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MI · 5 min read

Motivational Interviewing

Evoke the client's own reasons for change instead of arguing for it.

Originator: William R. Miller & Stephen Rollnick (1980s, for addiction)Best for: Substance use · Health behavior change · Treatment ambivalence · Adherence · Pre-treatment engagement

Core idea

MI is a collaborative, goal-oriented style of communication built on the observation that people are more persuaded by what they hear themselves say than by what they're told. The therapist resists the righting reflex — the urge to fix — and instead listens for and strategically amplifies change talk while softening sustain talk. Spirit (partnership, acceptance, compassion, evocation) matters as much as technique.

Key concepts

Spirit of MI
PACE — Partnership, Acceptance, Compassion, Evocation. Without it, the techniques are manipulation.
Change talk vs. sustain talk
DARN-CAT (desire, ability, reasons, need, commitment, activation, taking steps) vs. arguments for status quo.
Righting reflex
The clinician's instinct to correct, advise, persuade — the main thing to resist.
Four processes
Engaging → focusing → evoking → planning.
Ambivalence
Not resistance — the normal state when considering change.

What a session looks like

  1. 1
    Engage
    OARS (open questions, affirmations, reflections, summaries); build rapport.
  2. 2
    Focus
    Agree on what to talk about changing.
  3. 3
    Evoke
    Selectively reflect and elaborate change talk; explore importance and confidence (rulers 0–10).
  4. 4
    Plan
    Only when client is ready — collaborative change plan with specific next steps.

Signature techniques

OARS
Open questions, affirmations, reflections (simple, complex, double-sided), summaries.
Importance & confidence rulers
On a scale of 0–10, how important is this change? Why not lower?
Decisional balance
Explore pros and cons of change and of status quo — use cautiously, can reinforce sustain talk.
Elicit–provide–elicit
Ask permission, share info briefly, ask what they make of it — the MI way to give advice.
Rolling with resistance
Reflect rather than argue when sustain talk intensifies.

Evidence base

Hundreds of trials. Strongest for substance use; effective for diet, exercise, medication adherence, dental hygiene, problem gambling. Effect sizes small to moderate as a standalone but increases retention and outcomes when added to other treatments.

Common pitfalls

  • ▸Using OARS without MI spirit — technique without partnership is hollow.
  • ▸Premature focus on planning before the client is ready — pushes them back into ambivalence.
  • ▸Confusing reflection with parroting; complex reflections are the engine of MI.
  • ▸Treating MI as just empathic listening — it's also strategically directional.

Where to go next

Motivational Interviewing (4th ed.)
Miller & Rollnick
The current edition — major update with new four processes framework.
Building Motivational Interviewing Skills
David Rosengren
Practice-focused workbook.
MINT (Motivational Interviewing Network of Trainers)
mint-training videos & coding (MITI)
Skills coding is the only way to know if you're actually doing MI.