Helping people change unhealthy or damaging behavior is one of the most significant challenges therapists face (Hall, Gibbie, & Lubman, 2012).
When encouragement to stop harmful behaviors (heavy drinking, smoking, etc.) or to adopt a healthy lifestyle (exercise, taking medication, following a better diet) is ignored, it can be frustrating.
Yet, in their Stages of Change Model, Prochaska & DiClemente (1986) propose that readiness for change is crucial for any transformation, even a small one.
Motivational interviewing is an effective method for counseling an individual, overcoming ambivalence, enhancing motivation, and getting them ready for change (Hall et al., 2012).
This article provides a set of worksheets that can help the motivational interviewing process.
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Motivational Interviewing: 2 Real-Life Examples
Conversations about change take place every day. Our use of language – what we say and how we say it – can motivate or influence another’s behavior.
Therapists and counselors, in particular, regularly discuss behavioral and lifestyle changes with their clients.
Motivational interviewing (MI) “is designed to find a constructive way through the challenges that often arise when a helper ventures into someone else’s motivation for change” (Miller & Rollnick, 2013).
The following two real-life case studies provide examples of the scenarios clients present to their therapist and how the Motivational Interviewing Theory can help.
A 52-year-old man has a problem with alcohol. Despite his wish to change, he continues to drink heavily (Hall et al., 2012).
It is tempting to assume that the individual lacks motivation or is unaware of the risks, and for the therapist to adopt a paternalistic therapeutic style. However, when this approach is unsuccessful, the client’s lack of desire to change may cause the therapist to give up.
In contrast, using MI, the therapist respects the client’s autonomy and recognizes he is responsible for change. Using MI, it is possible to discuss the client’s reason for change without advising him to do so. Concerns about his drinking and its future impact on goals or values can be talked through and used to explore the pros and cons of drinking.
While the decision to change remains with the client, the therapist can offer to work with him to increase his confidence so that he can change.
A quiet and passive young man is so unhappy at work that he regularly wants to avoid the discomfort of being there by calling in sick (Miller & Rollnick, 2013).
Though not being bullied or harassed, he feels he is taken advantage of and given all the worst jobs. His doctor has referred him because of his low energy, sleep problems, self-deprecation, and risk of depression.
Using MI, it is possible to ask a series of open-ended questions such as, How are you feeling at work? and What change do you think would make the biggest difference? The process to uncover the desire, ability, reasons, and need for change begins.
The therapist listens to the answers, affirms, reflects, and summarizes. And only when there are signs of readiness to move forward does the conversation shift to planning.
Focus then moves to how to approach a meeting with the boss and adopt new ways to communicate.
7 Best Motivational Interviewing Worksheets
Motivational interviewing is a powerful evidence-based technique that helps clients talk themselves into making positive changes in their lives.
Those who believe they can change are more likely to be successful than those who do not (Miller & Rollnick, 2013).
While there is no single strategy for increasing the amount of change talk, therapists soon recognize what is (and isn’t) working from the client’s feedback (Miller & Rollnick, 2013).
However, there are several techniques the therapist can adopt that will help the client think and talk about the reasons for change.
Preparatory change talk
Asking open-ended questions is one of the most effective ways to evoke talk about change.
The DARN acronym is a helpful reminder of the four types of preparatory change talk:
Such conversations may not confirm that change will happen, yet asking evocative questions can help invite change.
For example, a client may say, “I want to stop smoking” (desire) rather than “I will stop smoking.” And while the client may list good reasons for not smoking, it does not (yet) mean they intend to stop.
Evocative questions include:
Desire questions typically use words such as want, wish, and like. The replies they generate usually show that a person wants something and are a significant component for change (Miller & Rollnick, 2013):
I want to change my job.
I would like to lose some weight.
I hope to pass these exams.
“Wanting is one component of motivation for change,” say Miller and Rollnick (2013).
The Desire Questions worksheet explores the reasons for change and captures the answers for later review.
In the ability component of motivation, the person must believe they can change for it to happen. Ability questions ask about what the person can or could do without them committing (Miller & Rollnick, 2013):
I would like to train to be a doctor (desire), but I don’t think I could get the grades (ability).
The Ability Questions worksheet captures or prompts the idea that change seems possible.
In time, the person may begin to recognize good reasons for change. Reason questions prompt for the specific reasons why (Miller & Rollnick, 2013).
They may not yet want to change or feel capable of change, but they may be able to list reasons for and against. Answers often take the form of an if… then statement:
If I exercise, then I will be in better shape.
The Reasons Questions worksheet captures why.
The fourth component of the DARN acronym is need. Such questions inquire about the change’s urgency without specifying the underlying reasons – although it is okay if they surface (Miller & Rollnick, 2013).
Again, need language does not suggest the desire or ability to change, but reflects the importance or urgency.
I need to…
I’ve got to…
The Need Questions worksheet captures what needs to happen.
Eliciting change talk
Sometimes encouraging change talk can require other approaches.
If your client shows little desire for change at present, it’s helpful to prompt discussion around what may happen in extreme situations (worst and best):
What concerns you most about your drinking?
If you make that change, what are the best results you can imagine?
The Querying Extremes worksheet captures what could happen if no action is taken or change occurs.
Sometimes it is worth reminding the client what things were like before the problem arose and compare it against how things are now:
What were things like when you first met?
What were the differences between you five years ago and now? What has changed?
The Looking Back worksheet asks the client to recall how things used to be before difficulties began and what life would be like if it were better again.
You can sometimes successfully elicit change talk by asking your client to imagine how the future could look if changes are (or are not) made:
If you make the changes, how do you think the future will be different from the past?
If you don’t make the changes, how do you think the future will differ from the past?
The Looking Forward worksheet asks the client to imagine the future with or without making the changes.
Only once you begin to hear more change talk can you move to mobilize. Miller and Rollnick describe preparatory change talk and mobilizing change talk as two sides of the same hill. The client goes up the first side before they can travel down the second.
Worksheets for Goal Setting
While preparatory talk signals a positive move from ambivalence, mobilizing change talk reflects a move toward setting goals and change.
Mobilizing change talk can lead to goal setting
Mobilizing change talk is often identified and grouped using the mnemonic CATs – commitment, activation, and taking steps.
“Commitment language signals the likelihood of action” and represents how people make promises to one another (Miller & Rollnick, 2013).
I intend to…
While not quite a commitment, activation language shows we are almost there; a pledge to act is made.
When such a comment is uttered, we often follow it with a question: When will you do it? Or how?
I intend to…
When hearing this sort of activation language in therapy, we know the client has already begun to take steps toward change.
Perhaps since the last session, they have made some changes or taken some steps:
I went to an introductory session at the local gym.
I contacted a job agency.
I’ve created a study planner and started to study.
Preparatory change talk (identified by the acronym DARN) represents the challenge and slog of walking up the hill. Mobilizing change talk (identified by the acronym CAT) represents coming down the other side and, despite its hazards, feels more manageable.
As part of the overall process of motivational interviewing, it is crucial to explore a person’s overall values and goals (Miller & Rollnick, 2013).
Completing change requires a person to move from where they are to where they need (or want) to be. Goal setting can be motivating and help them make that journey (Kremer, Moran, & Kearney, 2019).
One popular method of defining and capturing goals uses the acronym SMART (specific, measurable, attainable, realistic, and time-bound). The SMART+R worksheet helps capture goals, along with measures and rewards.
Another valuable approach is known as SCAMP. To maximize their effectiveness and maintain motivation, each goal should be:
- Challenging and controllable
- Measurable and multiple
Complete the SCAMP worksheet with the client to capture their goals (Kremer et al., 2019).
For Group Sessions
Motivational interviewing can be highly successful in group settings and appears to be a promising approach to resolve ambivalence in the direction of positive change (Miller & Rollnick, 2013).
A 2015 study involving adolescent drug and alcohol users found that change talk in a group setting had particular motivational value. And that “self-expressed speech that is an argument for change” can be used by members to help one another overcome ambivalence and resistance to healthy behavior (D’Amico et al., 2015).
Results confirmed that change talk positively affects individual (and overall group) outcomes and is a valuable mechanism for change (D’Amico et al., 2015).
The following motivation tools and worksheets can help cohesion and effectiveness within a group environment to facilitate helpful discussion:
- Creating Shapes Exercise
Before and during group sessions, the Creating Shapes Exercise can help change the social dynamics and stimulate new interactions.
- Human Typewriter
The Human Typewriter is a communication and sharing exercise that encourages people to break down barriers and get to know each other.
- Basic Need Satisfaction Through Communication
It’s helpful to weigh up the costs and benefits of new behavior using this exercise to bring clarity to decisional conflict.
- Active-Constructive Responding
Sharing positive personal events with others in a group environment can positively influence a sense of wellbeing. Use this exercise as guidance to implement it.
Popular Motivational Interviewing Techniques
Several techniques can help the process of MI and the overall progress of change.
Establishing a therapeutic relationship using OARS
The acronym OARS can represent the basic skills of MI. Each type of interaction can help build rapport while establishing a therapeutic relationship (Hall et al., 2012).
MI skills include the following:
- Open-ended questions encourage the client to talk.
I understand you are concerned about your drinking habits. Can you tell me about them?
- Affirmations can include compliments or statements of understanding. They build rapport and offer support during the process of change.
I appreciate that it must have taken a lot of courage to discuss your drinking habits today.
- Reflections rephrase what the client has said to capture the implied meaning and feelings.
You enjoy having a drink, but you are worried about your reliance on alcohol and its long-term effects.
- Summarizing links different points within the discussion while checking in with the client.
If it is okay with you, can I just check that I have understood everything we have discussed so far?
OARS offers foundational tools for mutual understanding before moving on to focusing, evoking, and planning (Magill et al., 2018).
Decision balance table
Counseling with neutrality involves working with the client to explore the pros and cons of making (or not making) a change (Magill et al., 2018).
For example, a client may be considering whether to stay in a job or leave. We can use a simple four-box table to explore the options.
An example decision balance table:
|Advantages of staying in the job||Advantages of leaving the job|
|Disadvantages of staying in the job||Disadvantages of leaving the job|
The aim is to consider each box equally, elaborate and reflect on the contents, and feed back into the conversation.
A Take-Home Message
Motivation research has shown MI to be as successful or better than either Cognitive-Behavioral Therapy or pharmacotherapy at decreasing unhealthy behavior (Magill et al., 2018).
Indeed, MI has been used successfully across broad settings, including reducing drug and alcohol use, helping clients quit smoking, and improving medication and treatment adherence (Hall et al., 2012).
To be most effective, MI must build a collaborative relationship between therapist and client. The client’s autonomy must be respected, and the therapist seen as a facilitator rather than an expert (Hall et al., 2012).
“MI is about arranging conversations so that people talk themselves into change, based on their own values and interests” (Miller & Rollnick, 2013).
And it is incredibly helpful in counseling and therapy. A 2018 meta-review of existing research confirmed that MI is effective at assisting change in clients and overcoming resistance (Magill et al., 2018).
The worksheets and techniques included take into account the importance of natural language in conversations about change and encourage conversations where people talk themselves into change (Miller & Rollnick, 2013).
We hope you enjoyed reading this article. Don’t forget to download our three Goal Achievement Exercises for free.
- D’Amico, E. J., Houck, J. M., Hunter, S. B., Miles, J. N. V., Osilla, K. C., & Ewing, B. A. (2015). Group motivational interviewing for adolescents: Change talk and alcohol and marijuana outcomes. Journal of Consulting and Clinical Psychology, 83(1), 68–80.
- Hall, K., Gibbie, T., & Lubman, D. I. (2012). Motivational interviewing techniques: Facilitating behaviour change in the general practice setting. Australian Family Physician, 41(9), 660–667.
- Kremer, J., Moran, A. P., & Kearney, C. J. (2019). Pure sport: Practical sport psychology. Routledge.
- Magill, M., Apodaca, T. R., Borsari, B., Gaume, J., Hoadley, A., Gordon, R. E. F., … Moyers, T. (2018). A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change. Journal of Consulting and Clinical Psychology, 86(2), 140–157.
- Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford Press.
- Prochaska, J. O., & DiClemente, C. C. (1986) Toward a comprehensive model of change. In W. R. Miller & N. Heather (Eds.) Treating addictive behaviors: Processes of change. Springer.