Motivational Interviewing

A basic MI skill. Open-ended questions invite the client to tell their story in their own words, without steering them in a particular direction. They open space for inquiry and let the client speak more than the therapist (70/30). Unlike closed questions, open ones launch the conversation about change and help uncover the client's values, desires, and meanings.

• 1. Frame the question so that it cannot be answered in one word ("tell me", "describe", "what do you think", "how do you see")
• 2. Ask the question and go quiet — give the client space
• 3. Listen carefully to what in the answer counts as change talk
• 4. Reflect what you heard, then ask the next open question
• 5. Avoid strings of several questions in a row — one question, one pause

When to use:

• At the start of a session, for building contact
• When you need to understand the client's world without interpretation
• For evoking change talk in the evoking stage
• When the client has closed down or gives one-word answers

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not ask several open questions in a row — that feels like interrogation
• ⚠️ Do not use disguised closed questions: "You have thought about it, haven't you?"
• ⚠️ Do not ask "why" — it can sound accusatory

Miller & Rollnick, 2013

Affirmations are the genuine recognition of the client's strengths, efforts, and values. It is not praise ("well done!"), but the noticing of concrete qualities and actions: "You kept coming to our meetings, even when it was especially hard. There is persistence in you." Affirmations strengthen self-efficacy and the therapeutic alliance. A genuine affirmation flows from sincere respect for the client.

• 1. Observe the client's concrete actions, words, or efforts
• 2. Frame the affirmation through a quality, not an evaluation: "You + concrete quality + concrete action"
• 3. Say the affirmation simply and without flattery — with no "but" after it
• 4. Give a pause, let the client take the words in
• 5. Do not wait for confirmation — carry on with the conversation

When to use:

• When the client takes a step toward change — even a small one
• When the client speaks about their values or strengths
• In low self-efficacy ("I won't manage anyway")
• To strengthen the therapeutic alliance at the start of the work
• After a hard period in which the client nevertheless coped

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Avoid surface-level "well done" — it sounds condescending
• ⚠️ Do not use affirmations as manipulation
• ⚠️ Affirmations must be concrete and sincere — the client feels what is fake
• ⚠️ Do not overload a session with affirmations — they lose weight

Miller & Rollnick, 2013

The fundamental MI skill — the expression of empathy through reflection. The therapist forms a hypothesis about what the client meant, and voices it as a statement (not a question). A simple reflection is a repeat or paraphrase; a complex reflection adds meaning, feeling, or a shift of emphasis. Key distinction: the intonation goes down. Reflection is the main instrument for expressing empathy and evoking change talk.

• 1. Listen actively — form a hypothesis about what the client means
• 2. Choose the level of reflection: simple (close to the words) or complex (deeper, beyond the words)
• 3. Say the reflection as a statement, with a falling intonation
• 4. Go quiet — wait for the client's reaction
• 5. If the client corrects you — accept the correction, that too is good

When to use:

• Constantly, as the main instrument in all the processes of MI
• When the client expresses ambivalence — a double-sided reflection
• When you need to explore experience more deeply — a complex reflection
• In sustain talk — an amplified reflection (without sarcasm)

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not finish a reflection with a rising intonation — it turns into a question
• ⚠️ Do not overuse the amplified reflection — it must be without sarcasm
• ⚠️ Do not actively reflect sustain talk — that strengthens it

Miller & Rollnick, 2013

A summary is an extended reflection that gathers several key elements from the conversation. It does three things: it confirms careful listening; it helps the client hear their own words gathered together; it structures the conversation. Types of summary: linking, transitional, collecting — the last is used before planning to gather all the change talk.

• 1. Announce the summary: "Let me gather what you have told me…"
• 2. List the client's key thoughts, especially change talk and values
• 3. If the situation is double-sided — reflect both sides of the ambivalence
• 4. In a collecting summary, finish on change talk, not on sustain talk
• 5. Finish with a question: "Have I missed anything?" or "How does that sound?"

When to use:

• At a transition between themes
• At the end of a session — a transitional summary
• Before moving to planning — a collecting summary
• When the conversation "scatters" and the threads need to be gathered
• After a long monologue from the client

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not add your own interpretations to a summary — only the client's words
• ⚠️ Mind the order: finish on change talk, not sustain talk
• ⚠️ Do not turn the summary into a therapist's monologue

Miller & Rollnick, 2013

Change talk is any statement by the client in favor of change. It is the heart of MI: the therapist does not convince, but creates conditions in which the client begins to argue for change themselves. Change talk divides into preparatory (DARN: Desire, Ability, Reasons, Need) and mobilizing (CAT: Commitment, Activation, Taking steps). Mobilizing change talk is more strongly linked with actual change.

• 1. Ask open questions about change talk: "What troubles you in the current situation?" (Need)
• 2. Use the importance and confidence rulers — they automatically evoke change talk
• 3. Explore values and discrepancy: "What matters to you in life? How does that sit with what is happening now?"
• 4. The "looking forward" technique: "If things go well, where do you see yourself in 5 years?"
• 5. When you hear change talk — reflect it, strengthen it, ask for more: "Tell me more…"
• 6. Do not reinforce sustain talk — make short reflections and return to change talk

When to use:

• In the evoking stage, as the main strategy
• In ambivalence — it helps tilt the scales
• In low motivation for change
• In work with addictions and chronic illness

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not strengthen sustain talk — it reinforces resistance
• ⚠️ Do not move to CAT (commitments) too early — a sufficient foundation of DARN is needed
• ⚠️ Remember: your task is to evoke, not to convince

Miller & Rollnick, 2013

EARS is the strategy for working with change talk once heard: Elaborating, Affirming, Reflecting, Summarizing. When the client utters a change-oriented statement, the therapist's task is to reinforce it without pressure. This is not "that's right! well done!", but the sincere recognition of the significance of what has been said and the invitation to develop the thought further.

• 1. Hear change talk — recognize it (desire, ability, reason, need, step)
• 2. Reflect the change talk (R)
• 3. Ask for elaboration or continuation: "Tell me more about this." (E)
• 4. Support a concrete effort or quality with an affirmation (A)
• 5. Include in your summary all the change-oriented statements that appeared (S)

When to use:

• Always, when the client utters change talk
• At any signs of movement toward change
• In the evoking and planning processes

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not react to change talk with excessive enthusiasm — that is pressure
• ⚠️ Do not move to planning at the first signs of change talk
• ⚠️ Do not ignore sustain talk — hear it, make a minimal reflection

Miller & Rollnick, 2013

Sustain talk — the client's statements in favor of keeping the current behavior. In MI, sustain talk is a normal part of ambivalence, not an enemy. The task is not to fight sustain talk, but not to strengthen it — switching instead to the exploration of change talk. A persistent pattern of sustain talk during a move to planning is a signal to slow the pace.

• 1. Recognize sustain talk — it is speech in favor of the status quo
• 2. Make a minimal simple reflection, without deepening: "This helps you relax."
• 3. Do not ask clarifying questions about sustain talk — that elaborates it
• 4. Move to change talk through a double-sided reflection: "And at the same time…"
• 5. Check: if sustain talk is growing, you may be moving too fast

When to use:

• Constantly — sustain talk is present in most MI sessions
• Especially important in work with addictions
• With mandated clients — those referred by a court or employer

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not argue or refute sustain talk — it strengthens through reactance
• ⚠️ Do not ask "why" about sustain talk — that sounds like a challenge
• ⚠️ Do not ignore it completely — the client must feel heard
• ⚠️ Rising sustain talk = a signal to rethink your actions

Miller & Rollnick, 2013

Discord is the moment when therapist and client find themselves on different shores: the client feels pressured, misunderstood, or not heard. This is a disturbance of the therapeutic relationship, not a trait of the client's character. Signals: interrupting, going off topic, going silent, attacking. The key: discord is a signal to change course, not to increase pressure.

• 1. Simple reflection — reflect what the client said, without evaluation
• 2. Amplified reflection — exaggerate the client's viewpoint; they will move to the other side
• 3. Double-sided reflection — hear both sides
• 4. Shift of focus — switch to a different theme or angle
• 5. Emphasizing autonomy — directly acknowledge the client's right to decide
• 6. Coming alongside — stand on the client's side

When to use:

• In rising resistance, interruptions, aggression
• When the client says: "You don't understand me"
• In mandated referrals (court, employer)
• When the pace of the conversation is too fast

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not argue, do not persuade, do not insist — that increases discord
• ⚠️ Do not ignore the signals of discord — they grow
• ⚠️ Avoid the "righting reflex" — the wish to explain the right answer

Miller & Rollnick, 2013

One of the four original principles of MI. The essence: help the client see the gap between their current behavior and what matters to them (values, goals, self-image). This creates inner discomfort — cognitive dissonance — which serves as fuel for change. The discrepancy must arise from the client's inner values, not from external pressure.

• 1. Explore the client's values through open questions: "What is most important to you in life?"
• 2. Make sure the client has named the value in their own words
• 3. Ask the linking question: "How does this relate to what is happening now?"
• 4. Reflect the discrepancy without judgment
• 5. Give the client space to notice the contradiction themselves

When to use:

• When the client names important values but behaves at odds with them
• In work with addictions: values of health, family, career
• When changing lifestyle: health, relationships, professional growth
• In evoking — as a way to strengthen need-talk

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not point out the contradiction directly — that triggers defense
• ⚠️ The discrepancy must be built only on the client's inner values, not yours
• ⚠️ Do not overuse the technique — constant emphasis on discrepancy is oppressive

Miller & Rollnick, 1991, 2013

A technique of directly exploring what matters to the client. Values are the compass of change in MI: when behavior diverges from values, inner motivation arises. The technique is carried out as an open conversation or through values card sort. Especially important in work with uncertainty and "unmotivated" clients.

• 1. Introduce the theme: "It matters to me to understand what is meaningful for you in life"
• 2. Ask an open question about values: "What is most important to you?"
• 3. Listen carefully — remember or write down the named values
• 4. Deepen by concretizing the value: "What does being a good father mean to you?"
• 5. Link the values to the theme of the conversation carefully, through a question

When to use:

• At the start of work — for establishing contact and understanding the client
• In ambivalence — values help find a foothold for change
• In work with "unmotivated" clients
• In planning — as the basis for change goals

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not turn the conversation about values into an interrogation
• ⚠️ Do not use values as an argument against the client
• ⚠️ Do not impose values — only explore those the client names

Rosengren, 2018; Miller & Rollnick, 2013

Two scales from 0 to 10 that help assess motivation and evoke change talk. The importance ruler: how important is change for the client right now? The confidence ruler: how confident are they that they can do it? The key moment: the question is not "Why not 10?" but "Why not 0?" — it is the second variant that launches change talk.

• 1. Introduce the ruler: "On a scale from 0 to 10, how important is it for you to change [concrete behavior]?"
• 2. The client names a number (for example, 6)
• 3. Ask the key question: "You said 6. Why not less — say, 2 or 3?"
• 4. The client explains why it is important — this is change talk
• 5. Summarize the change talk
• 6. Ask the second question: "What could raise this number from 6 to, say, 8?"
• 7. Repeat for the confidence ruler

When to use:

• When assessing readiness for change
• To evoke change talk in clients who struggle to speak about motivation directly
• As an entry point into the conversation about change
• In a mismatch between importance and confidence

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Never ask "Why not 10?" — it evokes sustain talk
• ⚠️ Do not use the rulers mechanically — they work only in the context of conversation
• ⚠️ Do not hand out the rulers in writing without a conversation — the effect is lost

Miller & Rollnick, 2013

A technique for the structured exploration of ambivalence: client and therapist together study the pros and cons of changing and not changing. The classic 2×2 matrix: good in the current behavior, bad in the current behavior, good in change, bad in change. Important: with an ambivalent client the technique can entrench ambivalence — use with care.

• 1. Introduce the technique: "Let's try to look at the situation from different sides."
• 2. Explore the pros of the current behavior — start here, the client feels heard
• 3. Explore the cons of the current behavior
• 4. Explore the pros of change
• 5. Explore the cons of change
• 6. Summarize both sides — finish on change talk

When to use:

• When the client themselves speaks of "two sides"
• When the client has already decided to change — for consolidation
• At the start of work, as an instrument for understanding the client's position

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ With an ambivalent client this may entrench ambivalence — use carefully
• ⚠️ Do not dwell on the cons of change — finish on arguments in favor of change
• ⚠️ Do not turn it into a mechanical exercise

Miller & Rollnick, 2013

A technique for evoking change talk by exploring the past, when the client felt better or things were different. It lets them recall who they were before the problem and compare with the current state. This creates a contrast effect — a gap between "then" and "now" that becomes a source of motivation. Especially effective in depression, addictions, chronic states.

• 1. Ask an orienting question: "Was there a period in your life when things were going better?"
• 2. Let the client tell you about that time
• 3. Deepen: "What was different then?", "How did you feel?"
• 4. Compare with the present: "What do you think has changed since then?"
• 5. Offer a link to change: "What would that you say to the current you?"

When to use:

• In low motivation or "I don't know what for"
• In addictions — before use began
• In depression or burnout — when the client has forgotten another life
• When the client says "it has always been like this"

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use it if the past was traumatic or heavier
• ⚠️ Do not become nostalgic with the client — the aim is contrast, not longing
• ⚠️ Make sure the conversation returns to the present and the future

Miller & Rollnick, 2013

A technique for evoking change talk by imagining a better future. The client projects themselves into a future where the change has happened, or, conversely, where nothing has changed. The positive version: "If everything worked out well — how would your life look?" The negative version: "If everything goes on as it is — what will happen in 5 years?"

• 1. Positive version: "Imagine a year has passed, and everything changed the way you wanted. What does your life look like?"
• 2. Let the client describe the picture in detail
• 3. Deepen: "What else? How do you feel? Who is beside you?"
• 4. Negative version: "If everything goes on as it is, where will you be in 5 years?"
• 5. Ask the linking question: "What needs to change for the future to be as you want it?"

When to use:

• In low motivation or "I don't know why"
• When the client is stuck in the present and sees no alternatives
• In work with addictions — visualizing life without the substance
• At the start of planning — as a description of the target state

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use only the negative version — it can be demoralizing
• ⚠️ Give enough time for a detailed description of the picture
• ⚠️ Do not move to planning right after the visualization

Miller & Rollnick, 2013

A technique for evoking change talk through the exploration of extreme scenarios: the worst (if nothing changes) and the best (if the change happens). Especially useful when the client shows low desire to change or minimizes the problem. Questions about extremes help the client step outside habitual thinking and see the full range of consequences.

• 1. Worst scenario: "Suppose you go on living this way. What is the worst that could happen?"
• 2. Let the client describe the worst — do not interrupt, do not soften
• 3. Reflect what you heard
• 4. Best scenario: "And now — if everything worked out. What would be the best result?"
• 5. Summarize both poles, finishing on the positive scenario

When to use:

• When the client minimizes the seriousness of the situation
• In low levels of desire (to change)
• When other techniques for evoking change talk are not working
• In work with addictions and risk-taking behavior

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not overuse negative scenarios — they can trigger fear and avoidance
• ⚠️ Make sure you finish on the positive pole
• ⚠️ Do not turn this into fear appeal — that does not work in MI

Miller & Rollnick, 2013

A technique of the focusing process of MI: a joint identification of the theme or direction of the conversation from several possibilities. Instead of the therapist deciding alone what "today is about", client and therapist together "map" the possible directions. The instrument — a bubble chart. The key principle: the client chooses the focus.

• 1. Introduce the context: "Today we could talk about different things. Let's look at what matters for you."
• 2. Show the bubble chart with possible themes and empty circles
• 3. Ask: "Look at this sheet — what resonates as important for you?"
• 4. Let the client add their own themes
• 5. Ask about priority: "What of these would you want to put first?"

When to use:

• At the start of a series of sessions or in work with several concerns
• When the client has many themes and it is unclear where to start
• In health-coaching work
• When the therapist has their own agenda, but it is important to preserve the client's autonomy

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not impose a theme that seems important to you — first listen to the client
• ⚠️ Do not overload the sheet — 6–8 bubbles maximum
• ⚠️ Agenda mapping is not for every session, but for the start of the work

Miller & Rollnick, 2013

A technique for exchanging information in the spirit of MI. Instead of lecturing, the therapist first finds out what the client already knows (Elicit), then with permission shares information (Provide), then returns the floor to the client to hear their reaction (Elicit). The key distinction: the information is given in one block, only when there is a request, and ends with the question "What do you think about this?"

• 1. First Elicit — find out what the client already knows: "What do you already know about the effect of alcohol on the liver?"
• 2. Ask permission: "May I share what we know about this?"
• 3. Provide — share the information briefly, in one block, without jargon
• 4. Second Elicit — return the floor to the client: "What do you think about that?"
• 5. Reflect the client's reaction and continue the conversation

When to use:

• When medical or practical information needs to be shared
• In work with addictions (risks, consequences)
• In chronic illness — information about treatment
• When the client directly asks: "And what do you think?"

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not give information without permission — that breaks the MI spirit
• ⚠️ Do not turn Provide into a lecture — one point, one time
• ⚠️ The second Elicit is mandatory — without it the information falls into the void

Miller & Rollnick, 2013

A structured instrument of the MI planning phase. When the client is showing enough mobilizing change talk (CAT) and expressing readiness for action, the therapist offers to build a change plan together. This is not a directive but joint work: the client defines the goals, the steps, the possible obstacles, and the sources of support.

• 1. Check readiness: "It seems you are ready to think about next steps. Is that right?"
• 2. Start with the goal: "What exactly do you want to change?" — let the client formulate it
• 3. Explore concrete steps: "What would be a reasonable first step?"
• 4. Explore obstacles: "What could get in the way? What is hard?"
• 5. Explore support: "Who could help you?"
• 6. Reinforce commitment: "How ready are you for this step, on a scale from 0 to 10?"

When to use:

• When the client expresses CAT (commitment, activation, taking steps)
• After enough change talk has accumulated in evoking
• At clear signs of readiness: "I want to start", "What do I need to do?"

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not hurry with planning — premature planning with weak motivation is doomed
• ⚠️ Do not take over the plan from the client — they must formulate the steps
• ⚠️ Return to evoking if sustain talk arises during planning

Miller & Rollnick, 2013

One of the four original principles of MI. Empathy in MI is the accurate understanding of the client's inner experience, conveyed through reflective listening. It rests on Carl Rogers's work: "accurate empathy" means a sincere wish to understand — how the client sees the world, what matters to them, what they are going through. Empathy is not a technique but the basic stance of MI.

• 1. Listen without judgment — do not evaluate the client's choices and actions inwardly
• 2. Form a hypothesis about the client's experience — what they feel, what matters to them
• 3. Reflect the hypothesis as a statement: "This feels unfair to you."
• 4. Notice when your reflection is accurate — the client continues, goes deeper
• 5. If the client corrects — accept the correction without defense

When to use:

• Constantly — empathy runs through the whole MI conversation
• Especially important in the first contact
• With the client's strong emotions — anger, shame, fear
• In discord — empathy restores connection

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Empathy ≠ agreeing with the client's behavior. You can understand — and not approve
• ⚠️ Do not confuse empathy with sympathy ("I feel so sorry for you")
• ⚠️ Do not use cliché phrases without a concrete reflection
• ⚠️ Empathy requires genuine interest — fake empathy the client feels at once

Miller & Rollnick, 2013; Rogers, 1951

The fourth principle of MI. Self-efficacy is the client's belief that they can change. Without it, even high importance of change does not lead to action. The therapist's task is to strengthen the client's confidence through exploration of past successes, affirmations, reflection of abilities, discussion of the successes of other people in similar situations.

• 1. Set the confidence ruler: "On a scale from 0 to 10, how confident are you that you can change [concrete thing]?"
• 2. The key question: "You said X. Why not less? What gives you this level of confidence?"
• 3. Reflect and affirm the resources that have appeared
• 4. Explore past successes: "Was there something you managed to change in your life? How did you do it?"
• 5. Offer options of the path (not directively)

When to use:

• In a mismatch: high importance, low confidence
• When the client says "nothing will work out anyway"
• In chronic unsuccessful attempts at change
• In the planning process

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not assure the client "you will definitely succeed" — that is insincere
• ⚠️ Do not minimize real obstacles — acknowledge them, and look for paths beside them
• ⚠️ Supporting self-efficacy does not mean unrealistic optimism

Miller & Rollnick, 2013; Bandura, 1997

A form of complex reflection: the therapist reflects the client's viewpoint with greater amplification than the client expressed. The goal — without sarcasm or irony — is to create conditions in which the client themselves takes the other side of the ambivalence. If the client says "I sometimes drink a little", the therapist may reflect: "Alcohol is not a problem in your life at all." The client will most likely correct — and formulate change talk themselves.

• 1. Hear sustain talk or minimization
• 2. Amplify it slightly — not to absurdity, but above what the client said
• 3. Deliver without sarcasm, neutrally or with a gentle intonation
• 4. Go silent — wait for the reaction
• 5. The client will most likely correct you — reflect their correction (change talk)

When to use:

• In persistent sustain talk
• When the client minimizes the problem
• When there is an unwillingness to change in a client with a high level of reactance

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ No sarcasm, no irony, no mockery — it destroys the alliance
• ⚠️ Do not overdo it — too strong an amplification sounds implausible
• ⚠️ Use rarely — it is a powerful instrument that requires accuracy

Miller & Rollnick, 2013

A form of complex reflection: the therapist reflects both sides of the client's ambivalence in one utterance, using the connector "and" (not "but"!). Structure: "On the one hand [sustain talk]… and [change talk]." It is important to end on change talk — that gives it the last word. "But" creates opposition; "and" holds both poles without conflict.

• 1. Hear both poles of the ambivalence
• 2. Formulate both sides without evaluation
• 3. Use "and", "while", "at the same time" — avoid "but"
• 4. Finish on change talk
• 5. Go silent — let the client respond

When to use:

• In obvious ambivalence: "I want to quit, but I can't"
• After a series of sustain talk — to reflect the other side too
• In the transition from sustain talk to change talk

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Never finish on sustain talk — it reinforces it
• ⚠️ Replace "but" with "and" — "but" creates confrontation
• ⚠️ Make sure both parts are accurate — otherwise the client will feel misunderstood

Miller & Rollnick, 2013

A technique for the detailed exploration of the client's usual day, most often connected with the problem behavior. The client describes how the day begins and unfolds: when and in what situation the behavior happens, how they feel, what they think, what follows. This is not an evaluation — it is a shared inquiry into the context. Especially effective in addictions: it lets the pattern be seen without direct confrontation.

• 1. Introduce: "Tell me about a typical day when you [drink / smoke]. From the very beginning — how do you wake up?"
• 2. Listen carefully, follow the context, triggers, consequences
• 3. Ask clarifying questions: "And what happened next?", "How did you feel?"
• 4. Do not evaluate, do not interrupt
• 5. Ask an open question about consequences and meaning-making

When to use:

• In addictions — as an alternative to formal questionnaires
• At the start of work — for understanding the context
• When the client denies the presence of a problem — the description of the day itself shows the pattern

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not turn this into an interrogation or a search for "proof of the problem"
• ⚠️ Do not interrupt the description with evaluative remarks
• ⚠️ After the telling, always ask a question that invites meaning-making

Miller & Rollnick, 2013; Rosengren, 2018