Motivational Interviewing
Motivational Interviewing tests the spirit, four processes, and micro-skills, plus your ability to distinguish change talk from sustain talk. The exam rewards restraint: evoking rather than instructing.
Spirit: PACE
Partnership, Acceptance (worth, autonomy, affirmation, accurate empathy), Compassion, Evocation. The righting reflex, the urge to correct or prescribe, is the main enemy.
Four processes
Engaging, focusing, evoking, planning. Do not jump to planning before engaging and evoking.
OARS
Open questions, Affirmations, Reflections (simple and complex), Summaries. Reflect more than you question; avoid the question-answer trap.
Change talk: DARN-CAT
Preparatory: Desire, Ability, Reasons, Need. Mobilizing: Commitment, Activation, Taking steps. Evoke it, reflect it, and ask for elaboration. Sustain talk concerns the behavior; discord concerns the relationship. Soften discord with reflection, apology, or shifting focus, and emphasize autonomy.
Information and rulers
Use elicit-provide-elicit: ask what the client knows, offer information neutrally, ask their reaction. Importance and confidence rulers ("Why a 6 and not a 3?") invite change talk rather than a score.
Worked example
Client: "I guess I could walk at lunch, but my knee hurts." Reflect the change talk first: "Walking at lunch feels doable, and the knee is the concern." Then ask, "If the knee were less of an issue, what would you try?" Do not problem-solve the knee unless the client asks.
Traps
- Premature planning.
- Confronting or arguing.
- Cheerleading instead of reflecting.
- Treating sustain talk as resistance or a personality flaw.
- Giving information without permission.
- Missing rising discord and continuing the same strategy.