Clinician tool
Motivational interviewing pocket guide
Stays on this device. Everything you enter here is saved only in this browser (IndexedDB) and is never sent to Meridian or any server — it works offline. Because entries can include client information, use a private, encrypted device, and clear or export to your EHR when you're done. This is a scratchpad, not the medical record of truth.
A pocket reference for Motivational Interviewing (MI) — the spirit, core skills, and how to recognize and evoke change talk — paired with two interactive worksheets you can use live in session. Entries save to this browser only.
MI Spirit (PACE)
Partnership — Work with the client as an active collaborator, not on them.
Acceptance — Convey absolute worth, accurate empathy, autonomy support, and affirmation of the client’s strengths and efforts.
Compassion — Actively prioritize the client’s welfare and best interests.
Evocation — Draw out the client’s own motivations and wisdom rather than installing your own.
OARS — core skills
Open questions — Invite elaboration rather than a yes/no answer.
“What worries you most about how the drinking is going?”
“How would you like things to be different a year from now?”
Affirmations — Recognize genuine strengths, efforts, and values.
“Even on a hard week, you still made it to every appointment.”
“Cutting back on your own was a real act of determination.”
Reflections — Mirror back meaning. Simple reflections restate; complex reflections add meaning or feeling. Double-sided reflections hold both sides of ambivalence; amplified reflections slightly overstate to invite the client to pull back.
Simple: “You’ve missed a few doses this month.”
Complex: “Taking the medication every day feels like admitting you’re sick.”
Double-sided: “Part of you likes how the pills help, and part of you resents needing them.”
Amplified: “So there’s really no downside at all to keeping things exactly as they are.”
Summaries — Collect, link, and transition — reflecting a set of statements back to the client.
“Let me make sure I have this — the drinking helps you unwind, and it’s also straining things at home and with your health. What else?”
“So on one hand the routine works; on the other, you’d like to feel more in control of it.”
Change talk vs. sustain talk
Change talk is any client speech that favors movement toward change; sustain talk favors the status quo. Listen for the balance, and let change talk guide where you go next.
Change talk — DARN-CAT
Desire — “I want to cut back.”
Ability — “I could probably manage one drink-free day.”
Reasons — “My blood pressure would improve.”
Need — “I have to do something before I lose my license.”
Commitment — “I will take the medication every morning.”
Activation — “I’m ready to give it a try this week.”
Taking steps — “I already poured out what was in the house.”
Sustain talk — arguments for the status quo
Desire to stay — “I actually enjoy my nightly drink.”
Ability doubts — “I’ve tried before and always slip back.”
Reasons to stay — “It’s the only thing that helps me sleep.”
Low need — “It’s honestly not that big a deal.”
No commitment — “Now really isn’t a good time to change.”
How to respond: reflect and reinforce change talk (ask for more, affirm, summarize it). Don’t argue against sustain talk — reflect it simply and roll with it, which usually softens it.
Rolling with discord & the righting reflex
When you hear pushback, treat it as a signal about the relationship or the pace — not a client to be corrected. Resist the righting reflex (the urge to fix, warn, or persuade), which tends to entrench sustain talk.
Reflect it — Simple, amplified, or double-sided reflections defuse defensiveness.
“You don’t think the medication is the real problem here.”
Shift focus — Move away from the sticking point to something more workable.
“Let’s set the diagnosis aside for now — what would make this week go better?”
Emphasize autonomy — Underline that the choice is genuinely theirs.
“It’s completely up to you whether you change anything at all.”
Reframe — Offer a different meaning for the same facts.
“Sounds less like failure and more like you’ve learned what doesn’t work for you.”
Come alongside — Side with the reluctance rather than opposing it.
“Maybe cutting back just isn’t worth it for you right now — and that would be understandable.”
Readiness ruler
Rate each dimension 0–10, then use the follow-up prompts to evoke change talk. Values save automatically.
How important is this change to you?
How confident are you that you could make this change?
How ready are you to make this change right now?
Evoking prompts
“You said importance is a 5 — why are you at a 5 and not a 0?” (evokes change talk)
“What would it take to move from a 5 to a higher number?”
Decisional balance
Best used when a client is genuinely ambivalent. Avoid it once someone is already committed to change — revisiting the pros of the status quo can inadvertently reinforce sustain talk.
Staying the same
Benefits / pros of not changing
Staying the same
Costs / cons of not changing
Making the change
Benefits / pros of changing
Making the change
Costs / cons of changing
MI is a clinical style, not a script — it is best developed and refined through formal training, coaching, and feedback on recorded sessions.