Motivational Interviewing

Motivational Interviewing (MI) is a way of talking with people about change, developed by William Miller and Stephen Rollnick— originally in the context of addiction, now used far more widely. It's formally defined as "a collaborative, goal-oriented style of communication with particular attention to the language of change,"designed to strengthen a person's own motivation and commitment to a specific goal.

The key insight is about ambivalence. When someone is "not motivated," they're usually not indifferent — they're torn, holding good reasons both to change and to stay the same. Directly arguing for change tends to make people defend the other side (the "righting reflex" backfiring). MI instead helps people explore and resolve that ambivalence in the direction of change themselves.

MI is often described as a way of being with people, not a set of techniques to use on them. That underlying spirit has four elements, sometimes remembered as PACE:

• Partnership — a collaboration between equals, not an expert directing a passive recipient.
• Acceptance— respecting the person's worth, autonomy, strengths, and right to make their own choices.
• Compassion— actively promoting the person's welfare and best interests.
• Evocation— drawing out what's already inside the person rather than installing what's missing.

Without this spirit, the techniques below become hollow or even manipulative. With it, they help people move.

MI unfolds through four overlapping processes. They're roughly sequential but you often loop back — you can't evoke well before you've engaged.

The moment-to-moment skills of MI are captured by the acronym OARS:

• Open questions— questions that invite reflection and can't be answered in a word ("What matters most to you about this?").
• Affirmations — genuine recognition of strengths, efforts, and worth (not flattery).
• Reflective listening — the heart of MI: reflecting back what you hear so the person feels understood and hears their own thoughts clearly.
• Summaries— gathering and playing back the threads of a conversation, especially the person's reasons for change.

A defining feature of MI is its close attention to the person's language. Change talkis any speech that favors change — desire ("I want to"), ability ("I could"), reasons ("it would help my kids"), need ("I have to"), and especially commitment ("I will"). Sustain talk favors the status quo.

The MI practitioner learns to recognize, evoke, and gently reinforce change talk — and to respond to sustain talk with curiosity and reflection rather than confrontation. As change talk grows and commitment language emerges, the conversation naturally moves toward planning. Research links the amount of client change talk to actual behavior change afterward.

MI is one of the most extensively researched communication approaches in health care. Meta-analyses show it is effective for substance use, and a wide range of health behaviors— often in remarkably brief encounters, and frequently as a way to boost engagement with other treatments. It's widely used across mental health, primary care, and recovery settings, including by peer workers.

Its effects depend heavily on fidelity to the underlying spirit — MI delivered as a checklist of tricks doesn't work. Done well, it's a respectful, efficient way to help people move toward the changes they already, on some level, want.

Many New Hampshire clinicians, recovery programs, and peer specialists use MI. Meridian maintains a verified directory to help you find support by region.