Motivational Interviewing Questions by Process

How to use the process questions

Use the motivational interviewing questions in table order. Miller and Rollnick’s fourth edition still uses engaging, focusing, evoking, and planning, and now calls those four moves tasks. The third edition called them processes. The question does not change with the label. Skip ahead to planning and the client hears a push.

Engaging: The first question asks for a reason to stay. It does not ask for a goal; it asks what would make staying worth it.

Focusing: The answer supplies a target. Focusing chooses the path. It does not argue for change.

Evoking: Listen for a reason in the client’s words. If you hear “it helps me sleep,” that is sustain talk. Reflect it before you ask again.

Planning: Listen for a step they can name after you have heard change talk. Asked too early, a planning question sounds like advice.

What you do after the question

OARS is the open question, then an affirmation, a reflection, and a summary. Miller describes the open question as one whose answer you do not already know, and he says you should be talking less than half the time. The other three moves are not questions. Ask once. Then use one of these before you ask again.

Offer the reflection as a statement. Your voice goes down at the end. A reflection with a rising tone is another question, and a question is more likely to pull a defense than a statement is.

After engaging

• Affirmation: You came in knowing we might not settle the use today, and you still said what would make the hour useful.

• Reflection: A useful hour is one where you leave with your own words for the week, not a plan you did not choose.

• Summary: You want the hour to be useful even without a decision, and useful means you hear yourself more clearly than you did on the way in.

After focusing

• Affirmation: You picked one target instead of trying to cover the whole week in one hour.

• Reflection: This hour is about the nights, and the fight at home is what happens after the nights.

• Summary: You chose the nights as the target. The mornings and the fight can wait until the nights are clearer.

After evoking

• Affirmation: You named a cost you actually notice, not a cost someone else assigned you.

• Reflection: Keeping it the same protects your sleep, and it also costs you the morning you wanted.

• Summary: You hear both sides. The use still does a job for you, and a part of you is tired of the cost.

After planning

• Affirmation: You named a step small enough to do on a bad day, not a promise you have already broken.

• Reflection: Tuesday and Thursday, food before the first pour, is the change you are willing to name.

• Summary: You are not agreeing to quit. You are agreeing to two nights that start with food. That is the step.

Do not stack the affirmation, the reflection, and the summary in one breath. Pick the one the answer needs. An affirmation after a real step. A reflection when you heard both sides. A summary when you are about to change the subject or close the hour.

Change-talk prompts

Miller and Rollnick still separate preparatory change talk from mobilizing change talk. They still call that set DARN-CAT. Ask for the want, the ability, the reasons, and the need while the client is ambivalent. Ask for a commitment, a readiness step, or something they have already done only after you have heard a reason in their words.

If the answer is sustain talk, do not correct it. Reflect the sustain talk, then offer one preparatory prompt. A second evoking question on top of an unreflected “but” is an argument.

Want

• Prompt: What do you want to be different about the evenings, if anything?

• What it evokes: Desire. A want, not a should. “I should cut back” is not desire until they say what they want instead.

Able

• Prompt: What have you already done, even once, that shows you can change a night like that?

• What it evokes: Ability. A past success. You do not supply the pep talk. You ask for the evidence they already have.

Reasons

• Prompt: If you changed this and nothing else, what would get better that you would actually notice?

• What it evokes: A reason in their week, not a lecture about health. If they cannot name a notice, you are still in engaging or focusing.

Need

• Prompt: What makes this matter now, rather than next year?

• What it evokes: Urgency in their words. “Nothing” is an answer. Do not move to planning on a nothing.

Commitment

• Prompt: What, if anything, are you willing to do this week?

• What it evokes: A commitment, or a clear no. A clear no is data. Do not upgrade it to a plan they did not make.

Already started

• Prompt: What have you already tried since we last met?

• What it evokes: A step already taken. If the answer is nothing, go back to a reason. Do not write a step they did not take.

A substance use script

Use the script when the hour is drinking or other drug use and you need a short run of motivational interviewing questions, not a general open-question drill. Jordan is composite. The lines are ones you can say. You do not argue for abstinence. You follow the change he names.

Write that step in his words. “Client agreed to cut back” is your summary, and it is larger than the change he named. If the next job is the trigger list, the craving plan, or the line you send to group or IOP, move to substance use counseling techniques. The questions got you the step. They do not replace the plan.

When you stop asking

A better question is the wrong tool in four situations. Name which one you are in before you reach for another stem.

Intoxication, withdrawal, or medical instability. Stop the sequence. Follow the medical and crisis path your practice already uses. Do not keep evoking while someone needs a medical decision. A reflection will not replace that path.

Discord. Arguing, sarcasm, one-word answers, or “you people always.” Drop the next question. Reflect the pushback. “You are tired of being asked about the drinking.” Then wait. Miller notes that questions pull defensiveness more readily than a statement does. If you ask again here, you are collecting a fight.

They already committed. Jordan named Tuesday and Thursday. Another “what worries you” question stalls him. Ask the planning question once, then move to how he will notice a bad day before he pours. That how-to lives with the relapse-prevention work, not in a second evoking prompt.

You need a number, a phase, or a story that is not about change. Importance and confidence are scaling questions. The first hour, the alliance, and the close are counseling session questions. Exploration that is not pointed at change talk is an open-ended question. Come back to motivational interviewing questions when the stuck point is the argument with themselves.

What you write

Write the process, the question you actually asked, and the change talk or sustain talk you heard. A line that says “used MI” is not a record a colleague can continue.

Put the line in the chart the same day. If the step is two nights with food before the first pour, that sentence is the plan for the week. Do not widen it because a smaller step looks unambitious in the note.

Download the session map

You already have the question for the process you are in. The session map is where the stage of change, the reflection, the harm-reduction goal in their words, and the group or IOP line live for the rest of the hour.

References

• Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press. https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781462552795
• Miller, W. R., & Rollnick, S. (n.d.). What’s new (and not new) in the 4th edition of motivational interviewing. Motivational Interviewing Network of Trainers. https://motivationalinterviewing.org/sites/default/files/what_new_in_mi-4.pdf
• Miller, W. R. (n.d.). OARS in motivational interviewing. https://res.cloudinary.com/psychwire/image/upload/v1559207479/pw.com/MI/resources/OARS_and_Motivational_Interviewing.pdf