Instructor’s Manual for

MOTIVATIONAL
INTERVIEWING
from the series
BRIEF THERAPY FOR ADDICTIONS

with
WILLIAM R. MILLER, PHD
and hosts Jon Carlson, PsyD, EdD and Judy Lewis, PhD

by
Randall C. Wyatt, PhD
&
Erika L. Seid, MA
MOTIVATIONAL INTERVIEWING

The Instructor’s Manual accompanies the DVD Motivational

Interviewing (Institutional/Instructor’s Version). Video available at
www.psychotherapy.net.
Instructor’s Manual Copyright © 2008, Psychotherapy.net, LLC. All
rights reserved. DVD version of Motivational Interviewing released by
Psychotherapy.net, 2007; VHS version by Allyn and Bacon, 2000.
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Wyatt, Randall C., PhD & Seid, Erika L., MA

Instructor’s Manual for Motivational Interviewing
with William R. Miller, PhD

Cover design by Sabine Grand

Order Information and Continuing Education Credits:

For information on ordering and obtaining continuing education
credits for this and other psychotherapy training videos, please visit us
at www.psychotherapy.net or call 800-577-4762.
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 Psychotherapy.net

Instructor’s Manual for

MOTIVATIONAL
INTERVIEWING
with William R. Miller, PhD

Table of Contents
Tips for Making the Best Use of the DVD 4
Group Discussion Questions 8
Reaction Paper Guide for Classrooms and Training 11
Motivational Interviewing Skill Codes 12
Session Transcript with Commentary 14
Suggestions for Further Readings, Websites and Videos 59
Video Credits 62
Earn Continuing Education Credits for Watching Videos 63
About the Contributors 64
More Psychotherapy.net Videos 66

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MOTIVATIONAL INTERVIEWING

Tips for Making the Best Use of the DVD

1. USE THE TRANSCRIPTS, COMMENTARIES AND SKILL CODES
Transcripts: Make notes in the video Transcript for future reference;
the next time you show the video you will have them available.
Highlight or notate key moments in the video to better facilitate
discussion during the video and post-viewing.
Commentaries: Take a look at the dialogue commentaries Miller
inserted throughout the transcript and post-session comments. These
reflect his thoughts, feelings and ideas about the session at different
points along the way. Pass out a copy of the transcript to viewers so
they can benefit from Miller’s insights and observations.
Coding the Session: Miller has coded the session using the
Motivational Interviewing Skill Codes.

2. GROUP DISCUSSION QUESTIONS

Pause the video at different points to elicit viewers’ observations
and reactions to the concepts presented. The Discussion Questions
provide ideas about key points that can stimulate rich discussions and
learning

3. LET IT FLOW
Allow the session to play out some so viewers can appreciate the work
over time instead of stopping the video too often. It is best to watch
the video in its entirety since issues untouched in earlier parts often
play out later. Encourage viewers to voice their opinions; no therapy
is perfect! What do viewers think works and does not work in the
session? We learn as much from our mistakes as our successes and it is
crucial for students and therapists to develop the ability to effectively
critique this work as well as their own.

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4. SUGGEST READINGS TO ENRICH VIDEO MATERIAL

Assign readings from Suggestions for Further Readings and Websites
prior to viewing. You can also time the video to coincide with other
course or training materials on related topics.

5. ASSIGN A REACTION PAPER

See suggestions in Reaction Paper section.

6. ROLE-PLAY IDEAS
After watching the video, organize participants into pairs. Assign
each pair to role-play a therapy session with a client struggling with
addiction, with a focus on applying the principles of Motivational
Interviewing (see item seven, below). Each role-play shall consist
of one therapist and one client. You can have the pair switch roles
and play out another stage if time permits. Let each client develop
their own addiction and play it out or assign them different types
and levels of addictions. After the role-plays, have the pairs come
together to discuss their experiences. First ask the clients to share their
experiences. Then have the therapists talk about their experiences in
the session. Finally, open up a general discussion on what participants
learned about Motivational Interviewing.
An alternative is to do this role-play in front of the group with one
therapist and one client; the entire group can observe, acting as the
advising team to the therapist. Before the end of the session, have
the therapist take a break, get feedback from the observation team,
and bring it back into the session with the client. Other observers
might jump in if the therapist gets stuck. Follow up with a discussion
that explores what does and does not work in using Motivational
Interviewing with this population.

7. WATCH THE SERIES

This video is one in a series portraying effective approaches to therapy
for addictions. Each video in the series presents a master therapist
working with a real client, just as you see here. By showing several

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MOTIVATIONAL INTERVIEWING

of the videos in the series, you can expose viewers to a variety of

approaches, allowing them an opportunity to see what fits best for
their own style and beliefs.
Key Aspects of Motivational Interviewing: Motivational
Interviewing is a process that helps people resolve their ambivalence
and move toward healthy change. The therapist creates an atmosphere
that is conducive to change by following five general principles.
First, the therapist expresses empathy, demonstrating nonjudgmental
understanding of the client’s perspective. Second, the therapist works
to develop discrepancy by helping clients explore the gaps between
their current behavior and the lives they would like to lead. Once
this discrepancy is perceived, clients can begin to make the case for
change. The fact that it is the client—not the therapist—who presents
the reasons for change helps with the third principle: avoiding
argument. The therapist avoids falling into the trap of being the
one whose arguments for change awaken resistance in the client.
The fourth principle, rolling with resistance, involves accepting the
reality of ambivalence and inviting the client to enter into the process
of problem solving. Finally, the therapist supports self-efficacy,
encouraging the client’s sense of the possibility of change

Addiction Treatment Models: Other videos in the series use different

therapeutic models. We can reflect upon the differences among these
models by exploring the following questions:
• How does the model explain the addictive process?
• What assumptions does the model imply
about the process of change?
• How is theory translated into practice in real-life situations?
• What is the role of the therapist?
• What outcomes are associated with successful therapy?
• How does the therapist work with people who have
mental health problems along with addictions?
• What kinds of research support the approach?
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 Psychotherapy.net

8. PERSPECTIVE ON VIDEOS AND THE

PERSONALITY OF THE THERAPIST
Psychotherapy portrayed in videos is less off-the-cuff than therapy
in practice. Therapists or clients in videos may be nervous, putting
their best foot forward, or trying to show mistakes and how to deal
with them. Therapists may also move more quickly than is typical
in everyday practice to demonstrate a technique. The personal style
of a therapist is often as important as their techniques and theories.
Thus, while we can certainly pick up ideas from master therapists,
participants must make the best use of relevant theory, technique and
research that fits their own personal style and the needs of their clients.

*A NOTE ON CONFIDENTIALITY
Because this video contains an actual therapy session, please take
care to protect the privacy and confidentiality of the client who has
courageously shared his personal life with us.

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MOTIVATIONAL INTERVIEWING

Group Discussion Questions

Professors, training directors and facilitators may use a few or all of
these discussion questions keyed to certain elements of the video or
those issues most relevant to the growth, development and interests of
the viewers.

INTRODUCTION
1. Client Centered and Directive: What do you think about
Miller’s portrayal of the therapist’s role in Motivational
Interviewing as including following the client and having
a specific idea about where the therapist wants the client
to go? As a therapist, how would you work with the
dynamic tension between these two approaches?
2. Ambivalence: Miller states that people with addictions are
fundamentally ambivalent: doing something that is pleasurable, in
spite of adverse consequences, or continuing to engage in a behavior
that is both pleasurable and destructive. What do you think about
Miller’s assertion that therapists may inadvertently stimulate or
reinforce clients’ resistance to treatment by taking a position on the
side of change and stopping the addiction? How does that work?
3. Confrontation: In your thinking about working with addicts,
do you find yourself in the “confront denial” camp, or more
in Miller’s “role with resistance” camp? What appeals to
you about one or the other of these two orientations? What
about the other one doesn’t sit as well with you? Why?
4. Five Steps: Miller outlines five components of Motivational
Interviewing: 1) Empathy and reflective listening, 2) Develop
discrepancy, 3) Avoid argument, 4) Role with resistance,
5) Support self-efficacy. How do these five components fit
with the way you currently think about psychotherapy and
addiction treatment? Do they conflict or coincide with your
ideas? Does Miller’s description of this process call any of
your current assumptions into question? Which ones?

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PSYCHOTHERAPY SESSION
5. Ambivalence: How did Miller work with Mike around his
ambivalence? Was his approach effective? What reactions
do you have when you think about sitting with clients who
are ambivalent about their addiction? How much do you
feel pulled to advocate for the client to stop using?
6. Two Approaches in One: In what ways do you see Miller meeting
Mike where he’s at and following him? In what ways do you
see Miller being more directive and helping Mike move toward
change? Do you think Miller balanced the two approaches in a way
that was helpful to Mike? What would you have done differently?
7. Drawing Out: How do you see Miller drawing out Mike’s
motivation for change? Give examples. In working with a
client like Mike, what potential pitfalls would you see for
yourself in drawing out the client’s motivation for change?
8. The Client’s Perspective: What do you think may have been
difficult about this session for Mike? Which specific moments
or interactions in this session seemed particularly powerful or
growth enhancing for him? As you think about using Motivational
Interviewing with your own clients, how do you think it might feel
for them? How does that impact your thinking about the work?

DISCUSSION
9. The Therapeutic Relationship: How would you characterise
the therapeutic relationship in this video? Did Miller form
a good alliance with Mike? How significant do you think
the relationship was in this particular course of therapy?
10. Miller’s Style: What about Miller allowed Mike to feel comfortable
enough to engage in the therapy? How did he join with Mike?

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MOTIVATIONAL INTERVIEWING

11. The Model: What do you think about this model for working
with clients who are addicted to substances? Does it make sense
to you? Do you see yourself using it in your work with this
population? What would be most challenging for you about itl?
12. Personal Reaction: How would you feel about being
Miller’s client? Do you feel an alliance could be made?
Would Miller be effective with you or not? How so?

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ReactionPaperforClassroomsandTraining
• Assignment: Complete this reaction paper and
return it by the date noted by the facilitator.
• Suggestions for Viewers: Take notes on these questions
while viewing the video and complete the reaction paper
afterwards, or use the questions as a way to approach
the discussion. Respond to each question below.
• Length and Style: 2-4 pages double-spaced. Be brief and
concise. Do NOT provide a full synopsis of the video. This is
meant to be a brief reaction paper that you write soon after
watching the video—we want your ideas and reactions.
What to Write: Respond to the following questions in your
reaction paper:
1. Key points: What important points did you learn
about psychotherapy and Motivational Interviewing
with clients who are addicted to drugs and/or
alcohol? What stands out in how Miller works?
2. What I am resistant to: What issues/principles/strategies did
you find yourself having resistance to, or what approaches made
you feel uncomfortable? Did any techniques or interactions
push your buttons? What interventions would you be least
likely to apply in your work? Explore these questions.
3. What I found most helpful: What was most beneficial to you as a
therapist about the model presented? What tools or perspectives
did you find helpful and might you use in your own work?
4. How I would do it differently: What might you
have done differently than Miller did in the video?
Be specific in what different approaches, strategies
and techniques you might have applied.
5. Other Questions/Reactions: What questions or
reactions did you have as you viewed the therapy in the
video? Other comments, thoughts or feelings?

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MOTIVATIONAL INTERVIEWING

Motivational Interviewing Skill Codes

The following code key is adapted from the Manual for the
Motivational Interviewing Skill Codes, Version 2.0, pp. 14-15 and
49. Use it to understand the codes Miller has inserted throughout
the session transcript below. Viewers interested in honing their
Motivational Interviewing skills can download the complete manual
at http://casaa.unm.edu/download/misc.pdf.

COUNSELOR BEHAVIOR CATEGORIES

AD Advise Subcategories: with (ADP) or without
permission (ADW)
AF Affirm
CO Confront
DI Direct
EC Emphasize Control
FA Facilitate
FI Filler
GI Giving Information
QU Question Subcategories: Closed (QUC) or Open
Question (QUO)
RC Raise Concern Subcategories: with (RCP) or without
permission (RCW)
RE Reflect Subcategories: Simple (RES) or Complex (REC)
RF Reframe
SU Support
ST Structure
WA Warn

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 Psychotherapy.net

SIX KINDS OF CHANGE TALK

Every time an example of one of these occurs in client speech, it is
recorded with a positive (+) or negative (-) valence, depending on
whether it reflects inclination toward (+) or away from (-) the Target
Change Behavior (TBC)
A Ability (A+) or inability to change (A-)
C Commitment to change (C+) or not to change (C-)
D Desire to change (D+) or not to change (D-)
FN Follow/Neutral
N Need to change (N+) versus lack of need for change, or a need
not to change (N-)
O Other
R Reasons to change (R+) or reasons not to change (R-),
(subcodes: d: Desire, a: Ability, n: Need)
T or TS Taking steps toward (T+) or away from change (T-)

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MOTIVATIONAL INTERVIEWING

Complete Transcript
of a Demonstration of
Motivational Interviewing
with William R. Miller, PhD
SESSION INTRODUCTION BY DR. MILLER

This session was recorded in the year 2000 in Chicago, Illinois. The
client was referred to discuss alcohol problems and knew that the
purpose of this videotaped interview was to demonstrate a specific
method in addiction counseling. I chose to be told nothing at all about
him ahead of time, so that the interview would closely parallel a first
clinical session. We met, sat down, and without further preparation
the filming began.

Motivational Interviewing Skill Codes: The left-hand boxes below

contain transcription of the 229 exchanges that constituted this
41-minute session. For those interested in psychotherapy process
research, these boxes also show expert codes for interviewer and client
responses, based on the Motivational Interviewing Skill Code, Version
2.0 (http://casaa.unm.edu/download/misc.pdf).

Session Commentaries: In the right-hand boxes I offer comments

on what was happening from my perspective during the session,
particularly my own thoughts and feelings as the session progressed,
and Motivational Interviewing (MI) strategies behind some of my
responses.
Before reading the transcript and my comments below, I suggest
that you just watch the whole interview once and form your own
impressions of what is happening along the way. Then go back if you
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 Psychotherapy.net

wish and take a more micro-level look at the conversation, and what
was going on in my head as we talked

Note to facilitators: We have marked indicators at five-minute

intervals throughout the transcript, which coordinate with chapter
markers on the DVD, so that you may easily skip to desired points
within the session.

TRANSCRIPT COMMENTS
Miller - 1: So, fill me in a little bit. What Knowing nothing about his situation, I
is it that brings you here today? (QUO) begin with an open question.
Mike - 1: Well, actually I’m doing a His first response bespeaks low
favor for a friend of mine. personal investment in being here.
He is doing a favor for a “friend” who
referred him.
Miller - 2: Uh huh.
Mike - 2: And he told me about a study He’s not too sure what to expect, but he
you guys were doing, and so I figured has an idea. I don’t know yet just what
I’d participate in it, and they told “addiction counselor” means to him,
me you were basically an addiction but it turns out to be a loaded term, as
counselor, and he thought I might be an we soon discover.
interesting subject. (FN)
Miller - 3: Uh huh.
Mike - 3: Okay?
Miller - 4: Okay. Well, tell me about I knew only that he was referred to
where you are now with the addictions discuss some form of addiction.
that you’ve been… (QUO)
Mike - 4: Well, what do you want to He seems to expect specific, closed
know in particular? (FN) questions.
Miller - 5: Well, are you in recovery
now, or... (GI)
Mike - 5: No, I’m not. (FN)
Miller - 6: Okay. Alright. So what are
the drugs or what it is you struggle
with? (QUC)

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MOTIVATIONAL INTERVIEWING

Mike - 6: Well, honestly cigarettes.

Miller - 7: Okay.
Mike - 7: That’s the biggest.
Miller - 8: Okay. (O +)
Mike - 8: Alcohol to a degree, (O +) but He minimizes problems with alcohol. I
I think I’ve had more of a problem with notice his understatement.
that two or three years ago, you know,
it seems to have gone down to a degree
(O +) and probably simply because of
the environment. (R+)
Miller - 9: So that’s kind of settled I simply reflect it instead of challenging
down. (RES) it. In MI one does not push back against
resistance or defensiveness.
Mike - 9: Well, not all that much. To my reflection of his minimizing, he
(O +) Okay, but enough, it’s gone down immediately responds with the other
simply because I’m getting too old to side of his ambivalence about alcohol.
do this stuff anymore if that make any In MI this is noted as “change talk.”
sense to you. (R+)
Miller - 10: It does. You can’t keep up A complex reflection, making a guess
with it anymore. (REC) about what he means.
Mike - 9: I don’t think I can. I really More change talk
don’t think I can. (R+)
Miller - 11: And then the cigarettes are I reflect his original statement.
still a real addiction for you? (RES)
Mike - 11: Yeah, I really do. I think they He reveals a little more, but in an
are worse. (O +) In the past I’ve done interesting way. His statement
cocaine. I’ve even done crack cocaine. that cocaine is not addictive at all
I’ve heard that’s one of the most seems provocative for an “addiction
addictive drugs around. Quite frankly, counselor.” He seems to be trying to
from my own personal experience, I pick a fight. I already like this guy, and
don’t find it addictive at all. (FN) enjoy talking with him.
Miller - 12: Yeah, it’s interesting how it I don’t push back, but just comment
is different for different people. (GI) that people have different experiences.
Mike - 12: Yeah.
Miller - 13: Yeah, but for you it’s Returning to what he has said is
tobacco and alcohol. (RES) problematic for him.
Mike - 13: Yeah. Yeah, and coffee.

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 Psychotherapy.net

Miller - 14: Yeah.

Mike - 14: I mean if we want to get that
specific. (FN)
Miller - 15: How far do you want to go
there? (RES)
Mike - 15: How do you want to go? I He belittles the concept of addiction.
got a lady that’s supposedly addicted to He seems to be looking for an argument
Chapstick. (FN) around some classic themes of
“addiction counseling.”
Miller - 16: It gets used for almost Instead of arguing, I reflect his
anything these days. (REC) dismissal of the term.
Mike - 16: Right. (FN)
Miller - 17: Yeah. Well, how might you I focus back on where he perceives a
like things to be different? I guess that’s need for change. It would have been
a good place to start. (QUO) very easy here to be caught up in
defending concepts. I sense he expects
me to do that.
Mike - 17: Well, basically, you know, He states that he is not committed to
I don’t, see that’s my problem. I don’t change. In MI, this is an example of
think I’m really all that committed “sustain talk,” an argument against
to making things all that different change. It is simply stating the other
(C -) because I’m not seeing that much side of his ambivalence.
harmful benefit (R-). I was told that
He explains a little more about
you are not able to slow down. It’s
what bothers him about the concept
progressive. You get worse and worse
of “addiction,” and is specifically
and worse and worse, and that just
questioning the idea of a progressive
doesn’t seem to be the case with me.
disease as has commonly been taught
Okay? I think that there are certain
in U.S. addiction treatment programs.
things in my lifestyle that just preclude
What treatment experiences has he
me not using, okay? (R-)
had?
He argues that he can’t abstain because
of his lifestyle – more sustain talk.
Miller - 18: Right. (FN)
Mike - 18: And that, and smoking has This is change talk with regard to
become a problem because I’m starting smoking, but not alcohol.
to play soccer, okay? (R+)
Miller - 19: So you can’t breathe. (RES)

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MOTIVATIONAL INTERVIEWING

Mike - 19: So I can’t breathe (R+). The

kinds are younger and younger. They
are half my age, twice my size. I’m
having a problem with it. (R+)
Miller - 20: You are noticing it. (RES)
Mike - 20: Okay. Yeah. (R+)
Miller - 21: So, I mean the message that I try to reflect his rejection of what
you shouldn’t use at all is like somebody others have told him.
out there telling you that, but that
doesn’t fit your experience. (REC)
Mike - 21: I don’t know. Use at all. He responds abruptly, sounding
What does that mean? What do you annoyed or defensive, signaling
mean by that? (FN) some dissonance in the counseling
relationship.
Miller - 22: Well, I guess maybe I I respond by taking responsibility for a
misunderstood you. I thought you were possible misunderstanding, and restate
saying people tell you that you can’t use the reflection.
or shouldn’t use or whatever. (GI)
Mike - 22: Oh yeah. Yeah, they’ve He realizes that I don’t know anything
told me that before, you know. I’ve about him. Did he think that I had a lot
been through (FN), I guess you know of background on him and was lying in
nothing about me do you? (FN) wait to trap him?
Miller - 23: Nothing at all. (GI)
Mike - 23: Okay, I’m sorry about that
(FN). I though at least they filled you in
on some... (FN)
Miller - 24: No, I asked not to be. (GI)
Mike - 24: Okay. Well, no. Alright, Here is an interesting moment in this
here’s what happened. I got a DUI a session. He leans forward, relaxes,
while back. I think it was back in ‘93, and basically says, “Well OK then,
and I had one prior to that in ‘85 and let me tell you my story.” There is a
went though some counseling. It was qualitative shift right here. Often in a
mandatory, state-driven. Basically you first MI session I perceive a moment of
go through the counseling, and after “join-up,” to borrow a concept from
you successfully complete it, you are the original horse whisperer, Monty
rehabbed. Actually rehabbed. Roberts, in which the client relaxes a bit
on fight/flight, and joins in more of a
conversation with the interviewer.

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 Psychotherapy.net

Miller - 25: Right.

Mike - 25: Then you get your driving Remember that a few minutes ago I
privileges back. And I guess what I’m was an “addiction counselor.” Now his
trying to say is that I’ve had some bad language changes and he talks about
experiences. Not bad experiences with addiction counselors in third-person as
the counselors, but I found them to be “them.” He distances me from his prior
not less than professional but just very experiences.
rigid in their approach. (FN)
Miller - 26: Okay. And that didn’t work
for you, that didn’t fit. (REC)
Mike - 26: It didn’t fit at the time, and Now he talks about a time in the past
at the time I don’t think I was really all when he was committed to changing his
that committed to quitting, and then I drinking. This is not coded as change
was, but at another time, but the other talk because it is stated in past tense,
time was because I was earning $40 but it does say that there are conditions
an hour, and I was working ten hours under which he could be motivated
a day five days a week, so guess what? to change. I wonder what they are. He
You’re not supposed to be able to quit, gives a clue: it’s when he has something
you see? That’s what those counselors that is too good to lose. Now a question
told me. That was strange that I was, that I have in mind is, “What would be
wasn’t it? So I mean, I guess what I’m good enough for him to want to make a
saying is that I do probably have a change in his drinking?”
rather negative attitude about some of
the things I’ve been through as far as
the state program is concerned. I don’t
know how I could explain that more, or
if you have any… (FN)
2-5
Miller - 27: Well, I think I’ve got it. It
sounds like your experience doesn’t
match what you were being told. (REC)
Mike - 27: No. (FN)
Miller - 28: They are telling you this is I join with his use of third-person
how you are, and you look at yourself language.
and say, no. (RES)

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MOTIVATIONAL INTERVIEWING

Mike - 28: Yeah, that’s not necessarily

true. And then there too you are
supposed to say well I’m an alcoholic
and I’ve always had problems and I
have to quit and I can never drink again
and this, that, and everything else.
And you had to really say that, see. Or
else you weren’t fitting in the role they
wanted you to play. Without fitting in
the role they wanted you to play you With cynical wit, he tests another spot
could not get your license back. So, you where he might arouse an argument
know, I played the game basically, and from me.
I went to AA, and I also found that just
to be a little bit on the, you know, it
didn’t work for me. It’s bumper sticker
therapy. Fake it till you make it. Wow,
how profound. Man, you guys are deep,
you know. (FN)
Miller - 29; Alright.
Mike - 29: And you know, yes seriously,
I’ve been there and these guys didn’t do
anything all day, but they didn’t drink
that day. You know, I would rather, let’s He begins to tell me things that he
say, lift weights, maybe build a patio, enjoys. He tests again whether I’ll argue
maybe program R base, and then drink with him.
instead of just not drink and do nothing
else. I just, I found that you know,
certain aspects of it I like, but I think
you have to have a deep seated religious
belief for it to work for you. (FN)
Miller - 30: Well, and it sounds like I could have asked what it was that he
you want to have an active life. Not liked about AA. Instead I pick up on the
drinking is not doing something, it’s theme of activity that competes with
doing nothing. (REC) drinking, offering a complex reflection
that prepares the way to explore what
might displace drinking.
Mike - 30; Yeah, it’s doing nothing.
(FN)

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Miller - 31: So, for you the question is I ask an open question in the form of a
what am I going to be doing? How do I reflection. I notice that I shifted here to
spend my time? Playing soccer, and... first person “I” in my reflection. This
(REC) more directly gives voice to what he
may be experiencing. It can be a little
risky to do this, to be the “I” voice for a
client. I was feeling fairly confident that
I understood him accurately.
Mike - 31: Yeah, that’s good. (FN) “That’s good.” It should be, because it’s
Actually I was thinking myself the way I his own material. He affirms that my
can best quit smoking is not by quitting reflection is on the mark, and also shifts
smoking but playing soccer three times the focus back to smoking.
a week. Okay? Now, I’m going for
something, okay? (C +)
Miller - 32: That’s right. (RES)
Mike - 32: And then all of a sudden
I’m having a problem breathing, okay?
(R+) So guess what? You’re gonna quit
smoking (O +). You’re not going to say
I gotta quit smoking, you know. But to
me that doesn’t work for me. (FN)
Miller - 33: It might even less than I reflect that he reacts negatively to
not work. It might make it less likely. coercive messages, even if they are his
(REC) own.
Mike - 33: I think it’s less likely (FN). Where is this going? Why is he telling
I quit smoking before for about four me about a return to smoking?
months (C +). Then I blew out my knee,
and you know, I went down to see my
brother, and boom (FN), right back He comes back around to drinking on
to it (C +). And you know, it’s the same his own.
thing with drinking. I think I was
actually more, how shall I say, I seem
to have more of a craving when I was
going through counseling.
Miller - 34: Right?
Mike - 34: Then when I wasn’t, okay? He echoes his backlash reaction to
So, it’s like okay, reverse effect. Guys being told what to do.
you really helped me a lot, you know.
(FN)

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MOTIVATIONAL INTERVIEWING

Miller - 35: Well, I wonder if it isn’t

being told you can’t or like being in
prison in a way. (REC)
Mike - 35: Yeah, it could be just He takes partial responsibility for
immaturity on my part. You know, if reacting negatively in the past to well-
you tell me I can’t do something, I’m intentioned advice. It seems to signal a
going to do something. willingness to negotiate.
Miller – 36: Right.
Mike - 36: You know, maybe what they
should say is you better drink every day
goddammit. I want you to drink a fifth
before noontime. Then maybe I’d say
“Screw you guys,” you know. I don’t
know. Maybe there is something about
my personality that is like that. So, you
know, what shall I say? One size doesn’t
fit all. (FN)
Miller – 37: Yeah, exactly. (RES)
Mike - 37; One size doesn’t fit all. (FN)
Miller - 38: And for you what matters I bring the focus back to what he
is having something that you are going does want in life. If we were working
toward, not something you run away together longer than this one session,
from. (REC) I might do more to explore with him
what he wants and values in life.
Mike - 38: Right, right. (FN)
Miller - 39: And one of those things is
soccer. (REC)
Mike - 39: Yeah. (R+)
Miller - 40: What else? (QUO) An open “what else” question to invite
what he values.
Mike - 40: Well, tennis (R+). How ‘bout Wow! Suddenly he is arguing for
backpacking (R+). You know, how ‘bout sobriety.
just waking up clear-headed. (R+)
Miller - 41: Yes, that’s right. (RES)
Mike - 41: I mean, don’t you think He continues to persuade me.
that’s kind of...
Miller - 42: That’s great. (RES)

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 Psychotherapy.net

Mike - 42: ...pleasurable, sometimes,

you know? (R+)
Miller - 43: So just getting up in the
morning and being able to think
clearly. (RES)
Mike - 43: Yeah but I’m telling you one And now, as usually happens with
thing right now. You know, sometimes someone who is ambivalent about
I won’t drink four, five, six days. If I change, he comes back to express his
smoke two packs of cigarettes, I wake doubts. “It’s not really alcohol that is
up with a hangover. I thought it was the the problem, but smoking.” In classic
booze, but it isn’t. (R+) American addiction counseling
this could be seen as “denial,” but
it is a perfectly natural expression
of ambivalence. He thinks that his
drinking is problematic, and also
at the same time he thinks that it is
not really a problem. If I take up the
“good” side of the argument here (or
anywhere) that his drinking really is a
problem, I can expect to elicit more of
the counterargument, which is precisely
what I do not want to do in MI.
Miller - 44: Even without the booze.
(RES)
Mike - 44: Oh, yeah. It’s carbon I certainly hear the smoker’s wheeze in
monoxide, man. You got no oxygen in his voice as he laughs.
your system. (FN) So. I guess that’s my
real problem right now is the cigarettes.
(O +)
Miller - 45: Uh huh.
Mike - 45: So.
Miller - 46: It sounds like you are Instead I offer a complex reflection of
not that worried about alcohol really. his sustain talk.
(REC)
Mike - 46: No, it’s bad (O +), but it’s not He acknowledges that “it’s bad,” then
as bad (O +). takes it back a bit. Ambivalence.
Miller - 47: Not causing you problems... I again reflect the sustain, status-quo
(REC) side of his ambivalence.

23
MOTIVATIONAL INTERVIEWING

Mike - 47: Well, it is. It will cause He responds with change talk.
anyone problems (R+).
Miller - 28: Hm, how so? (QUO) Asking for elaboration.
Mike - 48: Have a six-pack of beer, wake And there follows a string of change
up, try to program a computer. (R+) talk.
Miller - 49: Okay.
Mike - 49: And so, have a six-pack of
beer, wake up, find out how alert you
are for the first two hours of the day.
(R+)
Miller - 50: Right.
Mike - 50: It’s going to cause anyone
problems. (FN) You know, have a six-
pack, have a twelve-pack, try to play
soccer the next day. (R+)
Miller - 51: Right.
Mike - 51: Okay. It’s...
Miller - 52: It’s amount and the after-
effects of that. (REC)
2-10
Mike - 52: Right. Right. And I think I don’t have to give him a lecture about
my tolerance is up so high that it takes the risks of tolerance to alcohol. He
me too much to get the same buzz, already knows.
(R+) and unfortunately, the recovery,
it’s getting to the point where it is just
not worth it. (R+) If I could get like a
12-pack high on three beers, then I only
have three ounces I’ve got to process. If
it’s taking me 12 to get the same which
I got three on, now I got 12 to process
you see. (FN)
Miller - 53: Yep. (RES)

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 Psychotherapy.net

Mike - 53: So we are at a balance point A nice personal expression of his

where we are getting diminishing ambivalence, indicating that he is at
returns on ever expanding, how shall I a kind of tipping point. He certainly
say, quantities. (R+) didn’t seem to be at this point ten
minutes ago. This conversation is a
good example of how motivation for
change emerges in an interpersonal
context.
Miller - 54: Like the slot machine
doesn’t pay off so much anymore.
(REC)
Mike - 54: Well, you know, it’s Now he is making the kind of argument
addictions, so you’re stupid, so you keep that “addiction counselors” made
on playing it, you know. (O +) before.
Miller - 55; It is amazing. How long you
keep going. (REC)
Mike - 55: Yeah. (O +)
Miller - 56: But you’re, with alcohol, I reflect his statement of being at a
you are kind of hitting a point where tipping point in the motivational
this isn’t worth it anymore. (RES) balance.
Mike - 56: Yeah, yeah. (R+) But it is not He affirms that the motivation that
because anybody is telling me from the matters is his own, again rejecting
outside, because I’m being forced to external persuasion. He is persuading
do that. (FN) It’s just because I gotta himself, and the stream of change talk
wake up in the morning, and I know continues.
how I feel. Period, Okay? (R+) And I
think what has happened is before I
used to drink all the time, and I was
always drinking. And then I stopped
and found out how good I felt, okay?
Now I have a compare and contrast
whereas before I never had a compare
and contrast. (R+)
Miller – 57: Now you know. (RES)

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MOTIVATIONAL INTERVIEWING

Mike - 57: Now you know. Now you

know, hey wait, wasn’t it a lot better
when I was clear headed then when I
was, so, (R+) and to me then it does
become a problem because now at least
you have something you can you know,
you can relate to. You can say this is
how I am without it. This is how I am
with it. This is my performance without
it. This is my performance with it, you
know. (R+)
Miller - 58: It’s only when it’s a problem
for you, really, that it matters. (REC)
Mike - 58: Right. (FN)
Miller - 59: If somebody else is telling
you... (REC)
Mike - 59: Yeah, it doesn’t work. (FN)
Miller - 60: Or worse. More likely you
back away from it. (REC)
Mike - 60: Well, then why is the
approach the opposite? That’s what I,
I don’t mean to be belligerent toward
addiction counseling, but I can’t help
but be. Why, sometimes I wonder if
these people didn’t do more bad than
good... (FN)
Miller - 61: It doesn’t make any sense to
me. It’s human nature to push against
something when they push against you.
(GI)

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Mike - 61: Well, I always heard in AA

too, is the dumbest things I ever heard.
Some of the comments I heard that
were just god awful stupid. And these
people were just complete idiots. We
alcoholics don’t like to be told what to
do. I’m thinking wait. We alcoholics.
What are you some special breed of
people? No one likes to be told what to
do. You know what, I really got tired
of that kind of… The kind of like we’re
special because we have this disease or
Trying to persuade him to accept a label
come feel sorry for us because we have
like “alcoholic” would be a losing cause.
a disease. And quite frankly, the more
I read about alcoholism, no one knows
what the hell it is. So I’m not going to
But he does recognize dependence.
say I am cause until there is a definitive
area that we can agree on, you know, I
could say alcohol dependent. Now that
makes sense. It’s a bit more clinical...
(FN)
Miller - 62: That you can understand.
(RES)
Mike - 62: Yeah, that’s understandable,
but that’s one of the things I didn’t
like about AA is they wore it like a
badge. It’s nothing to be proud of, but
it’s nothing to be ashamed of. But you
certainly don’t do some reverse pride on
it, and you know, we’re special because
we’re this. We’re different. I didn’t see
any difference between those people
and normal people. (FN)
Miller - 63: It seems to work for some
people, but that’s not going to help you.
(REC)

27
MOTIVATIONAL INTERVIEWING

Mike - 63: Well, who do you think it

works for? Apparently highly religious
people who believe in higher powers
and miracles and some deity is going Sarcasm.
to come down and save them anytime
they have problems. I’m not that type of
person. (FN)
Miller - 64: That’s not you. And for Emphasizing his own intrinsic reasons
you it has to be some reason that you for change
see that persuades you, okay, it’s time.
(RES)
Mike - 64: Yeah, a little bit. (FN)
Miller - 65: A little bit. (RES) I wasn’t sure what “a little bit” meant,
and rather than asking, I simply
reflected it.
Mike - 65: A little bit more realistic,
okay. No nonsense, no bumper sticker
stuff. (FN)
Miller - 66: And not being able to
breathe on the soccer field is no
nonsense. (REC)
Mike - 66: I think that’s kind of, I don’t
know if you can get too much more
guttural than that you know, and so
that’s where it is. (FN)
Miller - 67: So, it’s having something Coming back to the theme of what
to pursue, having something to live for displaces drinking for him.
really. (REC)

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 Psychotherapy.net

Mike - 67: Yeah, yeah. That’s it in a He refers to William Glasser’s book,

nutshell. I’ve read a couple of books, which makes exactly this point, that
and the one thing I really enjoyed was addiction is displaced when we find
the book Positive Addiction. You know, something better.
having been a runner before, being
cross-country, I can see exactly how
that worked. Basically, this guy was
saying what had happened is he was
under the suspicions that a lot of people
running were actually, had drinking He comes back to smoking but begins
problem and ran themselves out of to tie it to drinking.
those. Now I think that is actually true
because after I run, I have about this
much desire to drink, and I have about
that much desire to smoke. (FN)
Miller - 68: Yeah. (RES)
Mike - 68: You got endomorphins, you
feel good, you are alert. (FN)
Miller - 69: Yep, yep. (RES)
Mike - 69: Why would you want to
pollute yourself, you know? (R+)
Miller - 70: Makes sense to me. (SU)
Mike - 70: So, that’s my deal on that. Not committed? This surprises me.
My read on who I am. (FN) But am I What does he mean?
committed? (C -) No. Total abstinence?
No. Not at all. (C -)
Miller - 71: Oh, to total abstinence.
Okay. Because I am hearing a lot of
commitment in what you are saying,
that it’s worth it to me to, in order to
be able to breathe on the soccer field...
(REC)
2-15
Mike - 71: Right. (C +)
Miller - 72: ...to do something about I am suppressing my “righting reflex”
cigarettes. (RES) here to say, “But what about drinking?”
Mike - 72: Yeah. (C -)

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MOTIVATIONAL INTERVIEWING

Miller - 73: To quit smoking even.

(REC)
Mike - 73: Yeah. (C +)
Miller - 74: So there I was hearing some
commitment. (REC)
Mike - 74: Yeah, I think there is. You see He comes back around to drinking on
when I quit smoking, I quit drinking, his own.
too, you know. (O +)
Miller - 75: Is that right? (QUC)
Mike - 75: Well, you have to. Well, I He is persuading me, making the
mean at least I have to. (C +) argument for change.
Miller - 76: Uh huh.
Mike - 76: Cause I can’t like drink. If I A minute ago he was not committed to
drink I’ll have a cigarette. (C +) abstinence. Now he says “I can’t drink.”
This is his strongest statement thus far
about drinking.
Miller - 77: Okay, they are that tied
together. (REC)
Mike - 77: Yeah. (FN)
Miller - 78: You do them together so
many...
Mike - 79: Well you...
Miller - 80: tens of thousands of times.
(REC)
Mike - 80: Yeah. Well, even coffee. You
know coffee, cigarette, just association.
Yeah, I think like when you drink, you
lose your judgment and your willpower He adds another down side of drinking.
just goes down. I don’t know if you call
it willpower. I think its just judgment.
(O +)
Miller - 81: Whatever it is. (RES)
Mike - 81: You are going, “Oh a
cigarette sure would taste good now.”
Oh, yeah, okay. (O +)

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Miller - 82: That happens with cocaine I wanted him to know that I had not
too. I mean people, drinking is the most missed his earlier statement about using
common reason why people go back to cocaine.
using cocaine when they really wanted
to stay away from it. (GI)
Mike - 82: Oh, really? (FN)
Miller - 83: Yeah. So that’s exactly what
you are talking about. (GI)
Mike - 83: There is such an association
between the two? (FN)
Miller - 84: Well, whatever it is. Or it
just kind of dulls down your judgment.
Mike - 84: Yeah.
Miller - 85: Enough that you say, “Oh
that would feel nice.” (RES)
Mike - 85: Should I ask if you drink? This is always an interesting question.
(FN) Sometimes, particularly with teens, I
tell them I will answer the question, but
want to know first what it will mean to
them if I say yes, and what it will mean
if I say no. Either way the client may
use it to disqualify me. I’m not really
concerned about that here.
Miller - 85: I do. Yes, I do. (GI)
Mike - 86: Well, you know how the He seems to use my answer to enhance
judgment goes. And let’s face it, it my credibility.
goes. It goes on everyone, you know.
They always say oh we alcoholics are
different. No, no, no, no. You feed
someone six beers and their judgment is
going to go down. (FN)
Miller - 87: It’s going to have that effect.
(RES)
Mike - 87: It’s a physiological reaction
to a toxic drug. You know, let’s face it.
(FN)
Miller - 88: Yep. (RES)

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MOTIVATIONAL INTERVIEWING

Mike - 88: So, it is. (FN)

Miller - 89: So, you really would be
talking about stopping cigarettes and
alcohol then. (REC)
Mike - 89: Well, yeah. (C +)
Miller - 90: In order to breathe. (R+)
Mike - 90: But I don’t want to think Huh? What’s this?
about it.
Miller - 91: Oh.
Mike - 91: I don’t want to think about Aha – he differentiates thinking about
that. (FN) doing something from actually doing it.
Miller - 92: Meaning you just want
to do it and not think about it, or you
don’t want to get serious? (QUC)
Mike - 92: Well, I would rather do it
and not think about it. (O +)
Miller - 93: Yep. Not much point in
thinking about it. (RES)
Mike - 93: Well, I mean, is there? (FN)
Miller - 94: No, no. (SU)
Mike - 94: Do I think about working Again his wit comes through.
out every day? Do I think about
brushing my teeth? If I did I wouldn’t
want to brush my teeth. I gotta brush
my teeth tomorrow. That’s going to be
pretty bad, you know that. I gotta brush
my teeth. You know what I’m saying?
(FN)
Miller - 95: I do. (RES)

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Mike - 95: I think that’s what happens

when people do that, and I see more
procrastination because it is worse to
think about having to go to the gym
and work out. My god it’s going to hurt
and oh I’m going to do those curls and
my biceps are going to kill me and then
I have to wake up and brush my teeth. How much better than if I had told
I think that when you think about stuff him, “Just do it!”
like that, I think it actually is more
counterproductive than just saying, oh
screw it. Just do it. (FN)
Miller - 96: Thinking about going to
sleep. (RES)
Mike - 96: Yeah. (FN)
Miller - 97: As long as you are doing
that you are not going to be going to
sleep. (RES)
Mike - 97: You’re not going to sleep, no.
I hope that makes sense to you. (FN)
Miller - 98: Oh, it does. No, it wasn’t
what I had meant by think about it, but
I see exactly what you mean, that if you
are thinking about something or like
trying. In other words if you are trying
to do it, you are not doing it. You either
do it or you don’t do it. But you don’t
try to do it. You don’t try to go to sleep.
You just go to sleep. (RES)
Mike - 98: You just go to sleep. (FN)
Miller - 99: So what would be great Instead of telling him how he can
is if that was just natural. You’re not change, I invite him, in a complex
thinking about it. It’s just natural to do reflection, to consider it himself.
it. (REC)

33
MOTIVATIONAL INTERVIEWING

Mike - 99: I mean, what do you think? And he does.

I’m thinking basically the thing I
could best do it just start running
again and just start really substituting
habits. (C +) I don’t think, I think
substitution of habit and making habits
so counterproductive or contradictory
I should say maybe which you just
replace one habit with another habit
rather than just try to get rid of one
habit. I think it kind of comes up to a
vacuum state. Now what do I do? I got
rid of this habit. Now what do I replace
it with? You know, so... (FN)
Miller - 100: Well, you are clearly
telling me that’s what works for you.
That’s what is going to do it. (REC)
Mike - 100: Well, that’s what has done He ties this back to the prior time when
it in the past. (R+a) That’s what’s done he “was committed” by having a life too
it in the past. Actually I got to join good to lose.
another soccer team. I can play with
even better people and that way I will
really get pissed off at myself, you know.
So. (C +)
Miller - 101: And that’s what worked for
you before? (QUC)
Mike - 101: Mm hm. (FN)
Miller - 102: Good indication. (EC)
Mike - 102: Yeah. Well, what hasn’t
worked for me is drug addiction
counselors, sorry to say. (FN)
Miller - 103: Yeah, yeah. No your
reaction to that was... (RES)

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 Psychotherapy.net

Mike - 103: Well, you have to realize He takes another shot at addiction
first off, most of the people there, and counselors, venting his reactive anger
I’m not trying to be apologist for them, that had him stuck.
but in a way I am. They were good
people. Most of the people there were
forced to be there. They weren’t there
on their own free will. So, of course,
they are going to be resistant. And most
of the people there, I mean you are
basically, you have to talk a certain way,
behave a certain way, do certain things
so they think you are, quote, whatever,
rehabbed. So you learn real quickly
how to play the game. What are you
looking for? Okay, what’s this counselor
looking for, or what’s this person want
me to say? Okay. I’m supposed to feel
this way about something because that’s
the way she’s been told that we define
this addiction. So what I’ll do is I’ll
just play in her bullshit even though it
isn’t true, and as long as I can do it in
a convincing way and fool her, boom,
whappo, I got it, and I got my license
back. And you know that’s a game
that I was playing the whole time, and
actually, I kind of lost respect for people
because they were so easy to fool. All I
did was I read the addiction counseling
books. I found out what they are
looking for, what the traits were... (FN)
2-20
Miller - 104: Played the game. (RES)
Mike - 104: Played the game. Found
out, you know, what they wanted
to hear. And to me that’s really
counterproductive. It, if anything, it’s
a waste of time, and it might even be
more harmful than it is helpful. (FN)
Miller - 106: It sounds like it was for
you. (REC)

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MOTIVATIONAL INTERVIEWING

Mike - 106: Yeah. Does anyone quit He reemphasizes the importance of his
anything if they are not committed to own personal commitment.
it? (FN)
Miller - 107: My own sense is it’s that
internal reason that really makes the
difference. When instead of there being
somebody out there... (GI)
Mike - 107: External. (FN)
Miller - 108: ...telling you, what’s telling
you is something inside of you. Your
lungs or whatever it is. (GI)
Mike - 108: I think this time it’s my Some committing language – “It’s
body. (R+) time.”
Miller - 109: Hey, yeah right. (RES)
Mike - 109: My brain is saying hey, “I’m
stupid (O +), but your liver doesn’t like
you too much. (R+) Your lungs are a
little pissed, you know.” (R+)
Miller - 110: Yeah.
Mike – 110: So.
Miller - 111: So, what gets in the way of Technically this is a backward question
your sticking with that? What gets in in MI because the answer to it is
the way of running? (QUO) sustain talk – why he doesn’t change.
Such questions can be useful, however,
particularly when hearing clear
motivation for change. What stands in
the way?
Mike - 111: You know, I don’t know.
I think it may be a fear of failure. I
really do. Could be that. (R+) Could be
just the amount of effort. (R-) Like I He’s already been moving toward
say it’s been going down, going down, change, but hasn’t wanted to take the
going down, but I seem to really have a plunge.
problem totally committing to just okay
this is the year man. Let’s do it. (C -)

36
 Psychotherapy.net

Miller - 112: Yeah, well because it is

pretty total. I mean, that was what I was
picking up earlier. At least the way you
are thinking about it. It means stopping
cigarettes and stopping drinking.
(REC)
Mike - 112: Well, you know, it used to
be a fear of withdrawal with drinking,
and when I quit I found out... (R-)
Miller - 113: It’s not a big deal. (REC) I am “continuing the paragraph,”
anticipating what he means to say.
Sometimes counselors worry about
“putting words in their mouth,” but
when you can do it accurately it moves
things along.
Mike - 113: It’s not. And that’s another
thing. Don’t tell people about DT’s
because quite frankly that doesn’t
happen all that often. (FN)
Miller - 114: It’s pretty rare. (RES)
Mike - 114: I mean, what do you get?
You get maybe higher energy level and
More change talk.
that’s it. (R+) And you feel better, okay?
(R+) I mean, whoa, you are going to
get DT’s, you are going to go through
withdrawal. Oh, you are going to have
to have doctor’s supervision. By telling
someone that you are just scaring the
fuck out of them. You know? Excuse my
French, but that’s what you do. (FN)
Miller - 115: That is something that
happens to some people but not very
many. (RES)

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MOTIVATIONAL INTERVIEWING

Mike - 115: Yeah. Yeah. But I’m really This is called “envisioning” in MI. He
worried about the smoking because I is looking ahead to having made the
remember last time I got just violent. change (in this case, quitting) and
I mean I was bad to be around for five anticipating the problems that may
days. I mean really bad. I mean I was come up. This can sound like resistance
just blowing up on everything. Every or counter-argument, but it is actually a
little thing I was just, everything was signal of increasing readiness to change.
just ticking me off. (R-) And then after
five days I was pretty cool, and after two
weeks I was real cool. (FN) And I was
kind of, yeah, but I’m thinking my god,
what if a client calls me up. What am I
going to do? (R-)
Miller - 116: Like five days in a
mountain hut somewhere. (REC)
Mike - 116: Oh well, you think a kayak He responds energetically to this
trip? Just throw me for five days out in idea. It’s doing something besides just
a kayak. (C +) quitting.
Miller - 117: That’s a nice idea. AF
Mike - 117: No cigarettes, (O +) no
booze. (O +)
Miller - 118: Yeah, the Grand Canyon
or something. (RES)
Mike - 118: Well, you see, that would be
very good. (O +)
Miller - 119: It would. (RES)
Mike - 119: I mean that’s what I was Committing language – still lower level
thinking of doing. (C +) (“thinking of”), but coming along.
Miller - 120: Something physical.
(REC)
Mike - 120: Yeah. Do something like
that. (C +)
Miller - 121: You’re committed. (REC) By which I mean, when you’re out there
with no alcohol or cigarettes, you are
committed.

38
 Psychotherapy.net

Mike - 121: Backpacking. 100 miles He picks up the image.

from nowhere. (C +) And maybe I could
reward myself with a cigarette by the
time I get there. By the time I get there
it will be ten days and I won’t want one.
(C +)
Miller - 122: Well, and the trip itself for
you sounds like it would be a reward.
(REC)
Mike - 122: Oh yeah. (R+)
Miller - 123: Doing it would be fun.
(RES)
Mike - 123: Yeah. (R+)
Miller - 124: So it might be a way to get
through those five days. (REC)
Mike - 124: Yeah. Yeah, like I say, I’m,
how shall I say? I’m teetering on the
Here is some “taking steps” language,
edge where you know I’ve cut down,
which also signals readiness for change,
(TS +) I’ve cut down, I know how it feels
and more change talk.
to at least not drink that much, (R+) but
now I’m finding out, hey, it’s not the
drinking that’s giving me the hangover.
It’s the cigarettes. (R+)
Miller - 125: Mm hm.
Mike - 125: And the drinking only
compounds it because when I drink I
smoke like a son of a bitch. (R+) And
one of the things is I think I’m cutting
down on my drinking, not because I’m
trying to cut down on my drinking,
but because I don’t want to smoke that
many cigarettes (R+d) which is weird,
and you’re not supposed to be that way.
Not by the definition of drug addiction.
(FN)
Miller - 126: Well, you are breaking all This is a guy who likes to break the
the rules. (REC) rules.

39
MOTIVATIONAL INTERVIEWING

Mike - 126: Yeah, I know. But I mean, I

wish they wouldn’t tell me rules there.
If they are not sure, I don’t want to hear
them.
Miller - 127: Uh huh.
Mike - 127: You know, I mean it’s like I Yet another rant against the form
think a lot of this crap is self-fulfilling of addiction counseling that he
prophecy. You have given people false experienced.
information and they are taking this
false information to heart because
these experts in the field, so called
experts, and it’s really funny how many
different variations of the definition of
alcoholism we have. All of them almost
contradictory. You get some poor slob
that’s going to say well so- and- so says
this, and they’ve been a leader in their
field for the last 20 years. So, therefore,
because they say this, I have to be this
way. And instead of defining themselves
as individuals, they go into the stupid
pattern or whatever type of behavior
that is supposed to be attached to them,
and they assume that behavior is theirs.
And that’s why I don’t like, it’s not, it
doesn’t work. And I don’t think it ever
will. I mean, do you agree with me, or
am I... (FN)
Miller - 128: Well, you know more Affirming his personal control and
about you than I do, obviously. (EC) wisdom
Mike – 128: Well, that’s the whole
thing. (FN)
Miller - 129: I believe you. (SU)
Mike - 129: Yeah, but I mean how many He asks but doesn’t need an answer.
people have you counseled in your
lifetime? (FN) I mean you’ve had to see
certain things works for certain people
and certain things work for other
people, and it’s not going to be one size
fits all. (FN)
2-25

40
 Psychotherapy.net

Miller - 130: No it isn’t. (SU)

Mike - 130; It just, it’s not there. (FN)
Miller - 131: I’ve worked with people
who have done really well in AA. And
I’ve worked with a lot of people who
have said, “Ah, it’s not for me. That’s
not my cup of tea.” (GI)
Mike - 131: And I’m not trashing them.
I mean if it works for you, fine. (FN)
Miller - 132: There you go. (SU) In Albuquerque this phrase is an
affirmation, an agreement.
Mike - 132: If it works for you that’s
fine. And I’ve seen it help a lot of
people, and I know the type of person
it is going to work for. It is not going to
work for me. (FN)
Miller - 133: Now, tell me about this Querying where he is in the balance. Is
teetering on the edge business. (QUO) it time for Phase 2 of MI – negotiating a
change plan and committing to it?
Mike - 133: Don’t know. I think it’s, like
I said, I think it’s fear of failure. (R-) I
think on my part it’s a fear of failure,
and it’s also the fear of withdrawal,
especially from nicotine. Because I
know how I get. (R-)
Miller - 134: Mm hm.
Mike - 134: And I’m committed (C +) Not quite ready for Phase 2 yet.
and then I’m not. It’s this ambivalent
feeling. (FN)
Miller - 135: Yeah.
Mike - 135: And I can’t seem to, you
know, and that’s where I’m stuck.
That’s where I’m stuck. I’m stuck in
that ambivalence (C -) which I guess is a He sees ambivalence as progress.
good thing in a way. I mean, it’s better
than just being not committed at all.
(O +)

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MOTIVATIONAL INTERVIEWING

Miller - 136: Well, that’s exactly right.

It’s a step forward. (REC)
Mike - 136: Yeah, it’s a step forward,
but it’s still… (FN)
Miller - 137: Becoming ambivalent is
the first step toward change. (GI)
Mike - 137: Yeah, but let’s face it, that’s This fellow reads psychology.
cognitive dissonance. The ambivalence
I really want to get over it, (O +) but I
can’t seem to, I can’t seem to just say
okay, today’s the day. This is it. (C -)
Miller - 138: Right.
Mike - 138; So maybe, I don’t know.
See I don’t know even what to do, quite
frankly... (FN)
Miller - 139: Well, you mentioned a I point him back to his own ideas on
couple of things. (REC) how to succeed.
Mike - 139: Yeah, see I’m thinking I
could cut down slowly. (C +) See, look
it, if I quit cigarettes, drink is going to
go. It’s going to have to go.
Miller - 140: Mmm hmm.
Mike - 140: Okay, so then that’s it. Back to committing language. Drinking
That’s out. Now that I know isn’t that is done, he says.
hard. (R+a)
Miller - 141: Right. You’ve done that.
(REC)
Mike - 141: Yes, but the nicotine, He is less confident of his ability to quit
ooooh, that’s a scary thing for me, man. smoking.
(R-)
Miller - 142: And you’ve done that
before also. Yes? (QUC)
Mike - 142: Playing. Yeah, I was playing
around. I was playing two games a
week. (FN)
Miller - 143: Okay.

42
 Psychotherapy.net

Mike - 143: Now I would have to start He has a change plan for smoking. He
running every day, an hour a day five doesn’t seem to need one for drinking.
days a week. (C +) I would have to It’s as if he’s already crossed that bridge.
gradually cut down, okay? (C +) And
then I would have to set a date, (C +)
and I guess go on the patch, (C +) and I
would have to stay away from anyone
that wants to have a beer with me,
because if I have one beer, boom. Right
back to smoking. (C +) Now I’m telling
you what happened with smoking.
What was it, four months? Whatever
it was, blow out the knee. As soon as
I started again, now this is, as soon as
I started again, I was back up to two
packs within a day. (FN)
Miller - 144: That’s scary isn’t it? (REC)
Mike - 144: Within a day. It wasn’t like
this gradual, “Oh I’ll just have one.” It
was just like boom, and I was just right
back in there, (FN) and then I feel the
lungs quit on me, (R+) yeah I guess a
fear of failure. I don’t know. Maybe it
was fear. I don’t know what it is. Maybe
it’s fear of failure. I don’t know. (R-)
Miller - 145: How confident are you that
you can do it? (QUO)
Mike - 145: That’s the problem. I don’t
know. (FN)
Miller - 146: You’re not sure. (RES) It would have been good here to ask
him to rate his confidence on a 0-10
scale, and then explore why he is as
whatever number he offers, rather than
zero. In what ways is he confident?
Mike - 146: I’m not too sure. I’m really
not too sure. (R-a)
Miller - 147: It’s not so much the
wanting to do it as, “I don’t know if I
could if I make the decision.” (REC)
Mike - 147: Right, right, right.

43
MOTIVATIONAL INTERVIEWING

Miller - 148: Mm, okay.

Mike - 148: It’s confidence probably.
(R-a)
Miller - 149: Well, and that’s what Instead I invite him to wrestle with how
would help. Something that you could he could do it.
really be confident in. Like the way you
I wasn’t conscious of using the phrase
lit up when we talked about the Grand
“lit up” here, but it plays on the
Canyon or something. Like I could get
smoking theme.
through five days that way. I could do
that. (REC)
Mike - 149: Am I supposed to spend
maybe a year out there? (FN)
Miller - 150: No, I’m just using that
example. (GI)
Mike - 150: Wait a second, if I made a
lot of money, that would be a good...
(FN)
Miller - 151: How long would it be?
Well, the first five days you said are the
tough ones. (REC)
Mike - 151: Yeah, the first five are
tough. (R-a) But really what it is, what
He does come up with part of a change
basically what it really is just not
plan – to avoid the immediate triggers.
hanging around Chris because Chris
Again he is envisioning what it will
will come over and he’ll want a beer.
be like to quit drinking, and thinking
(C +) I don’t care if he has a beer, but if I
seriously about how to do it.
have a beer, boom. I’m going to light up.
(O +)I’m going to have to stay away from
Bogden. (C +) That’s another guy on my
soccer team. (FN) It would have to be
like really staying away from a lot of
people I know. (C +) You know, maybe
I’m just making excuses for myself. I
don’t know. I don’t know. But I would
have to do that, and then I would really,
I would have to watch myself and not let
myself talk to any clients for five days.
Because I know how I get. (C +)
Miller - 152: Oh that five day period.
Yeah. (RES)

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Mike - 152: Yeah, I don’t know. I don’t

know. I’m still ambivalent. (FN)
Miller - 153: Well, that clearly is where
you are. (REC) And you are right
that that’s a normal place people pass
through. (SU) You are saying, “Well
let’s get through,” you know. (REC)
Mike – 153: I still want to... (FN) Hear the ambivalence – I want to, but
am not sure if I can. This often resolves
into “I’ll try,” which bespeaks higher
desire, lower confidence.
Miller - 154: It’s an unpleasant place to
be. (REC)
Mike - 154: Yeah. (FN)
Miller - 155: You either want to go back
to not being able to... (RES)
Mike - 155: Which is more He sees that saying “I can’t” is an
comfortable. Let’s face it. Which is out – a way of decreasing the tension
more comfortable. And I’ll tell you involved in ambivalence.
that right now. That’s a hell of a lot
more comfortable saying, “Ah, I’m not
going to quit smoking.” That’s more
comfortable. (R-)
Miller - 156: Either side is more
comfortable. (REC)
Mike - 156: Either side is more
comfortable than the ambivalence. The
ambivalence is the hell. (FN)
Miller - 157: It is. (SU)

45
MOTIVATIONAL INTERVIEWING

Mike - 157: That’s the hell. Okay, cause

well I know I shouldn’t (R+) but I will
(C +) and I don’t know if I should. (R+)
Here’s what it is. It’s knowing that He reminds himself of the reasons to
you are taking a carcinogen, a known quit smoking
carcinogen, and you are putting it in
your lungs. (R+) You know that it’s
upping your blood pressure. (R+) You
know it is increasing your chance of
lung cancer. (R+) You know it’s really
screwing up your soccer. (R+) It’s that, and comes back to drinking as well.
it’s doing that is pissing me off. (O +) It’s
knowing that you are taking a poison,
a poison called alcohol. (R+) You know
the second drink your judgment is
going to go to hell. (R+) And why am
I doing this? Let’s just bang that head
against that brick wall some more too
please. And that’s what pisses me off.
(O +) I mean if I was stupid, I could
forgive myself for it. If I define myself
as an addict, you know, and I think a
lot of people do, then they can forgive
themselves for it. (O +) But that’s, no.
(O +)
2-30
Miller - 158: That is not a way out of
you. (REC)
Mike - 158: No. That out doesn’t work.
That’s a cop-out. I mean, and see I wish
I was stupid and I could just say, didn’t
know any better. (R+)
Miller - 159: And you could sit back
here and...
Mike - 159: Yeah.
Miller - 160: ...be comfortable. (REC)
Mike - 160: Yeah, right. (R-)
Miller - 161: Now the place where you
are is real uncomfortable. (REC)
Mike - 161: Yeah. (FN)

46
 Psychotherapy.net

Miller - 162: And moving either way

from it is more comfortable. (REC)
Mike - 162: Of course. Of course.
Moving up or back. (FN)
Miller - 163: But staying in the Developing discrepancy – he is already
ambivalence, because you are conscious experiencing plenty of it
of it, you are conscious of taking in the
poison or the carcinogen or whatever it
is... (REC)
Mike - 163: That’s the problem. (R+)
Miller - 164: Boy. (SU)
Mike - 164: That is, what are you doing
this for? You know, what are you doing
this for? And... (R+)
Miller - 615: And that’s the teetering Again I am using “I” language in
then. “Which way am I going to move reflections to amplify awareness of his
off of this… (REC) dilemma
Mike - 165: Right. (FN)
Miller - 166: …beecause I don’t want to
stay here.” (RES)
Mike - 166: And not only that. You
know the guys at soccer they always kill
me. “Hey, you smoking again” Oh yeah.
You’re stupid, man? So I got a little peer
pressure going there. (R+)
Miller - 167: So they are not all pulling
you into drinking and smoking? (REC)
Mike - 167: Oh, no, no. They wouldn’t,
well it all depends. This is the Polish
soccer team. Most of these guys are
right off the boat, okay? And they do
drink a lot, so... (FN)
Miller - 168: They just give you a hard
time about smoking? (RES)
Mike - 168: Right, and they don’t
smoke. (FN)
Miller - 168: Oh, okay. (RES)

47
MOTIVATIONAL INTERVIEWING

Mike - 169: And I say, “Well listen,

you know, hey, if you want me to quit
More envisioning
smoking, I’m going to have to quit
drinking.” “Oh no you could.” “No,” I
says, “I can’t.” It doesn’t work that way
for me. And then having never done it
they don’t know. So I’m going to have and change planning
to like, if I do this, I’m going to have
to stay away from them at least long
enough to establish some type of... (C +)
Miller - 170: There you go. People who One of my longer speeches. I am doing
make it through change usually do it, a little educating while also affirming
I mean you’ve got it. Usually do what that he is right in his perception.
you are saying which is for a while avoid
the valley of the shadow of death, you
know. I mean avoid the difficult place.
And then it gets more okay. You’ve got
to not rush too quick back in there, but
it gets to be okay. You don’t then have to
stay away... (GI)
Mike - 170: Forever. (FN)
Miller - 171: Right. So it’s not forever
and ever. But for a while you are
probably right. (GI)
Mike - 171: Yeah. (FN)
Miller - 172: Or, somehow, get them to,
say, “Help me out guys.” I mean, if they
won’t do it, then you are right. (AD)
Mike - 172: No, it’s not like they are bad
guys. They just don’t know. See, they’re
not... (FN)
Miller - 173: Haven’t done it. (RES)
Mike - 173: You know, they don’t know.
I mean I think if you don’t smoke, you
don’t smoke cigarettes, you don’t know.
You’re not going to know. And how
could they possibly help it? (FN)
Miller - 174: Well, I only meant that
if they could get it in their heads that
what you are saying is right... (GI)

48
 Psychotherapy.net

Mike – 174: Yeah, right. (FN)

Miller - 175: That if they want to help
you stop smoking, they’ve gotta also not
encourage you to drink. (REC)
Mike - 175: Don’t come over with the
12-pack and want something. (FN)
Miller - 176: Yeah. (RES)
Mike - 176: You know, come on. (FN)
Miller - 177: So if you could ask them to I’m doing a little too much suggesting
do that, help you out that much, then... here
(REC)
Mike - 177: They’re guys. They’re guys. And he negates it.
(R-)
Miller - 178: They won’t... (RES)
Mike - 178: These are guys, okay?
They’re guys. I’m single you see. If I was
married I could blame it on my wife. In
fact, I’m thinking of getting married,
well I’m just kidding. But I’m thinking
of a rent-a-wife situation. See you rent
a wife and you tell all your guy friends,
“Hey, I’m a married man. My wife will
kill me if you guys come over.” Then
you get to get then the hell out of your
place. If you are a bachelor, they’re
trying to get away from their wives,
guess who they come over and hang
around with? You.
Miller - 179: Yep. (RES)
Mike - 179: And guess what. That
excuse doesn’t work. The only thing
they understand is some bitchy lady
with a skirt, okay? (FN)
Miller - 180: That would work. (RES)

49
MOTIVATIONAL INTERVIEWING

Mike - 180: And then you could clear

them out of the place. Otherwise, you
can’t clear them out, man. See, then
you have no excuse but to do what they
want to do. (R-)
Miller - 181: Yeah. (RES)
Mike - 181: That’s the way guys are. At
least the guys I know are that way. (R-)
Miller - 182: So, you are right. You I reaffirm his earlier commitment in a
would have to stay away from them for reframe.
a while. (REC)
Mike - 182: Right. Right. I hope I’m not He agrees.
babbling here. (C +)
Miller - 183: No, no. (SU)
Mike - 183: I seem to be all over the
place here. (FN)
Miller - 184: I mean you are giving me a
real good sense of who you are. (GI)
Mike - 184: Yeah. (FN)
Miller - 185: I mean I love to read a
book to the end, and I’d love to know
which way you are going to go from this
place. (GI)
Mike - 185: I would like to know
myself. I don’t even know. You know, I
don’t even know. Like I say, I’m still at
the ambivalent stage, and it’s getting
to the point where I’m going to have to
make... (FN)
Miller - 186: It’s too uncomfortable.
(RES)
Mike - 186: Well, yeah. But what do you He reaffirms his commitment to move
want to go back? I mean, where’s back? forward toward change.
Where’s back going to take you” (RES)
Miller - 187: Yeah. You know. (RES)
Mike - 187: Yeah. Yeah. (FN)

50
 Psychotherapy.net

Miller - 188: But it’s that “Can I do it?”

obstacle. (REC)
Mike - 188: Well, that’s, it’s a confidence
problems. (R-a)
Miller - 189: So something that would Inviting him to think more about how
help you be more confident. (RES) he could succeed. I am aware that
the time allowed for our interview is
coming to a close.
Mike - 189: Yeah, well, yeah, yeah. (FN)
Miller - 190: To be able to look at it and
say, “I could do that. I can see myself
doing that.”
(REC)
Mike - 190: Well, yeah, but what’s that
going to do? (O -)
Miller - 191: I’m not sure. (GI)
Mike - 191: It’s going to have to be
internal if it’s going to work for me.
Miller - 192: Mm hm.
Mike - 192: It can’t be anything
external. I can’t deal with cheerleaders.
I can’t deal with, “Oh you can do it you
can do it.” Hey, come on. I’m a little too
old for that. (O -)
Miller - 192: There is certainly nobody
pushing you. (REC)
Mike - 193: Well, you know, I’m going
to have to figure out that I can do it
myself or just not going to be able to get
done. And that’s just, the long and the
short of it is that’s what it’s really going
to take.(RES)
2-35
Miller - 194: That’s the bottom line.
(RES)

51
MOTIVATIONAL INTERVIEWING

Mike - 194: Yeah. I mean for a person

like me, that is the bottom line. And it
has to be important enough. But I think
it is important enough now or else I
wouldn’t be thinking about this in the
first place. (FN)
Miller - 195: That’s how it sounds.
(REC)
Mike - 195: You know, as far as It’s not fleeing from something that
I’m concerned, I don’t care if I die motivates him,
tomorrow. This is not about my health.
(FN)
Miller - 196: Mm hm.
Mike - 196: Boy I can’t stand, if I’m But chasing something.
not the fastest guy out there, I have
an identity crisis, okay? (R+) It’s my
arrogance, okay? (R+) It’s my conceit.
(R+) It’s my pride, okay? (R+) So I am
using all the negative stuff you’re never
supposed to have in AA to help me...
(TS +)
Miller - 107: Challenge. That’s what
will get you through. Sheer cussedness.
(REC)
Mike - 197: Yeah just sheer, you know,
if anything, arrogance. If anything,
probably that’s all it is. And it really
has nothing to do with health. It really
doesn’t. I mean I hate to admit it, but as
far as longevity and life, I don’t really
care about it. High quality of life?
Well, everyone dies. Everyone makes For him, emphasizing bad things that
such a big goddam deal out of it. I’m will happen to him if he doesn’t change
so goddam tired of these people who, will fall on deaf ears.
“Oh I eat these healthy food, and I do
this, and I know go out in the sun,”
and yeah, yeah, you’re 400 pounds
overweight, you don’t work out. You
know, don’t give me this live forever,
but live what? (FN)

52
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Miller - 198: We’re all going to die

anyhow. (RES)
Mike - 198: We’re all going to die
anyhow. What are you going to do? Just
never go out in the sun? (FN)
Miller - 199: But while you are here,
you want to be the best. (REC)
Mike - 199: Well, you know, it would He reaffirms positive motivation.
kind of be nice to wake up, you know,
and feel healthy and be able to do what
you like to do. (R+)
Miller - 200: It is. (SU)
Mike - 200: Uh, well, yeah, if you could
do what you like to do forever, hey. I
would like to do that. But I know that’s
not going to happen, and I accept that,
and to me it’s not so much a longevity
issue (FN) as it is a quality of life issue.
And so that’s the deal. (R+)
Miller - 201: You know the funny thing Probing commitment
is it sounds to me like you have made
up your mind. (REC)
Mike - 201: Possibly. (C +) He gives me a mid-range signal.
Miller - 202: Maybe. (RES)
Mike - 202: Yeah. I think I’m swaying.
(O +)
Miller - 203: Leaning just a little. (RES)
Mike - 203: Swaying (O +). I hope it’s
not a pendulum, you know. (R+d)
Miller - 204: I don’t know though. It’s Reflecting his status-quo voice.
kind of back there. (RES)
Mike - 204: Yeah, back there is more
comfortable. At least it’s known. It’s
known. See that’s... (R-)
Miller - 205: It’s predictable. (RES)

53
MOTIVATIONAL INTERVIEWING

Mike - 205: That’s all it is. It’s known.

(R-)
Miller - 206: It is predictable. (RES)
Mike - 206: That’s all it is. It’s known.
Yeah, someone told me and it made a
lot of sense. Bang your head against
a brick wall, you start to miss that
brick wall when you quit banging your
head against it. You know, I think
that’s what everything is. Not just
smoking, not just drinking, not just
doing whatever, cocaine or anything
else, but everything else. I think bad
relationships are like that.
Miller - 207: Mmm, hmm.
Mike - 207: I think bad jobs are like
that. I think living in bad areas of
town are like that. I think, it’s familiar.
Because it is familiar it is predictable.
(FN)
Miller - 208: Right. (RES)
Mike - 208: You are comfortable with
it. It’s not that terrible change (R-), you
know, that’s a scary thing. And you
know, maybe that’s what it is. So. (R-)
Miller - 209: What if you stopped
smoking and drinking and you still
couldn’t keep up with the young guys?
(QUO)
Mike - 209: Oh, I don’t think that is
going to be a problem. (O +)
Miller - 210: That’s alright. (RES)

54
 Psychotherapy.net

Mike - 210: I already can. That’s the

thing. It’s just that you know I’m
getting older, and this is not going
to last forever. I put a lot in a bank He comes up with another metaphor
account. I had a scholarship, marathon for his motivation for change.
scholarship, when I went to college
which I didn’t take. Ran a 4:32 mile,
always been fast. (FN)
Miller - 211: Really. (RES)
Mike - 211: But I always had, the way
I’m looking at it, I always had a bank
account, and I put a lot in that bank
account, that cardiovascular bank
account. (FN) Well, I’ve been drawing
off that bank account for a long time.
Now it’s just about... (R+)
Miller - 212: Balance is getting low.
(RES)
Mike - 212: Balance is getting low (R+).
So I have to kind of start filling it up
again. And... (R+n)
Miller - 213: That’s a nice image. AF
Mike - 213: Well, I think that’s exactly
what’s going on. (R+n)
Miller - 214: That works. (RES)
Mike - 214: You can only do this stuff
so long before you are going to start
feeling the effects. I’m starting to feel
the effects. Maybe I always was but I
was too stupid to realize it. I’m not too
sure. (R+)
Miller - 215: You don’t want to go into Complex reflection - continuing the
debt. (RES) paragraph within the metaphor.
Mike - 215: No. I don’t want to go into
debt. (R+)
Miller - 216: Makes sense to me (SU). I see that we are running out of the
Well, I’d love to know how the story allotted time for this filming session.
comes out. (GI)

55
MOTIVATIONAL INTERVIEWING

Mike - 216; Well, should we do a follow

up? (FN)
Miller - 217: I’d like to know. (GI)
Mike - 217: You know, I tell you. If I He envisions quitting two to three
do this, it’s not going to be for two to weeks from now.
three weeks, you know. Everyone says,
“Oh do it tomorrow.” You know what?
No. (FN)
Miller - 218: You are going to set a date
out there somewhere. (REC)
Mike - 218: Well, yeah. (C +)
Miller - 219: Not tomorrow. (REC)
Mike - 219: Not tomorrow. Not
tomorrow. Not today, not right now. I
mean, you know, I’m just not going to
do that you know. (FN) It’s going to be,
here’s what happens to me. When I start He returns to his primary change
doing shit that’s contradictory to bad theme.
habits, the bad habits start disappearing
almost naturally. And I start getting a
roll. (C +)
Miller - 220: Beautiful. (REC)
Mike - 220: And then I start getting to
the point where I want to continue this
good habit. Bad habits, I’m not really
thinking about. They are starting to go
away. So I want to kind of like steamroll
this turkey, and then as soon as I got
that steamroll thing going and I got this
thing on the run, it’s okay baby, and
now we’re going to get you. Now you
are vulnerable. Now you’re going to die. He is speaking here to his addiction.
That’s... (C +)
2-40
Miller - 221: That’s the plan that works
for you. (RES)
Mike - 221: Yeah. (FN)
Miller - 222: Good. (SU)

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Mike - 222: Does that work for other

people or am I strange? (FN)
Miller - 223: No, people are real
different in terms of the way they find,
and it’s kind of your personality and
what grabs you and what’s the thing
that finally tips the seesaw for you. (GI)
Mike - 223: I was told, “That doesn’t
work.” I was told, “Well no, no. One
size fits all. This is how we have to do
this. This is the only way we do it.” You
know, that’s what I was always told. It
made no sense to me, and I just really
lost respect for, you know, anyone
in the industry because, do you have
any intuition? Do you ever listen to
your clients? Have you ever thought
that there could be something called
individuals out there” “Hey, bell shaped
curve, guys. Hey, you know what it is.”
Guess what different IQ levels, different
personality traits. Guess what. (FN)
Miller - 224: People know something
about themselves. (REC)
Mike - 224: Yeah. (FN)
Miller - 225: Mmm hmm. Yeah. (RES)
Mike - 225: So, but I never got that far.
Of course, like I said, it was state run. It
was a little bit different, so. (FN)
Miller - 226: Well, I wish you well. I’d
like to know how the story comes out.
(GI)

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POST-SESSION COMMENTARY BY DR. MILLER

I felt a bit rushed because session length was prescribed by the filming.
It would have been good to offer him a recapitulation summary,
pulling together his change talk from the session, followed by a key
question. Had I done so, it might have been something like this.

“You’ve been thinking quite a lot about your drinking and smoking,
and you’ve reached a kind of tipping point. You don’t like labels and
the games you had to play in addiction counseling before, but in a
real sense you’d like to be done with alcohol and tobacco. You’d feel
better in the morning, have more energy and be able to think more
clearly and do the things you love to do. In fact, doing those things is
an important part of quitting, because it replaces them like a positive
addiction. You’re sure that you need to quit drinking in order to stop
smoking. Quitting drinking seems pretty easy to you – no big deal,
but you think smoking is likely to be tougher to kick. You liked the
idea of getting away for long enough to get through the five to ten days
it will take, and you also think that you’ll need to avoid your soccer
buddies for a while after that. It’s uncomfortable to stay on this seesaw,
and you’re also pretty clear that you don’t want to go back to status
quo just for the comfort of predictability. You also don’t want to think
about it much, but just do it. So how are you going to do it?”

I did follow up a year later to find out what happened. Mike had quit
drinking, but was still smoking.

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Suggestions for Further Readings,

Websites and Videos
BOOKS
Miller, W. R., & Carroll, K. M. (Eds.) (2006). Rethinking substance
abuse: What the science shows and what we should do about it.
New York: Guilford Press.
Miller, W. R., & Delaney, H. D. (Eds.) (2005). Judeo-Christian
perspectives on psychology: Human nature, motivation, and
change. Washington, DC: American Psychological Association.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing:
Preparing people for change (2nd ed.). New York: Guilford Press.
Miller, W. R., & C’de Baca, J. (2001). Quantum change: When
epiphanies and sudden insights transform ordinary lives. New
York: Guilford Press.
Miller, W. R., & Rollnick, S. (1991). Motivational interviewing:
Preparing people to change addictive behavior. New York:
Guilford Press.

WEB RESOURCES
In-depth Interview with Stephanie Brown, PhD on Psychotherapy and
Addictions
http://www.psychotherapy.net
William Miller’s faculty page at the University of New Mexico’s Center
on Alcoholism, Substance Abuse and Addictions
http://casaa.unm.edu/miller.html
Manual for Motivational Interviewing Skill Codes
http://casaa.unm.edu/download/misc.pdf
Website for Stephen Rollnick, co-developer of Motivational Interviewing
http://www.stephenrollnick.com
A resource for clinicians, researchers and trainers sponsored by the
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MOTIVATIONAL INTERVIEWING

Mid-Atlantic Addiction Technology Transfer Center

http://www.motivationalinterview.org
NAADAC: The Association for Addiction Professionals
http://naadac.org
The Center for Substance Abuse Treatment, US Department of Health
and Human Services
http://csat.samhsa.gov
National Institute on Alcohol Abuse and Alcoholism
http://www.niaaa.nih.gov

RELATED VIDEOS AVAILABLE AT

WWW.PSYCHOTHERAPY.NET
Cognitive Therapy for Addictions
–Bruce S. Liese, PhD
Couples Therapy for Addictions: A Cognitive-Behavioral Approach
–Barbara S. McCrady, PhD
Harm Reduction Therapy for Addictions
–Alan Marlatt, PhD
Integrating Therapy with 12-Step Programs
– Joan Ellen Zweben, PhD
Reality Therapy for Addictions
–Robert E. Wubbolding, EdD
Solutions Step By Step: A Solution-Focused Approach to Treating
Substance Abuse Problems
– Insoo Kim Berg & Norman Reuss
Stages of Change for Addictions
–John C. Norcross, PhD
Treating Alcoholism in Psychotherapy, Volumes I & II
– Stephanie Brown, PhD

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 Psychotherapy.net

Notes …

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MOTIVATIONAL INTERVIEWING

Video Credits
HOSTS:
Dr. Judy Lewis, Governors State University Professor
Dr. John Carlson, Governors State University Professor

FEATURED THERAPIST:
William Miller, PhD

SPECIAL THANKS TO:

Christine Nolan
John Cebuhar
Addison Woodward
Diane Alexander
Arthur Durant
Virginia Lanigan
Stephen G. Smith
David Sachetti

PRODUCED BY:
Governors State University

Copyright © 2007, Allyn and Bacon

DVD version released by Psychotherapy.net, 2007
VHS version by Allyn and Bacon, 2000.

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MOTIVATIONAL INTERVIEWING

About the Contributors

VIDEO PARTICIPANTS
William R. Miller, PhD, Featured Therapist, is Emeritus
Distinguished Professor of Psychology and Psychiatry at the
University of New Mexico. He served as Director of Clinical Training
for UNM’s doctoral program in clinical psychology and as Co-
Director of UNM’s Center on Alcoholism, Substance Abuse and
Addictions. He served as principal investigator for numerous research
grants and contracts, founded a private practice group, and served as a
consultant to many organizations including the United States Senate,
the World Health Organization, the National Academy of Sciences,
and the National Institutes of Health.
Dr. Miller’s publications include 40 books and over 400 articles
and chapters. Fundamentally interested in the psychology of
change, he has focused in particular on the development, testing,
and dissemination of behavioral treatments for addictions. In
recognition of his research contributions, Dr. Miller is a recipient of
the international Jellinek Memorial Award, two career achievement
awards from the American Psychological Association, and an
Innovators in Combating Substance Abuse award from the Robert
Wood Johnson Foundation. He maintains an active interest in
pastoral counseling and the integration of spirituality and psychology.
The Institute for Scientific Information lists him as one of the world’s
most cited scientists.
Jon Carlson, PsyD, EdD, Host, is Professor of Psychology and
Counseling at Governors State University and a practicing clinical
psychologist. He has authored 40 books, 150 journal articles, and
developed over 200 videos featuring leading experts in psychotherapy,
substance abuse treatment, and parenting and couples education.
Judith A. Lewis, PhD, Host, is Chairperson of the Department of
Addictions and Behavioral Health at Governors State University. She
is past President of both the American Counseling Association and
the International Association of Marriage and Family Counselors.
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 Psychotherapy.net

Dr. Lewis has written several books, including Substance Abuse

Counseling, and over 60 articles and book chapters.

MANUAL AUTHORS
Randall C. Wyatt, PhD, is Editor-in-Chief of Psychotherapy.net.
He is the Director of Professional Training at the California School
of Professional Psychology, San Francisco at Alliant International
University and a practicing psychologist in Oakland, California.
Erika L. Seid, MA, LMFT, Educational Programs Manager at
Psychotherapy.net, is a practicing psychotherapist in the San Francisco
area, specializing in cultural issues and sexual offender treatment.

65
MOTIVATIONAL INTERVIEWING

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MOTIVATIONAL INTERVIEWING

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