What MI is…



Engagement - Building rapport:

·      In MI the client-therapist relationship is in the forefront and it never left to chance or chemistry.

·      The MI therapist begins by developing trust, building rapport, by providing the client with an empathic, reflective, sounding-board so hey can hear what they say and feel heard.

·      The MI therapist will follow the spirit of MI by expressing empathy, respecting autonomy, assisting collaboration, reflecting genuineness.

·      The MI therapist will strive to create an atmosphere of safety and acceptance.

·      The MI therapist is careful not to address topics too soon, which could cause therapist-client dissonance and harm the MI relationship.



Goal Directed:

·      The MI therapist refers to identified goals, objectives and target behaviors.

·      The MI therapist attains clarity, through engagement, about the target behavior or goal being addressed, and then strives to keep the discussion focused on these targets in order to keep the communication focused and productive.

·      The MI therapist needs to be vigilant around the need to shift away from a topic when the client is expressing resistance or does not want to continue in this area.



The structure of a Goal-Directed discussion may be:

·      The client begins by discussing developmental issues or historical concerns that may cause pain and distress.

·      Once the discussion is complete, the MI therapist should begin to assist the client in discovering the relationship between the client’s history and their present goals.



Resolve ambivalence:

·      The MI therapist begins to facilitate the client’s exploration of ambivalence, with a discussion that emphasizes change talk and ‘tipping the balance’ towards behavior change.

·      The MI therapist begins to guide the client toward internal recognition about their behavior, whether their behavior is a problem, and helping the client reach a decision about change.



Menu of options:

·      The MI therapist assists the client in referring to a numerous actions that the client and provider collaboratively identify and agree to include in a behavior change plan.

·      The MI therapist uses a menu. This menu refers to the identification of six or seven specific actions that will be discussed.

·      The MI therapist places emphasis on the client’s willingness to pursue an identified action.

·      The MI therapist will only include actions on the plan that the client is willing to pursue.

·      The MI therapist will work with the client to assure the plan is fluid and capable of change.

·      The MI therapist prioritizes each action is directed toward confidence building while conveying the hope that change can be attained.



Pros and Cons:

·      The MI therapist uses this strategic intervention to assist with the exploration of the positive and negative experiences a client might have regarding a particular behavior.

·      The MI therapist uses this technique to elicit change talk when a client may not have identified any disadvantages voluntarily.

·      The MI therapist begins with an exploration of the positive experiences the client may have (This is known as “sustain talk”) until a level of comfort is reached and then they move on to what is “not so good” about the behavior.

·       The MI therapist assists the client, who is comfortable, to begin identifying elements of concern; either for the first time or in a way that is not resistant or guarded.

·       The MI therapist should place more emphasis on guiding the client to change talk, rather than involving themselves in “sustain talk.”

·       The MI therapist should always be concerned that “sustain talk” may be reinforcing and deflect from change talk.



The Decision Balance -- Not a required technique to practice MI (Miller & Rollnick, 2009).

This technique is not MI. It has been used routinely by some MI practitioners as a “required technique”, but is not formally recognized.



It is a form of identifying pros and cons within four quadrants.

Quadrant A -- What is good about continuing the behavior.

Quadrant C -- What is not good about changing the behavior.

Quadrant B -- What is not good about continuing the behavior.

Quadrant D -- What is good about changing the behavior.



Weight is given to Columns A+B as compared to columns C+D.

This technique currently has limited use in MI, because it offers little in the form of change talk.



Ask permission to give advice or information: AKA: Giving advice vs. Asking Permission.



Giving Advice: “AA groups would be good for you.”

Asking permission: “Would you be interested in hearing my ideas about what might be useful?”

If the client says yes, the practitioner might recommend AA or make other suggestions.



Providing an opportunity for the client to reject the suggestions:

“How do you think this might work for you?”

This allows the client pursues action only in areas agreed upon.



Giving Advice: “Read this information on the medication you are using.”

Asking permission: “Would you be interested in learning more about this medication?”

If yes, some written materials might be provided.



What MI is Not…

·      MI is not based on the transtheoretical model - the stages of change. They are two discrete models, and neither one requires the other;

·      MI is not a way to trick people to get them to do what they do not want to do;

·      MI is not a technique; it is more complex and better understood as a communication method;

·      MI is not the decision balance, this has been over utilized and misperceived as MI methodology;

·      MI does not require assessment feedback, this design is specific to MET;

·      MI is not a form of cognitive- behavior therapy, nothing is installed, rather MI elicits from people what is already there;

·      MI is not just client-centered counseling, it departs by being goal oriented and having intentional direction towards change;

·      MI is not easy, it involves a complex set of skills that are used flexibly;

·      MI is not what you are already doing, learning MI requires training, supervised practice and feedback; MI is not a panacea, it is not meant to be a school of psychotherapy, rather it is a particular tool for addressing a specific problem.



Metaphors that can be used during an MI session…

·      Ambivalence is a bit like having a committee inside your mind, with members who disagree on the proper course of action. (p. 7)

·      The partnership...conversation is a bit like sitting together on a sofa while the person pages through a life photo album. (p. 16)

·      Evocation...is like…drawing water from a well. (p. 21)

·      Planning is the clutch that engages the engine of change talk. (p. 30)

·      A simple reflection…is like an iceberg…it is limited to what shows above the water, the content that has actually been expressed, whereas a complex reflection makes a guess about what lies beneath the surface. (p. 58)

·      Practice without feedback…is like…golfing in pitch-black darkness. (p. 59)

·      A simple rhythm in MI is to ask an open question and then to reflect what the person says, perhaps two reflections per question, like a waltz. (p. 63)

·      Summaries are…strands that are woven together into a fabric, a single piece that contains all of their colors. (p. 69)

·      Summaries are like…seeing the forest instead of one tree at a time. (p. 69)

·      The focus is a light on the horizon toward which you keep moving. (p. 99)

·      MI is like dancing, moving together, in which you offer gentle guidance. (p. 103)

·      The smallest glimmer of change talk may be a coal that if given some air will start to glow, becoming the fuel of change. (p. 103)

·      Agenda mapping is like…examining a map at the outset of a journey. (p. 106)

·      This approach [agenda mapping] is like looking at a map and seeing the places you might go, perhaps like two people on a sailboat slowing down for a moment to agree on a new course before catching the wind again. (p. 106)

·      If the client’s life is like a forest, agenda mapping involves soaring over it for a moment with the perspective of an eagle. (p. 107)

·      Zooming in…is like pushing the plus (+) button to zoom in and get a better look at a particular area. (p. 108)

·      Agenda mapping can be…a matter of listening to the client’s story and puzzling together about a route out of the forest…where you may follow various streams to map the terrain (p. 116)

·      The interviewer is keeping the whole picture in focus (eagle view) rather than zooming down to a particular task (mouse view). (p. 116)

·      Change talk is a bit like walking up one side of a hill and down another. (p. 163)

·      MI helps people out of the forest of ambivalence…MI helps them to keep moving from tree to tree until at last they find their way out of the forest. (p. 166)

·      Early in an MI session the skill is often to discern a ray of change talk within the sustain talk, like spotting a lighthouse in a storm or detecting a signal within noise. It is not necessary to eliminate the storm or the noise, just follow the signal. (p. 178)

·      Discord is like fire (or at least smoke) in the therapeutic relationship. (p. 197)

·      Just as a smoke alarm alerts you to a change in the air, tune your ear to hear signals of dissonance and recognize them as important. (p. 204)

·      MI is like improvisational theater. No two sessions run exactly the same way. (p. 211)

·      As with motivation more generally, hope is evoked from within the client. The seeds of hope are already there, waiting to be uncovered and brought into the light. (p. 214)

·      Be careful not to give in to the righting reflex…that will shut [clients] down like alligator jaws. (p. 249)

·      Getting up on your soapbox tends to leave people with a soapy taste in the mouth. (p. 249)

·      Sometimes it moves quickly, but engaging, focusing, and evoking can be a slow step-by-step process like snowshoeing up the side of a mountain. The progress may be steady, but it feels effortful, there are likely to be a few backslides, and you have to pay attention to where you are going. (p. 257)

·      Planning…is more like a downhill ski…there is still the danger of running into trees, taking the wrong trail, or even heading off a cliff, so you still have to pay attention…(p. 257)

·      Mobilizing change talk…is language on the far side of the ambivalence hill…(p. 285)

·      You continue to explore the forest of change, moving from tree to tree in a reasonably straight line. Beneath the surface, seeds are germinating. (p. 289)

·      It can feel comfortable to take the lead [in a conversation], confident in one’s expertise, and it can also quite soon feel frustrating—a bit like pulling someone across the dance floor, trips and all. (p. 310)

·      Learning MI is like learning to fly an airplane…it is an on-going process and more than knowledge is involved. (p. 322)

·      Feedback is fundamental…It is difficult to learn archery in the dark. (p. 323)

·      Can you do MI in a few minutes? It is in a way like asking, Can you play the piano for 5 minutes? (p. 343)

·      Low-quality MI practice might be likened to half-doses of a vaccine or antibiotic: the right idea but insufficient strength. (p. 351)

·      An MI trainer should…be able to demonstrate it competently on the spot. It would be a rare violin teacher who cannot play the instrument competently. (p. 354).

·      While we hold a parental fondness for this growing child that we have nurtured, and entertain some worries for its future development, we have come far enough together to stand back in wonderment and curiosity to see what will happen next. (p. 402)



Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing) William R. Miller, Stephen Rollnick. The Guilford Press; Third Edition (September 7, 2012)



A FANTASTIC MI Resource --- http://www.motivationalinterview.org