Mental Health

Effective Motivational Interviewing Practices

Motivational interviewing is an effective way to help people change their perspectives or behaviors. The goal is to explore someone’s desire to make changes in their life based on what is important to them.

Motivational interviewing does not involve telling someone to change. Instead, it supports change by respecting people as experts and focusing on their experiences and values. It can also can improve relationships and help staff feel more confident when discussing sensitive issues. 

This resource will help you learn more about motivational interviewing. It includes video examples of strategies in action.

Using Motivational Interviewing

It is important to start the conversation in a way that helps the person you are speaking with feel heard and respected. Motivational interviewing works best when you come in with a spirit of:

  • Partnership: Be partners in the conversation. Work together and acknowledge the other person’s expertise.
  • Personal freedom: Consistently show respect, empathy, and encouragement. Resist giving advice. Instead, make sure the person you are speaking with knows you support their freedom to choose and make their own decisions. This is their autonomy.
  • Compassion: Recognize pain or distress. Show that you care and let them know you genuinely want the best for them.
  • Evocation: Focus on encouraging them to share their own thoughts and motivations. You can often do this by asking questions that help them talk about why they are considering change. For example, “What might be different if you made this change?”

The Process

A typical motivational interviewing conversation has four parts. It is helpful to start by asking for permission to talk about a sensitive topic. You might say, “I was hoping to connect with you for a few minutes this morning. Does that work for your schedule, or would it be better to find another time to talk?” 

The four parts of an motivational interviewing-based conversation, with examples, are as follows:

  • Engaging: Establish a trusting and respectful relationship where everyone is equal.
    • “In our program, we are committed to offering the best support we can for families. One of the ways we do that is by giving information about different topics. Right now, we are checking in with all our families about ________. Would it be okay for me to share this resource with you? I am curious about any thoughts you have about this.”
  • Focusing: Find and keep a direction. Be clear about the goal or direction for change. This direction is based on the reactions or information they share in the conversation.
    • “I wonder if there is one of these things you would like to talk about.”
    • “What changes, if any, are you hoping will come from our meeting?”
  • Evoking: Encourage them to talk about their own thoughts and motivations for making the change.
    • “Can you share with me what concerns and questions you might have?”
  • Planning: Make a specific change plan that everyone is willing to follow.
    • “May I follow up tomorrow?”
    • “What is the next step?”

Conversation Strategies

Motivational interviewing uses four conversation strategies. These are proven to support people in talking about their feelings. The strategies offer a way to respectfully help another person explore their own motivations for changing a behavior.

  • Open-ended questions: Ask questions that they cannot answer with one word, like yes or no. Open-ended questions have many possible answers and encourage people to reflect.
    • “Tell me more about … ”
    • “How are you feeling about … ”
  • Affirmations: Use statements that recognize a person’s strengths. Affirmations encourage progress toward positive change. They need to be genuine and relevant.
    • “I’m so impressed with the way you … ”
    • “It takes a lot of strength to go through all you have been through.”
  • Reflective listening: Repeat or summarize what someone says to show you understand. It helps people feel heard and lets you check that you’re on the same page.
    • “It sounds like you … ”
    • “You’re feeling like … ”
    • “You sound unsure about … ”
  • Summaries: Bring together different things someone has been saying. Summaries help tie information together.
    • “Let me see if I understand so far … ”
    • “You care for your son very much and are concerned we might not be meeting his needs.”

Motivational Interviewing in Action

As you watch the videos below, reflect on how the motivational interviewing process and its strategies are being used to address sensitive topics.

Example 1: A teacher talks with a caregiver about her child’s behavior.

In this video, Ms. Jefferson (a teacher) shares concerns with Mary (a parent) about her son Joe’s behavior. Ms. Jefferson would like to get permission for the program's mental health consultant to observe Joe. 

As you watch:

  • Consider how Ms. Jefferson uses each part of the motivational interviewing process.
  • Reflect on your own thoughts and feelings about this interaction.

Examples of How Ms. Jefferson Uses Each Stage of the Motivational Interviewing Process

Part of processTime stampWhat it sounded like
Engaging0:38–0:50
  • “Thank you so much for coming in today to discuss how things are going with Joe.”
  • “I know it can be hard to rearrange your work schedule, and it sounds like it wasn’t easy with your boss. I know you are very committed to Joe.”
Focusing1:00– 1:38
  • “I know I called you for this meeting but before we get started, I wanted to see if there were any topics or concerns that you wanted to address? What should we put on the agenda?”
  • “Well, the main reason I called this meeting was to talk more about Joe’s behavior in class and see if we can put our heads together to come up with some solutions.”
3:58– 5:10
  • Would it be okay if we talked about Joe’s progress and what we have been doing?”
  • “However, we are concerned that the hitting and biting have not improved since our last meeting, despite some of the things that we have tried already.”
  • “We would like to have our mental health consultant, Ms. Gibson, come in and observe Joe in the class. She will observe how Joe and the other kids interact. We can even give her your suggestion of paying close attention to Joe’s interactions with Alex. Her job is to give us her perspective or ideas on what might be contributing to Joe’s behaviors.”
Evoking5:10– 6:40
  • “I hear your hesitation to have Ms. Gibson observe Joe. Let me assure you we do not think Joe is mental or something. It sounds like maybe her title, mental health consultant, might have put you off?”
  • “You are right; Joe isn’t crazy. This is not just Joe’s problem. In fact, really we need help trying to figure out what we can do to support Joe.”
Planning7:48– 9:07
  • “You know you may or may not be interested in just meeting with Ms. Gibson? You could get a sense of her for yourself. Not just taking my word for it.”
  • “You are unsure. That makes sense. We’ve talked about a lot today. Maybe it would be helpful to let this all sink in? What if we talked on the phone tomorrow just to see how you are thinking about it?”
  • “What time is the best time to call you?”

Reflect on the Conversation

After you watch the video, think about your own impressions of the discussion:

  • What were your thoughts as you watch the video?
  • Do you feel Ms. Jefferson is genuine and is fostering a trusting relationship with the parent?

Example 2: A home visitor talks to a caregiver about the results of a depression screening.

In this video, Sarah (a home visitor) and Tammy (a parent) discuss the results of Tammy’s depression screening.

As you watch:

  • Consider how Sarah uses motivational interviewing conversation strategies.
  • Pay attention to how these strategies support Tammy to talk about her feelings, motivations, and concerns.
  • Reflect on your own thoughts and feelings about this interaction.

Examples of How Sarah Uses Motivational Interviewing Conversation Strategies
Addressing Amalia’s “Fussiness”
Time stamp: 1:05–2:04

Conversation strategyWhat it sounded like
Open-ended questions
  • “So, you’re exhausted because of Amalia’s fussiness. Do you want to spend some time talking about that, or do you have other things on your mind?”
Affirmations
  • “Dealing with a new baby can be overwhelming, especially with everything else you have on your plate.”
Reflective listening
  • “You are right that babies come to the world with their own temperament or way of being.”
Summaries
  • “It doesn’t sound like Amalia’s crying is a priority for you right now but do know if you decide you want to talk about it, we can.”

Sharing Results from the Depression Screening
Time stamp: 2:20–4:54

Conversation strategyWhat it sounded like
Open-ended questions
  • “I know we spoke a little about depression last week, when I gave you the screening, but I would like to talk more about it. What is your understanding of depression?”
Affirmations
  • “You have a lot to deal with and it’s really impacting your sleep schedule, not to mention whether you have any energy left for other things.”
Reflective listening
  • “It seems like the idea that you might be experiencing depression doesn’t fit with how you see things.”
Summaries
  • “You put your children’s needs first. It sounds like you don’t have time for anything else. I respect that. Would it be okay if I shared one more piece of information?”

Reflect on the Conversation

After you watch the video, think about your own impressions of the conversation:

  • What were your thoughts, feelings, and reactions?
  • How did Sarah use motivational interviewing to help Tammy explore getting help for depression?