directing and following.

Question 68

Implementation Intention

Answer 68

Implementation Intention—A stated intention or commitment to take a specific action.

Question 69

Importance Ruler

Answer 69

Importance Ruler—A scale (typically 0–10) on which clients are asked to rate the importance of making
a particular change.

Question 70

Integrity

Answer 70

Integrity—To behave in a manner that is consistent with and fulfills one’s core values.

Question 71

Intrinsic Motivation

Answer 71

Intrinsic Motivation—The disposition and enactment of behavior for its consistency with personal goals
and values.

Question 72

Key Question

Answer 72

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.

Question 73

Labeling Trap

Answer 73

Labeling Trap—The clinical error of engaging in unproductive struggles to persuade clients to accept a
label or diagnosis.

Question 74

Lagom

Answer 74

Lagom—(Swedish) Just right; not too large, not too small. See also Goldilocks Principle.

Question 75

Linking Summary

Answer 75

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.

Question 76

Looking Back

Answer 76

Looking Back—A strategy for evoking client change talk, exploring a better time in the past.

Question 77

Looking Forward

Answer 77

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.

Question 78

Menschenbild

Answer 78

Menschenbild (German)—One’s fundamental view of human nature.

Question 79

MET

Answer 79

MET—An acronym for Motivational Enhancement Therapy.

Question 80

MIA–STEP

Answer 80

MIA–STEP—A package of training materials for MI supervisors, produced by the U.S. Center for
Substance Abuse Treatment.

Question 81

MINT

Answer 81

MINT—The Motivational Interviewing Network of Trainers, founded in 1997 and incorporated in
2008 (www.motivationalinterviewing.org).

Question 82

MISC

Answer 82

MISC—The Motivational Interviewing Skill Code, introduced by Miller and Mount as the first system
for coding client and interviewer utterances within motivational interviewing.

Question 83

MITI

Answer 83

MITI—The Motivational Interviewing Treatment Integrity coding system, simplified from the MISC
and focusing only on interviewer responses, to document fidelity in MI delivery.

Question 84

Mobilizing Change Talk

Answer 84

Mobilizing Change Talk—A subtype of client change talk that expresses or implies action to change;
examples are commitment, activation language, and taking steps.

Question 85

Motivational Enhancement Therapy (MET)

Answer 85

Motivational Enhancement Therapy (MET)—A combination of motivational interviewing with
assessment feedback, originally developed and tested in Project MATCH.

Question 86

Motivational Interviewing

Answer 86

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.

Question 87

Need

Answer 87

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.

Question 88

OARS

Answer 88

OARS—An acronym for four basic client-centered communication skills: Open question, Affirmation,
Reflection, and Summary.

Question 89

Open Question

Answer 89

Open Question—A question that offers the client broad latitude and choice in how to respond; compare
with Closed Question.

Question 90

Orienting

Answer 90

Orienting—The process of finding a direction for change when the focus of consultation is unclear. See
also Focusing.

Question 91

Overshooting

Answer 91

Overshooting—A reflection that adds intensity to the content or emotion expressed by a client. See also
Amplified Reflection.

Question 92

Partnership

Answer 92

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.

Question 93

Path Mapping

Answer 93

Path Mapping—The process of choosing a change plan when there are several possible routes toward
the goal.

Question 94

Permission

Answer 94

Permission—Obtaining by the interviewer of client assent before providing advice or information.

Question 95

Person-centered Counseling

Answer 95

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.

Question 96

Phase 1

Answer 96

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.

Question 97

Phase 2

Answer 97

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.

Question 98

Planning

Answer 98

Planning—The fourth fundamental process of MI, which involves developing a specific change plan that
the client is willing to implement.

Question 99

Prefacing

Answer 99

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.

Question 100

Premature Focus Trap

Answer 100

Premature Focus Trap—The clinical error of focusing before engaging, trying to direct before you have
established a working collaboration and negotiated common goals.

Question 101

Preparatory Change Talk

Answer 101

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.

Question 102

Q Sorting

Answer 102

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.”

Question 103

Querying Extremes

Answer 103

Querying Extremes—A strategy for evoking change talk by asking clients to imagine best consequences
of change or worst consequences of status quo.

Question 104

Question–Answer Trap

Answer 104

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.

Question 105

Reactance

Answer 105

Reactance—The natural human tendency to reassert one’s freedom when it appears to be threatened.

Question 106

Readiness Ruler

Answer 106

Readiness Ruler—See Change Ruler.

Question 107

Reason

Answer 107

Reason—A form of client preparatory change talk that describes a specific if–then motive for change.

Question 108

Recapitulation

Answer 108

Recapitulation—A bouquet summary offered at the transition from evoking to planning, drawing
together the client’s change talk.

Question 109

Reflective Listening

Answer 109

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.

Question 110

Reflection

Answer 110

Reflection—An interviewer statement intended to mirror meaning (explicit or implicit) of preceding
client speech. See also Simple Reflection, Complex Reflection.

Question 111

Reframe

Answer 111

Reframe—An interviewer statement that invites the client to consider a different interpretation of what
has been said.

Question 112

Resistance

Answer 112

Resistance—A term previously used in MI, now deconstructed into its components: sustain talk and
discord.

Question 113

Righting Reflex

Answer 113

Righting Reflex—The natural desire of helpers to set things right, to prevent harm and promote client
welfare.

Question 114

Running Head Start

Answer 114

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.”

Question 115

Self-Actualization

Answer 115

Self-Actualization—The pursuit and realization of one’s core values—becoming what one is meant to
be. See also Telos.

Question 116

Self-Disclosure

Answer 116

Self-Disclosure—Sharing something of oneself that is true when there is good reason to expect that it
will be helpful to the client.

Question 117

Self-Efficacy

Answer 117

Self-Efficacy—A client’s perceived ability to successfully achieve a particular goal or perform a
particular task; term introduced by Albert Bandura.

Question 118

Self-Esteem

Answer 118

Self-Esteem—A client’s general level of perceived worth.

Question 119

Self-Motivational Statement

Answer 119

Self-Motivational Statement—See Change Talk.

Question 120

Self-Regulation

Answer 120

Self-Regulation—The ability to develop a plan of one’s own and to implement behavior in order to carry
it out.

Question 121

Shifting Focus

Answer 121

Shifting Focus—A way of responding to discord by redirecting attention and discussion to a less
contentious topic or perspective.

Question 122

Simple Reflection

Answer 122

Simple Reflection—A reflection that contains little or no additional content beyond what the client has
said.

Question 123

Smoke Alarms

Answer 123

Smoke Alarms—Interpersonal signals of discord in the working alliance.

Question 124

Spirit

Answer 124

Spirit—The underlying set of mind and heart within which MI is practiced, including partnership,
acceptance, compassion, and evocation.

Question 125

Stages of Change

Answer 125

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.

Question 126

Status Quo

Answer 126

Status Quo—The current state of affairs without change.

Question 127

Summary

Answer 127

Summary—A reflection that draws together content from two or more prior client statements. See also
Collecting Summary, Linking Summary, Transitional Summary.

Question 128

Sustain Talk

Answer 128

Sustain Talk—Any client speech that favors status quo rather than movement toward a change goal.

Question 129

Taking Steps

Answer 129

Taking Steps—A form of client mobilizing change talk that describes an action or step already taken
toward change.

Question 130

Telos

Answer 130

Telos—(Greek) The natural, mature end state of an organism toward which it grows, given optimal
conditions.

Question 131

TNT

Answer 131

TNT—An acronym for a Training of New Trainers in motivational interviewing; begun in 1993.

Question 132

Transitional Summary

Answer 132

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.

Question 133

Transtheoretical Model

Answer 133

Transtheoretical Model—A complex model of change developed by James Prochaska and Carlo
DiClemente, one part of which describes stages of change.

Question 134

Undershooting

Answer 134

Undershooting—A reflection that diminishes or understates the intensity of the content or emotion
expressed by a client.

Question 135

Values

Answer 135

Values—A person’s core goals or standards that provide meaning and direction in life.

Question 136

Values Sorting

Answer 136

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.”

Question 137

Working Alliance

Answer 137

Working Alliance—The quality of the collaborative relationship between client and counselor, which
tends to predict client retention and outcome.

Question 138

ACCEPTANCE

Answer 138

to be accepted as I am

Question 139

ACCURACY

Answer 139

to be correct in my opinions and beliefs

Question 140

ACHIEVEMENT

Answer 140

to have important accomplishments

Question 141

ADVENTURE

Answer 141

to have new and exciting experiences

Question 142

ART

Answer 142

to appreciate or express myself in art

Question 143

ATTRACTIVENESS

Answer 143

to be physically attractive

Question 144

AUTHORITY

Answer 144

to be in charge of others

Question 145

AUTONOMY

Answer 145

to be self-determined and independent

Question 146

BEAUTY

Answer 146

to appreciate beauty around me

Question 147

BELONGING

Answer 147

to have a sense of belonging,

being part of

Question 148

CARING

Answer 148

to take care of others

Question 149

CHALLENGE

Answer 149

to take on difficult tasks and problems

Question 150

COMFORT

Answer 150

to have a pleasant and comfortable life

Question 151

COMMITMENT

Answer 151

to make enduring, meaningful

commitments

Question 152

COMPASSION

Answer 152

to feel and act on concern for others

Question 153

COMPLEXITY

Answer 153

to embrace the intricacies of life

Question 154

COMPROMISE

Answer 154

to be willing to give and take in

reaching agreements

Question 155

CONTRIBUTION

Answer 155

to make a lasting contribution

in the world

Question 156

COOPERATION

Answer 156

to work collaboratively with others

Question 157

COURAGE

Answer 157

to be brave and strong in the

face of adversity

Question 158

COURTESY

Answer 158

to be considerate and polite

toward others

Question 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.

Answer 159

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.

Question 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.

Answer 160

I - +Complex reflection (CR).

Question 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.

Answer 161

I - +CR

Question 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

Answer 162

I - +CR

Question 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.

Answer 163

I - +CR

Question 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.

Answer 164

C - Engagement is good so far, and he is
expressing change talk, but is exercise
the focus?

I - + CR of change talk.

Question 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.

Answer 165

C - Focus on exercise is confirmed, and he
starts with sustain talk.

I - +CR

Question 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?

Answer 166

C - Change talk and sustain talk together.

I - + Reflecting the change talk;
affirmation.
Asking for elaboration.

Question 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?

Answer 167

I - ? OQ, but asking for elaboration of
sustain talk. The expected result would
be more sustain talk.

Question 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.

Answer 168

C -Sustain talk.

I - –[MI-inconsistent] Offering information/
advice without permission.

Question 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.

Answer 169

C - More sustain talk.

I - +CR

Question 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. . . .

Answer 170

I - + CR Bringing the focus back.

Question 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.

Answer 171

I - + A good MI summary of change talk

offered thus far.

Question 172

28 C - Right. The pain is really slowing me down.

29 I - How much do you already know about exercise and aging?

Answer 172

I - + OQ, possible beginning of an elicit–provide–elicit sequence.

Question 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?

Answer 173

C - Change talk.

I - + Affirmation.
Closed question, but MI-consistent.

Question 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.

Answer 174

I - + CR that is a nice reframe of sustain

talk.

Question 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.

Answer 175

I - + CR Continuing the paragraph.

Question 176

36 C Right.

37 I So I asked you before what kinds of exercise you have tried.

Answer 176

I - + OQ.

Question 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?

Answer 177

I - + OQ.

Question 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?

Answer 178

Taking steps.
Sustain talk.

I - + Affirmation.
OQ.

Question 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.

Answer 179

I - +CR

Question 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.

Answer 180

C - Change talk (desire). “Dunlap disease”
is a southwestern joke: “My belly done
lapped over my belt.”

I - + Adding a focus.

Question 181

46 C - I’d look better.

47 I - What other advantages might there be for you to exercise
more?

Answer 181

C - Change talk (reason).

I - + OQ Shifting focus a bit to exercise.

Question 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.

Answer 182

C - Change talk (reason).

I - + CR.

Question 183

50 C - It runs in my family, and I’ve seen what can happen.

51 I - You know what can happen.

Answer 183

C - Change talk (reason).

I - + Simple reflection.

Question 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.

Answer 184

C - Change talk (reason).

I - + Reflection. Continuing the paragraph.

Question 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?

Answer 185

C - Change talk (reasons).

I - + OQ (elicit).

Question 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?

Answer 186

C - Change talk (reason) and giving
permission.

I - + Providing information with permission
followed by eliciting.

Question 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.

Answer 187

C - Change talk.

I - + Reflection linking to prior material.

Question 188

60 C - Yes, I guess so.

61 I - You guess so? Well is it or isn’t it?

Answer 188

I - –MI-inconsistent: Confront.

Question 189

62 C - Well mostly I came about my back.

63 I - You’re not really that concerned about the diabetes.

Answer 189

C - Backpedaling.

I - + Reflecting sustain talk (without any sarcasm).

Question 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.

Answer 190

C - Change talk.

I - + Simple reflection.

Question 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.

Answer 191

C - Change talk.

I - + CR Testing the water a bit on action
planning.

Question 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.

Answer 192

I - + Avoids the trap of making one

suggestion.

Question 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?

Answer 193

I - + Transitional summary.

Question 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?

Answer 194

I - + Summary of change talk.

Question 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.

Answer 195

I - + Continuing the summary of change

talk.

Question 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?

Answer 196

I - + Continuing the summary of change

talk.

Question 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.

Answer 197

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.

Question 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.

Answer 198

I - + Affirmation. Reframe.

Question 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.

Answer 199

I - + Apology. Reframe.

Question 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?

Answer 200

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.

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.

Answer 201

I - + Simple reflection.

Question 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.

Answer 202

I - +CR

Question 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.

Answer 203

I - +CR

Question 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.

Answer 204

I - +CR

Question 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.

Answer 205

I - –Advice without permission; not terribly off track, but now they must discuss the
interviewer’s idea.

Question 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?

Answer 206

C - Uh oh. Will the interviewer become the problem solver?

I - + The interviewer recovers with an open
question to elicit solutions from the
client.

Question 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?

Answer 207

I - + Affirm, OQ.

Question 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?

Answer 208

I - + OQ.

Question 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.

Answer 209

I - + Reflection, emphasizing choice.

Question 210

104 C - Yeah. That might work.

105 I - You’re not sure yet.

Answer 210

I - + Reflecting voice tone of ambivalence.

Question 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.

Answer 211

C - Mobilizing change talk: Activation.

I - + Summarizing a change plan.

Question 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?

Answer 212

C - Change talk (ability).

I - + Eliciting instead of giving information
he may already have.

Question 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.

Answer 213

C - Change talk (reasons).

I - +CR

Question 214

112 C - Maybe even lose some weight, too.

113 I - So are you going to do it or not?

Answer 214

C - Change talk (reason).

I - –[Definitely MI-inconsistent] Closed
question, and pressing for commitment
too quickly.

Question 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.

Answer 215

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.

Question 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?

Answer 216

I - + CR .
Continuing the change plan.

OQ, eliciting.

Question 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.

Answer 217

C - Mobilizing change talk.

I - + CR, with an implicit “What else?”

Question 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.

Answer 218

I - + CR.

Question 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.

Answer 219

I - +CR

Question 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?

Answer 220

I - + Importance ruler.

Question 221

126 C - Seven maybe, or eight.

127 I - Seven or eight. That’s pretty high! Why such a high number?

Answer 221

I - + OQ follow-up.

Question 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?

Answer 222

C - His own change talk summary.

I - + Confidence ruler.

Question 223

130 C -Ten.

131 I - Ten! My word! No doubt about it.

Answer 223

I - + CR.

Question 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.

Answer 224

I - + CR.

Question 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.

Answer 225

I - +CR

Question 226

Now what is your hunch?

Do you think that the interviewer should try now for a firm commitment? Why
or why not?

Answer 226

no answer given..guess you have to decide?