Motivational Interviewing in Wellness: Techniques for Driving Sustained Behavior Change

For individuals seeking to adopt healthier habits—be it improving nutrition, increasing physical activity, or managing chronic stress—the biggest obstacle is often not a lack of knowledge, but a lack of internal resolve.¹ Traditional, confrontational wellness coaching, characterized by prescribing solutions and emphasizing deficits, frequently leads to resistance and short-lived motivation. Motivational Interviewing (MI), developed by psychologists William R. Miller and Stephen Rollnick, offers a humanistic, evidence-based alternative.² MI is a collaborative, goal-oriented style of communication designed to strengthen a person’s own motivation for and commitment to change.³ This article dissects the core techniques of MI, from establishing its foundational spirit to mastering the core skills of OARS (Open-ended questions, Affirmations, Reflections, and Summaries).⁴ By focusing on resolving ambivalence and eliciting Change Talk, MI transforms the dynamic of wellness coaching from fixing a problem to facilitating the individual’s inherent capacity for sustained, autonomous behavior change.⁵

Check out SNATIKA and ENAE Business School’s prestigious online MSc in Health and Wellness Coaching and Diploma in Health and Wellness Coaching before you leave.

1. The MI Spirit: Collaboration, Evocation, and Autonomy (CEA)

Motivational Interviewing is less about a rigid set of steps and more about a foundational spirit that guides the interaction. This spirit stands in direct contrast to the authoritarian or "expert" model prevalent in older forms of counseling. Adhering to the three components of the MI spirit is crucial for minimizing client resistance and maximizing intrinsic motivation<SUP><small>1</small></SUP>.

1.1. Collaboration (Partnership)

MI views the relationship as a partnership, not a hierarchy.⁶ The practitioner recognizes the client as the ultimate expert on their own life, history, and experience.⁷ The language used reflects this: "How might we explore this?" rather than "You must do X." This collaborative stance respects the client's perspective and reduces the power imbalance that often makes clients defensive.⁸ In wellness, this means co-creating a meal plan or exercise routine rather than handing down a pre-written prescription.

1.2. Evocation (Drawing Out)

The core principle of MI is that people already possess the inner resources, reasons, and potential for change. The interviewer’s job is not to put motivation into them, but to evoke it from them.⁹ This aligns with Self-Determination Theory which posits that intrinsic motivation (doing something because you value it) is far more sustained than extrinsic motivation (doing something for a reward or to avoid punishment). The practitioner constantly asks, "What reasons do you have for wanting to move more?" rather than, "Here are the health benefits of exercise."

1.3. Autonomy (Respecting Choice)

MI practitioners fully accept the client's right to choose whether or not to change.¹⁰ This radical acceptance is paradoxically one of the most powerful motivators. When a client feels judged or pushed, they often exhibit psychological reactance—the urge to do the opposite of what they are told.¹¹ By respecting autonomy—"The decision about what comes next is entirely yours"—the practitioner lowers the stakes, reduces resistance, and allows the client’s inherent desire for health to surface naturally.¹²

2. The Problem of Ambivalence: The Decisional Balance

The primary target of MI is ambivalence, the natural human state of feeling two ways about a change. A smoker knows cigarettes are unhealthy but finds comfort in the habit. An executive wants better sleep but values the productivity gained from working late. This internal conflict is what keeps people stuck. Traditional methods often mistakenly try to beat the "good reasons" for the status quo (Sustain Talk) by overwhelming them with facts about the change (Change Talk), leading to a frustrating "wrestling match."

2.1. Defining Ambivalence

Ambivalence can be understood through the Decisional Balance, which weighs the pros and cons of both changing and not changing:¹³

The MI strategy is not to diminish the pros of not changing, but to gently and non-judgmentally explore the cons of not changing and amplify the pros of changing, thus tipping the balance toward action.

2.2. Eliciting Change Talk (DARN)

Change Talk is any client speech that favors movement in the direction of change.¹⁴ MI techniques are specifically designed to evoke, recognize, and reinforce this language, focusing on four key categories (DARN)<SUP><small>2</small></SUP>:

• Desire: Statements about preference for change (e.g., "I wish I could feel more energized.")
• Ability: Statements about capability (e.g., "I think I could manage two short walks a week.")¹⁵
• Reasons: Specific arguments for change (e.g., "If I lose weight, my doctor said I can reduce my medication.")¹⁶
• Need: Statements recognizing urgency or necessity (e.g., "I need to start sleeping better, or I won’t pass my exams.")

3. Core Skill I: Open-Ended Questions (O)

Open-ended questions are the primary tool for evocation. They are designed to encourage the client to talk more, think deeper, and articulate their own perspective, generating the critical Change Talk necessary for motivation. Unlike closed questions ("Did you exercise this week?"), which invite a one-word answer, open questions invite narrative and reflection.

3.1. The Function of Open Questions

The goal is to shift the client from a defensive, reactive posture to an exploratory, proactive one. Good open questions serve several functions in a wellness setting:

• Eliciting Desire: "What are your hopes for your health in the next six months?"
• Exploring Importance: "Suppose you did start meditating every day. What difference would that make in your life?"
• Scaling and Severity: "On a scale of 1 to 10, where 1 is not important at all and 10 is the most important thing, where would you place improving your diet? And why did you pick a 6 and not a 3?"
• Addressing the Gap: "You mentioned you want to be able to keep up with your grandchildren, but you also mentioned that your back hurts too much to walk the length of a football field. What do you make of the difference between those two statements?" (This explores the discrepancy between current behavior and core values).

4. Core Skill II: Affirmations (A)

Affirmations are positive, specific statements made by the practitioner about the client's strengths, efforts, and intentions. They are vital for boosting self-efficacy—the client’s belief in their own ability to succeed. Affirmations counteract the internalized self-criticism and shame that often accompany failed attempts at behavior change.

4.1. Rules for Effective Affirming

Affirmations must be genuine and grounded in specific, observed behaviors or expressed intentions:¹⁷

• Focus on Effort, Not Just Outcome: Instead of "Great job losing 5 pounds," try "I really admire how you stuck to your walking routine even though the weather was bad. That shows real commitment."
• Acknowledge Intentions: "It took a lot of honesty and courage to share how stressed you are about your job. That tells me you're serious about finding a way to manage it."
• Validate Past Successes: "Even though you haven't been able to quit smoking entirely, you managed to cut back by half last year.¹⁸ That demonstrates you have the ability to make powerful changes when you set your mind to it."

Affirmations gently shift the client’s self-perception from being a "failure" to being a "person capable of positive action," reinforcing their Ability to change.¹⁹

5. Core Skill III: Reflective Listening (R)

Reflective Listening is the centerpiece of MI. It is the process of listening carefully and hypothesizing what the client means, then checking that hypothesis by stating it back as a reflection. This technique assures the client that they are being heard and understood, validating their emotional landscape.

5.1. Simple vs. Complex Reflections

• Simple Reflection: Stating back what the client said, often rephrased slightly.²⁰ (Client: "I just don't have time to meal prep." Practitioner: "So, time constraints are a major hurdle for you.")
• Complex Reflection: Adding meaning or emotion to the client's statement, attempting to capture what was implied but not explicitly said.²¹ (Client: "I hate my job, but I can't afford to leave it, so I guess I’ll just live on caffeine and anxiety." Practitioner: "It sounds like you feel trapped in your current situation, and that lack of control is leading you to rely on less healthy ways to cope.") This complex reflection deepens the conversation by reflecting an emotional Con of the status quo.

5.2. Double-Sided Reflections

Double-sided reflections are used specifically to address ambivalence by reflecting both sides of the client's conflict in a single statement (using the word "and", never "but").²²

• Example: "On one hand, you really enjoy the social aspect of having late-night drinks with your colleagues, and on the other hand, you’re worried that those drinks are making it impossible to stick to your gym schedule and are hurting your sleep." This neutral summary of the dilemma prepares the client to explore one side more deeply.

6. Core Skill IV: Summaries (S)

Summaries are strategic tools used to collect, organize, and present the client's own statements back to them. They serve three primary purposes: bridging, collecting, and linking.

6.1. Collecting and Linking

A good summary is not just a recitation; it is a strategic curation of the client's Change Talk, often collected over several minutes or sessions. The practitioner consciously selects and groups the client's Desire, Ability, and Reason statements, linking them together to create a powerful internal argument for change.²³

• Example Summary: "Let me see if I have this right. You told me that you wish you had more energy (Desire). You also said that since you successfully quit soda last month, you know you can stick to healthy changes (Ability). And the main reason you want to tackle your stress is to be a more patient parent (Reason/Value). Is that correct?"

By hearing their own reasons and abilities synthesized in one clear statement, the client is often moved closer to resolving their ambivalence and preparing for the final phase: planning and commitment.

7. Navigating Sustain Talk: Rolling with Resistance

When a client speaks in favor of the status quo ("I don't have time," "It's too hard," "I like my pizza"), this is called Sustain Talk (arguments against change). In MI, sustain talk is not viewed as hostility or stubbornness, but as a normal reaction to being pushed.

7.1. Rolling with Resistance

The practitioner's response to Sustain Talk should be to "roll with resistance"—that is, to avoid arguing, challenging, or correcting the client.²⁴ Arguing back only causes the client to defend their current position more strongly (The "wrestling match").²⁵

• Avoid: "But you know that pizza isn't good for your cholesterol."
• Use (Reflection): "So, it feels like the enjoyment and convenience of that pizza is really important to you right now." (Simple reflection).
• Use (Amplified Reflection): Reflect the client's statement back in a slightly exaggerated, but non-sarcastic way.²⁶ (Client: "I can't possibly give up my morning coffee ritual." Practitioner: "It sounds like giving up that coffee would be completely devastating to your life right now.") This subtle exaggeration often causes the client to step back and qualify their statement, reducing the resistance ("Well, maybe not devastating, but it would be really hard.").

8. The Planning Phase: Commitment Language (CAT) and Implementation Intention

Once Change Talk is dominant and Sustain Talk has diminished, the conversation naturally transitions to planning. This is the shift from DARN (Desire, Ability, Reason, Need) to CAT (Commitment, Activation, Taking Steps).

8.1. Eliciting Commitment Language

The goal is to get the client to articulate their next steps, using strong, active verbs:

• Commitment: Statements of intent (e.g., "I will join the gym this week," "I’m going to call the therapist.").²⁷
• Activation: Preparing for action (e.g., "I plan to look up the gym’s opening hours," "I’m ready to block out 30 minutes tonight to try that sleep app.").
• Taking Steps: Concrete action already in motion (e.g., "I already bought new running shoes.").

8.2. Implementation Intention

The practitioner helps the client translate vague commitment into concrete, actionable steps using the "If-Then" structure (Implementation Intention). This moves the change out of the realm of motivation and into the realm of habit and routine<SUP><small>3</small></SUP>.

• Vague Commitment: "I'm going to eat healthier."
• Implementation Intention: "If I walk past the vending machine at work, then I will automatically reach for the apple I packed instead." Or, "If I wake up at 7:00 AM, then I will immediately put on my exercise clothes."

This technique anchors the new behavior to an existing environmental or temporal cue, significantly increasing the likelihood of follow-through.

9. Integration into Digital Wellness and Coaching Models

MI principles are highly adaptable to modern, digital wellness coaching, enhancing the efficacy of remote and asynchronous interactions.

9.1. Asynchronous MI

In app-based coaching or email check-ins, the practitioner can still use the MI framework:

• Reflections in Text: Using text to reflect emotional tone ("I hear how frustrating it must be to hit a plateau") builds rapport even without a visual cue.
• Open Prompts: Digital prompts should prioritize open-ended questions over data entry. Instead of "Did you track your steps?" try "What were the biggest lessons you learned from your movement this week?"
• Affirmation Through Feedback: Automated or personalized feedback can affirm effort and ability ("Your consistency in logging your mood shows real dedication to self-awareness").

9.2. Managing Scale in Digital Coaching

Digital tools can automate the collection of Change Talk.²⁸ For instance, a chatbot or journaling feature can prompt users to articulate their reasons for change. This data can then be summarized and presented back to the user (a digital summary), helping them visualize their own motivation and progress, strengthening autonomy and evocation without constant human intervention.

Conclusion: Facilitating Intrinsic Change

Motivational Interviewing represents a profound shift in the delivery of wellness and health behavior coaching. It is an acknowledgment that sustainable change stems from an individual's intrinsic values and self-determination, not from external pressure or shame. By mastering the non-judgmental MI Spirit and applying the core skills of OARS to strategically elicit and reinforce Change Talk, practitioners can effectively resolve the debilitating conflict of ambivalence. MI transforms the dynamic from the practitioner trying to "fix" the client, to the client being gently guided to uncover and activate their own powerful reasons for a healthier life. This collaborative approach yields not just temporary adherence, but deep-seated commitment, making it the gold standard for driving sustained behavior change in the digital age.

Check out SNATIKA and ENAE Business School’s prestigious online MSc in Health and Wellness Coaching and Diploma in Health and Wellness Coaching before you leave.

Citation List

1. Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press.²⁹
2. Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. Guilford Press.
3. Sheeran, P., & Orbell, S. (2000). Self-regulation and the theory of planned behavior. In M. P. Zanna (Ed.), Advances in experimental social psychology, 32, 61-123. Academic Press. (Foundational work on implementation intentions.)
4. Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. (Core theory supporting the MI Spirit.)
5. Miller, W. R., & Moyers, T. B. (2015). The phenomena of resistance and sustain talk in motivational interviewing. Behavioural and Cognitive Psychotherapy, 43(5), 629–645.
6. Bandura, A. (1997). Self-efficacy: The exercise of control.³⁰ W. H. Freeman and Company. (Pillar concept addressed by MI Affirmations.)³¹
7. Moyers, T. B., Rowell, L. N., & Manuel, J. K. (2016). The relationship of therapist ratings of Motivational Interviewing skill to client change and outcome: A meta-analysis. Journal of Consulting and Clinical Psychology, 84(1), 1–11.
8. Hardcastle, S. J., et al. (2017). Motivational interviewing in physical activity and nutrition interventions: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1-19. (Meta-analysis of MI efficacy in wellness.)
9. Rollnick, S., et al. (2010). Motivational interviewing: A means to encouraging shared decision making. American Journal of Preventive Medicine, 39(5), S269-S272.
10. Cox, V., & Miller, W. R. (2013). The Motivational Interviewing Treatment Integrity (MITI) Code Manual 4.2.1. University of New Mexico. (Tool for measuring the fidelity of MI skills.)