First MI session — engaging, focusing, and listening for change talk
Don't argue. Don't fix. Reflect, ask open questions, and listen for the client's own reasons to change.
Framing
Motivational Interviewing isn't a technique you bolt on — it's a stance. The first session establishes that stance: collaboration, evocation, autonomy. The change talk comes from them, not you.
"I'm not here to talk you into anything. What I'd like to do today is hear what's going on in your own words, what you're noticing about it, and what — if anything — you'd want different. Whatever you decide is up to you. That's not a line; that's actually how this works."
Assessment questions
What brings you in today, in your own words?
Why · Open, non-leading start.
On a scale of 0–10, how important is it to you to change X right now? Why that number and not lower?
Why · The 'why not lower' pulls change talk.
On 0–10, how confident are you that you could change it if you decided to? Why not lower?
Why · Surfaces strengths and past successes.
What are the good things about X, and what are the not-so-good things?
Why · Decisional balance — but stay neutral while they list.
Key moves
OARS the whole session
Open questions, Affirmations, Reflections (more than questions), Summaries.
Roll with resistance
When you hear sustain talk, don't push back. Reflect it. The wave passes faster than you'd think.
Catch and elaborate change talk
When the client says 'I guess I could try…' — slow down. Ask what they meant. Have them say more.
End with a summary that emphasizes their change talk
Not a balanced summary — a strategically weighted one.
Listen for
- DARN-CAT — Desire, Ability, Reasons, Need / Commitment, Activation, Taking steps
- Sustain talk vs. change talk ratio — track it
- Discord — disagreement with you specifically (different from ambivalence about change)
- Values implicit in their complaints ("I just want to be a better dad")
Closing the session
Summarize their change talk back to them. Ask: "So what do you think you'll do?" — then be quiet.
Optional, and only if the client offers it. Suggested rather than assigned.
Common mistakes
- Asking too many questions and reflecting too few — flip the ratio
- Sliding into the righting reflex when the client says they don't want to change
- Forcing a goal at the end of a session that wasn't ready for one
- Treating MI as a 'phase' before 'real' therapy — it's the therapy when ambivalence is the problem