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Introduction to
Motivational Interviewing
Tim Bingham BA
What is motivational interviewing?
“a therapeutic style intended to help clinicians work with
patients to address the patient’s fluctuation between
opposing behaviors and thoughts.”
Source: Miller and Rollnick, Motivational Interviewing 1991.
Characteristics of Motivational
Interviewing
Client directed towards change
Feedback and information offered selectively
Empathic reflection used selectively
Therapist creates or amplifies client discrepancies to enhance

motivation
Characteristics of Motivational
Interviewing
De-emphasis on labels
Emphasis on personal choice
Therapists elicits client’s own concern
Resistance is normal
Client provides goals and change plans
Resistance
When we see our freedom to act in a particular way

threatened, the behaviour seems more desirable and we will
be more likely to choose that behaviour
“You’re a drug addict”…”No I’m not”
“You’ve got to stop”…”No I don’t”
Ambivalence
Ambivalence is being in two minds about something
Ambivalence is normal.
General principles of M.I.
1. Express empathy
2. Develop Discrepancy
3. Roll with resistance
4. Support self-effiacy
5. Avoid Arguments
Express Empathy
Empathy is the ability to see the issue from the other persons

point of view
Acceptance facilitates change
Skillful reflective listening is fundamental
Develop Discrepancy
The client rather than the counselor should present the

arguments for change
A discrepancy between present behavior and important

personal goals or values will motivate change
Roll with Resistance
Avoid arguing for change
Resistance is not directly opposed
Roll with the resistance by seeing it from the persons point

of view
Support self efficacy
The counselor’s own belief in the person’s ability to change

becomes a self-fulfilling prophecy
A person’s belief in the possibility of change is an important
motivator
5. Avoid Argumentation
Arguments are the least effective
way of exploring a subject
The 5 skills of M.I.
1: Ask open ended questions
2: Affirm
3: Listen Reflectively
4: Summarising
5: Eliciting “change talk”
Open ended questions are...
Questions that do not invite brief answers.

Affirming is…
Recognising the work that the client has done in relation to
their problem
Listening reflectively is...
Statements to mirror back the clients own experiences

to them
Types of Reflection
Neutral: Emphasis not changed
Enhanced: Amplifying or minimising in direction of

change
Double sided: Reflects both sides of ambivalence
Selective Reinforcement
Statements supportive of the therapists agenda are reinforced

through neutral or amplified reflection
Statements inconsistent with the agenda are neither
reinforced by words nor actions
Summarising is...
Listening to the client and reflecting back to the client the

main points of what they are feeling or thinking every few
minutes.
Eliciting changetalk
In MI.. The client…provides the argument for change”
There are 4 types of changetalk
1: Problem recognition
2: Expression of concern
3: Intention to change
4: Expression of optimism
Methods for Evoking Change Talk
1: Ask open ended questions
2: Use the importance ruler (1-10)
3: Explore the decisional balance (pros and cons)
4: Elaborating
5: Exploring Goals and Values
Thanks for your time
Do you feel motivated?

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Introduction to Motivational Interviewing Techniques

  • 2. What is motivational interviewing? “a therapeutic style intended to help clinicians work with patients to address the patient’s fluctuation between opposing behaviors and thoughts.” Source: Miller and Rollnick, Motivational Interviewing 1991.
  • 3. Characteristics of Motivational Interviewing Client directed towards change Feedback and information offered selectively Empathic reflection used selectively Therapist creates or amplifies client discrepancies to enhance motivation
  • 4. Characteristics of Motivational Interviewing De-emphasis on labels Emphasis on personal choice Therapists elicits client’s own concern Resistance is normal Client provides goals and change plans
  • 5. Resistance When we see our freedom to act in a particular way threatened, the behaviour seems more desirable and we will be more likely to choose that behaviour “You’re a drug addict”…”No I’m not” “You’ve got to stop”…”No I don’t”
  • 6. Ambivalence Ambivalence is being in two minds about something Ambivalence is normal.
  • 7. General principles of M.I. 1. Express empathy 2. Develop Discrepancy 3. Roll with resistance 4. Support self-effiacy 5. Avoid Arguments
  • 8. Express Empathy Empathy is the ability to see the issue from the other persons point of view Acceptance facilitates change Skillful reflective listening is fundamental
  • 9. Develop Discrepancy The client rather than the counselor should present the arguments for change A discrepancy between present behavior and important personal goals or values will motivate change
  • 10. Roll with Resistance Avoid arguing for change Resistance is not directly opposed Roll with the resistance by seeing it from the persons point of view
  • 11. Support self efficacy The counselor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy A person’s belief in the possibility of change is an important motivator
  • 12. 5. Avoid Argumentation Arguments are the least effective way of exploring a subject
  • 13. The 5 skills of M.I. 1: Ask open ended questions 2: Affirm 3: Listen Reflectively 4: Summarising 5: Eliciting “change talk”
  • 14. Open ended questions are... Questions that do not invite brief answers. Affirming is… Recognising the work that the client has done in relation to their problem
  • 15. Listening reflectively is... Statements to mirror back the clients own experiences to them Types of Reflection Neutral: Emphasis not changed Enhanced: Amplifying or minimising in direction of change Double sided: Reflects both sides of ambivalence
  • 16. Selective Reinforcement Statements supportive of the therapists agenda are reinforced through neutral or amplified reflection Statements inconsistent with the agenda are neither reinforced by words nor actions
  • 17. Summarising is... Listening to the client and reflecting back to the client the main points of what they are feeling or thinking every few minutes.
  • 18. Eliciting changetalk In MI.. The client…provides the argument for change” There are 4 types of changetalk 1: Problem recognition 2: Expression of concern 3: Intention to change 4: Expression of optimism
  • 19. Methods for Evoking Change Talk 1: Ask open ended questions 2: Use the importance ruler (1-10) 3: Explore the decisional balance (pros and cons) 4: Elaborating 5: Exploring Goals and Values
  • 20. Thanks for your time Do you feel motivated?

Editor's Notes

  1. Exercise on change