You use motivational interviewing in your practice.
You reflect.
You ask open questions.
And yet…
If this feels familiar, you are not alone.
In many cases, the issue is not a lack of knowledge.It is a question of how the skills are being used.
The latest edition of Motivational Interviewing (Miller & Rollnick, 4th edition) highlights several important evolutions in the approach. These help clarify five common difficulties that often explain why you may feel stuck, and how to move forward.1. Responding to change talk… without cultivating it
In MI trainings, you often learn to use reflective listening. This is an important skill. A key element is learning to recognize and reflect specifically change talk. Because if you only respond to what is already present, the conversation may remain limited.
Example
Client:
“I know I should cut down… but I don’t know.”
Reflection:
“You’re unsure about making a change.”
This is accurate.
It keeps the conversation clear, but it does not move it forward.
A more helpful direction
“What concerns you most about continuing this way?”
Here, you begin to evoke additional change talk, rather than waiting for it to emerge.
Key point:
Responding to change talk is useful. Cultivating it is essential.
2. Confronting sustain talk… instead of softening it
When clients express reasons to maintain the status quo or disadvantages of changing (sustain talk), it is natural to want to correct or challenge. In practice, this often creates tension and slows the conversation.
Example
Client:
“Drinking is the only thing that helps me relax.”
Common response:
“But it’s also causing problems.”
This can increase friction.
A more helpful direction
“Given how much stress you’re under, it makes sense that you would rely on something that helps in the moment.”
This response does not endorse the behaviour. It reduces defensiveness and keeps the conversation open.
Key point:
Sustain talk is not something to eliminate. It is something to work with skillfully.
3. Using skills correctly… but without direction
You may already be applying the core skills of motivational interviewing appropriately.
You:
Yet, despite this, the conversation may not progress. A good conversation is not the same as a conversation that leads to change.
Example
Client:
“I’m torn. Part of me wants to change, part of me doesn’t.”
Reflection:
“You’re feeling conflicted.”
This is correct. But it maintains the current state.
A more helpful direction
“A part of you is starting to question whether this can continue.”
This reflection gently highlights movement toward change.
Key point
Accuracy is not enough. Interventions need to be purposeful and directional, guiding the conversation toward more change talk, not just reflecting it.
4. Underusing affirmations
Affirmations are a core component of motivational interviewing. However, in practice, they are often:
The latest edition further clarifies their role, including the distinction between more basic and more developed forms.
Example
Client:
“I almost didn’t come today.”
Common response:
“I’m glad you came.”
This is supportive, but limited.
A more helpful direction
“Even with everything going on, you still showed up. That says a lot about your commitment.”
This highlights effort, persistence, and values.
A simple affirmation acknowledges behaviour. A more developed affirmation highlights effort or values.
Key point
Effective affirmations strengthen:
They are not an accessory. They are part of the process.
5. Applying techniques… instead of embodying the approach
Motivational interviewing is often taught through techniques:
These are essential.
At the same time, the latest edition reinforces that motivational interviewing is fundamentally a relational style, grounded in:
It is possible to sound technically correct, but still feel distant in the conversation.
Consider the difference:
“What would you like to change?”
The same question can be asked:
Clients perceive this difference immediately.
When the approach becomes mechanical:
Key point
Motivational interviewing is not only what you say.It is how you are with the client.
In summary
These five difficulties are not separate problems.
They reflect a single pattern:
Practice, with intentional use of these skills, is key.
Conclusion
If your conversations feel repetitive or stalled, the solution is not to learn more tools.
It is to use the ones you already know:
The difference is not subtle. It is what separates conversations that explore change from conversations that produce it.
As the well-known martial arts saying goes:
“Fear not the man who has practiced 10,000 kicks once, but the man who has practiced one kick 10,000 times.”