Motivational Interviewing: Application

How to apply motivational interviewing skills in session for clients with chronic depression. 

The Spirit of Motivational Interviewing
• Collaboration – Working in partnership rather than taking an authoritarian stance. 

Ex: “I’d like us to look at this together, as a team. You’re the expert on your experience, and I can bring some tools we can experiment with. How does that sound to you?” 

Ex: “We can figure out together what feels realistic for you right now — nothing will be decided without your input.”

This reduces hierarchy and communicates respect and encouragement in someone who feels powerless or hopeless by their depressive symptoms.

• Evocation – Drawing out the client’s own motivations and resources for change. 

Ex: “When you think back to a time when things felt even a little lighter, what do you remember helped?” 

Ex: “What are the small things, even if they seem minor, that sometimes make your days just a bit more manageable?”

Ex: “What would be different for you if your depression eased just a little?”

Chronic depression often comes with hopelessness. Evocation helps reconnect the client with even faint or forgotten sources of motivation, reinforcing that they still have inner resources.
• Autonomy – Respecting the client’s right and capacity for self-direction. 

Ex: “Of course, it’s completely up to you whether you try this or not — you know yourself best.”

Ex: “You’ve lived with this depression for a long time, so you’ll know what feels doable and what doesn’t. I trust you to decide if now feels like the right time to try something new.”

Ex: “Whatever pace feels manageable for you is the pace we’ll go.”

Depression often makes people feel stuck or powerless. Affirming autonomy restores a sense of control and choice.

Core Principles of MI
• Express Empathy – Use reflective listening to understand the client’s perspective.
    Ex: “You’ve been carrying this heaviness for so long, and it makes sense that you’re tired of trying.”

Empathy validates the client’s experience and creates safety, reducing shame and isolation.
• Develop Discrepancy – Help clients see the gap between current behavior and future goals.
    Ex: “You’ve told me relationships matter deeply to you, and at the same time, the depression has made it harder to connect with friends.”

Unveiling discrepancies gently surfaces ambivalence, creating internal motivation without pressure.
• Roll with Resistance – Avoid arguing; resistance is met with acceptance.
    Ex: “You’re saying part of you doesn’t even want to change at the moment. That’s important for us to acknowledge.”

When you roll with resistance instead of arguing, resistance often softens. The client feels respected, not pushed.
• Support Self-Efficacy – Highlight client strengths and belief in their ability to change.
  Ex: “I can see the effort it took just to come here today — that shows real persistence.”
  Ex: “Even though you’ve been struggling for years, you haven’t given up on yourself. That says a lot about your strength.”

It shifts the focus from deficits to strengths, increasing hope and agency.

Core Skills (OARS)
• Open-ended Questions – Encourage elaboration and exploration.
  Ex: “What is your day usually like when the depression feels heaviest?”
Allows the client to answer from their own experiences and allows you to find potential motivators.
• Affirmations – Recognize client strengths and efforts.
  Ex: “The fact that you care enough to talk about this shows your determination to find a way forward.”
Affirmations counter hopelessness by spotlighting small but meaningful strengths.
• Reflections – Mirror back client thoughts and feelings to enhance understanding.
    Ex: “It sounds like part of you feels too tired to try, and another part of you still wishes things could be different.”
Reflections communicate empathy, help the client feel heard, and gently guide them toward recognizing their own ambivalence.
• Summaries – Pull together key points to reinforce progress and direction.
    Ex: “To sum up, you’re feeling weighed down, but you’ve also identified some reasons and small ways you might want things to shift.”
Summaries affirm the client’s perspective, reinforce hope, and clarify direction without imposing solutions.

The Four Processes of MI
• Engaging – Building a working relationship.
  Ex: “There’s no rush — I’d like us to get to know each other at a pace that feels comfortable for you.”
  Ex: “You’re the expert on your experience, and I’d like to work alongside you.”
Clients with chronic depression often feel misunderstood and drained; engagement builds the alliance that sustains MI.
• Focusing – Identifying the key area(s) for change.
  Ex: “You’ve shared a lot about feeling stuck. Of the things you’ve mentioned — like energy, relationships, or daily routine — which feels   most important for us to start with?”
Depression can feel overwhelming; focusing brings clarity and respects the client’s autonomy.
• Evoking – Drawing out the client’s motivation and reasons for change.
  Ex: “What would life look like if the depression lifted even a little?”
Instead of giving pep talks, the therapist elicits “change talk” — the client’s own reasons for hope.
• Planning – Developing a commitment and steps toward change.
  Ex: “Given what we’ve talked about, what feels like one small step you’d be open to trying this week?”
Planning makes change feel tangible and achievable, even for clients weighed down by chronic depression. You can utilize SMART goals to help this feel more attainable. Start slow.

Applying MI in Clinical Settings 

• Build rapport early through empathy and non-judgment.
• Listen for and reinforce 'change talk.'
• Use reflective statements to diffuse resistance.
• Encourage small, realistic steps toward change