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Flashcards in Motivational Interview Deck (50):

Reflective listening

  • Most important skill in MI

  • A response to a statement

  • NOT a question

  • Slows the pace and shows empathy
  • Keeps the client involved
  • Demonstrates that you are listening attentively and really hearing
  • Drop your voice

  • Under shoot rather than overshoot
    • say less rather than more – short and simple
  • Requires continuous alert tracking
  • Used strategically to emphasize aspects of client’s view, emotion, ambivalence, and change talk
    • Don’t use reflection as a way to teach we call that teaching, not reflecting



  • Four skills are important from start to finish – t
    • they form the acronym OARS
  • Asking Open Questions
  • Affirming

  • Reflective Listening

  • Summarizing


Preparation Characteristics

  • Ambivalence is decreasing
  • Making plans for change


MI Process: Engaging

  • Using OARS, non-verbals to establish positive therapeutic relationship

  • First few minutes of session critical phase


Major Goal of MI

Change Talk


Simple reflection

  • repeating, rephrasing, paraphrasing


Contemplation Characteristics

  • Ambivalent

  • May seek information and/or ask for consultation





  • Maintained behavior change for at least 6 months
  • Change takes less effort


Other ways to Elicit Change Talk

  • Decisional Balance exercise
  • Scaling ruler exercises


MI Process: Focusing

  • Agenda setting
  • Negotiation of target behavior


MI Spirit: Acceptance

  • Person-centered conditions:
    • Absolute worth and potential, what Carl Rogers called unconditional positive regard 
(can do no wrong)
    • Accurate empathy 

    • Autonomy Support 

    • Affirmation 


MI Process: Planning

  • Commitment to and plan for action
  • Envisioning what it would be like
  • Setting goals

  • Considering change options
  • Transition to Action


Motivational Interviewing

  • Motivational Interviewing is a client- center, goal-oriented counseling style designed to evoke and strengthen personal motivation for behavior change.



Treatment Goals & Strategies

  • Affirm commitment and efforts to change 

  • Discuss benefits of change 

  • Explore high-risk situations and develop strategies to prevent relapse 


Asking Open Questions

  • A good place to start

  • Can’t be answered “Yes” or “No”
  • Encourages client to do most of the talking
  • Makes no assumptions
  • Allows clinician to begin to understand client’s perspective
  • Ask fewer questions!
  • Don’t ask three questions in a row
  • Ask more open than closed questions
  • Offer two reflections for each question asked


The ‘PACE’ of the MI SPIRIT

  • Partnership/collaboration

  • Acceptance: respect autonomy, absolute worth, affirmation, accurate empathy
  • Compassion – acting in the interest of another
  • Evocation – of client’s Change Talk, values, goals, strengths, wisdom


Helpful Hints for Using the Rulers

  • Be specific about which ruler you are using (Importance, Confidence, Readiness) 

  • Define target behavior (quitting, cutting down [to how many] ) 

  • Define target substance (stick to one) 

  • Use the visuals (picture of the ruler) 


Traps to Avoid

  • Question/Answer
  • Premature Focus
  • Taking Sides

  • Expert Role
  • Blaming


Factors that Contribute to Long-Term Change

  • Feeling that change is a personal choice
  • Feeling that change is important

  • Having a positive encounter with clinician
  • Having adequate self-confidence about the ability to make a change



  • Special form of reflective listening
  • Draws together key points
  • Gather what you’ve heard and present to client
  • Shows you’ve heard and therefore ENGAGED with the client
  • Ensures that you’ve got a clear picture
  • Enables the client to add information

  • Enables the client the opportunity to hear their own story
  • Helps to provide a point from which to move forward 

  • Provides a strategic way to redirect dialogue 

  • Useful to summarize periodically during time together 

  • Offer summaries strategically, with purpose 

  • Continue, rather than interrupt, momentum 


Building Confidence


  • What would make you more confident about making these changes?
  • Why have you given yourself such a high score on confidence? 

  • How could you move up higher, so that your score goes from X to Y? 

  • How can I help you succeed? 

  • What are some of the practical things you would need to do to achieve this goal? Which of those sound achievable? 


MI Spirit: Compassion

  • Intentional commitment to work in the best interests of the other person
  • Active promotion of the person’s welfare Not sympathy or identification


Contemplation Treatment Goals and Strategies

Tip the balance in favor of change
Elicit reasons for changing & not changing
Strengthen confidence (self-efficacy) for change
  • Action strategies will likely increase resistance


Processes of Motivational Interviewing

  • Four Processes
    1. Engaging
    2. Focusing
    3. Evoking
    4. Planning


How to recognize resistance

  • excusing

  • claiming
  • impunity
  • minimizing
  • pessimism
  • reluctance
  • disagreeing
  • blaming
  • ignoring
  • denying
  • challenging
  • discounting
  • hostility
  • inattention
  • non-answer
  • no response
  • sidetracking a
  • arguing
  • interrupting


Complex reflection

  • reflection of feelings, unspoken meaning


Stages of change

  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Relapse & Recycling Change
  • Termination


Preparation Treatment Goals and Strategies

  • Reinforce commitment and motivation for change
  • Explore accessible & effective change strategies and resources


Action treatment goals and strategies

  • Affirm commitment to change

  • Discuss necessary steps for change
  • Explore additional resources

  • Discuss potential barriers



  • Start by asking clients what they already know or want to 
know about an area of interest (elicit) 

  • Once clients describe what they know, then the 
practitioner can add to it (provide). 

  • This method avoids telling clients what they already know, respects their skills and knowledge, and allows the practitioner to provide only the information clients need. 

  • Ask the client’s view on what information has been offered (elicit)


How do you know when you've got it right?

  • The patient is talking more than you 

  • The patient is actively talking about 
behavior change 

  • You are listening carefully and gently directing the interview 

  • The patient is actively asking for 
information and advice. 


Giving Advice or Information: MI-style

  • Ask permission 

  • Relate advice to “other people” 

  • Disavow that advice will necessarily apply to the client 

  • Offer advice menu 

  • Check in with client about his/her ideas about advice 


MI Process: Evoking

  • Eliciting, exploring, discussing patient’s Change Talk, goals, values, strengths, relative to the target behavior


Precontemplation Treatment Goals & Strategies

  • Advice can be counter productive I
  • Information or feedback → helpful in raising awareness & increasing perception of risk


Recognizing Change Talk

Patients say things that indicate:

  • Recognition of the problem
  • Concern
  • Intention to change 

  • Optimism about change 


Exploring importance

  • Why are you at x and not y? (always start with the higher number)
  • Or, how did you get from x to y? (always start with the lower number)
  • What would have to happen for it to become much more important for you to change?
  • What would have to happen before you seriously considered changing?


Decisional Balance


  • Ambivalence: Normal Pros and Cons: Weigh Discrepancy: Increase
  • Uses the “conflict” of the good and not-so- good things about the behavior to promote positive change
  • Most useful in Precontemplation and Contemplation stages as a tool to increase motivation
  • Good things about my behavior: 

  • Not so good things about changing my behavior: 

  • Not so good things about my behavior:
  • Good things about changing my behavior:



Scaling Rulers and Questions

  • Can use after Decisional Balance 
  • Use in following order:
    • 1. Importance 2. Confidence 3. Readiness
  • Importance and readiness may seem the same at face value, but are different.
Scaling questions are used to elicit change talk but must be followed with good use of OARS for each ruler


MI Spirit: Partnership

  • Collaborative – Extent to which the clinician behaves as if the interview is occurring between two equal partners, both of whom have knowledge that might be useful in the problem under consideration (MITI 3.1) 

  • Resist the “righting reflex” 

  • Client talks more than the clinician 

  • Asks permission before giving advice or suggestions 



  • Often - but not necessarily always - MI explores and seeks to resolve ambivalence by “tilting” the balance in favor of change.
  • ambivalence is kind of like going back & forth between decisions


Motivational Interviewing Elements

  • MI spirit of respect for autonomy, collaboration, evocation of client strengths, solutions, goals throughout the relationship 

  • Movement through the processes of MI – engaging, focusing, evoking, planning 

  • Use of OARS – asking open questions, affirming, reflecting, summarizing 

  • Elicitation of Change Talk and Commitment Talk 


MI Spirit: Evocation

  • Flows from premise that client already has what is necessary for change
  • Clinician task - to elicit, or draw forth, strengths and resources
  • Change talk and commitment talk
  • Necessary in order to understand the client’s ambivalence, perspective and wisdom about the change


Transition & Blending

  •  Studies have shown that MI works better among people who are resistant, angry or demonstrate low motivation to change a person’s health behavior 

  • MI maybe contraindicated for patients who are ready for action. - Resnikow 

  • As clients move into the action and maintenance stages, other interventions have been shown to be effective, such as CBT with substance abuse 

  • MI can continue to be used as a general counseling style with OARS 

  • Ambivalence may occur at any time. MI interventions can be helpful during those brief periods. 



  • Acknowledges client’s strengths and positive behaviors – focuses on efforts 

  • Best when avoiding “I” statements 

  • Be sure they are genuine and specific 

  • Find your actual connections – won’t work to pretend 

  • Critical in building rapport – notice client’s strengths and efforts 

Important to affirm behaviors

  • Easy to forget positive things when talking about problems
  • Use judiciously – too many diminish impact
  • Direct toward something specific , i.e., a client behavior that has furthered movement toward change
  • Affirm specific behaviors and values that support change
  • Latin – “to make firm”
  • Use to strategically anchor (make firm, drive home, reinforce) internal strengths, values, beliefs, thoughts or behaviours.
  • Use to support, to anchor, self-efficacy
  • Does NOT mean to agree, praise or approve but rather to see the client’s strengths, skills, and insights and reinforce them.


MI Spirit: Autonomy Support

  • extent to which the clinician supports and actively fosters client perception of choice
    • ​not attempting to control the client’s behavior or choices. 

  • Explores clients options genuinely 

  • Acknowledges client option not to change 
without sarcasm, that it’s their choice 

  • Gives credence to client’s ideas about change and motivation (MITI 3.1) 


Strategies for eliciting Change Talk

  1. Asking Evocative Questions about Concerns and Pulling for Strengths 

  2. Asking for Elaboration/Examples 

  3. Assessment Feedback 

  4. Exploring Good Things and Not-So-Good Things (Decisional 
  5. Looking Back 

  6. Looking Forward 

  7. Imagining Extremes 

  8. Exploring Goals and Values 

  9. Use Change Rulers and Scaling Questions 


Precontemplators Four R's

  • Reluctant  
  • Rebellious  
  • Resigned
  • Rationalizing


Precontemplation Characteristics

o Not considering the possibility of change o FourR’s–Reluctant, Rebellious, Resigned, Rationalizing o Problems identified by others(e.g.,spouse, court, parent) rather than by self


Empathy & Compassion

  • Degree to which the clinician understands or makes an effort to grasp the client’s perspective and feelings.
  • NOT to be confused with warmth, acceptance, genuineness, or client advocacy, which are independent of empathy. 

  • Often demonstrated by reflective listening is an important part of this characteristic, but also by any and all effort to understand the client’s perspective and convey that understanding to the client. (MITI 3.1) 

  • Goes beyond collecting facts, history, and asking information- seeking questions. 

  • Often demonstrated by sincerely encouraging the client to elaborate, say more