4. The Motivational Interviewing Process

The Process

The fundamental processes in motivational interviewing are:

1. Engaging
2. Focusing
3. Evoking
4. Planning

The four processes somewhat linear:

  • Engaging necessarily comes first.
  • Focusing (identifying a change goal) is a pre-requisite for Evoking.
  • Planning is logically a later step.
  • Engaging skills used throughout Motivational interviewing
  • Focusing is not a one-time event; re-focusing is needed, and focus may change.
  • Evoking can begin early.
  • “Testing the water” on planning may indicate a need for more of the above.

 

 

 

 

 

 

Engaging

Some key questions for the interviewer to ask themselves:

  • How comfortable is this person in talking to me?
  • How supportive and helpful am I being?
  • Do / understand this person's perspective and concerns?
  • How comfortable do / feel in this conversation?
  • Does this feel like a collaborative partnership?

 

 

Focussing

Some key questions for the interviewer to ask themselves:

  • What goals for change does this person really have?
  • Do I have different aspirations for change for this person?
  • Are we working together with a common purpose?
  • Does it feel like we are moving together, not in different directions?
  • Do I have a clear sense of where we are going?
  • Does this feel more like dancing or wrestling?

Outcomes of focusing may be:

  • Single goal
  • Set of goals prioritised
  • Set of changes towards longer term goal

 

Evoking

Some key questions for the interviewer to ask themselves:

  • What are this person's own reasons for change?
  • Is the reluctance more about confidence or importance of change?
  • What change talk am I hearing?
  • What am I doing intentionally to evoke and strengthen change talk?
  • What concerns, goals, or values does this person hold that would encourage this change?
  • Am I steering too far or too fast in a particular direction?
  • Is the righting reflex pulling me to be the one arguing for change?

What are you hearing?

Preparatory Change Talk
  • Desire (want, like, wish…)
  • Ability (can, could…)
  • Reason (if…then)
  • Need (need, have to, got to…)
Mobilising Change Talk
  • Commitment
  • Activation
  • Taking Steps

What are you doing?

Eliciting Change Talk
  • Ask evocative questions
  • Use importance and confidence questions/rulers
  • Looking back or looking forward
  • Exploring values
  • Exploring pros and cons of change and staying same (NB: focus on pros of change and cons of staying same)
Responding to Change Talk (All EARS)
  • Elaborating – give me an example, in what ways,
  • Affirming – commenting positively on the person’s statement
  • Reflecting - continuing
  • Summarising – collecting change statements

 

 

Planning

It is time for planning when:

  • There is sufficient engagement
  • Clear shared goal
  • Sufficient client motivation for the change
  • Test the water…

Some key questions for the interviewer to ask themselves:

  • What would be a reasonable next step toward change?
  • Am I hearing mobilizing change talk that may signal readiness to discuss when and how change might occur, even a first step?
  • What would help this person to move forward?
  • Am I remembering to evoke rather than prescribe a plan?
  • Am I offering needed information or advice with permission?
  • Am / retaining a sense of quiet curiosity about what will work best for this person?