The Four Processes: Evoking

By Mia Croyle, MA

In the third edition of Motivational Interviewing: Helping People Change (Miller & Rollnick, 2013), we are introduced to the four processes. In previous newsletters, we discussed the first two of these, engaging and focusing. The third process is evoking. This process is where our method becomes distinctly motivational interviewing.  Our objective in this process is to evoke the other person’s own motivations (or plans) for change.   The evoking process pays special attention to “change talk” or the other person’s arguments for change.  In the evoking process, we work on three specific practitioner skills dealing with change talk:

01. Recognizing change talk: If you listen closely enough,people often tell you their own motivations for change.  One of the challenges in recognizing change talk is that it often comes intertwined with its opposite – sustain talk (a person’s arguments for not changing).  A patient statement that includes that ambivalence might sound like: “I know my health would get a whole lot better if I quit smoking, and I’d save money, too, but I just don’t think I can do it right now.”  The part that’s underlined is the change talk!

02. Responding to change talk:  When we hear change talk, we want to affirm it, reflect it back, and ask the other person to elaborate so we can continue to encourage their internal motivation and help them build their own case for change.  Using the statement from above, it’s pretty tempting to start addressing the sustain talk part of that ambivalence by convincing the patient that he can indeed do it.  A response that is more likely to evoke more change talk would be to reflect the change talk and ask for elaboration.  That might sounds like: “So, quitting smoking would help your health and your wallet.  What aspect of your health in particular would you expect to see improve?”

03. Evoking change talk: Sometimes we have to work a little harder to get patients to offer up their arguments for change.  This requires the practitioner to be strategic and intentional with the questions asked and the ways the other person’s statements are reflected back.  One of the most straightforward ways to get change talk is simply to ask for it.  “What would be the best thing about being an ex-smoker?” or “If you did decided to quit, what would you hope to get out of it?”

Evoking is at the heart of Motivational interviewing.  When we stand on the secure foundation of an engaged and collaborative relationship and have a shared focus, we can effectively partner with our patients to help them give voice to their motivation for change and then help support them while they put that motivation into action in the planning process.

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