Motivational Interviewing (동기면담)

"People are generally better persuaded by the reasons which they have themselves discovered than by those which have come into the minds of others." — Blaise Pascal

"If you argue for change, the client argues against it." — William R. Miller

The Spirit of MI (MI의 정신)

MI is NOT a technique. It's a way of being with people. The spirit has four elements:

1. Partnership (협력)

• MI is done with people, not to them (함께 하는 것이지, ~에게 하는 것이 아니다)
• You are not the expert on their life — they are
• Two experts in the room: you (on the topic) and them (on themselves)

2. Acceptance (수용)

Four components:

• Absolute worth (절대적 가치): Every person has inherent worth
• Accurate empathy (정확한 공감): Deep understanding of their experience
• Autonomy support (자율성 지지): Their right to choose, even poorly
• Affirmation (긍정): Recognize their strengths and efforts

3. Compassion (연민)

• Actively promote their welfare and prioritize their needs
• Not your agenda — their well-being
• Different from sympathy (feeling sorry) — compassion is active

4. Evocation (환기)

• Draw out what's already there — don't install motivation
• They have the seeds of change; you water them
• "What matters to YOU about this?" not "Here's why you should change"

The Righting Reflex (교정 반사)

What It Is

The Righting Reflex is the natural, well-intentioned urge to fix people — to tell them what's wrong and how to fix it. It's the #1 enemy of MI.

Why It Backfires

When you argue FOR change, the other person reflexively argues AGAINST it. This is psychological reactance (심리적 반발). You literally push them further from change by trying to pull them toward it.

You: "You really should exercise more."
Them: "Yeah but I don't have time."
You: "Even 15 minutes would help."
Them: "You don't understand how busy I am."

→ You've made them rehearse their reasons NOT to change.

The MI Alternative

You: "What would be different if you were more active?"
Them: "I'd probably feel better. Sleep better too."
You: "So energy and sleep matter to you."
Them: "Yeah, I've been exhausted lately."
You: "What might be a small step that could work with your schedule?"

→ THEY are now arguing FOR change.

OARS: The Core Skills (핵심 기술)

O — Open Questions (개방형 질문)

Questions that cannot be answered with "yes" or "no."

A — Affirmations (긍정/인정)

Recognize strengths, efforts, and values — NOT praise ("good job").

Affirmations are about who they are, not your approval.

R — Reflections (반영/반사)

The most important MI skill. Repeat back what they said — at or beyond their level of meaning.

Aim for 2:1 reflections to questions. Most people ask too many questions and don't reflect enough.

S — Summaries (요약)

Collect what they've said and present it back — like a bouquet of their own words.

Three types:

1. Collecting summary (수집 요약): "So far you've mentioned X, Y, and Z."
2. Linking summary (연결 요약): "Earlier you said X, and now you're saying Y — how do those connect?"
3. Transitional summary (전환 요약): "Let me pull together what you've shared before we move on..."

Change Talk vs Sustain Talk (변화 대화 vs 유지 대화)

Change Talk — DARN-CAT (변화 대화)

Preparatory:

• Desire (욕구): "I want to..." / "I wish I could..."
• Ability (능력): "I could..." / "I might be able to..."
• Reasons (이유): "I'd be healthier if..." / "My family would..."
• Need (필요): "I have to..." / "Something needs to change..."

Mobilizing:

• Commitment (다짐): "I will..." / "I'm going to..."
• Activation (활성화): "I'm ready to..." / "I'm willing to..."
• Taking steps (실행): "I already started..." / "Yesterday I..."

Your job: Evoke, recognize, and reinforce Change Talk. When you hear it, REFLECT it back.

Sustain Talk (유지 대화)

Arguments for NOT changing: "I can't...", "It's not that bad...", "I've tried before..."

Your job: Don't argue against it. Roll with it. Reflect it and explore the ambivalence.

The Readiness Ruler (준비도 척도)

A powerful technique for evoking Change Talk:

"On a scale of 1 to 10, where 1 is not at all ready and 10 is totally ready, how ready are you to make this change?"

Then the magic follow-up:

"Why did you pick [their number] and not a lower number?"

This forces them to articulate reasons FOR change — their own Change Talk.

Example:

• Client: "I'd say a 4."
• You: "A 4. What made you pick 4 and not a 1 or 2?"
• Client: "Well, I know it's affecting my health, and my kids have been worried..."
• You: "So your health and your kids' concern matter to you."

Never ask why they didn't pick a HIGHER number — that evokes Sustain Talk.

The Magic Follow-Up Question

After they give a number (e.g., "I'm at a 4"):

• "Why aren't you at a 10?" (focuses on deficit -> resistance)
• "Why a 4 and not a 1?" (focuses on existing motivation -> change talk)

This question forces them to articulate their OWN reasons for change. Whatever they say IS change talk. Reflect it back and build on it.

Example:

"So you're at a 4. What makes it a 4 and not a 1?" "Well, I guess I know I should probably..." "So part of you already sees the value in..." (reflection)

Rolling with Resistance (저항과 함께 구르기)

When resistance appears, don't push back. Use these strategies:

Process: The Four Processes of MI (MI의 4단계)

1. Engaging (관계 맺기)

Build a working alliance. Use OARS. Establish trust.

• "Tell me what brings you here."
• "What would be most helpful to talk about?"

2. Focusing (초점 맞추기)

Identify a specific direction for the conversation.

• "Of all the things you mentioned, which feels most important?"
• Agree on the target behavior or decision.

3. Evoking (환기하기)

The heart of MI. Draw out Change Talk.

• Use the readiness ruler
• Ask evocative questions: "What would be different if...?"
• Reflect and amplify Change Talk

4. Planning (계획하기)

Only when readiness is sufficient. Do NOT plan prematurely.

• "What might be a good first step?"
• "How would you like to go about this?"
• Strengthen commitment: "How confident are you?"

Sub-commands

/mi

Full MI session guide for a specific situation. Identifies the stage, suggests OARS interventions, and flags Righting Reflex traps.

Input: Describe the person, the change topic, and their current stance.

Output:

## MI Session Guide

**Current Stage**: [Engaging/Focusing/Evoking/Planning]
**Righting Reflex Risk**: [High/Medium/Low]

### Change Talk Heard
- DARN: ...
- CAT: ...

### Sustain Talk Heard
- ...

### Recommended Interventions
1. [OARS technique]: "[specific script]"
2. ...

### Questions to Evoke Change Talk
- ...

### Traps to Avoid
- ...

/mi:oars

Generate OARS responses for a specific statement.

Input: What the person said.

Output: One example each of Open question, Affirmation, Reflection (simple + complex), and Summary.

/mi:change-talk

Analyze a conversation excerpt. Identify all Change Talk (DARN-CAT) and Sustain Talk. Score the balance.

/mi:readiness

Run a readiness ruler exercise. Generate the question, follow-ups for any score, and confidence ruler.

Anti-patterns (하지 말아야 할 것들)

1. The Expert Trap (전문가 함정) — Telling them what to do. MI is about evoking, not installing.
2. Premature Planning (성급한 계획) — Jumping to "how" before they've decided "whether." Plan only when Change Talk outweighs Sustain Talk.
3. The Question-Answer Trap (질문-대답 함정) — Rapid-fire questions feel like interrogation. Reflect at least twice for every question.
4. Arguing for Change (변화를 위한 논쟁) — Every argument you make for change, they'll counter. Let THEM argue for it.
5. Labeling (라벨링) — "You're in denial" or "You're an addict." Labels trigger reactance. Describe behavior, not identity.
6. Taking Sides in Ambivalence (양가감정에서 편 들기) — If they're ambivalent, reflect BOTH sides. Don't tip the scale — let them.
7. Ignoring Sustain Talk (유지 대화 무시) — Pretending resistance doesn't exist makes it louder. Acknowledge it, then explore.
8. Confusing MI with Manipulation (MI를 조작과 혼동) — MI respects autonomy. If your goal is to trick them into compliance, you're not doing MI.

References

• William R. Miller & Stephen Rollnick, Motivational Interviewing: Helping People Change (3rd ed., 2013)
• Miller & Rollnick, Motivational Interviewing in Health Care (2008)
• motivationalinterviewing.org — MINT (Motivational Interviewing Network of Trainers)
• See: references/oars-guide.md