Motivational Interviewing (MI)

What is it?

Interviewing is a key competency for successfully engaging families. The skills needed for interviewing are empathy, attending to non-verbal interactions, active listening, correct use and timing of questions, and empathic responses. Motivational Interviewing is a practice that engages families.

Why does it matter?

For a family to recognize what to change and getting a family to change is even more challenging. Motivational interviewing is a straightforward and common-sense process that asks people you work with to look at what needs to be changed and gives you questions to ask to help change occur.

Interviewing is essential to gather information, give successful feedback, and develop successful interventions. Also, a good interview is related to having a good relationship with families. This also leads to successful intervention and treatment that is heavily dependent on workers' relationships with children and families

Practice strategies that work

Developing empathy, genuineness, and warmth are the critical elements of an interview and developing trust with families. A fundamental way to establish trust is using the OARS Technique developed through Motivational Interviewing. OARS stands for Open-ended questions, Affirming, Reflective listening, and Summarizing.

We ask questions that can't be answered with a yes or no. We ask questions that are more evocative in that they bring out the clients thoughts about change. For example: 

  • "What do you think could change?" 
  • "What is at stake if you don't make a change in this area of your life?" 
  • "What do you think would happen if you continue as you are?" 

Those are all questions that can help the person you're talking to really speak about change on their own terms and bring out their internal or intrinsic motivation for change. In this way, we increase the likelihood that the person argues for change instead of us.

Ask yourself, "what's inside this person that's good already?" How can you help them to boost their own sense of self, their own confidence and self-efficacy, their ability and belief that they can change? By pointing those qualities or attributes out in a positive way, you increase the likelihood that they will change. Rather than simply praising them, saying a trite positive comment like, "nice job!", an affirmation highlights a stable positive characteristic of the person based on observed evidence. Affirmations can often have the word "you" in them more than the word "I". 

"You're really showing your dedication again today by those comments you made in that group discussion." 

"There’s that patience and focus again. I saw it when you were listening to your son in the waiting area.”

When we are counseling or listening to someone with a problem or issue, we are tempted to ask questions or give advice. In MI, we call this the “righting reflex”. However, we find that by demonstrating, using a statement – a listening statement, showing the person that you hear what they’re saying, that you both improve the relationship and create an opportunity to highlight reasons for change. For example: 

  • “I’m hearing that you feel sad today.” 
  • “You feel challenged by this difficult situation.” 
  • “On one hand you want to continue to drink because for you it’s a way to reduce stress, yet you also are worried about how the drinking impacts your relationship.” 

By making a statement like this, you’re showing them that you understand. You’re showing them that you have a sense of empathy. Empathy is compelling in the change process. Sometimes we highlight what we call “change talk”, that is, when the person is talking about their reasons to change. In a reflective statement, we can point out a reason that the person thinks it is important to change. So a person might say, “I know I really need to eat healthier because I really want to be around for my kids later in life” and using a reflective statement, something like “What you’re saying is that your kids are really important to you”, you’re highlighting the reason for them, why they’d like to change, instead of imposing from without the reasons why you think they should change.

One way to think about summaries is that they are a bunch of reflections that band together to highlight a theme the person you’re talking to is relating. You are helping them to see some the bigger meaning or the general concept that might be important to them. As someone, I once trained in Motivational Interviewing once said, “A summary is like a magic mirror.” You’re holding up this mirror to the person a general picture of their life, and then they can see what they think needs to change. 

O is for open-ended questions

We ask questions that can't be answered with a yes or no. We ask questions that are more evocative in that they bring out the clients thoughts about change. For example: 

  • "What do you think could change?" 
  • "What is at stake if you don't make a change in this area of your life?" 
  • "What do you think would happen if you continue as you are?" 

Those are all questions that can help the person you're talking to really speak about change on their own terms and bring out their internal or intrinsic motivation for change. In this way, we increase the likelihood that the person argues for change instead of us.

Ask yourself, "what's inside this person that's good already?" How can you help them to boost their own sense of self, their own confidence and self-efficacy, their ability and belief that they can change? By pointing those qualities or attributes out in a positive way, you increase the likelihood that they will change. Rather than simply praising them, saying a trite positive comment like, "nice job!", an affirmation highlights a stable positive characteristic of the person based on observed evidence. Affirmations can often have the word "you" in them more than the word "I". 

"You're really showing your dedication again today by those comments you made in that group discussion." 

"There’s that patience and focus again. I saw it when you were listening to your son in the waiting area.”

When we are counseling or listening to someone with a problem or issue, we are tempted to ask questions or give advice. In MI, we call this the “righting reflex”. However, we find that by demonstrating, using a statement – a listening statement, showing the person that you hear what they’re saying, that you both improve the relationship and create an opportunity to highlight reasons for change. For example: 

  • “I’m hearing that you feel sad today.” 
  • “You feel challenged by this difficult situation.” 
  • “On one hand you want to continue to drink because for you it’s a way to reduce stress, yet you also are worried about how the drinking impacts your relationship.” 

By making a statement like this, you’re showing them that you understand. You’re showing them that you have a sense of empathy. Empathy is compelling in the change process. Sometimes we highlight what we call “change talk”, that is, when the person is talking about their reasons to change. In a reflective statement, we can point out a reason that the person thinks it is important to change. So a person might say, “I know I really need to eat healthier because I really want to be around for my kids later in life” and using a reflective statement, something like “What you’re saying is that your kids are really important to you”, you’re highlighting the reason for them, why they’d like to change, instead of imposing from without the reasons why you think they should change.

One way to think about summaries is that they are a bunch of reflections that band together to highlight a theme the person you’re talking to is relating. You are helping them to see some the bigger meaning or the general concept that might be important to them. As someone, I once trained in Motivational Interviewing once said, “A summary is like a magic mirror.” You’re holding up this mirror to the person a general picture of their life, and then they can see what they think needs to change. 

Strategies for effective MI: 

  1. Ask open-ended questions: who, what, when, where, why, how 
  2. Practice Reflective Listening: restate the meaning, “Let me make sure I understand this” 
  3. Summarize: this helps to identify what information should be included and what can be taken out 
  4. Affirm-respond with “I hear” or “I understand” 
  5. Elicit a self-motivational statement from the person you are working with, “I know I have to do this...”

Additional Resources

Motivational Interviewing Network of Trainers (MINT)

SAMHSA - Empowering Change: Motivational Interviewing

Find this book at your local library.

Motivational Interviewing by Stephen Rollnick and William Richard Miller. Miller is considered the founder of MI. 

Dr. Jonathan Fader Demonstrates Motivational Interviewing Skills - from the Albert Einstein College of Medicine presented "Motivational Interviewing" at The Art of Medicine: A Physician-Patient Communication Conference on Nov 19th, 2011

Talking To Change - A Motivational Interviewing Podcast

Integrated Care In Action Podcast: Foundations Of Motivational Interviewing