Addictions Case Study: Part 2 – Diagnostic Impressions

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CHAPTER 10

Evoking Cultivating Change Talk

You learn what you believe in that same way that other people learn what you believe—by hearing yourself talk.

—Daryl Bem

The reason I talk to myself is because I’m the only one whose answers I accept.

—George Carlin

A common misunderstanding about MI is that it’s just about good listen- ing, the kindly skills of the engaging task. Indeed, some professionals

have believed that’s all you really need to do as a helper.1 Sometimes skillful listening is enough for people to change, simply by virtue of having been seen and heard respectfully. It’s also true that without empathic listening you are not practicing MI.

To this foundation of engaging, MI adds the evidence-based skills of paying particular attention to the person’s own language—the “change talk” described in Chapter 6. What is often missed about MI is a purpose- ful, directional aspect whereby you use specific evoking skills to move toward a clear focus or goal, a skill we call cultivating change talk. Train- ing in MI may sometimes give insufficient attention to this strategic direc- tional component, thereby diminishing the efficacy of MI.2 Having a per-

son voice their own motivations for change can help them to realize their goals, and you don’t have to wait passively for someone to express their reasons for change. This chapter offers more depth on how to cultivate change talk.

Cultivation is an apt metaphor— preparing

In MI we use specific evoking skills to move toward a goal.

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Evoking: Cultivating Change Talk 175

and using the soil to help seeds sprout and grow. The spirit and method of MI are the soil in which motivation grows. Typically, you don’t need to provide the seeds; you just water and nourish them. Sometimes sprouts are already visible and just require some encouragement. You also avoid nurturing whatever competes with the growth of sprouts, an aspect of cul- tivation that we will discuss further in Chapter 14 on softening sustain talk and discord.

Recognizing, Inviting, and Strengthening Change Talk

In Chapter 6, we described three important aspects of the evoking task. First, you need to be able to recognize change talk when you hear it. It is tuning your ear to notice change talk and know that you’ve just heard something important. When learning MI, students often miss important bits of change talk embedded within what they hear. This can happen for various reasons, including not paying attention, being distracted by gather- ing intake information, passively allowing the person to carry on a mono- logue, or not knowing how to respond in order to elicit more from the per- son. When you do hear change talk, notice and remember it. Change talk often comes intermixed with sustain talk. Here is an example illustrating vaccine hesitancy, with some embedded change talk (indicated by boldface font):

“I don’t like needles, and I’m not planning to get this flu vaccine. How do I know what’s really in it? They’re kind of guessing about the viruses anyhow, aren’t they? I mean I don’t want to get sick or anything, but I’m pretty healthy. I guess it helps you not get really sick if you do get the virus, but I was never sick at all last year. I’ve been watching how other people have reacted to the vaccine, and most of them seem fine, although I worry about longer-term effects.”

Noticing such embedded change talk is a key skill in MI. A second skill that we discussed in Chapter 6 is inviting change talk

rather than just waiting for it. The most straightforward way is to ask an open question the natural answer to which is change talk. There are also devices like the importance ruler, looking back or forward, imagining extremes, and exploring values (see Chapter 6). All of these are intended to get some change talk started.

Of course, it also matters how you respond to change talk when you hear it, a third skill discussed in Chapter 6. In short, you can reflect it, ask more about it, and affirm it. Take on a mindset of curiosity: when you hear change talk, you want to hear more and understand it better. Remember

Notice embedded change talk.

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bits of change talk like flowers and assemble them into little posies or bou- quets that you offer back as a summary. When you’re hearing change talk, the simple question, “What else?” may open up new themes.

In this evoking task, you are thinking one step ahead: “If I say this, what will the person probably say next?” In the evoking task of MI, you choose to say things that are likely to evoke change talk rather than sustain talk, and then you learn immediately whether your guess was right. It’s not like chess where you have to think ahead a number of moves. Just one step, and then you adjust.

Here is a conversation between a person newly diagnosed with diabe- tes and a behavioral health counselor working in the medical clinic. Bold- face print indicates patient change talk.

COUNSELOR: Your doctor asked me to meet with you because you were recently diagnosed with type 2 diabetes. I wonder how you’ve responded to this news.

Open question

PATIENT: I certainly wasn’t expecting to be told that I have diabetes. It was a shock. I feel fine.

COUNSELOR: Diabetes often is a surprise. You weren’t really having any symptoms.

Reflection

PATIENT: Well, I was getting up to urinate several times a night, but I didn’t really think that much about it.

COUNSELOR: You did notice that you were getting up more often during the night.

Reflection

PATIENT: It’s been happening for a while, and I thought maybe I had a urinary tract infection so that’s why I went to see the doctor.

COUNSELOR: And so you received the news . . . it looks like 3 weeks ago now, and it was a shock. What have you been doing so far to take care of yourself?

Open question intended to evoke change talk (taking steps)

PATIENT: The nurse showed me how to check my blood with test strips.

COUNSELOR: Good! How is that going for you? Open question

PATIENT: OK, I guess. (silence) I try to remember to check it in the morning before breakfast. Is that often enough?

Change talk. “Try” implies some difficulty in doing it.

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Evoking: Cultivating Change Talk 177

COUNSELOR: Checking before breakfast tells you your fasting glucose level. It’s also good to test two hours after meals. What did your doctor tell you about how often to test?

PATIENT: I don’t remember. A few times a day maybe.

COUNSELOR: OK. And what do you already know about how testing can help you?

Open question intended to evoke change talk

PATIENT: It’s important to know how high your sugar is?

A question, but still suggests openness to change

COUNSELOR: Yes, that’s one way it helps—to be aware of your current sugar level. How else might it help?

A “what else?” question

PATIENT: I don’t know. If it’s too high maybe I can do something different.

The counselor is asking open questions strategically intended to evoke change talk. You’ll notice that the early change talk here sounds tentative,

but that’s OK. Don’t worry about qualifi- ers like “maybe” and “I guess;” it’s still change talk.

There is a lot more than just question and answer in artful evoking of change talk. How you respond when you do hear change talk can spin it into a conversation

richer in self- motivating language. Here is a portion of a conversation with a smoker.3 He has just been talking about his need for cigarettes and how smoking is embedded in his whole life. That’s where this segment begins (change talk is again highlighted in boldface).

SMOKER: If I could have a cigarette right now I would.

Sustain talk

INTERVIEWER: It’s that much a part of your life, that you feel like you would have one even right now.

Reflecting sustain talk

SMOKER: Absolutely. And I think you find yourself going out at 10 o’clock, 11 o’clock at night to go to the store to grab a pack of cigarettes when you smoke because it’s what you need, physically

And predictably, the reflection of sustain talk is followed by more sustain talk.

How you respond to change talk can prompt richer self- motivating language.

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178 a dEEPEr diVE inTo Mi

need it, but you also like it because you enjoy it.

INTERVIEWER: There’s a part of you that really enjoys smoking.

What a brilliant little reflection! It echoes his enjoyment and also suggests that there is another part of him, without asking for it. And he replies with the other part.

SMOKER: Right. And then there’s a part that says, “You really don’t want to, or you shouldn’t.” And it has nothing to do with people saying you can’t. It’s the fact that after a period of time you start—the flavor or the taste, the problems become an issue.

INTERVIEWER: Mm hmm. On the one hand, you really like it, and it’s good for you— helps you, and on the other hand you’re noticing some things you don’t like about it, like you have to go out at night and get it, you have to look for a break, and then there’s also something about the flavor and the taste, you said.

Double-sided reflection . . . . . . with change talk that he has already mentioned coming at the end

SMOKER: Yeah. You just get to a point where it’s not enjoyable anymore. You’re just doing it strictly out of habit, probably because of the nicotine that you want, but it’s really not because you want it. It’s because it gets to a point where you have to have it. And I’ve never tried to quit. I mean, I’ve been smoking for a long time and I never once said, “You know what, I’m going to quit smoking.”

INTERVIEWER: And why is that, do you think? An open question, the expected answer to which would be sustain talk

SMOKER: I think it becomes so much a part of your life, it becomes what you do, it’s everything that you are . . . if you

And sustain talk is what happens—a beautiful subjective description

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Evoking: Cultivating Change Talk 179

go fishing, you go hunting, you go to sporting events, everything you do—that cigarette becomes part of who you are, even to a point where you can’t imagine yourself looking in a mirror without holding a cigarette. It is part of you, part of who your character is, even.

of the experience of nicotine dependence

INTERVIEWER: So cigarettes are now a part of your character.

Reflection of sustain talk

SMOKER: Absolutely. It becomes part of your character. I’ve had people tell me they can’t even imagine me without a cigarette, can’t imagine what I’d look like without a cigarette.

And more sustain talk

INTERVIEWER: And you can’t even imagine yourself without a cigarette.

Reflection

SMOKER: No, so you just . . . it becomes who you are. But at the same time you know some things are happening. One is you know that the taste isn’t there anymore. The cost is getting really, really high, so now you’re finding yourself going to these lesser brands, or making this run to the reservation so you can bypass . . . I mean you have to do so much to smoke a cigarette and to maintain that desire that it gets really ridiculous, quite frankly.

And then, having expressed some sustain talk, he naturally offers change talk, a good example of ambivalence. Three minutes into the interview his change talk is beginning to outweigh his sustain talk.

INTERVIEWER: Smoking used to be carefree for you, but now it’s actually causing you a lot of trouble.

Double-sided reflection

SMOKER: It’s a challenge now. It’s not just “go get a pack of cigarettes.” It’s now, “How much do they cost? Which ones are the cheaper ones? Did you pick up a carton at the reservation because it’s so much cheaper with no taxes? Did you burn that hole in your clothes? Oh my God, that shirt—I burned a hole.” I mean, you start running into more and more issues. Then you start wondering, “What’s the return of this? What is the value?”

More change talk

Even though he is saying “you” here, he is clearly talking about himself.

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INTERVIEWER: Yeah, I was just going to ask you about that because you mentioned earlier that you’re smoking more and enjoying it less, and not only that, but then here come all of these sort of burdens or costs.

Reflecting his change talk. Her language here alludes in reverse to a cigarette commercial about smoking less and enjoying it more.

SMOKER: I would be a terrible smoke commercial. A terrible commercial.

And he catches the allusion.

The interviewer asks for and reflects some sustain talk at the begin- ning. Remember that the first challenge is engaging, which can be strength- ened by letting the person know you are understanding. Soon, however, she shifts into evoking his antismoking motivations, and just with reflections she evokes a lot of change talk without directly asking for it.

This interview also illustrates the impact of how you respond when you hear change talk. In this case, the interviewer’s only response was reflective listening focused on the change talk. You can also affirm and ask for more elaboration or for an example. Here are some examples of how you might respond to invite further change talk from the person mentioned above who was recently diagnosed with type 2 diabetes. (In Chapter 14 we will give similar examples for responding to sustain talk and discord.) The example responses are marked as open questions (O), affirmations (A), or reflections (R), with client change talk in boldface.

Change talk statements about diabetes Possible MI-consistent responses

“I don’t really like vegetables. I can eat more of them, but I don’t enjoy them.”

“You’d be willing to add more vegetables to your diet even though you don’t like them.” (R) “Your health is that important to you.” (A)

“I used to exercise regularly but I don’t anymore. I guess I could.”

“If you did start exercising again, what do you think you would do?” (O)

“If I get into a routine of checking my blood sugar, I think I can stick with it.”

“You’re someone who persists once you make up your mind to do something and figure out a way.” (A)

“I certainly don’t want to lose my eyesight. I’m thinking about taking this supplement that I’ve heard can help with blood sugar levels.”

“How is your vision important to you?” (O) “You’re willing to try new things that could help you stay healthy.” (R) “What do you know about it?” (O)

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Evoking: Cultivating Change Talk 181

FOR T HER A PIS T S: Therapeutic Evocation

The directional evoking task in MI is one example of the more general skills of evocation in counseling and psychotherapy.4 Within your own theoretical orientation, are there particular responses that you hope to hear from clients during therapy? You probably have an intuitive sense of this—that you’re glad when you hear your clients say particu- lar things, but why? From a clinical research perspective, there should be good evidence that clients’ saying or doing these things during counseling sessions predicts and promotes better treatment outcome. Therapeutic evocation is the further step of strategically encouraging your clients to respond in a particular way during sessions. It is literally calling forth from your clients that which is healing.

An example within a person- centered perspective is experienc- ing,5 the depth of clients’ introspective engagement in therapy, which is reliably measurable from what they say during sessions.6 At a low level of experiencing, clients speak about themselves in abstract, superficial, impersonal ways, giving past-tense descriptive accounts with little emotional content. High experiencing is more immediate, first- person, present-tense, and emotionally engaged.7 There is strong evidence that in- session experiencing predicts better treatment out- come within various therapeutic orientations.8 Therapists who are more empathic, accepting, and affirming encourage higher levels of sustained client experiencing.9

Similarly, practitioners of functional analytic psychotherapy (FAP) are alert for clinically relevant behaviors that occur within sessions that could favor or interfere with positive change. Within a relational and contextual approach, FAP therapists seek to decrease in- session problem behaviors and reinforce improvement- relevant responses.10

In MI, particular attention is paid to client change talk and sus- tain talk, the balance of which predicts whether change will occur.11 Therapist responses clearly influence this balance in both experimen- tal studies and sequential analyses.12,13 This directional evocation is just one aspect of the efficacy of MI, and it occurs within the larger relational context of this method.

Evoking Both Why and How

In sum, it matters what client language you invite and strengthen. Strategic evoking of squares 1 and 4 in a decisional balance (see Chapter 9) is likely to help the person move toward change, assuming that’s what you intend to do. If you want to stay neutral without influencing the direction of choice,

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182 a dEEPEr diVE inTo Mi

then you would intentionally pay equal attention to advantages and disadvantages of change.

Here is one more example of evoking change talk with someone who is low in confidence. The counselor is talking with a middle-aged woman who is considering whether to enter a community college and vocational training program.14 She had tried to enroll once before but never completed the application process. She says she would like to get some skills and a reliable career, but then she immediately expresses some doubts about whether she can.

COUNSELOR: So you tried to enroll once before and didn’t quite make it through the process, but you’re feeling like you want to change how you work now.

Reflecting prior change talk

STUDENT: Well, I think I might want to, but I don’t know if I can do the paperwork and be with all the young students and do the tests.

And she replies revealing both sides of her ambivalence

COUNSELOR: You’ve got some doubts about whether you can do it.

Reflecting sustain talk

STUDENT: Yeah, I don’t think I’m really smart enough to go to school.

More sustain talk

COUNSELOR: Hm. So part of you thinks you haven’t got what it takes to make it through an academic program.

Reflecting “part of” her that has doubts

STUDENT: I have to do something. She replies with change talk (need).

COUNSELOR: So you may be right about that— you might not have what it takes. On the other hand, when I was looking at your paperwork, your aptitude—you’ve got some pretty clear aptitude and you got your GED [General Educational Development diploma], which a lot of people can’t manage to do. I feel like your paperwork is telling me that you’ve got some things going for you that are pretty strong.

STUDENT: Well, but the GED was really easy.

COUNSELOR: Was it?

It matters what language you invite

and strengthen.

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Evoking: Cultivating Change Talk 183

STUDENT: Right, but I don’t know about the other work, the tests and things. It’s been a long time since I’ve been in school, so I really don’t think that I’m cut out for that.

COUNSELOR: So the GED felt really easy, so that makes you kind of discount it; it doesn’t really count because it was easy.

Amplified reflection

STUDENT: Well, maybe so. I never really thought of it that way. But certainly the classes have to be a lot harder.

COUNSELOR: So you kind of feel like you’re in over your head, that you’re not going to be able to manage.

“Coming alongside” instead of disagreeing

STUDENT: And there are all these young people around here [on campus] and I know I’d be the oldest one. That makes me really uneasy, being around so many younger people.

COUNSELOR: Right, because they probably have a lot more energy than us older people.

Straight-faced but gently teasing

STUDENT: (Laughs.) Well, maybe so. I never really thought of that either. (Smiles.)

And she gets it.

COUNSELOR: (Also laughing) What’s making you laugh right now?

STUDENT: I feel like I have a lot of energy, but I don’t know about going to school with younger people and studying. I haven’t studied for a long time.

Change talk and sustain talk together

COUNSELOR: Huh. So I’m kind of seeing this list developing of all the reasons why you don’t think you can do it. (Counts them off one, two, three on her fingers.) You can’t do it because you’re too old, you can’t do the paperwork, you don’t know if you’re smart enough. So you’ve kind of got this list of the reasons why it won’t work. And yet I’m sensing that there’s another list somewhere. I don’t know what’s on your other list.

Summarizes the student’s sustain talk and then asks for the other side

STUDENT: Well, I really want to do this. Change talk

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184 a dEEPEr diVE inTo Mi

COUNSELOR: You do! Tell me the reasons. Asking for more

STUDENT: I’ve never really had a career in my life, and I need to find something to support myself because I can’t live like this anymore.

COUNSELOR: You’ve never had a career, so this feels like a big leap.

STUDENT: Oh, I’ve had a few different things. I waitressed for a while. Mostly just waitressing.

COUNSELOR: OK, so we’ve got your No list, but your Yes list is “Yes, I want a career. Yes, I need safety and want to support myself.” What else is on the Yes list?

Starting a bouquet of change talk What else?

STUDENT: Well, my friend, she told me that she did it. So she said that if she did it, I could do it, too. My sister has been telling me that I should do it, too.

COUNSELOR: So your friend and your sister both kind of believe in your ability to accomplish this.

Reflection

STUDENT: Yeah.

COUNSELOR: What makes them believe that? Evoking strengths

STUDENT: I don’t know. Maybe they see something in me that I don’t?

COUNSELOR: What do you think they see?

STUDENT: Maybe that I’m a pretty strong person.

COUNSELOR: Huh! Now by “strong” do you mean that you lift weights?

Again, gently teasing

STUDENT: (Grins.) No, that I’m determined. Is that a right word for it?

Change talk

COUNSELOR: So you’re strong in that you’re determined, like when you set your mind to something you’re determined to make it happen.

STUDENT: To do it, even though I haven’t been very successful a lot of times.

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Evoking: Cultivating Change Talk 185

COUNSELOR: But your friend and your sister see that when you’re determined to do something you really have a lot of energy behind it.

STUDENT: I guess maybe they see that I’m capable of doing it.

Although the counselor in this case was a professional helper, most of this conversation could have as easily been between the student and a friend. The skills are deceptively simple—mostly reflections and open ques- tions—but all the time the interviewer is consciously purposeful in evoking the student’s own change talk as a source of hope. The tone is lighthearted and supportive. The temptation for either a friend or a professional helper is to argue with her and try to persuade her that she should enroll. Instead the student is gradually deciding, despite her reservations, that she not only needs to but also can do it.

MI in Groups

Human services are often delivered to groups and not just to individuals. There are group medical visits, mutual support groups, educational, coun- seling, and skill training groups. An obvious advantage is the potential cost- effectiveness as compared with serving one person at a time, and there can be other benefits as well. There can be synergy among participants who learn and practice together, supporting each other in pursuing change and growth.

Is it possible to provide MI in groups? Clearly, the answer is “yes.”15 The spirit and method of MI can be practiced with groups as well as indi- viduals and can be delivered virtually via online groups.16 The engaging skills of MI can guide how you respond to participants and even how you encourage them to respond to each other. For example, you can establish some group guidelines to encourage MI consistency: listen to understand before responding, ask permission before offering advice, avoid labeling people or being judgmental. You don’t have as much time to engage with each participant, hearing and responding to their individual stories, but the group observes how you respond to other members as well as themselves. You can also model an MI approach when responding to sustain talk and discord that emerge in the group.

Often the topical focus for an MI-informed group is chosen in advance. For example, MI groups have been used effectively to help people with job finding,17 weight loss,18 diabetes management,19 and reducing alcohol use.20 A group MI format can also be used to help participants set their own goals for change.21

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186 a dEEPEr diVE inTo Mi

A distinctive characteristic of MI groups is the evoking task of inviting and strengthening client change talk.22 Again, a challenge here is that in groups each individual gets less talk time. As a group leader, you can pose open questions that invite change talk and have group members take turns in answering as you respond with reflection and affirmation. To give each individual more time for motivational reflection, you can assign in- session or between- session writing tasks to evoke their own change talk, then dis- cuss these in the group. You can build a collective summary of change talk themes, writing them down for the group as they are voiced. Similarly, in the planning process you can invite, reflect, record, and summarize ideas for the how of change. Draw together broader themes of challenges, change talk, feelings, and values being expressed. There can be inspiring synergy as group members voice their own change talk about why and how. Keep group members engaged by inviting those who have been silent to speak. Realize that even while people are not speaking up themselves, change may be percolating as they listen to others in the group.

An MI approach in groups is compatible with conveying information or skill- building, helping participants to relate the material to their own situation and values. Providing information to a group is a well-worn path in many settings. Using ask–offer–ask (see Chapter 11) provides structure for a discussion that is lively and information-rich and that can be guided by asking questions such as, “What does this information mean for you going forward?” or “What struck you the most personally about this infor- mation?” The expression of change talk and hopes for the future are a common outcome.

Compared to a straight didactic approach, an MI group can improve client outcomes.23 You can cultivate change with groups as well as indi- viduals. As in individual MI, counselor questions, reflections, and affirma- tions can increase group change talk, which in turn predicts subsequent individual behavior change.24

PERSON A L PERSPEC T IV E : Vertical Ambivalence

Occasionally, one side of a person’s ambivalence is not consciously perceived. One pole is in plain sight, while the other—which may be equally or more potent—has been excluded from the person’s con- scious awareness. In such vertical ambivalence,25 the person is cognizant of one motivation but is not consciously aware of a strong conflicting motive. This can leave people puzzled about their own per- sistent behavior or overzealous about the conscious motive. I encoun- tered this ambivalence in my clinical practice. One client, for example, longed to be warmly loved, and yet was continuously attracted to men

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Evoking: Cultivating Change Talk 187

who were uncomfortable with emotional intimacy. The unconscious motivation may be discernible from such inconsistencies. In her case she was trying to rewrite her childhood relationship with an emotionally distant father, hoping this time to get him to love her.

How can you help people resolve ambivalence when they seem unaware of an important piece of the puzzle? It was a friend who pointed out such an inconsistency in my own life when I claimed to feel no interest in having children. “Whenever I see you in a room with adults and children,” he said, “you’re the one on the floor talking and playing with the kids. What’s that about?” 26 Just pointing to the para- dox may not make an immediate difference, but it can set the wheels in motion. My client experienced an “aha” insight when talking about her father, but continued to feel romantically attracted to men who were unlikely to give her what she wanted. In my own case it was a few months before a crucial puzzle piece fell into place when I remem- bered how my own father had been emotionally devastated by my young sister’s death and realized that I had essentially lost them both that day, though he lived another two decades. In fact, I love children as he did, but I wasn’t sure I wanted to risk anything that could do that to a man. We now have three adopted children who are an inseparable part of our lives.

I don’t have a better suggestion for dealing with vertical ambiva- lence than to provide patient, empathic support, perhaps with some double-sided reflections, while they integrate what they have not quite been ready to consider. From a psychodynamic perspective, this is a matter of the appropriate timing of interpretation. Sometimes peo- ple are able to work through such vexing conflicts within a safe and empathic helping relationship like MI.

—Bill

In Chapter 11 we take up another important function of helpers: to offer information and advice, but in a particularly skillful way. Offering your own expertise— information and advice—could occur anywhere dur- ing MI. How you do it is as important as what you say.

K E Y C O N C E P T S

• Cultivating change talk • Embedded change talk • Experiencing (see “For Therapists:

Therapeutic Evocation” on p. 181) • Vertical ambivalence

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-02-09 04:55:08.

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188 a dEEPEr diVE inTo Mi

K E Y P O I N T S

• To person- centered engaging skills, MI adds a purposeful, directional element whereby you use specific evoking skills to move toward a clear focus or goal.

• The evoking task involves skills for recognizing, inviting, and then responding to change talk in a way that strengthens it.

• When evoking, think one step ahead: If I say this, what is the client likely to say next?

Notes and References 1. The most famous is Carl Rogers, pioneer of client- centered counseling, which he

originally called “nondirective,” a term he subsequently abandoned in favor of a “person- centered” way of being. Kirschenbaum, H. (2009). The life and work of Carl Rogers. American Counseling Association.

Rogers, C. R. (1980). A way of being. Houghton Mifflin. 2. Forman, D. P., & Moyers, T. B. (2021). Should substance use counselors choose a

direction for their clients? Motivational interviewing trainers may be ambivalent. Alcoholism Treatment Quarterly, 39(4), 446–454.

3. The interviewer here is Dr. Theresa Moyers. This is one of 14 demonstration inter- views in Miller, W. R., Rollnick, S., & Moyers, T. B. (2013). Motivational Inter- viewing: Helping People Change (DVD series). The Change Companies. www. changecompanies.net/products/motivational- interviewing- videos. Used by permis- sion.

4. Miller, W. R., & Moyers, T. B. (2021). Effective psychotherapists: Clinical skills that improve client outcomes. Guilford Press.

5. Gendlin, E. T. (1961). Experiencing: A variable in the process of therapeutic change. American Journal of Psychotherapy, 15(2), 233–245.

6. Klein, M.  H., Mathieu- Coughlan, P., & Kiesler, D.  J. (1986). The experiencing scales. In L. S. Greenberg & W. M. Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 21–71). Guilford Press.

7. Stiles, W. B., McDaniel, S. H., & Gaughey, K. (1979). Verbal response mode cor- relates of experiencing. Journal of Consulting and Clinical Psychology, 47(4), 795– 797.

8. Goldman, R. N., Greenberg, L. S., & Pos, A. E. (2005). Depth of emotional experi- ence and outcome. Psychotherapy Research, 15(3), 248–260.

Harrington, S., Pascual-Leone, A., Paivio, S., Edmondstone, C., & Baher, T. (2021). Depth of experiencing and therapeutic alliance: What predicts outcome for whom in emotion- focused therapy for trauma? Psychology and Psychotherapy: The- ory, Research and Practice, 94(4), 895–914.

Hill, C. E. (1990). Exploratory in- session process research in individual psycho- therapy: A review. Journal of Consulting and Clinical Psychology, 58(3), 288–294.

Pascuel-Leone, A., & Yervomenko, N. (2017). The client “experiencing” scale as a predictor of treatment outcomes: A meta- analysis on psychotherapy process. Psychotherapy Research, 27(6), 653–665.

9. Wiser, S. G., & Goldfried, M. R. (1998). Therapist interventions and client emotional experiencing in expert psychodynamic– interpersonal and cognitive– behavioral therapies. Journal of Consulting and Clinical Psychology, 66(4), 634–640.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-02-09 04:55:08.

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Evoking: Cultivating Change Talk 189

10. Tsai, M., Yard, S., & Kohlenberg, R. J. (2014). Functional analytic psychotherapy: A behavioral relational approach to treatment. Psychotherapy, 51(3), 364.

Villas-Bôas, A., Meyer, S. B., & Kanter, J. W. (2016). The effects of analyses of contingencies on clinically relevant behaviors and out-of- session changes in func- tional analytic psychotherapy. The Psychological Record, 66(4), 599–609.

11. Houck, J. M., Manuel, J. K., & Moyers, T. B. (2018). Short- and long-term effects of within- session client speech on drinking outcomes in the COMBINE study. Journal of Studies on Alcohol and Drugs, 79(2), 217–222.

Magill, M., Apodaca, T.  R., Borsari, B., Gaume, J., Hoadley, A., Gordon, R. E. F., et al. (2018). A meta- analysis of motivational interviewing process: Tech- nical, relational, and conditional process models of change. Journal of Consulting and Clinical Psychology, 86(2), 140–157.

12. Miller, W. R., Benefield, R. G., & Tonigan, J. S. (1993). Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. Jour- nal of Consulting and Clinical Psychology, 61, 455–461.

Glynn, L. H., & Moyers, T. B. (2010). Chasing change talk: The clinician’s role in evoking client language about change. Journal of Substance Abuse Treatment, 39(1), 65–70.

13. Moyers, T. B., & Martin, T. (2006). Therapist influence on client language during motivational interviewing sessions. Journal of Substance Abuse Treatment, 30(3), 245–252.

Moyers, T. B., Martin, T., Houck, J. M., Christopher, P. J., & Tonigan, J. S. (2009). From in- session behaviors to drinking outcomes: A causal chain for motiva- tional interviewing. Journal of Consulting and Clinical Psychology, 77(6), 1113– 1124.

Walthers, J., Janssen, T., Mastroleo, N. R., Hoadley, A., Barnett, N. P., Colby, S. M., et al. (2019). A sequential analysis of clinician skills and client change state- ments in a brief motivational intervention for young adult heavy drinking. Behav- ior Therapy, 50(4), 732–742.

14. The interviewer is Dr. Carolina Yahne. This transcribed interview is from Miller, W.  R., Rollnick, S., & Moyers, T.  B. (1998). Motivational Interviewing (DVD series). University of New Mexico. Used by permission.

15. Wagner, C. C., & Ingersoll, K. S. (with contributors). (2013). Motivational inter- viewing in groups. Guilford Press.

Ingersoll, K. S., Wagner, C. C., & Gharib, S. (2006). Motivational groups for community substance abuse programs (3rd ed.). Substance Abuse and Mental Health Services Administration.

Velasquez, M., Stephens, N. S., & Ingersoll, K. (2006). Motivational interview- ing in groups. Journal of Groups in Addiction and Recovery, 1, 27–50.

16. Webber, K. H., Tate, D. F., & Quintiliani, L. M. (2008). Motivational interviewing in Internet groups: A pilot study for weight loss. Journal of the American Dietetic Association, 108(6), 1029–1032.

17. Britt, E., Sawatzky, R., & Swibaker, K. (2018). Motivational interviewing to pro- mote employment. Journal of Employment Counseling, 55(4), 176–189.

18. Resnicow, K., Taylor, R., Baskin, M., & McCarty, F. (2005). Results of Go Girls: A weight control program for overweight African- American adolescent females. Obesity Research, 13, 1739–1748.

19. Knight, K. M., Bundy, C., Morris, R., Higgs, J. F., Jameson, R. A., Unsworth, P., et al. (2003). The effects of group motivational interviewing and externalizing con- versations for adolescents with Type-1 diabetes. Psychology, Health and Medicine, 8(2), 149–157.

20. Labrie, J.  W., Lamb, T.  F., Pedersen, E.  R., & Quinlan, T. (2006). A group

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motivational interviewing intervention reduces drinking and alcohol- related conse- quences in adjudicated college students. Journal of College Student Development, 47, 267–280.

21. Lincourt, P., Kuettel, T. J., & Bombardier, C. H. (2002). Motivational interviewing in a group setting with mandated clients: A pilot study. Addictive Behaviors, 27, 381–391.

22. Shorey, R. C., Martino, S., Lamb, K. E., LaRowe, S. D., & Santa Ana, E. J. (2015). Change talk and relatedness in group motivational interviewing: A pilot study. Journal of Substance Abuse Treatment, 51, 75–81.

23. Santa Ana, E. J., LaRowe, S. D., Gebregziabher, M., Morgan-Lopez, A. A., Lamb, K., Beavis, K. A., et al. (2021). Randomized controlled trial of group motivational interviewing for veterans with substance use disorders. Drug and Alcohol Depen- dence, 223, 108716.

24. D’Amico, E. J., Houck, J. M., Hunter, S. B., Miles, J. N. V., Osilla, K. C., & Ewing, B. A. (2015). Group motivational interviewing for adolescents: Change talk and alcohol and marijuana outcomes.ÿJournal of Consulting and Clinical Psychology, 83(1), 68–80.

25. Baek, Y. M. (2010). An integrative model of ambivalence. Social Science Journal, 47(3), 609–629.

26. Miller, W. R. (2022). Out of the depths. In On second thought: How ambivalence shapes your life (pp. 63–72). Guilford Press.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-02-09 04:55:08.

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