Quick Reference — 50 MI Q&A

1. 1. What is Motivational Interviewing?
   A collaborative, person-centred counselling style designed to strengthen personal motivation and commitment to change by exploring and resolving ambivalence.
2. 2. Who developed MI?
   William R. Miller and Stephen Rollnick developed MI in the 1980s, initially for alcohol problems; it has since broadened to many behaviour changes.
3. 3. What are MI’s core principles?
   Express empathy, develop discrepancy, roll with resistance, support self-efficacy, and evoke change talk.
4. 4. What is ‘change talk’?
   Client statements favoring change (e.g., desire, ability, reasons, need, commitment). Evoking and reinforcing these predicts behaviour change.
5. 5. What is ‘sustain talk’?
   Client arguments for maintaining the status quo (e.g., “I can’t,” “It’s not that bad”). MI helps explore and reduce sustain talk.
6. 6. What are the ‘OARS’ skills?
   Open questions, Affirmations, Reflective listening, and Summarising — core microskills in MI.
7. 7. How do open questions differ from closed ones?
   Open questions invite elaboration and reflection; closed questions elicit brief factual answers. MI favours open questions for exploration.
8. 8. What is reflective listening?
   A skill of restating or paraphrasing the client’s meaning to show understanding and encourage deeper exploration.
9. 9. Why are affirmations important?
   Affirmations recognise client strengths and efforts, building rapport and self-efficacy without judgment.
10. 10. How to use summaries in MI?
    Summaries pull together key points and highlight change talk or discrepancies, helping clients hear their own motivations and decisions.
11. 11. What is ‘developing discrepancy’?
    Helping clients see the gap between current behaviour and broader goals/values to create motivation for change.
12. 12. How do you ‘roll with resistance’?
    Avoid arguing, reflect resistance, shift focus, and use the client’s perspective to explore alternatives non-confrontationally.
13. 13. When is MI not appropriate?
    MI alone is insufficient for acute psychosis, active mania, severe cognitive impairment, or when immediate safety/crisis intervention is required.
14. 14. How long are MI sessions?
    MI can be brief (5–15 minutes) or part of longer therapy; multiple sessions often enhance efficacy, depending on the target behaviour.
15. 15. Can MI be used remotely?
    Yes — MI translates well to phone or telehealth, though reflective listening and rapport need careful attention without visual cues.
16. 16. What is a ‘change plan’?
    A collaboratively developed, practical plan specifying steps, supports, and timelines the client is willing to try after motivation is established.
17. 17. How do you evoke change talk?
    Ask evocative questions (e.g., “What are the reasons you might want to change?”), reflect any change talk, and highlight it in summaries.
18. 18. Give an example of an evocative question.
    “On a scale of 0–10, how important is it for you to make this change — and why not a lower number?”
19. 19. What is ‘ruler’ scaling?
    Using 0–10 scales for importance/confidence to quantify motivation and explore reasons behind the score and ways to raise it.
20. 20. How to respond to ‘I don’t want to change’?
    Reflect the statement, explore ambivalence gently (pros/cons), and ask about past attempts or values to open discussion.
21. 21. What are complex reflections?
    Reflections that go beyond the client’s words to infer meaning, feelings, or values — used cautiously to deepen conversation.
22. 22. What’s the role of autonomy in MI?
    MI emphasises client choice and control — emphasising autonomy reduces resistance and promotes ownership of change.
23. 23. How do you handle discrepancy when it’s denied?
    Use gentle curiosity: explore the client’s goals/values first, then reflect behaviors and invite their view on alignment without confrontation.
24. 24. Can MI be combined with CBT?
    Yes — MI often precedes CBT to enhance engagement, motivation, and readiness to do the cognitive and behavioral work CBT requires.
25. 25. How to set collaborative goals in MI?
    Elicit the client’s priorities, check alignment with values, set small achievable steps, and confirm commitment before planning.
26. 26. What is ‘MI-consistent’ behaviour?
    Behaviours that align with MI principles: open questions, reflections, affirmations, supporting autonomy, and eliciting change talk.
27. 27. What is ‘MI-inconsistent’ behaviour?
    Confrontation, unsolicited advice, premature persuasion, arguing, shaming, or directing without permission — these reduce engagement.
28. 28. How to give advice within MI?
    Ask permission first (“May I share an idea?”), then offer options and ask what the client makes of them to keep autonomy central.
29. 29. How to measure MI fidelity?
    Use validated coding systems (e.g., MITI — Motivational Interviewing Treatment Integrity) via recorded sessions and trained raters.
30. 30. What is a ‘decisional balance’ exercise?
    A structured exploration of pros and cons of change vs staying the same, helping clients clarify ambivalence and values.
31. 31. How to respond to very low confidence?
    Explore past successes, scale confidence, suggest tiny experiments to build mastery, and affirm strengths that support change.
32. 32. What is ‘sustain talk reflection’?
    Reflecting sustain talk neutrally acknowledges ambivalence and reduces its persuasive power, inviting exploration instead of escalation.
33. 33. How to open an MI session?
    Start with a warm check-in, ask about the client’s priorities, and use open questions to invite their agenda rather than imposing yours.
34. 34. How to close an MI session?
    Summarise key points, highlight any client commitments or change talk, agree on small next steps, and confirm supports and safety if relevant.
35. 35. How to work with ambivalence?
    Normalize ambivalence, explore both sides, elicit change talk, and help the client weigh values against current behaviour.
36. 36. Is MI directive?
    MI is goal-directed (towards change) but non-prescriptive — it guides clients to articulate their own reasons and plans for change.
37. 37. How to train in MI?
    Effective training includes interactive workshops, practice with feedback, recorded session review, and ongoing supervision to build skill and fidelity.
38. 38. How long until MI shows effects?
    Some brief MI interventions show early effects (weeks) for behaviours like brief alcohol use reduction; sustained change often needs follow-up and supports.
39. 39. Can MI reduce resistance in mandated clients?
    Yes — emphasising autonomy, empathy, and collaborative problem-solving can reduce reactance even when participation is mandated.
40. 40. Example of a reflective statement for fear?
    “It sounds like part of you worries that trying could lead to failure, and another part doesn’t want to keep feeling stuck.” — captures ambivalence and emotion.
41. 41. How to use ‘values’ in MI?
    Ask about what matters most (family, health, work) and link change goals to those values to strengthen motivation and meaning.
42. 42. What is ‘hypothetical change talk’?
    Asking “Suppose you decided to change, what would be different?” invites imagining benefits and can elicit desire/ability statements.
43. 43. How to document MI in notes?
    Record client’s expressed goals, key change talk, agreed action steps, readiness/confidence scales, and any safety or referral needs.
44. 44. How to handle relapse in MI?
    Use empathic listening, explore triggers without judgment, elicit learning, and collaboratively create a revised plan emphasizing small achievable steps.
45. 45. Can MI be used with families?
    Yes — adapting MI principles to family sessions can support collective motivation and reduce conflict while respecting individual autonomy.
46. 46. How to manage time constraints while using MI?
    Use brief MI techniques: one or two evocative questions, focused reflection, and a short summary to quickly elicit change talk.
47. 47. What supervision is helpful for MI?
    Regular review of recorded sessions with an MI-trained supervisor, use of fidelity tools (MITI), and targeted feedback on OARS and evoking techniques.
48. 48. How to integrate MI into routine care?
    Train staff in brief MI skills, use MI-consistent language in assessments, and embed brief MI steps into workflows (screening, brief advice, referral).
49. 49. How to respond when a client finally commits?
    Affirm the decision, explore specific steps, set realistic small goals, enhance confidence, and plan supports and follow-up to sustain momentum.
50. 50. Key pitfalls to avoid in MI?
    Arguing, giving unsolicited advice, rushing to solutions, ignoring sustain talk, and failing to affirm strengths — these undermine MI’s effectiveness.

Further Resources & Training

If you’d like, Emocare can provide printable PDFs, shorter cheat-sheets, recorded role-play scripts, or a MITI-based feedback package for training. Reply with which format you prefer.