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Are you a therapist looking for motivational interviewing worksheets? We’ve got you covered.
This guide to motivational interviewing worksheets gives mental health therapists a brief overview of motivational interviewing, its benefits, and how this technique can be used effectively in your therapy practice.
We’ve also included a free downloadable motivational interviewing worksheet PDF to save to your electronic health record (EHR) for repeated use with clients.
What is motivational interviewing?
Motivational interviewing is a person-centered counseling approach used to support change.
Often used in substance use disorder treatment, motivational interviewing can help individuals find motivation and strengthen their commitment to improving their relationship with substances.
Motivational interviewing has also been successfully used to improve other health outcomes and behaviors, such as increasing physical activity, medication adherence, dental hygiene, and weight management.
Motivational interviewing assumes four things:
Ambivalence about changing substance use is expected.
The individual can overcome ambivalence by exploring their values and motivations.
The therapeutic relationship is a collaborative process in which both people bring expertise.
Change occurs in an environment of support, empathy, and collaborative partnership, where exercising free choice and the right to self-determination are promoted.
The core counseling skills of motivational interviewing include OARS:
Ask Open-ended questions that invite the client to tell their story. For instance, “What brings you to therapy?” or “In what ways are you concerned about your substance use?”
Affirm clients by showing positive regard, emphasizing their strengths and past successes, and reflecting on their efforts. For example, “I see you took a big step by coming to therapy for support with your substance use. That takes a lot of courage.”
Reflective listening shows respect, establishes trust, invites clients to explore, promotes collaboration, provides support, and considers cultural and racial differences. For instance, a client might explain that they drink because they experience social anxiety. You may reflect, “I hear you say you drink because you feel anxious in social situations.”
Summarize or distill information for clients. For example, summarize their earlier statements when collecting information, highlight reasons for change, and identify steps the client has committed to achieving their goals.
Motivational interviewing and the stages of change
Motivational interviewing has historically incorporated the stages of change model, also known as the transtheoretical model of change (TTM).
The key stages of the change model are:
Precontemplation: The client is not yet considering change, may deny the problem, lack awareness of the consequences of substance use, or underestimate the consequences.
Contemplation: At this stage, individuals recognize a problem, consider the pros and cons of change, and contemplate change. However, they still need to commit to taking action.
Preparation: At this stage, the client is ready to take action and may begin formulating a plan for behavior change. They may also take small steps toward change.
Action: The client actively engages in the change process, makes visible and positive lifestyle changes, and intends to keep moving forward.
Maintenance: The client has sustained their changes for over six months and intends to continue the behavior by engaging in relapse prevention behaviors.
However, according to the Substance Abuse and Mental Health Services Administration, those using motivational interviewing have moved away from the phases of change model in favor of overlapping processes that involve the critical components of motivational interviewing:
Engaging
Engaging involves establishing rapport with the client using opening strategies, like OARS. To promote client engagement in the change process, avoid traps like labeling or posturing as an expert.
Focusing
Focusing involves developing a mutually agreed agenda that identifies a target behavior to promote change.
Evoking
Evoke clients' motivation for change by engaging them in change talk, reflecting, listening, reframing, emphasizing autonomy, and developing a discrepancy between their behavior, goals, and values.
Clinicians also evoke hope and confidence to support the client’s self-efficacy and recognize the signs of a client’s readiness for change.
Planning
Planning involves supporting the client in identifying accessible and appropriate change goals and plans.
Strengthen the client’s commitment to change through identifying intentions and actionable steps the client is willing to take.
Examples of motivational interviewing
Below are some examples of questions and statements to help guide clients through completing the motivational interviewing worksheet.
Examples of open-ended questions
“What are some things you like and dislike about your substance use?”
“What would you like to work on in therapy?”
Examples of affirmative statements
“It’s really strong of you to notice something that isn’t working for you and seeking support.”
“You took a big step coming here today.”
“You went to an AA meeting last week and had a drink afterward. You still came here today, so I see how you keep showing up for yourself and your goals.”
Examples of questions to elicit change
“What will happen if you stop drinking/using substances?”
“What would happen if you don’t change your drinking habits?”
“What improvements do you see if you reduce your drinking? How would it impact your relationships?”
“In what ways have friends and family expressed their concerns about your drinking?”
Examples of reflective listening
“You drink because you’re finding it isolating in your marriage.”
“It sounds like you are saying you want to improve your relationship with alcohol, but you don’t know how to stop.”
“You’re afraid that your health will continue to deteriorate if you keep smoking marijuana.”
“I hear your desire to change and see how you’ve tried to address it by…”
Summarizing statement example
“You have come to therapy to help change your relationship with substances because it is affecting your relationships, and you’re worried about losing your family and your job. You like drinking because it relieves stress from your busy job and eases social anxiety. You’ve also identified that it impacts your performance at work, and your wife is worried about how much drinking costs you financially and your health. That sounds hard to navigate, and I can see why you want to change. You have made efforts to moderate your drinking, have attended a few AA meetings, and have shown up to therapy. It sounds like you have also identified why it's essential to stop drinking, and you feel a renewed commitment to achieving your goals. Does that sound accurate?”
How to use motivational interviewing worksheets
You can download and use the motivational interviewing worksheet in several ways.
The motivational interviewing worksheet PDF can be adapted based on the specific age of the client.
For instance, you could use it as a motivational interviewing adolescent worksheet for clients to work on between sessions.
You could also use the motivational interviewing stages of change worksheet to describe the change process to clients, externalize the impact of their substance use, and promote readiness for change.
Sources
Bischof, G., Bischof, A., & Rumpf, H. J. (2021). Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice..
Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation for change in substance use disorder treatment.
Motivational Interviewing Network of Trainers. (2019). Understanding Motivational Interviewing and Motivational Groups for Community Substance Abuse Programs.
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