10 Motivational Interviewing Therapy Exercises & Activities to do with your Clients

Making changes in our lives can be a challenging and scary experience. Having reservations or concerns about making changes is a normal part of life, and can often present as a concern for the clients we work with. So what helps us reach a point where we are ready to make a change?

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There are three key factors needed for individuals to be ready to change. To begin, they need to feel as though they want to make the change. This is often connected to developing internal sources of motivation. We need to feel as though we have the skills to support us while we make the change. This can include learning and practicing skills that we have not developed yet. Lastly, feeling supported by those around us can have a lasting impact on our desire to change a behavior or work towards a goal. Connection is an important part of our lives, and it can help us feel safe when taking risks and making changes. 

Motivational interviewing, also known as MI, combines the values of humanistic psychology and principles from person-centered counseling into a commonly used treatment modality (Seligman, L. & Reighenberg, L.W., 2010). Motivational interviewing was developed by William Miller and Stephen Rollnick in the 1980s and has continued to benefit clients in the decades since. Counselors and Therapists can use motivational interviewing techniques to promote behavioral change within our clients when they are ready (Seligman, L. & Reighenberg, L.W., 2010).

When we use motivational interviewing strategies and skills in sessions, we allow our clients to control the sessions. They are viewed as the experts of their history and experiences, whereas we are allies that can help them reach goals that they may have. MI avoids talking about mental health diagnoses and persuasion.

The spirit of motivational interviewing the spirit of motivational interviewing includes:

• Collaboration
• Evocation
• Compassion
• Acceptance

The combination of the four components of the MI spirit helps develop an environment that allows clients to feel safe and welcome, even with reluctance about being there. A focus within motivational interviewing is developing a healthy therapeutic alliance so that there is a supportive environment for change.  Counselors work to explore ambivalence that clients may have about making behavioral changes, and reframe their concerns rather than confronting the client. 

Mental Health Concerns That Can Benefit from Motivational Interviewing Therapy

When motivational interviewing was initially developed by Miller and Rollnick, it was used to work with clients who were struggling with alcohol use and abuse (Seligman, L. & Reighenberg, L.W., 2010). A motivational enhancement therapy program was developed and included 4 sessions over a 12-week period for those who were struggling with their drinking behaviors (Seligman, L. & Reighenberg, L.W., 2010).

Since then, motivational interviewing has been used with clients living with other mental health concerns and behavioral issues. This includes individuals living with eating disorders, and clients living with a dual diagnosis (Seligman, L. & Reighenberg, L.W., 2010). Motivational interviewing can effectively be used with adolescents, couples, and individuals who are incarcerated (Seligman, L. & Reighenberg, L.W., 2010).

Motivational interviewing works best with individuals who are in the pre-contemplation or contemplation stage of change. These are clients who have not fully committed to behavioral change and still have reservations about making changes to their life. Because of this, MI may not be as effective for clients who are already committed to making changes in their lifestyles. Additionally, motivational interviewing may not be the best fit for clients who are struggling with trauma, post-traumatic stress disorder, depression, and other severe mental health concerns.

Motivational Interviewing Activities to do with Clients

Motivational interviewing exercises can be an effective tool for counselors who are working with ambivalent clients. We know that motivational interviewing skills can be used to help our clients make a shift in their thinking, which can help them move towards making behavioral changes. If you are interested in using motivational interviewing exercises with your clients, there are several options you can choose from.

Motivational interviewing activities that can be used during therapy sessions include:

1. When we are working with clients who have reservations or are unsure about making changes regarding a behavioral concern, a commonly used motivational interviewing exercise includes exploring the client’s core values. By exploring what is important to them, we can support our clients while they investigate the relationship between their values and their current behaviors. Thinking of important values in session can be challenging when put on the spot, so many clients may benefit from using a Core Values Worksheet, like the one available at TherapyByPro. Allow for time to process their experience after completing the worksheet, and explore any reflections they may have.
2. A simple MI exercise that we can do with our clients is to make a T chart that lists the pros and cons of making a change to their behavior. This list does not need to dive into the emotion behind the pros and cons but can focus on simply creating the list. Once we have a completed pro and con chart, we can then spend time exploring the two categories, and if seeing the pros and cons written out have any impact on the client’s motivation for change.
3. Another tool that counselors can use with clients who are unsure about making changes to their lifestyle or behaviors is a Readiness Ruler.  The key to this motivational activity is the discussion that explores questions such as why they rated the importance of changing the behavior, what would make their desire for change increase, and what they would be giving up if they were to make this change. This discussion can provide clients with an opportunity to explore their ambivalence. 
4. Counselors who are using motivational interviewing can use a variety of counseling skills including open-ended questions, making affirmations, using reflections, and summarizing. These skills can easily be remembered by using the acronym OARS. These skills help the client facilitate the session and have the clinician walk alongside the client as they progress through their counseling journey.
5. TherapyByPro offers a Change Plan Worksheet that can be used to explore questions such as what they are looking to change, why this change is important, obstacles that they may experience, and what skills they have that can support them while they make the change. Additionally, clients are asked to explore a challenge in the past that they were able to overcome and what helped them through that time. Using this worksheet to help guide a conversation would allow clients to talk about their concerns and hesitations without feeling judged or criticized.
6. Motivational interviewing includes focusing on the importance of change talk. In order to do this, we can provide psychoeducation about change talk and the benefits that it can have on our reservations about changing. Spend time talking about the difference between change talk and sustain talk. Time can be spent exploring their personal examples of sustained talk, and how they can be modified to fit into a change talk mindset.
7. To build on the importance of change talk, TherapyByPro offers worksheets that align with the motivational interviewing acronym DARN. DARN stands for desire, ability, reasons, and need for change, which are key components of change talk.  The Desire Questions Worksheet can help clients explore their own desire for change. This worksheet has three main questions, followed by a rating question that asks about the strength of their desire to change. Allow time to process this worksheet, and explore any shifts in their perspective that has occurred while completing this worksheet.
8. Following the worksheet discussed above, TherapyByPro offers worksheets to explore the other aspects of the DARN acronym. The Ability Worksheet explores what skills are needed to accomplish their goal, tasks they need to do to accomplish their goal, and ideas that they have about how they can accomplish their goal. Each of the questions is followed by a rating scale regarding their perceived ability to accomplish the listed task. Time can be spent exploring any shifts in your client’s perspective that have occurred since completing the worksheet.
9. The TherapyByPro Reasons Worksheet continues to explore the DARN acronym. This worksheet focuses on the reasons why they should work towards accomplishing their goal or making a behavioral change. This includes the downsides of staying as they currently are, the benefits of changing, and their motivation for wanting to change.  After each question, the client is asked to rate the strength of their response in compelling them to make a change. Allow for time to explore any shifts in their perspective that may have occurred in their thinking since completing the worksheet.
10. The Need Worksheet focuses on exploring the urgency in reaching their goal or making the identified behavior change. Questions included on this worksheet are what needs to change, why the change is important, and what they need to do. Time can be spent exploring if their need to change is compelling, and the importance of their to-dos. Allow for time to explore any shifts in their perspective that may have changed while completing this worksheet.  

Final Thoughts On Choosing Activities for Motivational Interviewing

The list of clients who can benefit from the use of motivational interviewing has grown significantly since it was developed in the ‘80s. The truth about our work is that we work with clients who are seeking help to please others. Whether this is a spouse, another family member, school, an employer, or a legal entity, external motivation can sometimes be more impactful than internal motivation.

Motivational interviewing can be used to help clients develop internal motivation as the explore the behavioral change or goal that brought them to you. Motivational interviewing can be used as a tool to help facilitate and promote a healthy therapeutic relationship when you begin meeting with new clients. Once your client has moved into the action phase of the stages of change, you can then begin using other therapeutic approaches.

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

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Resources:

Seligman, L. & Reichenberg, L.W. (2010). Theories of counseling and psychotherapy: Systems, strategies, and skills (3rd Edition, pp 159). Pearson Education, Inc.

Motivational Interviewing Therapy Exercises for Clients FAQs

Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.