Process improvement for behavioral health

Use Motivational Interviewing During Treatment


Clients are stuck between wanting to change and, at the same time, not wanting to change and need help focusing on their motivation to change and stay in treatment.


Use open-ended questions and empathetic conversation to engage or re-engage clients in treatment. Express empathy and concern. Expect and honor resistance. Help motivate clients to engage or re-engage in treatment. Create discrepancy to point out that the client seems to want to change and not want to change, at the same time. Summarize their needs and concerns so that they know they have been heard.

Featured Stories

The Center for Drug Free Living in Orlando, Florida increased continuation rates to the fourth session by 27 percent. They had counselors make audio or videotapes of sessions so they could review and discuss the use of Motivational Interviewing techniques in staff meetings.

Addiction Research and Treatment Services in Denver, Colorado increased continuation rates through the first 30 days of treatment for their opioid maintenance outpatient population from 79 percent to 87 percent over a three-month period. They asked clinicians to focus on using MI techniques and strategies when scheduling the second session. For more information, see the ARTS MI Competencies and their business case.

Lessons Learned

  • Have counselors listen to tapes so that they can learn from each other and get practice assessing fidelity to Motivational Interviewing (MI).
  • Practice incorporating just one or two Motivational Interviewing principles each week.

Tracking Measures

Cycle Measure

No-show rate

Data Collection Form

No-show Tracking Spreadsheet



  • 1. Decide at which point in the treatment process you want to use MI, for example, at assessment appointment, during first treatment session, or with clients at risk for leaving.
  • 2. Select a few counselors who are willing to experiment with using MI principles or techniques. Some training in MI is desirable.
  • 3. Select one or two MI principles or techniques to practice using.
  • 4. Collect baseline data for the no-show rate at the session(s) following the one where MI will be used.


  • 5. Have the counselors use the selected principles or techniques with a sample of clients during the next two weeks.
  • 6. Audiotape or videotape a sample session.
  • 7. Track and calculate the no-show rate at the following appointment for the clients who experienced MI.


  • 8. Check the fidelity of the change. Was the change implemented as planned?
  • 9. Evaluate the change:
    • Did the counselor use the selected MI principles or techniques consistently? Use fidelity tools Add to portal to help with the evaluation.
    • Did the session flow smoothly for the counselor?
    • Did the no-show rate decrease?


  • 10. Adjust how the selected MI principles or techniques are used and re-test this promising practice for an additional two weeks. If needed, role-play the MI principles or techniques among counselors to get more practice. Add two more MI principles or techniques when ready.

Repeat this series of steps until counselors feel more proficient at using MI principles and techniques. Expand the types of sessions in which MI principles and techniques are used. Train additional counselors in Motivational Interviewing.

Related Information

More Stories

Mid-Columbia Center for Living in The Dalles and Hood River, Oregon used Motivational Interviewing techniques to re-engage clients to attend treatment if they appeared on the verge of missing a session. These techniques helped develop discrepancy for the client between where they are and where they want to be, encouraged change talk, and supported the client’s sense of self-efficacy. They reinforced this approach with contingency management.

Catalyst Behavioral Services in Oklahoma City, Oklahoma has counselors ask clients what they want, what they’re doing, and how their current behavior is helping them get what they want, in order to raise clients’ cognitive dissonance. This approach is based on William Glasser’s work and on Motivational Enhancement Techniques.

Fayette Companies in Peoria, Illinois has counselors use Motivational Interviewing to create a discrepancy and support self-efficacy. See page 35 of the Fayette Manual for Recovery Coaching and Personal Recovery Plan Development.