A common question that often arises in motivational interview training sessions is, “how soon during the interview should an interviewer start asking questions?” The short answer is simple. “You should ask questions of your client whenever you need to – in order to help along the particular process within which the conversation is operating.” The key here is to always be strategic with your question-asking and to use the questions to facilitate the specific process you are facilitating when you need to pose the question. (If this seems confusing to you, please read on!)
In the ENGAGING PROCESS, questions are asked that will help the interviewer obtain a better understanding of what the client is thinking, feeling, and doing. Questions in the engaging stage are not designed to bring a focus to the discussion or to evoke change talk. (It’s not possible to know what change talk is until you have a focus!). Similarly, when working within the engaging process, questions are not meant to help construct a plan for change. Instead, when engaging, questions serve to help the interviewer develop a deeper empathy with the client’s thinking. Such questions come from a place of curiosity, where the intent is to understand the logic behind the client’s point of view.
At other times in an MI interview, when working within any of the other three processes, questions serve to aid in the fulfillment of the specific process that the interviewer is facilitating. Asking questions that are designed to bring a mutual focus to the conversation between interviewer and client is essential and necessary when working within the FOCUSING PROCESS.
Similarly, the questions that you will ask in order to evoke change talk, once a particular focus has been established, will have different characteristics than engaging or focusing questions.
EVOKING QUESTIONS serves to give clients a “hand up” so that their answers will help them to begin hearing their desire, ability, reasons, need, and commitment (DARN-CATS) for a change related to the focus. Evoking work is an essential element of effective MI practice – so much so that it is almost always a major component of all motivational interviewing courses.
Finally, questions asked in the PLANNING PROCESS are designed to transition the conversation from “change talk” to “change action” (or, in other words, to the design of action steps.) You can imagine the problems that arise in interviewer-client dynamics if you were to begin asking planning questions when you and your client are still working to engage. Moving to higher process questions while working within a lower process presents real problems in MI work.
So, simply put, feel free to use process-matched questions any time; they will help you achieve the conversational process you are facilitating. That’s what is meant by the “strategic questioning” in MI work.
Below, I’ve provided a few examples of how different questions could be asked in response to specific “bits” of client speech, depending on the process the interviewer facilitates. Look at the examples, and then complete the following exercise (starting on line 5).
Try constructing a few logical questions to facilitate the two processes noted below each client statement. Take your time to think your questions through. You’ll get better and quicker at this the more you practice with strategic question-asking. Give me a call if you get stuck, and we can try putting both of our heads to it. This approach is integral to motivational interviewing for professionals who are working to enhance their ability to guide conversations effectively.
1
I don’t like the idea of taking that medication, even though I know I probably should take it. My doctor says I should take it all the time – not just when I have the symptoms. I guess it needs to build up in your bloodstream or something. But I don’t know. It messes with a person’s brain chemicals, and that seems a bit scary to me. (Target = medication compliance)
1Q
A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:
What is your thinking about the effect that the pills have on how your brain works?
A USEFUL QUESTION TO FULFILL THE EVOKING PROCESS IS:
When you say that you know you should be taking the pills, how do you think that might be helpful for you? This question reflects one of the key to motivational interviewing skills, focusing on the client’s perspective.
2
There’s an elder in our community who I kind of respect quite a bit. He has a lot of wisdom about certain things. His name is Frank. My Mom wants me to go see him and tell him about my problem. He really has a lot of knowledge about this stuff. In fact, he had this kind of problem too – a long time ago. We’ll see. Maybe I just need to get up the guts to call him. (Target = obtaining community support)
2Q
A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:
When you say you kind of respect Frank, what do you mean by that? How so?
A USEFUL QUESTION TO FULFIL THE PLANNING PROCESS IS:
What would you have to do to get up the guts to look into what he has to say? [Engagement in community support is often encouraged in highlighting the importance of external resources as part of planning.]
3
I’m just so angry all the time. I know everybody is saying that I’m depressed. To be honest, though, I think anger is a bigger issue for me. I don’t always show it, but on the inside, I’m always just itching to bite someone’s head off. I wish I could figure out what’s up with me. (Target = obtaining a mental health assessment)
3Q
A USEFUL QUESTION TO FULFIL THE FOCUSING PROCESS IS:
So, there might be two different concerns here. Depression and also some anger or irritability. Do they seem to be connected in any way? Is there a relationship between them?
A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:
What can you tell me about that tendency to keep your anger on the inside? What stops you from showing those feelings more? These inquiries are part of the foundation for focusing on client self-exploration.
4
I don’t like any of this. It’s all b.s. as far as I’m concerned. Everybody is telling me what to do and how to do it – and even when I should be doing it. Everybody thinks they are an expert about me and my problems. Nobody gives a crap about what I think about any of it. They only care about what they want me to do. (Target = development of a treatment plan)
4Q
A USEFUL QUESTION TO FULFILL THE EVOKING PROCESS IS:
Yah. I could see how that would be pretty frustrating, all right. So, let me ask you this. What do you think you should be doing? What’s your take on the next steps here?
A USEFUL QUESTION TO FULFILL THE FOCUSING PROCESS IS:
So, if you and I agree that the focus here needs to be on what you want, and given that you’re more of an expert on you than anybody else is, how would you like to get started? What should we be talking about in our chat today? This approach emphasizes the principles taught in motivational interviewing workshops for people who practice MI.
5
It’s weird to me that I am getting sort of interested in giving up the cigarettes. I’ve never really worried too much about smoking, but ever since my daughter was born, it’s different. I feel guilty about it. I think role modelling is important for young kids. But wow, quitting is no picnic in the park. I’ve tried before, and it’s not something I look forward too. Besides, I love smoking. (Target = smoking cessation)
5Q
A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:
A USEFUL QUESTION TO FULFIL THE EVOKING PROCESS IS:
6
I’d kind of like to sign up for that “Big Results” group at my husband’s gym. It’s a special exercise class for bigger people. I like that idea because I hate being in there when there’s all these fitness buffs working out and there I am – packin’ 40 extra pounds in all the wrong places! But I don’t know. What if I sign up and I’m the biggest one there? (Target = increased exercise)
6Q
A USEFUL QUESTION TO FULFIL THE EVOKING PROCESS IS:
A USEFUL QUESTION TO FULFIL THE PLANNING PROCESS IS:
7
I sort of feel like my wife doesn’t understand me. She doesn’t seem to appreciate how hard I work to put bread on the table and get all our bills paid every month. I have a lot of pressure on me and that’s why I’m so testy all the time. She never listens when I tell her about all of that. (Target = couple’s counselling)
7Q
A USEFUL QUESTION TO FULFIL THE ENGAGING PROCESS IS:
A USEFUL QUESTION TO FULFIL THE EVOKING PROCESS IS:
8
Well, they were saying I should look into getting some help! Hah! What a joke! Help for what? Where am I supposed to start? My marriage is only running on three cylinders. My boss says that if I ever get caught with alcohol on my breath at work again, I’ll be out of a job. My son says he doesn’t want to talk to me again unless I’m “stone cold sober,” as he puts it. And, on top of all of that, now the doctor says my blood sugar is all out of whack, and I need to get some tests done to see about that. The list is longer than that too – but you get the picture, I’m sure. I don’t need support. I need a bloody miracle! (Target = obtaining assessment of major life areas)
8Q
A USEFUL QUESTION TO FULFIL THE FOCUSING PROCESS IS:
A USEFUL QUESTION TO FULFIL THE EVOKING PROCESS IS: