What are effective ways to use MI to develop client decision-making skills?

1 The core principles of MI

MI is based on four core principles that guide the interaction between the practitioner and the client. Expressing empathy involves showing genuine interest, respect, and understanding of the client's perspective, feelings, and values. Developing discrepancy helps the client recognize the gap between their current situation and their desired goals, and the consequences of not changing. Rolling with resistance means avoiding arguments, judgments, or confrontations with the client, and instead using reflections, summaries, and open questions to elicit their own reasons for change. Finally, supporting self-efficacy affirms the client's strengths, abilities, and choices while encouraging them to take responsibility and action for their own change.

3 The stages of change model

MI is based on the assumption that people go through distinct stages of change when they are considering or making a decision. These stages include precontemplation, where the client is not aware or interested in changing their behavior and may deny or minimize the problem; contemplation, which is when the client is aware of the problem and the benefits of change, but is ambivalent or uncertain about changing; preparation, where the client has decided to change and is planning to take action soon; action, which is when the client is actively taking steps to change their behavior; and maintenance, where the client has sustained their change for a period of time and may need strategies to prevent relapse or cope with challenges.

5 The role of feedback in MI

Feedback is an essential tool in MI, as it offers the client objective and relevant information about their behavior and its consequences, while also motivating them to change. Feedback can be delivered in various ways - such as using scales or charts to compare behavior to the norm or goals, tests or assessments to show the impact of behavior on health or performance, or stories or examples to illustrate the benefits or risks of behavior. When giving feedback, ensure you ask for permission first, use a non-judgmental and supportive tone, emphasize the positive aspects of the feedback, and invite the client to share their reactions and opinions. Additionally, you should encourage them to identify their own strengths and areas for improvement while exploring options and plans for change.

6 The process of change talk in MI

Change talk is a term that refers to the statements that the client makes that indicate their readiness, willingness, or ability to change their behavior. It can be categorized into four types: preparatory change talk (e.g. expressing desire or need to change), mobilizing change talk (e.g. expressing commitment or taking steps to change), sustaining change talk (e.g. affirming and maintaining the change), and implementing change talk (e.g. taking action or reinforcing the change). As a practitioner, your role is to elicit, reinforce, and shape change talk by using strategies such as asking evocative questions, using the importance and confidence rulers to assess motivation and self-efficacy for change, reflecting the client's change talk, summarizing themes and patterns of their talk, affirming their efforts and achievements, asking for elaboration or examples, and asking for permission or feedback to offer suggestions.

7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?