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If you’re looking for a developing discrepancy worksheet for clients, this article gives therapists an overview of the developing discrepancy motivational interviewing strategy, including examples.
We’ve also included a free downloadable developing discrepancy worksheet to save to your electronic health record (EHR) that you can print and share with clients.
What is motivational interviewing (MI)?
Developing discrepancy is one of the core principles used in motivational interviewing (MI).
Motivational interviewing is a person-centered and collaborative therapeutic approach that helps to resolve ambivalence and build motivation for change.
Commonly used in substance use treatment, motivational interviewing is also helpful for other health-related behaviors and clients working toward specific goals.
The key principles underpinning motivational interviewing include:
Ambivalence is normal. Individuals may struggle with the decision to change.
Exploring values and motivations can help to overcome ambivalence.
Collaboration is essential. The client is an expert in their lives and can change through a collaborative approach.
Change thrives in a supportive environment that promotes partnership, acceptance (autonomy, absolute worth, accurate empathy, and affirmation), compassion, and evocation.
Motivational interviewing involves four overlapping processes:
Expressing empathy: Using empathy and reflective listening to build rapport, trust, and demonstrate understanding of the client’s perspective.
Developing discrepancy: Supporting the client in recognizing the gap between their current behavior and their desired goals and values.
Rolling with resistance: Clinicians avoid confrontation and instead accept resistance as part of the change process, emphasizing a collaborative and supportive therapeutic alliance.
Supporting self-efficacy: Motivational interviewing encourages and reinforces the client’s ability and motivation to change.
The core skills clinicians practice in MI include asking open-ended questions to help clients explore their thoughts, providing affirmations to reinforce strengths and past successes, reflective listening to foster trust and self-awareness, and summarizing insights to help clients process and reinforce them.
Steps to developing discrepancy in motivational interviewing
As we briefly touched on, the second stage of motivational interviewing is developing discrepancy.
This step supports the client in recognizing the disparity between their current behaviors and their values, goals, or desired outcomes.
The focus of this step is to foster internal motivation for change and resolve client ambivalence rather than a more directive approach that may pressure the client into changing.
The steps to the developing discrepancy motivational interviewing strategy include:
Identify core values and goals
The therapist helps clients explore what truly matters to them (e.g., family, health, career, relationships).
Contrast with current behavior
The clinician gently points out how the client’s actions may not align with these values.
Elicit self-motivated change
Instead of telling the client what to do, the therapist asks reflective questions to help them recognize the inconsistency.
Evoke hope and confidence to support self-efficacy
The therapist reminds clients that they have the power and self-efficacy to make changes based on their own values.
The benefits of developing discrepancy include:
Increases self-awareness of how behaviors are impacting their well-being and others
Enhances motivation to change
Reduces resistance by encouraging the client to explore their arguments for change
Strengthens their commitment to change and take action when they identify the need to change behavior
Developing discrepancy examples
The techniques for the developing discrepancy motivational interviewing strategy involve:
Values exploration
“What kind of person do you want to be?”
“What is most important to you in your life?”
“If you could change one thing about your life, what would it be and why?”
“What do you want your relationships, health, or career to look like five years from now?”
“What are some of your biggest hopes for the future?”
Reflective listening (clarifying the gap)
“You said you want to be a better parent, but you mentioned that your drinking sometimes affects your ability to be present with your children. How do you feel about that?”
“I hear you saying that quitting smoking is difficult, and you mentioned your health is a priority. How does that feel for you?”
“On one hand, you enjoy the social aspect of gambling, but on the other hand, you feel stressed about money. How do you make sense of that?”
Affirmations
"It takes a lot of courage to reflect on how your actions align with your values."
"I appreciate that you’re open to looking at both sides of this decision."
"You’ve already started making small changes, which shows real determination."
"Your willingness to reflect on this shows your commitment to personal growth."
Scaling questions
“On a scale of one to 10, with one being not a priority and 10 being very important, how important is it for you to change? Why did you choose that number?”
“On a scale of one to 10, how confident are you in your ability to change? What would help you move up one point?”
“If you stayed at the same number for the next year, how would that impact your life?”
Decisional balance
This involves weighing the pros and cons of change vs. staying the same, such as:
“What are the benefits of continuing this behavior?”
“What would improve in your life if you made this change?”
“What would be the hardest part about that change?”
“What are the downsides of continuing?”
Exploring ambivalence and change talk
“What concerns do you have about staying the same?”
“If nothing changes, where do you see yourself in five years?”
“What’s one small step you could take toward change?”
“What strengths do you have that could help you succeed?”
Many of the questions above are included as prompts for clients to respond to in the developing discrepancy worksheet.
How to use the developing discrepancy worksheet
You can download and use the developing discrepancy worksheet in several ways.
First, you can print the worksheet and use it in person or share it virtually as an in-session prompt.
Therapists can also give the developing discrepancy motivational interviewing strategy worksheet to clients to reflect on their discrepancies between therapy sessions, or use it to prompt further discussion about change in future sessions.
Another way to use the developing discrepancy worksheet is to provide it to supervisees as an educational resource.
Sources
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
Substance Abuse and Mental Health Services Administration (US). (2019). Enhancing motivation for change in substance use disorder treatment: Updated 2019. Rockville, MD: Author. (Treatment Improvement Protocol (TIP) Series, No. 35). Chapter 3—Motivational interviewing as a counseling style.
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