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.


The Four Processes: Focusing

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 our newsletter, we discussed the first of these, engaging. The second of the four processes is focusing. Our objective in this process is the collaborative, ongoing process of seeking and maintaining direction. 

In Motivational Interviewing. there are three main sources of focus, and in almost every instance. we rely on some combination of them all:

01. The other person (the “patient”): people generally have concerns, preferences, ideas, and values that influence our focusing process. For example, in BSI, if a patient screens positive for potential risk in the areas of tobacco use and depression, the patient will have some ideas about where he or she would like to start, and we certainly give priority to those ideas.

02. The setting: in BSI, we are in a healthcare context and generally, our health educators have a pre-established list of behaviors that they are trained and sanctioned to address. If patients have concerns that fall outside these areas, the health educator can refer patients to other resources.

03. The helping professional’s clinical expertise: in BSI, this is informed by the results of the screen and brief assessment. Other members of the healthcare team, such as the physician, may also have clinical expertise that informs our focusing process.

Like each of the four processes, focusing is an ongoing process. Once we have established a focus, we continue to attend to focusing throughout our interaction. We may need to revisit our focus at times to make sure we are still on the same page with the other person.


The Four Processes of MI: Engaging

By Mia Croyle, MA

In the third edition of Motivational Interviewing: Helping People Change (Miller & Rollnick, 2013), we are introduced to the four processes.  The first of these is engaging.  Our goal in this process is to establish and maintain a collaborative working relationship with the other person.

Ways to promote engagement:

  • Ask for and listen to what the other person wants
  • Seek an understanding of how important the topic at hand may be to the other person
  • Look for what you can genuinely appreciate and comment positively about
  • Provide the person with some sense of what to expect
  • Offer hope – explain how what you do may help

Ways to promote disengagement:

  • Assume an expert role
  • Move too quickly into an assessment process
  • Prematurely focus on one specific problem
  • Use language that indicates labeling or blaming


What’s New in Motivational Interviewing: The Four Processes

By Mia Croyle, MA

The third edition of Motivational Interviewing: Helping People Change (Miller & Rollnick, 2013) is the authoritative presentation of Motivational interviewing (MI).  This edition represents the latest in what is known about this powerful approach to facilitating change after 30 years of research and clinical experience.

One of the newest ideas introduced in this edition is that of the four processes which occur in a generally sequential, yet overlapping and recurring, fashion in the motivational conversation.

These four processes are:

  • Engaging – building the relational foundation for a collaborative working relationship.
  • Focusing – developing and maintaining a specific agenda.
  • Evoking – drawing out the other person’s own motivation for change and his or her ideas about whether and why to make a change.
  • Planning – partnering with the person to consider their thoughts about when and how they might want to go about making a change.

To be clear, MI is much more than a simple four-step checklist.  It is a complex intersection of these four processes with our core set of skills and a specific style that helps us engage in purposeful conversations that can help people change.

For more information, buy the book here or contact us at info@wiphl.org to learn more about motivational interviewing.


Three Ways to Support Your Patient’s Autonomy While Sharing Information

By Mia Croyle, MA

During the behavior change process, a skillful practitioner does not rely solely on his or her authority, expertise and knowledge to provide the motivation for a patient to make changes. Rather, the practitioner holds back on theirown expertise, using it strategically and not before the patient is ready to receive it.

Here are some tips on how you, the practitioner, can tell when a patient is ready to receive information that you have to share and how to make sure the patient stays engaged and empowered while you share it.

  1. The person asks for the information – if the patient asks you for information, that is usually a clear and obvious sign that he/she is interested in hearing what you know. Be sure to provide the information in small, digestible bites and check in with the patient for his/her understanding and reactions to the information.
  2. You ask permission to share the information – permission asking allows us the check in with the patient in a transparent way and shows that you respect their autonomy. You’ll rarely get a “No,” but be prepared to respect it if you hear it.
    Can I share some information with you?
    Is it okay with you if I tell you what we know?
  3. You reinforce the patient’s autonomy in regards to how to respond to the information
    This may or may not work for you….
    What you decide to do with this information is up to you…