Motivational Interviewing Basics for Case Managers

Motivational interviewing is a widely used counseling approach for helping people talk themselves into change, instead of being talked into it. For case managers, it is a practical alternative to persuading, warning, or lecturing.

The idea behind it

Most people facing a big change feel two ways about it. If a worker argues for change, the person naturally argues for staying the same. Motivational interviewing draws out the person's own reasons for change.

The four core skills

These are often remembered as OARS.

Open questions invite more than a yes or no. "What worries you about your drinking?" instead of "Do you want to stop drinking?"

Affirmations recognize strengths and effort. "You came in today even though this week was rough."

Reflections show you are listening and let the person hear their own thinking. "Part of you is tired of the shelter, and part of you is nervous about living alone."

Summaries pull the conversation together. "So far you've said you want your own place, and that staying sober feels like the hardest part."

Listen for change talk

Change talk is anything the person says in favor of change: a desire, a reason, a need, a step taken. When you hear it, reflect it and ask for more. "You said you want to see your daughter more. Tell me about that."

Common traps

• The fixing reflex. Jumping in with advice before the person has asked.
• Question after question. Aim for more reflections than questions.
• Arguing with resistance. Reflect it instead: "You're not ready to think about treatment right now."
• Rushing to a plan. Planning works once the person is ready.

Respect autonomy

The decision belongs to the client. Saying so out loud often lowers defensiveness: "It's your call. I'm here either way."

Getting better at it

Motivational interviewing takes practice and feedback. It pairs naturally with the verbal communication techniques taught in our Engagement Training.