Motivational Interviewing Worksheets, Books

Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed and departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non-directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal.^[rx] MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationships.^[rx]

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.

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 therapists 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 the 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:

• Desire
• Ability
• Reasons
• Need

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

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 of 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,” said Miller and Rollnick (2013).

The Desire Questions worksheet explores the reasons for change and captures the answers for later review.

Ability questions

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.

Reasons questions

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 it. 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.

Need questions

The fourth component of the DARN acronym is needed. 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 must…
I’ve got to…

The Need Questions worksheet captures what needs to happen.

Eliciting change talk

Sometimes encouraging change talk can require other approaches.

Querying extremes

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.

Looking back

Sometimes it is worth reminding the client what things were like before the problem arose and comparing 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.

Looking forward

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

“Commitment language signals the likelihood of action” and represents how people make promises to one another (Miller & Rollnick, 2013).

I will…
I intend to…
I promise…

Activation

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 will…
I intend to…

Taking steps

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).

Setting goals

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:

• Specific
• Challenging and controllable
• Attainable
• Measurable and multiple
• Personal

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 resolving 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 well-being. 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

 

Motivational Interviewing Books to Help Clients

Motivational interviewing recognizes that ambivalence is a normal aspect of human behavior and a necessary part of the change process. It can provide a helpful method for resolving such ambivalence through eliciting and reinforcing change talk (Miller & Rollnick, 2013).

Research has confirmed the importance of the client’s autonomy and their relationship with the MI practitioner to arrive at a change plan.

The following books provide valuable insight into the research, theories, and practices of MI and guide the reader through how to increase their own or their clients’ motivation for change. We have grouped the reading into three sections: a general approach to MI, specific applications of MI, and workbooks.

General Approach to Motivational Interviewing

To introduce you to material regarding MI, we first start with a more general approach and list books that fall within this grouping.

1. Motivational Interviewing: Helping People Change – William Miller and Stephen Rollnick

This is one of the bestselling and most authoritative books on the subject of MI. The text uses a clear and practical style to guide both students and professionals through MI’s four key processes: engaging, focusing, evoking, and planning.

Using numerous examples, this highly accessible book explains how to implement the approach across a broad context, providing extra supporting resources from a companion webpage.

Additional features include boxes providing special topics and personal reflections, a quick reference glossary, and online questions and case studies.

At the end of each section is a helpful list of the key points summarizing what has been covered.

Find the book on Amazon.

2. Motivational Interviewing and CBT: Combining Strategies for Maximum Effectiveness – Sylvie Naar and Steven Safren

Sylvie Naar and Steven Safren’s book shows how therapists can combine MI with the incredible power of Cognitive-Behavioral Therapy (CBT) to deliver better outcomes for their clients.

The authors explain how it is possible to use MI strategies, either as a pre-treatment intervention or during CBT, to boost motivation in the client and strengthen the therapeutic relationship.

Thirty-five reproducible handouts, along with sample dialogues and learning exercises, are available from the website that accompanies the book.

Find the book on Amazon.

3. Fundamentals of Motivational Interviewing: Tips And Strategies for Addressing Common Clinical Challenges – Julie Schumacher and Michael Madson

This book is an essential guide for anyone wishing to understand how to use MI across multiple disciplines and professions.

The techniques and skills introduced can guide clients from many backgrounds (including those with a criminal past, anxiety and mood problems, and poor health) to make positive life changes.

The text is highly accessible, well organized, and aimed at busy individuals, whether they are new to MI or more experienced providers. Clear examples are given throughout, and the book is equally valuable for the student, teacher, or user of MI.

Find the book on Amazon.

Specific Applications of Motivational Interviewing

MI being used in very specific applications is the second grouping of books we review.

1. Motivational Interviewing in Health Care: Helping Patients Change Behavior – Stephen Rollnick, William Miller, and Christopher Butler

The authors wrote this book for healthcare professionals interested in understanding how behavioral change can help patients manage underlying conditions.

While concise, the text contains several powerful tools to improve communication with clients and encourage them to make more positive health choices, including exercise, weight loss, and medical adherence.

The dialogues and vignettes contained within enliven MI’s core skills and how we can use them in healthcare settings.

The book has been very well received and is a core text for several educational institutes and a must for professionals in healthcare environments.

Find the book on Amazon.

2. Motivational Interviewing in Nutrition and Fitness (Applications of Motivational Interviewing) – Dawn Clifford and Laura Curtis

Healthcare practitioners have the potential to help patients and clients implement long-lasting changes to their nutrition and fitness even when the transformation is not easy and met with resistance.

This book presents MI as a proven counseling approach to working through ambivalence, helping clients break free of the quick-fix approach to wellness and well-being.

Worksheets and forms for working with clients are downloadable and printable, and detailed dialogues guide conversations on exercise, body image, and meal planning.

This book is of particular importance within the discipline of dietary and physical activity, where resistance to change is often prevalent.

Find the book on Amazon.

3. Motivational Interviewing for School Counselors – Reagan North

Reagan North is a school counselor who has learned how to use MI within the educational setting.

North provides a practical approach, explaining how MI ideas and techniques can help make positive changes to students’ lives, motivating them to form relationships, improve grades, kick unhelpful habits, and ultimately live more meaningful lives.

The book helps counselors tap into students’ needs and desires and use MI to change habits and work toward goals.

Find the book on Amazon.

4. Motivational Interviewing in Social Work Practice – Melinda Hohman

Most social workers are familiar with their clients’ ambivalence regarding changing existing behavior and its potential for damaging themselves and others. MI can help clients draw on their strengths and commit to positive changes.

Melinda Hohman’s book introduces MI’s fundamentals and how to implement its core skills and techniques practically and helpfully.

Using open-ended questions, affirmations, reflections, and summaries can help support clients’ autonomy and identify their values in line with social work principles.

Case examples bring the text to life, and best practices provide a valuable guide for social workers across multiple settings.

Find the book on Amazon.

5. Motivational Interviewing for Leaders in the Helping Professions: Facilitating Change in Organizations – Colleen Marshall and Anette Nielsen

This book also explores the use of MI in the healthcare and social services setting, but this time it is aimed at leaders.

Colleen Marshall and Anette Nielsen introduce the reader to powerful techniques to support employees through mentoring, performance issues, and redesigning processes.

The authors say they aim to help organizations become “unstuck” through the skilled use of core motivational interviewing principles.

The user-friendly text is well supported, with many worksheets, reflection exercises, and extended case studies available from a companion website.

Find the book on Amazon.

6. Motivational Interviewing in Schools: Conversations to Improve Behavior and Learning – Stephen Rollnick, Sebastian Kaplan, and Richard Rutschman

Written by one of the creators of MI plus two school teachers, this book is a valuable read for teachers wishing to use MI as a counseling approach with their students. It covers how to make use of everyday interactions with students to inspire change.

The text includes all the essential skills and strategies required for MI, along with sample dialogues with students and their parents that promote personal growth and problem-solving.

The companion website provides additional downloadable resources for use by teachers, school psychologists, counselors, and social workers.

Find the book on Amazon.

7. Motivational Interviewing with Adolescents and Young Adults – Sylvie Naar-King and Mariann Suarez

Sylvie Naar-King and Mariann Suarez explore MI’s incredible value for helpful and productive conversations with young adults and adolescents.

The book is centered around helping practitioners build rapport with young people to increase motivation, overcome ambivalence, and make positive, healthy changes.

While particular attention is paid to eating disorders, substance abuse, obesity, and chronic illness management, it also includes behavioral problems.

Find the book on Amazon.

8. Motivational Interviewing for Clinical Practice – Petros Levounis, Bachaar Arnaout, and Carla Marienfeld

This excellent guide to MI in clinical practice takes the reader through all the motivational interviewing steps, skills, and strategies needed to adopt and even teach the approach.

The book is valuable for both beginning clinicians and experienced practitioners (including nurse practitioners, family physicians, counselors, and social workers) and includes insightful and engaging case examples to clarify its application.

Each chapter ends with a set of study questions and answers to challenge understanding and drive home the points covered. This valuable text is perfect for anyone who requires a better understanding of the value of motivational work in the treatment of their patients.

Find the book on Amazon.

9. Motivational Interviewing in the Treatment of Anxiety – Henny Westra

This book introducing MI’s principles focuses on helping those with anxiety overcome ambivalence and increase their intrinsic motivation to change.

Henny Westra explains how to use MI as a pre-treatment or combined with CBT (or other anxiety-focused treatments) to overcome motivational impasses.

The book includes detailed coverage of several case studies to understand the best use of MI to help patients experiencing anxiety or depression.

Both practical and compassionate, this guide explains to new and experienced clinicians how to apply MI to access clients’ maximum potential and wisdom.

Find the book on Amazon.

MI Workbooks

MI workbooks are practical approaches to getting to know and applying this concept. Select any of the following for useful guidance.

1. The Motivational Interviewing Workbook: Exercises to Decide What You Want and How to Get There – Angela Wood

Angela Wood’s workbook is a practical guide to support the use of MI, helping clients as they identify, understand, and make changes to their lives.

This easily understood book is ideal as homework for clients between sessions or interested individuals working alone.

It will clarify readers’ commitment to change, build their motivation, and empower them for the future.

Key points covered include:

• Learning what MI is and how it can help personal change
• Identifying what you want to do while recognizing obstacles
• Exploring why you want to make the change
• How to develop a detailed and practical plan to get to where you want to be

Find the book on Amazon.

2. Building Motivational Interviewing Skills: A Practitioner Workbook – David Rosengren

This book is an essential text for mental health and healthcare professionals who require a clear and practical approach to MI.

This second edition has been updated to include the most recent advances in theory and practice and is a popular book among practitioners.

Providing clear explanations of the key MI concepts, helps the reader build a deep understanding of MI’s four processes: engaging, focusing, evoking, and planning.

David Rosengren explores the importance of open-ended questions, affirmations, reflective listening, and summarizing, and includes sample dialogues and practical motivational interviewing exercises.

The 80 reproducible worksheets offer a valuable resource to practitioners, clients, and anyone wishing to engage in motivationally enhancing conversations using MI.

Find the book on Amazon.

3. How to Do Motivational Interviewing: A Guidebook – Bill Matulich

Bill Matulich is an experienced psychologist, psychotherapist, and MI instructor.

In this concise book, he explores how to use the client’s arguments to encourage behavior change while taking the reader through MI’s core elements.

This succinct step-by-step guide will help those new to MI develop the skills needed to work with clients and is the perfect introduction for anyone in the helping profession.

Find the book on Amazon.

Psychology Resources

We have many tools that can help increase the motivation required for change alongside worksheets that are valuable for identifying and working toward goals:

• Building New Habits
  Creating and implementing new habits is often easier when we understand how they work.
• Social Problem Solving & Goal Planning
  It is essential that we recognize and understand our problem-solving goals and identify and confirm the existence of any barriers.
• SCAMP – Goal Setting
  The SCAMP acronym is useful when capturing and defining goals.
• 17 Motivation & Goal-Achievement Exercises
  If you’re looking for more science-based ways to help others reach their goals, this collection contains 17 validated motivation & goals-achievement tools for practitioners. Use them to help others turn their dreams into reality by applying the latest science-based behavioral change techniques.

3 Goal Achievement Exercises Pack

Our free Goal Achievement Exercises Pack features three of our top tools from the Psychology Toolkit©, all of which center on the themes of motivation and goal achievement:

• Advanced Goal Analysis
  This exercise teaches clients the many different ways goals may be structured and invites them to examine their goal formulations. By carrying out this detailed analysis, clients can consider how they might reformulate less effective goals to support their successful attainment.
• Goal Visualization
  This visualization invites clients to identify a personal goal they’d like to accomplish and imagine the emotions and actions involved in achieving it over one year. By doing this, clients can increase their expectations of success, enhance motivation, and initiate planning and problem-solving actions in the present.
• Realizing Long-Lasting Change by Setting Process Goals
  This intervention teaches different approaches to habit-formation that support long-lasting change and goal achievement. In it, clients identify one goal they’d like to accomplish and develop a habit creation plan to guide sustainable efforts toward this goal.

All three exercises are instantly available for free when you download our Goal Achievement Exercises Pac.

A Take-Home Message

Behavior change is a crucial aspect of human health. Indeed, many of our health problems are preventable or can be improved by ourselves or others (Rollnick, Miller, & Butler, 2007).

Motivational interviewing does not trick people into doing what they don’t want; rather, it is a valuable clinical style for “eliciting from patients their own good motivations for making behavior changes in the interests of their own health” (Rollnick et al., 2007).

While it is seemingly foundational, health professionals are often not taught how to get their patients to follow treatment plans or help them change their health behaviors (Levounis, Arnaout, & Marienfeld, 2017).

MI is an essential clinical practice that engages clients in their treatment, requiring knowledge of skills including using open-ended questions, reflections rather than closed-ended questions, and summarizing to move them toward change.

The books within this article all share valuable research, theory, and practices that encourage clients to make their own decisions regarding adopting positive changes in line with their deeply held values.

Let us know in the comments below if you have found any other reading material equally applicable to Motivational Interviewing, that you would like to recommend.