10 MI Therapy Activities & Exercises to do with your Clients in Therapy

Embarking on the journey of change can be daunting and filled with uncertainty. It is natural for individuals to have reservations and concerns when contemplating making changes in their lives. These reservations often arise in the clients we work with. Therefore, understanding what facilitates the readiness for change becomes crucial.

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The readiness for change in individuals relies on three essential factors. Firstly, a genuine desire to make the change is crucial, often stemming from cultivating internal motivation. Secondly, acquiring the necessary skills to support the change plays a significant role. This may involve learning and practicing new skills that may be unfamiliar. Lastly, feeling supported by the people around us can profoundly influence our willingness to change behaviors or work towards our goals. Connection and a sense of safety fostered through supportive relationships are vital during times of risk-taking and change.

Motivational interviewing (MI) is a widely used therapeutic approach that integrates humanistic psychology values and person-centered counseling principles (Seligman, L. & Reighenberg, L.W., 2010). Developed by William Miller and Stephen Rollnick in the 1980s, motivational interviewing continues to benefit clients by facilitating behavioral change when they are ready (Seligman, L. & Reighenberg, L.W., 2010). Counselors and therapists can employ motivational interviewing techniques to support clients in their readiness for change.

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By incorporating motivational interviewing strategies and skills during sessions, we empower our clients to take control of their therapeutic journey. Recognizing their expertise in their own history and experiences, we position ourselves as allies who can assist them in achieving their goals. Motivational interviewing steers clear of focusing solely on mental health diagnoses and avoids persuasive tactics. Instead, it fosters a collaborative and non-judgmental environment where clients are supported in exploring their own motivations and finding their own solutions.

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

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. 

Why Motivational Interviewing?

Motivational Interviewing (MI) is a client-centered, evidence-based therapeutic approach that may be chosen for several compelling reasons:

  1. Collaborative and Empathetic: MI is rooted in collaboration and empathy. Therapists work alongside clients, fostering a non-judgmental and supportive atmosphere that respects the individual’s autonomy and choices.
  2. Behavior Change: MI is highly effective for addressing behaviors that individuals may be ambivalent about changing, such as addiction, substance abuse, unhealthy eating habits, or lifestyle choices.
  3. Effective for Ambivalence: MI is particularly well-suited for individuals who have mixed feelings or ambivalence about making changes in their lives. It helps them explore and resolve their ambivalence.
  4. Goal-Oriented: MI focuses on setting and achieving goals that align with the client’s values and preferences. It helps clients identify their own reasons for change.
  5. Evidence-Based: MI has a robust evidence base, demonstrating its effectiveness in various fields, including addiction treatment, mental health, healthcare, and more.
  6. Client-Centered: MI is inherently client-centered, respecting the individual’s unique experiences, values, and goals. It tailors therapy to the client’s specific needs and preferences.
  7. Enhanced Intrinsic Motivation: MI aims to enhance an individual’s intrinsic motivation for change, helping them find their own reasons and internal resources for making positive changes.
  8. Respectful and Non-Confrontational: MI avoids confrontation and resistance, instead using techniques that encourage clients to explore their own feelings and motivations in a safe and non-judgmental environment.
  9. Skill Building: MI equips clients with practical skills and strategies for decision-making and behavior change, fostering self-efficacy and empowerment.
  10. Transdiagnostic Application: While MI is commonly used for addiction and behavior change, it can be adapted for a wide range of issues, including mental health, diet and exercise, medication adherence, and more.
  11. Short-Term and Long-Term Benefits: MI can produce relatively rapid changes in behavior, and these changes often have long-lasting effects when clients are motivated to make and sustain changes.
  12. Positive Therapeutic Relationship: MI places a strong emphasis on the therapeutic relationship, fostering trust and rapport between the therapist and client.
  13. Cultural Sensitivity: MI can be applied with cultural sensitivity and adapted to respect diverse cultural perspectives and values.
  14. Enhanced Communication Skills: MI enhances an individual’s communication skills, including active listening and empathetic responding, which can improve relationships beyond the therapeutic context.

While MI is highly effective for certain issues, it is important to consider an individual’s specific needs and preferences when selecting a therapy approach. MI may be particularly well-suited for those who are ambivalent about making changes in their lives and seek a collaborative, client-centered, and supportive approach to address their concerns. Keep reading to learn Motivational Interviewing activities you can do with your clients.

Mental Health Concerns That Can Benefit from Motivational Interviewing Therapy

Initially developed by Miller and Rollnick, motivational interviewing was primarily used to assist individuals dealing with alcohol use and abuse (Seligman, L. & Reighenberg, L.W., 2010). A specific program called motivational enhancement therapy was established, involving four sessions over a 12-week period, to support those struggling with problematic drinking behaviors (Seligman, L. & Reighenberg, L.W., 2010).

Since its inception, motivational interviewing has expanded its application to various mental health concerns and behavioral issues. It has proven effective for individuals with eating disorders, as well as those with a dual diagnosis (Seligman, L. & Reighenberg, L.W., 2010). Motivational interviewing can also be beneficial for adolescents, couples, and individuals in correctional settings (Seligman, L. & Reighenberg, L.W., 2010).

It is important to note that motivational interviewing is most suitable for individuals in the pre-contemplation or contemplation stage of change. These clients are still uncertain about making behavioral changes and may have reservations. Consequently, MI may not be as effective for individuals who are already committed to making lifestyle changes. Furthermore, clients dealing with trauma, post-traumatic stress disorder, depression, and other severe mental health concerns may require alternative therapeutic approaches, as motivational interviewing may not be the most appropriate fit for their needs.

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. 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.
  2. The TherapyPatron.com 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.
  3. 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.
  4. Following the worksheet discussed above, TherapyPatron.com 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.
  5. 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 TherapyPatron.com. Allow for time to process their experience after completing the worksheet, and explore any reflections they may have.
  6. 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.
  7. 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.
  8. This discussion can provide clients with an opportunity to explore their ambivalence.
    To build on the importance of change talk, TherapyPatron.com 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.
  9. TherapyPatron.com 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.
  10. 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.

Final Thoughts On Choosing Activities for Motivational Interviewing

Thank you for reading this resource on 10 MI Therapy Activities and Exercises you can do with your clients in therapy sessions. 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.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

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View all of our Motivational Interviewing Therapy Worksheets

Resources:

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

Kayla VanGuilder, MA, LCMHC
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.

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