Motivational Interviewing is a way of talking with people about change, developed by William Miller and Stephen Rollnick. Most people who come to you about drinking, smoking, tablets or sugar already feel two ways about it. That is ambivalence, and it is normal. Your job is to help the person hear their own reasons for change, in their own voice.
In the room the urge to explain, warn and advise is strong. Miller and Rollnick call it the righting reflex, and its usual effect is to make the person defend things as they are. Role-play is where you can catch that urge in yourself without a client paying for it. Every client on this page is a fictional training example, and nothing here is medical advice.
All clients on this page are fictional training examples, written to realistic clinical presentations. They are for learning, not clinical advice.
Core Motivational Interviewing skills to practise
Most of the method rests on OARS: open questions, affirmations, reflections and summaries.
- Open questions: invite a story, not a yes or no.
- Affirmations: name a real strength or effort you have just seen. "Great!" is praise, and people know the difference.
- Reflections: say back what you heard, as a statement. Complex reflections add the meaning or feeling the person implied but did not say.
- Evoking change talk: draw out the person's own desire, ability, reasons and need for change (DARN), then reflect it accurately, without inflating it.
- Responding to sustain talk and discord: reflect both calmly, never argue, and do not ask for more reasons to stay the same.
- Asking permission before information: Elicit-Provide-Elicit.
- Planning only when ready: commitment language such as "I will" or "I'm going to" is the sign.
Motivational Interviewing role-play scenarios
Each card gives a fictional client, their first words and the skills to work on. Write your own response before you read ours.
Scenario 1
A planter sent by his family about his drinking
Joseph, 46, owns a rubber plantation in Kottayam district, Kerala. He drinks every evening. His wife brought him after her brothers raised it with him, and he is braced for a lecture.
“My wife's brothers think I am some drunkard. I am a planter, sir. Every evening I take a little. That is all.”
- Responding to discord
- Naming the referral pressure neutrally
- Emphasising autonomy
A strong response: Acknowledge the pressure without joining the in-laws, and notice that he came. If he later talks about cutting down and mentions feeling shaky or sweaty when he tried before, treat that as a flag for possible dependence. Ask permission, explain that stopping suddenly can be unsafe, and recommend a medical assessment before he stops or cuts down sharply. Beyond that referral, give no advice. UK guidance (NICE CG115) says people with moderate or severe dependence usually need medically assisted withdrawal.
Common pitfall: Agreeing with the in-laws or reaching for a label such as "alcoholic". Describe the behaviour, never the person.
Scenario 2
Diabetes self-care after a high blood test
Abdullah, 52, is a senior government administrator in Sharjah. His GP referred him after his three-month sugar test came back high again. He is courteous, agrees quickly, and nothing changes.
“The doctor sent me. He says the sugar is high again. I know, I know, I should be more careful.”
- Open questions about his own worries
- Specific affirmations
- Avoiding the information dump
A strong response: Get curious about what he thinks, since he has heard everything else: "What worries you most about the diabetes, if anything?" If fasting comes up, suggest he raises medication timing with his doctor, and leave dosing alone.
Common pitfall: The lecture on sugar and carbohydrates. He will say "yes, yes" with perfect politeness and switch off.
Scenario 3
"I should cut down" with nothing behind it
Emma, 24, is a final-year nursing student in Bristol who uses cannabis daily. She speaks fluent therapy and wants very much to please you.
“So, yeah, I know I need to cut down. I'm totally on board, I just need, like, strategies?”
- Hearing "I should" as early change talk, not commitment
- Evoking her own reasons
- Not planning too early
A strong response: Reflect the need she has voiced, then slow down and find out what matters to her before any plan appears: "What would cutting down make possible for you?"
Common pitfall: Hearing "I need to" as a decision and going straight to a detailed plan. It is a reason for change, not a commitment to act. Wait for "I will".
Scenario 4
Stopping blood pressure tablets because of side effects
Lakshmi, 58, is a retired schoolteacher in Kochi. A month ago she stopped her blood pressure tablets because they left her tired. Her daughter, a pharmacist in Dubai, is upset with her.
“I feel better without them. My daughter keeps phoning me about it, but it is my body.”
- Emphasising autonomy
- Elicit-Provide-Elicit
- Exploring values
A strong response: Agree that the decision is hers, because it is, then explore. With her permission, suggest she tells her doctor she has stopped and talks through the side effects, since other options may exist. Say nothing about any particular medicine.
Common pitfall: Siding with the daughter, or insisting she restart. Every push produces a push back.
Example Motivational Interviewing script with teaching notes
A short exchange from a second session with Joseph, the fictional planter from the first scenario. Watch the change talk grow each time it is reflected rather than pushed.
Client:My father drank every day and nothing happened to him.
Therapist:In your family, a drink every evening was just normal for a man. So it's hard to see why it should be a problem for you.
A complex reflection of sustain talk. It argues with nothing, and does not ask for more reasons to drink.
Client:Yes. Well, he died at 61. They said a stomach problem.
Therapist:Sixty-one. And you're not sure it was only a stomach problem.
Reflects what he hinted at with "they said". No warning added on top.
Client:Actually, it was his liver. I don't usually say that.
Therapist:Thank you for telling me. It takes courage to say it out loud.
An affirmation of a specific effort he has just made. Not "well done".
Client:My daughter's wedding is in eight months. I want to be there for her children also.
Therapist:You want to be around for a long time, for her and for the grandchildren to come.
Change talk, reflected at the strength he gave it. Go one step further than the person did and they tend to step back.
Client:But the estate, the loan, the prices. In the evening I need something.
How to give and get feedback on Motivational Interviewing practice
Record the role-play. Fidelity tools such as the Motivational Interviewing Treatment Integrity code (MITI) rate the counsellor's speech, not the client's response to it.
Two indicators are worth tracking: reflections per question (the MITI manual suggests at least one as a fair baseline and two as good) and the share of reflections that are complex (about 40% fair, 50% good). The manual's authors say plainly that these thresholds rest on expert opinion and have not been validated against outcome data. Use them as a guide, not a pass mark.
- Did I reflect more than I asked questions?
- Did I ask permission before giving information or advice?
- Did I argue, warn, label or take the family's side at any point?
- Did I raise any safety issue clearly, with permission, and without threats?
Read more about Motivational Interviewing, the evidence behind it and the skills you practise.