Motivational interviewing

Picture a client who says, "I know I should quit drinking, but..." — and every time you push, they push back harder. Motivational Interviewing (MI), developed by William Miller and Stephen Rollnick, was built for exactly this ambivalence. MI is a collaborative, client-centered method for strengthening a person's own motivation and commitment to change.

Everything rests on the MI spirit, four interlocking attitudes: Partnership (working with, not on, the client), Acceptance (honoring autonomy and worth), Compassion (prioritizing the client's welfare), and Evocation (drawing motivation out of the client rather than installing it). Remember it as PACE. Motivation isn't something you give the client — it's something you evoke.

The core micro-skills spell OARS: Open-ended questions, Affirmations, Reflective listening (the workhorse), and Summaries. These keep the client talking and feeling understood.

The engine of change is change talk — any client statement favoring change (desire, ability, reasons, need, commitment). The counselor's job is to selectively evoke and reinforce change talk while softening sustain talk (arguments for the status quo). Crucially, MI warns against the righting reflex — the counselor's urge to fix, argue, and persuade, which only provokes resistance.

When a client resists, MI says roll with resistance rather than confront it — back off, reflect, and reframe, because arguing for change makes the client argue against it. MI pairs naturally with the stages of change, a separate model that tells you when a client is ready to move.

Clinical Pearl: MI's golden rule is evoke, don't install — resist the righting reflex and roll with resistance. If a stem shows a counselor arguing or persuading a reluctant client, that's the MI error; the MI-consistent move is to reflect and elicit the client's own change talk.