A successful motivational interviewing conversation has four different processes: engagement, focusing, evoking, and planning. The steps often aren’t linear.
Motivational Interviewing (MI) is a coaching or counseling style based on the fundamental idea that motivation must come from the person making the personal change (rather than change being forced by the counselor).
The creators of MI, William Miller and Stephen Rollnick, define motivational interviewing as “a directive, client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence.”
In their book “Motivational Interviewing: Helping People Change,” Miller and Rollnick have defined four essential processes of motivational interviewing that the practitioner and the client should move through.
The general process of MI is dynamic and can differ based on the client’s needs, and the four processes aren’t linear. Practitioners can return to previous processes any time. However, certain processes need to come before others; for example, focusing always needs to come before evoking.
If you’re a healthcare professional or mental health therapist you’re probably familiar with the concept of engagement, also known as relationship-building or therapeutic rapport. This is an essential process for any health counseling, not just MI.
Trust is critical in the MI relationship. The person receiving care needs to understand that their MI practitioner wants what is best for them and that they and their counselor are equal partners.
To build engagement during this process, MI practitioners rely on several key MI concepts, including:
- accurate empathy
- OARS (open questions, affirmations, reflections, and summaries)
The care recipient should enter into the relationship knowing that their MI practitioner will not try to force them to make changes they are not ready to make. Their autonomy will always be honored, as will their expertise on their own life.
Engagement is a process that happens continuously throughout the entire MI relationship — not just as a first step.
And although the processes of MI are not often linear, engagement needs to come first. Without engagement, discord (conflict) will likely come up in the relationship later.
MI is more than a supportive conversation. For MI to be effective, both the care recipient and the practitioner need to be in agreement about the end goal of treatment.
The second process of MI — focusing — is where goal agreements take place. Focusing is a necessary prerequisite for the next process of MI: evoking. Without focusing, this practice isn’t MI.
In some settings, some goals are predetermined. For example, a substance use counselor providing court-ordered treatment will by definition try to move the care recipient toward changing their substance use habits.
When there is a predefined focus, but the client doesn’t share a willingness to set this as the goal of treatment, then the focus should be negotiated between you. Practitioners can also use evoking (the next process of MI) to decrease the client’s ambivalence (mixed feelings).
But focusing is also where the care recipient’s expertise on their own life needs to come into play. For example, they might say that to be able to change their substance use habits, they need to first find a mental health therapist to address their depression. Their expertise about what’s best for them needs to be honored.
MI doesn’t work when the overall goal of the conversation isn’t clear, defined, and agreed upon between both parties.
In many ways, the process of evoking is what makes MI unique among counseling styles. Other counseling or therapy methods also include engagement, focusing, and planning — but evoking is how MI practitioners increase motivation toward change.
Evoking is an MI-specific process where the practitioner draws out “change talk” from the care recipient about the focus. Change talk is any statement made by the care recipient that supports making the change.
For example, in the statement “I know I need to quit drinking, but I just don’t think I can do it,” the statement, “I know I need to quit drinking” is change talk.
MI practitioners evoke change talk using various methods, including:
- open questions
- targeted reflections
- providing summaries
For example, after hearing the above statement the MI practitioner might reflect in a way that emphasizes the change talk, such as, “This is really important to you — you know you need to quit, and at this point, you’re just looking for ways to be successful.” They could also ask a question: “What are the reasons you think you need to quit?”
For evoking to be successful, MI practitioners must be able to recognize, reflect, and ask questions to elicit change talk even when the care recipient is very ambivalent. This is also why focusing is so important — without a determined focus or goal it’s impossible to know what change to evoke change talk for.
MI differs from other counseling methods because practitioners actively encourage (evoke) change talk and hope rather than instilling it. In the process of evoking, practitioners never give unsolicited advice or tell the care recipient why they have to change. Instead, they draw out the client’s reasons for wanting or needing to change.
If practitioners don’t recognize change talk, and if they try to force the person to change, then discord will arise in the relationship.
Planning is the only process that’s not necessary for the MI relationship. This is because, if evoking is done well, then care recipients are often able to make a plan on their own.
As a practitioner, perhaps the most important part of planning is remembering that you don’t need to have all of the answers. Trust your client’s expertise on their own life. Although you can provide some professional expertise when necessary, your client will also have answers about what type of plan will work best for them.
One of the most important tasks in the MI process of planning is helping the care recipient get there. To do this, you can ask key questions, such as:
- So you’ve told me that you need to change and that you feel like you can if you really put your mind to it. What do you think you’ll do next?
- What’s your plan for moving forward?
- How will you know if you’ve been successful in your plan?
Planning is also the process in which attending to possible barriers to success could be appropriate. Talking about barriers earlier in the processes, when the care recipient may still be ambivalent, could be counterproductive.
On top of being familiar with the four processes of MI, there are also other concepts you need to keep in mind to be able to successfully facilitate an MI conversation:
- Check your righting reflex. The
righting reflexis a key MI concept. It refers to the practitioner’s instinct to “fix” the client. Remember that your role is to be a guide, not a savior.
- Don’t be afraid to move between processes. For example, if discord arises while you’re evoking around a specific goal, then move back to focusing to discuss a different goal with your client.
- Remember to use more reflections than questions. Asking too many questions in a row, especially closed questions, can make your client feel interrogated.
- Try to let go of the “assessment mindset.” Your goal as an MI practitioner is to evoke motivation from the client to change. It isn’t to gather factual information. You can practice MI even when you don’t have all the facts about the client’s life.
- Keep the spirit of MI in mind as you move through the processes. The four spirits of MI are:
There are four processes to an MI conversation: engaging, focusing, evoking, and planning.
Planning is the only process that isn’t a necessary component of MI. Although the processes are dynamic and often not linear, there is also a logical sequence to them (for example, engaging must necessarily come first — but it can also be revisited later on in the process).
To learn more MI strategies, look for opportunities to train with a member of the Motivational Interviewing Network of Trainers (MINT).