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What are some of the common pitfalls or mistakes that Motivational Interviewers make?

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Motivational interviewing (MI) is a skillful and collaborative way of helping people explore and resolve their ambivalence about changing their behavior. It is based on four core principles: expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. However, even experienced MI practitioners can make some common pitfalls or mistakes that can hinder the effectiveness of their interventions. Here are some of them and how to avoid them.

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1 Asking too many questions

While asking open-ended questions is a key technique in MI, asking too many questions can make the conversation feel like an interrogation or a test. This can reduce the client's engagement, autonomy, and motivation to change. Instead of asking too many questions, try to use more reflections, affirmations, and summaries to show that you are listening, understanding, and validating the client's perspective. You can also use elicit-provide-elicit (EPE) to offer information or advice in a respectful and collaborative way.

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Kristin M. Smith, LMHC

Site Director, Department of Mental Health
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Rushing the process. MI is a marathon, not a sprint. Pushing harder or faster than the client is ready for will result in shut down, not progress. In a goal driven and oriented world, MI is about embarking on a journey with another person.

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2 Giving premature or unsolicited advice

Another common mistake in MI is giving advice or feedback before the client is ready or interested in hearing it. This can trigger resistance, defensiveness, or disinterest from the client, who may feel that you are not respecting their autonomy or choice. Instead of giving premature or unsolicited advice, try to assess the client's readiness and interest in changing their behavior, and use EPE to ask for their permission and preference before providing any information or suggestions. You can also use decisional balance to help the client weigh the pros and cons of changing or staying the same.

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Kerry Arnold

Assistant Professor at Community College of Philadelphia
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When I am teaching college students about the process of Motivational Interviewing, they are simultaneously learning about the Prochaska model of stages of change. What helps in not making the mistake of giving feedback that a client is not ready to hear or that it's too soon, is to be aware of what stage of change the client is in and to meet them THERE. A client in contemplation is steeped in ambivalence, so guiding them in weighing pros/cons is an example of meeting them in this place of wrestling with options. This would not be the time to talk about decisions or actions.

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3 Confronting or challenging resistance

Resistance is a natural and expected part of the change process, and it can manifest in different ways, such as arguing, interrupting, denying, or ignoring. However, confronting or challenging resistance can backfire and increase the client's opposition or reluctance to change. Instead of confronting or challenging resistance, try to roll with it and use reflections, reframing, or paradox to acknowledge and diffuse it. You can also use change talk to elicit and reinforce the client's own reasons and confidence for change.

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4 Using labels or diagnoses

Labels or diagnoses can be useful in some contexts, but they can also be counterproductive in MI, especially if they are imposed or stigmatizing. Labels or diagnoses can create a power imbalance between the interviewer and the client, and they can limit the client's sense of agency or possibility. Instead of using labels or diagnoses, try to use person-centered and strength-based language that honors the client's identity and potential. You can also use scaling questions to help the client assess their own situation and goals.

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5 Forgetting to follow up

MI is not a one-time event, but a process that requires ongoing support and feedback. Forgetting to follow up with the client can undermine the rapport and trust that you have built, and it can also reduce the client's commitment and accountability to change. Instead of forgetting to follow up, try to schedule regular sessions or contacts with the client, and use them to review their progress, challenges, and plans. You can also use motivational interviewing tools such as action plans, commitment statements, or contingency contracts to help the client stay on track and motivated.

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6 Neglecting self-care

MI can be emotionally and mentally demanding, as it requires a lot of empathy, patience, and creativity. Neglecting self-care can lead to burnout, compassion fatigue, or reduced effectiveness. Instead of neglecting self-care, try to practice mindfulness, relaxation, and self-compassion techniques to cope with stress and maintain your well-being. You can also seek supervision, consultation, or peer support to enhance your skills and confidence in MI.

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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?

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John Whitson-Russell

I help you to change the things you want but can’t on your own. And teach others to do the same. Proud Health Service Lead. #MotivationalInterviewing. #BehaviourChange #Lifestyle #Leadership #Coach #Trainer #Retirement
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This article misses a lot of the Motivational Interviewing specific pitfalls or “traps” that MI describes. Here are a couple. “The Expert Trap” - communicating that, based on your expertise, you have all the answers to the person’s problem(s). - here letting go of the assumption that you are supposed to have (and provide) the right answers. “The Premature Focus Trap” - focusing before engaging and building rapport and trust - the trap of focusing in on the first thing the person says. “The Planning Trap” - moving straight to planning now all that motivation stuff is out of the way. - continue to visit evoking, and focus on how the person (not you) would like to move forward. Adapted from Miller and Rollnick (2012)

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Gary Norman

Behavioral Health Leader
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Motivational interviewing is often described as being driven by the client. And it’s the role of the therapist to be closely tuned into the client to know what type of questions to ask, how much to push, how much do pull and how much to let things be as they are. But the reality is the therapist is always in charge of the structure and the pace. The therapist designs the set of questions to be used to fine-tune where the client actually is in their change process. The therapist moves the process along at a pace that they decide is best for the client. The therapist controls the process, and therefore controls the boundaries of where the conversations move. We often say the client drives the process, but mostly it’s the therapist.

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What are some of the common pitfalls or mistakes that Motivational Interviewers make?

1

2

3

4

5

6

7

1 Asking too many questions

2 Giving premature or unsolicited advice

3 Confronting or challenging resistance

4 Using labels or diagnoses

5 Forgetting to follow up

6 Neglecting self-care

7 Here’s what else to consider

Motivational Interviewing

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What are some of the common pitfalls or mistakes that Motivational Interviewers make?

1

2

3

4

5

6

7

1 Asking too many questions

2 Giving premature or unsolicited advice

3 Confronting or challenging resistance

4 Using labels or diagnoses

5 Forgetting to follow up

6 Neglecting self-care

7 Here’s what else to consider

Motivational Interviewing

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