Motivational Interviewing, with practical examples

A different way to talk about change

Most of us try to help people change the same way: we explain why they should, tell them how, and then feel frustrated when they don't. Motivational Interviewing, by psychologists William R. Miller and Stephen Rollnick, starts from a different place. People are far more likely to change for their own reasons than for ours, and those reasons are usually already there, waiting to be heard.

Miller first described the approach in the early 1980s while working with people struggling with alcohol, and the two authors have refined it through several editions since. (The fourth edition is subtitled Helping People Change and Grow.) Today it is used by counselors, doctors, nurses, coaches, teachers and parents, for everything from addiction to diabetes care to homework.

“A collaborative conversation style for strengthening a person's own motivation and commitment to change.”

In plain terms, MI is a way of talking with someone so that they hear themselves make the case for change. It is not a trick for getting people to do what you want. The authors are clear that it only works, and is only ethical, when it serves the other person's goals and values.

The spirit of MI

Before any technique, the authors describe an underlying mindset. Without it, the skills below can feel hollow or manipulative. With it, even clumsy words tend to land well. Recent editions describe four parts:

• Partnership

  You work with the person, not on them. They are the expert on their own life; you bring curiosity and some skills. It feels more like dancing than wrestling.

• Acceptance

  Not approval of every choice, but respect for the person: their worth, their right to decide, their strengths, and a real effort to understand how things look from where they stand.

• Compassion

  You actively care about the other person's wellbeing and keep their good, not your own agenda or comfort, at the center of the conversation.

• Evocation and empowerment

  You assume the person already has wisdom, reasons and strengths for change, and your job is to draw them out and help them see what they are capable of.

The four processes

An MI conversation moves through four overlapping processes. They build on each other like steps, but you will often circle back. If trust slips, you return to engaging.

1. 1

   Engaging

   Building a working relationship of trust. Without it, nothing else lands.

   "What brings you here today, and what would make this time worth it for you?"

2. 2

   Focusing

   Agreeing on a direction: which change, or which part of life, the conversation is about.

   "Of the things we've touched on, sleep, stress and your job, which feels most important to look at first?"

3. 3

   Evoking

   Drawing out the person's own reasons and hopes for change. This is the heart of MI.

   "If you did start going to bed earlier, what difference would you hope to notice?"

4. 4

   Planning

   When the person is ready, helping them shape a specific plan they own, and checking in on commitment.

   "So what feels like a realistic first step this week?"

The core skills: OARS

Four everyday communication skills carry most of MI. They are simple to describe and take a lifetime to master.

Open questions

Open questions invite a story instead of a yes or no. "Do you want to sleep better?" gets one word. "What would better sleep change for you?" gets the person thinking out loud about their own reasons. Questions that start with "what", "how" or "tell me about" usually open things up; "why" questions can sound like an accusation, so use them gently.

Affirmations

An affirmation recognizes something genuinely good in the person: a strength, an effort, a value. It is not empty praise or "good job". Compare "Great work!" with "You kept going to that class even on weeks when it was hard. That takes real determination." The second one is specific, true, and about who they are.

Reflective listening

Reflections are the backbone of MI. A reflection is a statement, not a question, that offers back your best guess at what the person means. It shows you are listening, lets them correct you, and helps them hear their own thoughts more clearly.

• Simple reflections stay close to what was said. "I'm so behind at work." "You're feeling buried."
• Complex reflections add meaning or feeling the person hinted at but didn't say. "You're feeling buried, and you're worried people will think you can't handle it."
• Double-sided reflections hold both sides of ambivalence, joined with "and" rather than "but", ideally ending on the side that leans toward change.
• Continuing the paragraph means gently guessing the next sentence the person hasn't said yet, which often moves the conversation forward.

Make your voice go down at the end. "You're worried about him." sounds like understanding; "You're worried about him?" sounds like doubt. And if your guess is wrong, that's fine. The person will correct you, and you will both understand more.

Summaries

A summary is a longer reflection that gathers several things the person has said, like picking flowers into a bouquet. Summaries show you have been paying attention, link ideas together, and help transition to what comes next. A good one often ends with an invitation: "What did I miss?" or "Where does that leave you?"

Informing and advising, with permission

MI doesn't forbid advice. It changes how we give it. Ask permission first, offer information briefly, and then ask what the person makes of it. This rhythm is often called elicit, provide, elicit:

1. 1. Elicit

   "What do you already know about how caffeine affects sleep?" or "Would it be okay if I shared something other people have found helpful?"

2. 2. Provide

   "Caffeine can stay in the body for many hours, so an afternoon coffee can still be working at bedtime. That may or may not fit for you."

3. 3. Elicit

   "What do you make of that?" or "How does that fit with what you've noticed?"

Change talk and sustain talk

When people are ambivalent, they say things on both sides. Anything that leans toward change is change talk. Anything that leans toward keeping things as they are is sustain talk. Research on MI suggests that the more change talk a person voices, and the less sustain talk, the more likely they are to actually change. So a big part of MI is learning to notice change talk, draw it out, and respond to it.

A common way to remember the kinds of change talk is DARN-CAT. The first four are "preparing" talk; the last three show that the person is starting to move.

• D

  Desire

  "I want to feel rested again."

• A

  Ability

  "I could probably put my phone in the kitchen at night."

• R

  Reasons

  "I'd be more patient with the kids if I slept more."

• N

  Need

  "Something has to change. I can't keep running on empty."

• C

  Commitment

  "I'm going to be in bed by eleven this week."

• A

  Activation

  "I'm ready to try it. I'd like to start tonight."

• T

  Taking steps

  "I bought an old-fashioned alarm clock yesterday."

How to draw it out

• Ask evocative questions: "What worries you about how things are now?" "If you decided to change, how might you do it?"
• Look back and look forward: "What were things like before this started?" "If nothing changes, where do you see yourself in five years?"
• Explore extremes: "What's the best thing that could happen if you made this change?"
• Connect to values: "What matters most to you in life? How does this fit with that?"

How to respond when you hear it

When change talk appears, don't rush past it. Ask for more detail ("In what ways?"), affirm it, reflect it back, and include it in your summaries. You are helping the person hear their own case for change, more than once, in their own words.

The importance and confidence rulers

Two simple questions can open up a whole conversation. Ask the person to rate, from 0 to 10, how important the change is to them, and how confidentthey are that they could do it if they decided to.

The key move is asking why the number isn't lower. That invites the person to explain their reasons for change. Asking why it isn't higher invites them to defend the status quo. The confidence ruler works the same way and often reveals what support or first step would help most.

Responding to sustain talk and discord

Earlier editions spoke of "resistance". Later editions split it in two. Sustain talk is about the behavior ("I don't really drink that much"). Discord is about the relationship: arguing, interrupting, tuning out, "you don't get it". Discord is a signal to change what you are doing, not a sign that the person is difficult. Some ways to respond:

• Simple reflection

  "You're feeling pushed right now, and you don't like it."

• Amplified reflection

  "So there's really nothing about this that concerns you at all." (Said gently, with no sarcasm. People often answer by naming a concern.)

• Double-sided reflection

  "Part of you is tired of everyone talking about this, and part of you wonders if they have a point."

• Emphasizing autonomy

  "This really is your call. Nobody can make this decision for you."

• Reframing

  To "My wife nags me nonstop about my drinking", try: "She really cares about what happens to you."

• Apologizing or shifting focus

  "I think I got ahead of you there. I'm sorry. Let's go back to what matters most to you."

Practice: write a reflection

Reflections get easier with practice. For each statement, write or say a reflection before you open the suggestions. There is no single right answer; the suggestions are just a few of many good options.

1. 1"I want to eat better, but cooking after work feels impossible."

   Show suggested reflections

   • Simple: "Cooking at the end of the day feels like too much."
   • Double-sided: "Eating better matters to you, and you also need a way that fits a tired weeknight."

2. 2"My mom keeps telling me to go to therapy. I'm fine."

   Show suggested reflections

   • Simple: "You're tired of being told what you need."
   • Complex: "You'd like people to trust that you know yourself."

3. 3"I've been meditating twice a week, but I want it to be every day."

   Show suggested reflections

   • Affirming reflection: "You've already built a real habit, and now you're ready to stretch it."
   • Follow-up question: "What helps on the days you do it?"

4. 4"I don't even know why I'm here. My husband made the appointment."

   Show suggested reflections

   • Simple: "Coming here wasn't your idea."
   • Continuing the paragraph: "...and you're wondering what he hopes will come of it."

5. 5"Maybe I drink a bit more than I used to, but everybody does on weekends."

   Show suggested reflections

   • Double-sided: "You've noticed it's crept up a bit, and it also seems pretty normal compared to the people around you."
   • Avoid: "A bit more? Do you know how many drinks a week is considered risky?" That invites a defense.

6. 6"I could ask my boss for help, but she'd probably think I'm not cut out for this job."

   Show suggested reflections

   • Complex: "You care a lot about how she sees you, and asking feels like a risk to that."
   • Follow-up: "What would it look like to ask in a way that shows how seriously you take the work?"

Want more? Try this with a friend: one of you shares a real, low-stakes change you have mixed feelings about, and the other may only use reflections for three minutes. No questions, no advice. Then swap. Most people are surprised how much comes out.

Common pitfalls

The authors describe a handful of traps that quietly derail conversations about change. Nearly everyone falls into them; noticing them is half the battle.

• The question-and-answer trap

  Firing off question after question turns the person into a passive form-filler. Aim for at least as many reflections as questions; skilled practitioners often use two reflections for every question.

• The expert trap

  Acting as if you have all the answers leaves the person nothing to contribute, and their own wisdom never surfaces.

• The premature-focus trap

  Rushing to the problem you think matters before you understand what the person is concerned about.

• The labeling trap

  Insisting someone accept a label, like "addict" or "lazy", creates a fight that has nothing to do with change.

• The blaming trap

  Getting pulled into whose fault it is. MI is about what happens next, not who caused what.

• The chat trap

  Friendly small talk that never gets anywhere. Warmth matters, but the conversation also needs a direction.

• Arguing for change

  When you take the "you should change" side, the person naturally takes the "but" side, and they talk themselves out of it.

Questions for reflection

Take your time with these. You might write about one, or talk it through with someone you trust.

• Think of the last time someone tried to fix a problem you hadn't asked them to fix. How did it feel, and what did you do?
• Where does my own righting reflex show up most: with my kids, my partner, my clients, or myself?
• Is there a change I've been ambivalent about? What would I say on each side if someone just listened?
• Who in my life listens in a way that helps me think more clearly? What exactly do they do?
• In my next hard conversation, could I try two reflections before I ask a question or give advice?
• For parents: what would my child say they want for themselves, if I asked and then really listened?