Motivational Interviewing

Maxie Holman
 MI
Humanistic

Client-centered approach

Working to elicit a change in the clients behavior

Developed by William R. Miller and Stephen Rollnick in

early 1980s

Focuses on reframing resistance and resolving

ambivalence

Encouraging the client to believe that they will become

the primary change agent for their future
 Motivational Interviewing was initially designed as a
brief intervention for problem drinking, but more
recently this approach has been applied to a wide range
of clinical problems including substance abuse,
compulsive gambling, eating disorders, anxiety
disorders, depression, suicidality, chronic disease
management, and health behavior change practices (as
cited in Arkowitz & Miller, 2008; Arkowitz & Westra,
2009) (Corey, 2013, p.191)
 5 Stages of Change
Change is not a linear progression
Precontemplation Stage- the client has no intentions of changing their
behavior.
Counselor = nurturing parent

Contemplation Stage- When the client acknowledges a problem

behavior,. No plan for change, but are considering the idea.
Counselor = Socratic teacher

Preparation Stage- show small shifts toward change and have intent to
take action
Counselor = experienced coach
Action Stage- taking steps to modify their
behavior
Counselor = consultant

Maintenance Stage-the client has to

continue to focus on success and make
plans to avoid relapsing.
MI Spirit
Never depleting optimism

The counselor needs to help keep the client on track

towards change and tap into the clients intrinsic
motivation

Must be genuine not to diminish the partnership

created

Builds collaborative relationships - a partnership with

the client

Evoke autonomy- client to take ownership of behavior

5 Basic Principles
EE: Express Empathy DD: Develop Discrepancy

RR: Roll with Resistance SS: Support Self-Efficacy

CC: Commitments to Change

EE: Expressing Empathy
Outwardly show empathy for the client
No judgment

Unconditional positive feedback

Create an environment of acceptance

Use reflective listening

Normalize what the client is experiencing- reassuring them that

ambivalence is normal

Asking permission- by asking for permission before giving advice

or asking certain questions; this communicates respect for
clients. Also, clients are more likely to discuss changing when
asked, than when being lectured or being told to change (Sobell
& Sobell, 2008, p. 1).
DD: Developing Discrepancy
Work with the client to identify areas in which the client says
one thing but is taking action towards another
Acknowledge this difference and discusses ways in which to
align these two areas
Sometimes just getting clients to think about their behavior
in this challenging manner acts as an eye-opener, getting
clients to recognize they have not made changes (Sobell &
Sobell, 2008, p. 8).
Allows the client to present the arguments for change on
their own.
Listen for the self-motivational statements- the Change
Talk
RR: Rolling with Resistance
Resistance will arise during sessions

Although individuals may see the advantages to making life changes,

they also may have many concerns about changing (Corey, 2013, p. 192)

Arguments are counterproductive to the MI spirit

It is important that the counselor remembers that being defensive, breeds
defensiveness in the client.
Ineffective responses to resistance include arguing, disagreeing,
challenging, judging, criticizing, blaming and sarcasm.

Be wary of warning the client of negative consequences or seeking to

persuade with logic or evidence.
Clients may feel that the counselor is analyzing them, being
confrontational, or taking an authoritative role

Receiving resistance? then it is time to change strategies.

The MI spirit would advise the counselor to never meet resistance head-
on.
Asking for Permission
Advice or feedback can be helpful for the counselor to provide.

It is a tricky maneuver when doing this with the MI spirit,

because most people do not like being told what to do. Rather,
most individuals prefer being given choices in making decisions,
particularly changing behaviors (Sobell & Sobell, 2008, p. 6).

If the Client requests advise, then the counselor may offer it.
If advice is not requested, then the counselor must ask the client
for permission.

A possible way to lead into advice giving, is with questions that

allow clients to compare their behavior to that of others.
Then the counselor can ask if the client is interested in learning more
about the topic.
If not, roll with the resistance and change course.
If so, then the counselor should be prepared to provide the client
with relevant advice/ feedback /material available to the client.
SS: Support Self-Efficacy
Empower them to feel as though they can make a change in behavior
and that they have the control to do so.

Can be developed by looking back to past triumphs

Encouraging the client to repeat the successful steps they took.

Giving a voice to changes they have made can increase self-confidence

Embraces their ability to be the primary change maker in their own

lives.

Once clients believe that they have the capacity to change and heal,
new possibilities open up before them (Corey, 2013, p. 192)

A belief in the possibility of change is an important motivator for clients;

it can be like the self-fulfilling prophecy.
CC: Commitment to Change
Autonomy must be built- it is the client that is
responsible for choosing and carrying out personal
change

Help the client believe there is hope in reach and there

are alternatives available.

At this time therapist shift their focus to strengthening

clients commitments to change and helping them
implement a change plan (Corey, 2013, p. 193).
Use your OARS

OARS are the MI strategies

used during sessions.
Open-ended questions
Affirmations
Reflective listening
Summaries.
Open-Ended Questions
Allows for a richer / deeper conversation

This technique can help reduce a clients confusion and

increase clarity of thought or feeling about an issue or
topic.

If the counselor uses too many back-to-back close-

ended questions- Client may feel as though it is an
interrogation.
Affirmations
Affirmations are a way to positively reinforce the self-
motivational statements/ change talk, attempts to
change, or changed behaviors can boost the clients
self-esteem.

While affirmations help to increase clients confidence

in their ability to change, they also need to sound
genuine (Sobell & Sobell, 2008, p. 6) or the counseling
relationship may weaken.
Reflective listening
Carefully listen to what the client is saying, and then formulate the
meaning conveyed by the client

Next the counselor will reflect their understanding of the meaning back
to the client, modified strategically to tap into the client's intrinsic
motivation to change.

Also helpful in checking the accuracy of counselors understanding of

what the client is saying

Can help the client feel validated - enhance the empathetic

relationship.

Suspend advice or suggestions and do not portray agreement or

disagreement with what the client has shared.

They are just repeating back what the client is saying in a potentially
more direct and concise way in effort to clarify meaning with the client.
Summaries
Should be used periodically through the session to mark the
progress of the discussion.

Use summaries strategically to repeat back a clients Change

Talk

Do a grand summary of what has been covered at the end of a

session

Can also be helpful to transition a talkative client to the next

topic

By including reluctance/resistance in the summary, then

emphasizing optimism for the clients capacity to change, the
counselor is ending the dialogue in a direction towards
change.
Decisional Balance (DB)
Technique to illustrate the cost and benefits of the behavior,
to help resolve ambivalence, and increase motivation to
change

The BD exercise is structured this way intentionally to

acknowledge the current connections the client has to the
behavior but ends with the client providing change talk

Written exercise
benefits of continuing the behavior
costs of stopping the behavior
costs of continuing the behavior
benefits of stopping the behavior
Readiness to Change Ruler
Used during every session

Scaling strategy conceptualizes readiness or motivation

to change along a continuum
10-point scale
1 = definitely not ready to change
10 = definitely ready to change

Counselors will refer to the clients readiness to change

number when framing questions during the session to
gage the clients current motivation.

An example of this is: Last week when we met, your

motivation to change number was 7. This week, your
number is 4. What has change during this past week?
What would it take for you to get back to a 7?
Limitation
Clients can become frustrated with the counselors summaries
and continued open-ended questioning.

The client might feel as though the counselor is not actually helping
them.

MI will not work for a client who is just looking for the counselor to
tell them what they are doing wrong and how to change it, because
this goes against the core of what MI is and the MI spirit.

If the client is not willing to open up and speak with you.

MI does not work, because the entire philosophy behind MI is

based on drawing upon the information provided by the client.

The counselor's role is not to give advice or set forth a plan.

This practice is based on the client's willingness to participate
and be solution focused.
Strengths
The MI spirit

Based in a place of optimism

Creates a safe/supportive environment for client

The OARS and the five principles generate open dialogues

between the client and the counselor

Applicable to all populations

It allows for the counselor to adjust and flow with the client

Though very active in the process, the counselor takes a back

seat in MI sessions and allows the client to take the steering
wheel.

Mi truly is focused on and achieves allowing for the client to be

the prime change agent, which can lead to more long last
changes of behavior(s).
Applications to Student Affairs
Outside of a campus counseling center, the most direct
application for MI is in Conduct and Alcohol and Other Drugs
(AOD) counseling. B.A.S.I.C.S. (Brief Alcohol Screening &
Intervention of College Students)

Conduct setting- conduct officers use the five principles of MI

EE: will likely be able to create an environment where the
student is comfortable enough to explore their decision
making process.
DD: will identify the discrepancies between the students
actions and the campus policy as well as what the student is
saying versus how they are behaving.
RR: No student wants to go through a conduct procedure, so
rolling with resistance is a familiar practice for conduct
officers.
CC:to build self- efficacy and responsibility in students and
help them change their behavior in the future.
Other SA Applications
Strengthen Faculty/Staff relationships
helping to build rapport, trust and confidence in the work that
each other does.
if the faculty or staff uses MI with students
to increase feelings of empowerment and be supportive to a
student that is academically unmotivated or struggling.

Career Development & Academic Advising

focuses in on student priorities
DB exercise could help with a student navigating a change in
major, or job searching
can provide feedback to discuss discrepancies between
students current behavior and desired outcomes, to help
them set a path towards being successful academically and
with their careers.
SA Applications Continued
Residence Life
Paraprofessionals - Resident Advisors (RAs)
By using the OARS, RAs are able to connect with residents and
have deeper dialogues that can lead to more well behaved and
connected communities.
Professional staff in their interactions with residents
Engaging in difficult conversations with residents or when
navigating mediations.
Many residence life programming models also include efforts
that align with MI, working to develop residents self efficacy
and build on their abilities to problem solve.
Other successful outcomes include getting students to the
Counseling Center or getting them involved in co-curricular
activities.
Method of Communication
MI is not only a style of counseling, it is ultimately a
method of communication used with broad applications
to even daily conversations.
It is just responding to someone with a reflection of what
you think you just heard, instead of commenting/replying.
Or, you can try asking an open-ended question rather than
a question that could result in a one-word answer.
You can take a few minutes longer to hear someone out
completely, then reflecting and clarifying as needed,
instead of responding immediately.
Try asking a person for permission, before offering advice
or suggestions (Smith, 2012, p. 5)
Discussion

How do you see implementing MI into your practices?

What do you feel would be some of your challenges?

Successes?

Questions for me?

 REFERENCES
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Development. Journal Of College Counseling, 16(2), 158-175. doi:10.1002/j.
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