1. Introduction to
Motivational Interviewing
Tim Bingham BA

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?