Reference · Intervention and Practice

Motivational interviewing and stages of change

The short answer

Motivational interviewing is collaborative and client-centered, and it evokes the client's own reasons for change.[1][2][3] Its classic principles: express empathy, develop discrepancy, roll with resistance, and support self-efficacy.[1][2][3] Match the approach to the stage of change: raise awareness in precontemplation, weigh pros and cons in contemplation, build the plan in preparation.[4][5]

The key ideas

  • Motivational interviewing: four principles

    Express empathy, develop discrepancy between goals and current behavior, roll with resistance (avoid argument), and support self-efficacy. MI is collaborative, client-centered and evokes the client's own reasons for change, built on Rogers. These four principles are the classic formulation; current MI (Miller and Rollnick 2013, TIP 35 2019) organizes practice into four processes (engaging, focusing, evoking, planning) and reframes resistance as sustain talk and discord.[1][2][3]

  • Motivational interviewing OARS skills

    OARS: Open-ended questions, Affirmations, Reflective listening, Summaries. Reflections are the core skill; affirmations build confidence; summaries link statements and highlight change talk.[3]

  • Motivational interviewing: ambivalence and change talk

    MI treats ambivalence as normal and helps the client voice their own reasons for change (change talk) instead of the worker persuading. Good for low-readiness clients, substance use and health behaviors.[1]

  • Transtheoretical model: stages of change

    Precontemplation, contemplation, preparation, action, maintenance (relapse may occur; some versions add termination). Match the intervention to the stage rather than pushing action on everyone.[4][5]

  • Stages of change: precontemplation

    Person does not see a problem and has no intent to change in the next 6 months; worker builds rapport, raises awareness without confrontation, and offers information, with permission, once rapport exists.[4]

  • Stages of change: preparation

    Intends to act soon (about the next 30 days) and has taken small steps; worker helps set goals and a concrete plan.[4]

  • Stages of change: maintenance

    Behavior change sustained for roughly 6 months or more; work shifts to relapse prevention and coping with triggers. Relapse is common and treated as a learning opportunity, not failure.[4]

How the ASWB exam tests it

  • The right answer reflects and explores ambivalence; wrong answers argue, confront, give advice early, or push a plan.[1][2][3]
  • Pick the response that fits OARS: an open question or a reflection beats a closed question or advice.[3]
  • Resistance signals a mismatch; shift approach rather than confront.[1]
  • Precontemplation: raise awareness, no pushing; contemplation: weigh pros and cons; preparation: plan; action: support; maintenance: relapse prevention.[4][5]
  • When a client denies a problem, do not push an action plan.[4]
  • A client who has called a program and wants help is ready to build a plan.[4]

The common trap

Pushing an action plan, arguing, or giving advice early. The best answer reflects and explores the client's ambivalence.[1][2][3][4]

Try a related question

  1. LBSW practice · Assessment and Planning

    During the FIRST home visit, a 62-year-old client denies having an alcohol problem. What communication approach is BEST?

    • A.Use reflective listening to acknowledge the client’s perspective
    • B.Confront the client with evidence of their drinking behavior
    • C.Explain the health risks of excessive alcohol use
    Show answer

    Answer: A. Use reflective listening to acknowledge the client’s perspective

    Reflective listening fosters rapport and helps the client feel heard, making it the BEST approach in an initial visit.

More LBSW practice questions with answers

Related explainers

Sources

  1. 1.NCBI Bookshelf (SAMHSA TIP). www.ncbi.nlm.nih.gov/sites/books/NBK64964/
  2. 2.NCBI Bookshelf (StatPearls). www.ncbi.nlm.nih.gov/sites/books/NBK589705/
  3. 3.SAMHSA TIP 35 (2019), NCBI Bookshelf. www.ncbi.nlm.nih.gov/sites/books/NBK571068/
  4. 4.NCBI Bookshelf (StatPearls). www.ncbi.nlm.nih.gov/sites/books/NBK556005/
  5. 5.PubMed Central (peer-reviewed). www.ncbi.nlm.nih.gov/pmc/articles/PMC6390443/

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