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# Motivational interviewing

- Technique

It is a collaborative conversation that helps a person find their own reasons to change, instead of trying to convince them.

Updated Nov 5, 2026

## Key points

- Spirit: partnership, acceptance (including autonomy and empathy), compassion and evocation.
- Four processes: engaging, focusing, evoking and planning.
- OARS: Open questions, Affirmations, Reflections and Summaries.
- DARN-CAT change talk: Desire, Ability, Reasons, Need; then Commitment, Activation and Taking steps.
- Avoid the ‘righting reflex’: arguing increases sustain talk; meet resistance with reflection, not confrontation.
- Develop discrepancy between current behaviour and the patient's goals or values.

## What it is

Motivational interviewing, described by Miller and Rollnick, is a person-centred conversational style that strengthens a person's motivation and commitment to change. It starts from the view that ambivalence (wanting and not wanting to change) is normal. Instead of giving orders or arguments, the clinician draws out the patient's own reasons and respects their autonomy. It has evidence in alcohol, tobacco and other substance use, and is used in chronic disease and adherence.

## Key facts

- Sustain talk is the patient's reasons for not changing; discord is tension in the relationship. Together they replace the old idea of patient ‘resistance’.
- Commitment and taking-steps talk predict change better than desire or reasons.
- Simple reflections repeat; complex ones add meaning or emotion; a double-sided reflection joins both sides of the ambivalence.
- It is brief and fits a consultation: it is used as a brief intervention in primary care and emergency departments.

## How it is done

- Engage: listen with reflections and build trust before talking about change.
- Focus: agree the topic together (‘What would you like us to talk about today: sugar, walking or cigarettes?’).
- Evoke: ask for their reasons: ‘What would you gain if you stopped smoking?’
- Use the 0-to-10 ruler: ‘How important is it to you?’, then ‘Why a 6 and not a 3?’
- Reflect and summarize change talk, giving back both sides of the ambivalence.
- Ask permission before giving information (ask–tell–ask).
- Plan small, concrete goals chosen by the patient, and reinforce self-efficacy.

## Change talk (DARN-CAT), with a tobacco example

| Type | What it expresses | Example |
| --- | --- | --- |
| Desire | Wants the change | ‘I would like to quit smoking.’ |
| Ability | Believes they can | ‘I quit once for a whole year.’ |
| Reasons | Concrete advantages | ‘My children would not have to breathe the smoke.’ |
| Need | Feels it is necessary | ‘I have to do something about this cough.’ |
| Commitment | States they will do it | ‘I am going to stop on the first of the month.’ |
| Activation | Ready to start | ‘I am ready to give it a try.’ |
| Taking steps | Has already acted | ‘This week I threw out the lighters.’ |

## Clinical notes

- It pairs well with the stages of change: it is especially useful in precontemplation and contemplation.
- Motivational enhancement therapy is a short structured version that helps build the resolve to stop alcohol or other drugs and to stick to the goals.

## Memory aid

Row with OARS: the patient holds the rudder and the clinician only helps the boat move forward.

## Test yourself

Think of the answer, then tap the question to see it.

## What does OARS stand for in motivational interviewing?

Open questions, Affirmations, Reflections and Summaries: the four core skills.

## What is the righting reflex and why is it avoided?

It is the clinician's urge to convince or correct; it makes the patient defend not changing and increases sustain talk.

## A patient rates the importance of cutting down drinking at 4 out of 10. What do you ask?

‘Why a 4 and not a 1?’: the patient then voices their own reasons for change.

## What are the four processes of motivational interviewing?

Engaging, focusing, evoking and planning.

## Which kind of change talk best predicts future behaviour?

Mobilizing talk: commitment, activation and taking steps, more than desire or reasons.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/behavioral-science/motivational-interviewing/)

## Elsewhere in DurgiPedia

- [Medicines, allergies and habits: tobacco, alcohol and other substances](https://durgical.com/en/clinical-exam/medicines-allergies-and-habits-tobacco-alcohol-and-other-substances/)

## Connections

## Related 6

- [The stages of change (transtheoretical model)](https://durgical.com/en/behavioral-science/the-stages-of-change/)
- [Screening and brief intervention (SBIRT) and harm reduction](https://durgical.com/en/behavioral-science/screening-and-brief-intervention-and-harm-reduction/)
- [Addiction concepts: reward, tolerance, dependence and withdrawal](https://durgical.com/en/behavioral-science/addiction-concepts-reward-tolerance-dependence-and-withdrawal/)
- [Self-efficacy, locus of control and planned behavior](https://durgical.com/en/behavioral-science/self-efficacy-locus-of-control-and-planned-behavior/)
- [How to improve adherence](https://durgical.com/en/behavioral-science/how-to-improve-adherence/)
- [Communication skills: open questions, empathy and teach-back](https://durgical.com/en/behavioral-science/communication-skills-open-questions-empathy-and-teach-back/)

## Related conditions 6

- [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/)
- [Tobacco use disorder](https://durgical.com/en/conditions/tobacco-use-disorder/)
- [Obesity](https://durgical.com/en/conditions/obesity/)
- [Opioid use disorder, overdose and withdrawal](https://durgical.com/en/conditions/opioid-use-disorder-overdose-and-withdrawal/)
- [Stimulant use disorder (cocaine, amphetamines)](https://durgical.com/en/conditions/stimulant-use-disorder/)
- [Cannabis use disorder](https://durgical.com/en/conditions/cannabis-use-disorder/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Treatment | National Institute on Drug Abuse (NIDA)](https://nida.nih.gov/research-topics/treatment) (National Institute on Drug Abuse (US), 2024); [Theory at a Glance: A Guide For Health Promotion Practice (Second Edition)](https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf) (National Cancer Institute, National Institutes of Health (US), 2005).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/behavioral-science/motivational-interviewing/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/motivational-interviewing/