The 4 Processes of Motivational Interviewing

Want to engage and support those you work with in social and human services? Here we explore the 4 processes of motivational interviewing.

Rapport is connection. Rapport is engagement. Rapport is the number one indicator of a positive outcome in any human service relationship. Science says so, our experience and the experience of those we’ve shared with say so, and likely your own experience says so as well. Motivational Interviewing is known for its capacity to build rapport rapidly.

 

Employing the 4 Processes of Motivational Interviewing is a helpful structure that begins with engagement and moves the conversation along to support us to guide conversations with those we serve in an effective and time-efficient manner.

 

If you work in social services, health care, human outreach, or any other supportive profession, chances are you’ve experienced some of the challenges that can happen when we as human beings try to connect and talk about tough topics. But when it’s a vital part of providing effective and time-efficient services, structure is our friend.

 

Here we’ll explore Motivational Interviewing—what it is and how the 4 Processes of Motivational interviewing—which are: Engage, Focus, Evoke, and Plan—can support you to have engaging, time-efficient, effective, and guiding conversations with those you serve.

 

What is Motivational Interviewing (MI)?

Motivational Interviewing is a natural, organic, and empowering conversational approach for building connection and energizing (aka motivating) a person to embrace positive and healthy behavior change.  Taking meds, showing up for appointments, applying for jobs, getting up on time to go to school, following conditions of probation, healing trauma, and on are various examples of behavioral topics that MI has been proven effective in addressing.

 

MI is widely used throughout social services, healthcare, and other human service settings. This evidence-based conversation style helps people connect with their clients and empower their choice to heal and change. More than simply a rote, step-by-step procedure or a “trained skill,” Motivational Interview or MI is a mindset and philosophy. MI is a way of being with a person to empower them.

 

Motivational Interviewing supports practitioners to look at the holistic needs of those they serve. They are able to get in tune with the person’s entire experience and honor the journey of the individual. MI is a culturally reverent approach that is a part of a trauma-informed care approach.

 

The Spirit of MI or values of MI are Partnership, Acceptance, Compassion, and Evocation. Learning how to behavioralize these values in our work with other humans supports us in collaborating, sharing, connecting, and holding space with people at a point of transition and change in their lives. By helping served persons discover their inner resources, strengths, resilience, and desire for change, the Motivational Interviewer is a facilitator or guide. MI supports us to step away from the idea that any of us can change a fellow human being. We can’t “change” anyone. Instead, we can create the space to empower people to find their own direction and make positive changes themselves.

 

Motivational Interviewing recognizes that people are experts at directing their lives—or can become so. Those who employ MI believe that each human being has the ability to make choices, change, heal and move down a healthier path. An MI practitioner won’t approach the conversation with the intent to install “fixes,” reasons for change, or judge the other person. Instead, they act as a partner, guide, and collaborator. They create a safe, accepting (aka non-judgmental) space where the person can discover their own reasons and motivations to make positive changes. MI believes all humans have within them that which they already need to go on the journey of healing and change. Our job is to help them surface it.

 

At the core, the Motivational Interviewer focuses on the change discussed during the MI process. Then, similar to a mirror, they “hold up” these change comments and reflect them back to empower the served person. This allows service providers to take a supportive approach in helping the person move toward wellness.

 

Throughout the 4 processes of Motivational Interviewing, the practitioner will use the skills of D’OARS:

  • Deep Listening
  • Open questions
  • Affirmations
  • Reflections
  • Summarization

Of course, these active listening skills are useful in any conversation to achieve engagement, but they’re particularly crucial to the MI process. Building connections with those you serve, listening and helping the served person surface those important insights will further the conversation and empower the person to move forward to successful outcomes. Science says so, our experience and the experience of those we’ve shared with say so, and likely your own experience says so as well.

 

The 4 Processes of Motivational Interviewing

Motivational Interviewing can be applied in many different settings and with many diverse populations. Throughout the process of MI, the interviewer and interviewee might discuss any number of concerns like legal challenges, mental health issues, substance abuse, relationships, and career choices. Because these topics are often sensitive and can bring up fears, feelings of shame and blame, and in particular ambivalence (feeling two ways about changing a behavior), it’s crucial that the interviewer holds space for the served person by creating a safe, judgment-free environment for sharing.

 

In the video below, we share a sample that reflects the 4 processes of motivational interviewing. In this interview, you can see the skills that the interviewer draws on and how he applies the 4 processes to the conversation.

 

Tracking the 4 Processes of Motivational Interviewing

 

 

When we’re practicing MI, we have participants use a worksheet to identify the 4 Processes of Motivational Interviewing to gain insights on how they can be applied in their own work with served persons.

 

Practitioners don’t need to follow a specific order when applying 4 processes of Motivational Interviewing. Instead, the conversation may weave between the different processes.

 

As we shared, the 4 Processes of MI are: Engage, Focus, Evoke, and Plan. Let’s take a quick dive into each.

 

Engage

Engaging is the heart and first step of a successful MI conversation. To build a strong relationship between you and the served person, connections and rapport are vital. During the engagement process, the interviewer begins to establish a vibe of curiosity and, most importantly, empathy.

 

Offering affirmations is an integral part of engaging too. The MI process supports you to empower the served person—supporting and reflecting the positive information they share. This results in the served person talking themselves into change. Engaging requires respect for the individual and compassion for their journey. MI supports the interviewer to be sincere, truthful, and trustworthy to facilitate a safe space for the conversation.

 

Focus

Focusing is an agreement between the interviewer and the interviewee. It is agreement that specifically identifies the behavioral topic or focus of the conversation. It’s important that both parties settle on a shared focus to drive the conversation forward in a positive direction. To this end, the practitioner may ask, “What do you want to check in about today?”

 

From there, the interviewer may want to reiterate the focus throughout the conversation—keeping in mind that asking can help build rapport and engagement. For example, “Would you mind if I shared some ideas on how to address that?” which is an expression of partnership.

 

During an MI conversation, it is preferred to have a single focus. Multiple focuses and topics may arise during the natural flow of the conversation. MI helps us continue to partner and engage the served person by maintaining focus on one topic at a time. Reiterating and revisiting the focus can help ensure that the interviewer meets the client’s needs and concerns.

 

Evoke

Evoking means helping the client draw out their reasons “why,” which MI refers to as “change talk.” Why do they want to change? What are their abilities to go down a different path? What needs will this meet from their perspective?

 

In some cases, the client might want to focus on change to achieve freedom, health, a better relationship, greater financial stability, or something entirely different. Helping the interviewee identify their “why” may be a new experience for the served person. Each person has a motivation or reason for their behavior, but most people haven’t had an opportunity to identify and articulate that reason before.

 

Sometimes in situations where a client is unsure or even seems indifferent to the idea of their why for change (like a court-mandated program, for example), it’s helpful to listen carefully and attentively to the client’s discussions about change. Change talk is always there if we are tuned in to the language of change.

 

Plan

If evoking is the “why,” then planning is the “how.” How will the interviewee take their newfound insights and motivations and apply them forward to the next steps?

 

Planning can be a challenging process for many people. “I’m going to do it,” or “I’m not going to do it,” doesn’t really offer a plan. Instead, a skilled Motivational Interviewer will often help the client dig a little deeper in a way that’s appropriate for the situation (based on their insights, the rapport they’ve built together, and the focus of the interview).

 

Clarifying during the planning process, breaking the plan down into small steps, and identifying “just one” next step can help the client succeed. We can support the client to identify potential hurdles, fears, concerns, and roadblocks so they can troubleshoot before they’re faced with a barrier to their success. We want to keep the process focused on a manageable plan that feels appropriate for the served person and their situation.

 

Motivational Interviewing is a valuable skill for trauma-informed care practitioners to build. We offer MI guidance and skill-building collaborations for those interested in learning more about this important technique. Please reach out with any questions or for more information.

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