Motivational Interviewing

Lesson 15 introduced the core communication skills — OARS. Motivational interviewing puts those skills to work with a specific purpose: helping people resolve their mixed feelings about change and find their own motivation to act. It's one of the most researched coaching approaches, used across nutrition, exercise, smoking, alcohol and many other health behaviors.

What Motivational Interviewing Is

Motivational interviewing is a collaborative, person-centred way of talking about change, developed by psychologists William Miller and Stephen Rollnick. It strengthens a person's own motivation and commitment by drawing out their reasons for change — not by persuading, warning or lecturing.

The key insight: when a helper argues for change, the person tends to argue back for staying the same. When the person hears themselves voice their own reasons for change, they're more likely to act. MI is not a trick to make people do what the coach wants — the direction of change comes from the client's own goals and values.

The Spirit of MI

MI is a mindset before it's a set of techniques. Its underlying "spirit" is often remembered as PACE:

Core principles

Earlier descriptions of MI summarise its approach as four principles — still common on exams:

You may also see these summarised as RULE: Resist the righting reflex, Understand the client's motivations, Listen with empathy, and Empower the client.

The Four Processes

An MI conversation moves through four overlapping processes. The most recent (2023) edition of Miller and Rollnick's book calls them the four tasks — the structure is the same. Each builds on the one before, though coaches often loop back.

Jumping straight to planning before engaging and evoking is one of the most common mistakes — the plan may be sound, but the client isn't committed to it.

Ambivalence

Ambivalence means feeling two ways about something at the same time: "I want to eat better, but I love my evening snacks." It's a normal, expected part of change — not denial or a lack of willpower. People often stay stuck because both sides feel equally strong.

A decisional balance exercise helps a client look at both sides — the benefits and costs of changing, and the benefits and costs of staying the same:

The coach doesn't argue for either side — the goal is for the client to see the whole picture and explore it. Developing discrepancy happens naturally when the client notices how the current behavior conflicts with what they value.

Change Talk and Sustain Talk

Change talk is anything the client says in favour of change. Sustain talk is anything in favour of staying the same ("I don't have time to cook"). Both are normal. The more change talk a client voices, the more likely they are to change — so MI coaches listen for it and invite more of it.

Change talk is often remembered as DARN-CAT:

Responding to change talk — EARS: Elaborate ("Tell me more about that"), Affirm, Reflect and Summarise. Collecting several change-talk statements into one summary — a "bouquet" — lets the client hear their own case for change.

Rolling With Discord

When the conversation becomes tense — the client argues, interrupts or disengages — MI calls this discord (older editions called it "resistance"). It's a signal to change approach, not to push harder. Useful responses:

• Simple reflection: "You're not sure this is the right time."
• Double-sided reflection: "On one hand, sugary drinks get you through the afternoon; on the other, you'd like to cut back." It captures both sides of the ambivalence.
• Emphasising autonomy: "It's completely your decision."
• Reframing: Client: "I've failed at every diet." Coach: "You've kept trying, even when it was hard."
• Shifting focus: moving away from a sticking point to something the client cares about.

Common Traps to Avoid

For a deeper look at MI and goal-setting, see NBHWC Lesson 6: Motivational Interviewing 4.0 & Goal-Setting Theories.