Free Therapist Training›Motivational Interviewing Toolkit›Fidelity Checklist
Last updated: November 11, 2026
A motivational interviewing fidelity checklist is a structured tool for reviewing a recorded session to see how closely the clinician's responses match MI. This recording review form, for supervisors and for clinicians reviewing their own work, is built on the concepts of the MITI 4 coding system and comes with a completed review of a 20-minute segment, with the tallies and arithmetic shown, a step-by-step review guide and a free PDF.
The template comes from Sentio's free motivational interviewing toolkit, and MI is one of the core therapy models taught in the Sentio MFT program. The toolkit's practice scenarios pick up where a review ends, with original client statements for rehearsing the skill the review names.
This is an optional aid from Sentio's motivational interviewing toolkit. It uses concepts from the MITI 4 coding system but is not the MITI and does not produce MITI scores.
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Recording details
| Item | What to record |
|---|---|
| Clinician, reviewer and date | The clinician's name or initials, who reviewed the recording (a supervisor, or the clinician for a self-review) and the date of the review. |
| Client consent to record | Confirmation that the client's informed consent to recording is on file, as law and agency policy require. |
| Session and segment | The session date and the start and end time stamps of a 20-minute segment, chosen at random before listening, as in the MITI 4 study. |
| Change discussed | The change the session focused on, in the client's words. |
Behavior tally
| Item | What to record |
|---|---|
| Giving Information (GI) | Tally each time the clinician shares facts, explains something, or reports feedback or a professional view while staying neutral, with no push toward a choice, no advice and no warning. |
| Questions (Q) | Tally every question, open or closed, since the MITI 4 counts them together. |
| Simple Reflection (SR) | Tally each reflection that mirrors what the client just said without adding much meaning or emphasis. |
| Complex Reflection (CR) | Tally each reflection that goes beyond the client's words by adding meaning or emphasis, such as a feeling, a value or the larger picture. |
| Affirm (AF) | Tally each genuine statement recognizing something good in the client: a strength, an effort, a good intention or the client's worth. |
| Emphasize Autonomy (EA) | Tally each statement that puts the decision with the client by highlighting the client's control, freedom to choose, and own capacity and responsibility for change. |
| Confront (C) | Tally each time the clinician directly disagrees with, argues against, corrects, criticizes, blames, shames, labels, warns or ridicules the client, moralizes, or questions the client's honesty. |
| Seek Collaboration (Seek) | Tally each attempt to share power with the client or to recognize the client's own expertise, such as inviting the client's ideas before offering any. |
| Persuade with Permission (PwP) | Tally each attempt at direct influence, such as advice or a suggestion, that comes with a clear emphasis on collaboration or the client's autonomy, for example after asking permission. |
| Persuasion (Per) | Tally each open attempt to change the client's views or behavior through argument, logic, facts, advice or suggestions, without that emphasis on collaboration or autonomy. |
Summary arithmetic
| Item | What to record |
|---|---|
| Total reflections | Simple Reflection plus Complex Reflection. |
| Reflection-to-question ratio | Total reflections divided by Questions. |
| Percent complex reflections | Complex Reflection divided by total reflections, times 100. |
| Total MI Adherent | Seek Collaboration plus Affirm plus Emphasize Autonomy. |
| Total MI Non-Adherent | Persuasion plus Confront. |
Global dimensions
| Item | What to record |
|---|---|
| Cultivating Change Talk | Moments, with time stamps, when the clinician encouraged the client's own language for the change and the client's confidence in making it, and moments when a chance to do so passed. |
| Softening Sustain Talk | Moments, with time stamps, when the clinician kept the focus away from reasons against change or for keeping things as they are, and moments when the conversation stayed on them. |
| Partnership | Moments, with time stamps, that conveyed that the client holds most of the expertise and wisdom about the change, and moments when the clinician took the expert role. |
| Empathy | Moments, with time stamps, when the clinician understood or worked to understand the client's perspective and experience, and moments when that understanding slipped. |
Client language (optional)
| Item | What to record |
|---|---|
| Change talk | Two or three of the client's statements in favor of change, quoted briefly with time stamps, with the type where useful: desire, ability, reasons, need, commitment, activation or taking steps. |
| Sustain talk | Two or three of the client's statements in favor of keeping things as they are, quoted briefly with time stamps, and how the clinician responded. |
Feedback
| Item | What to record |
|---|---|
| Strengths | Two or three moments, with time stamps, where the clinician's MI was strongest, to play back first. |
| One skill to rehearse next | A single skill, why the tallies or notes point to it, and how it will be rehearsed, for example a named exercise and set of practice statements. |
| Next review | The date of the next recording review. |
Behavior codes, global dimensions and summary formulas follow Moyers et al. (2016), https://doi.org/10.1016/j.jsat.2016.01.001.
What Does a Completed Recording Review Look Like?
In this fictional example, D.O.'s clinical supervisor reviewed a randomly chosen 20-minute segment of the third session with Marcus, 46, who has been drinking most evenings since a layoff eight months ago; the same session appears in the progress note example.
Recording details
| Item | What the supervisor recorded |
|---|---|
| Clinician, reviewer and date | Counselor D.O., reviewed by D.O.'s clinical supervisor on November 19, 2026. |
| Client consent to record | Marcus's signed consent to audio recording for supervision has been on file since his intake on November 3, 2026. |
| Session and segment | Session 3, November 17, 2026, 50 minutes; segment from 12:00 to 32:00, chosen at random before listening. |
| Change discussed | His evening drinking. He wants to “get back in control” and is not sure that means never drinking again. |
Behavior tally
| Code | Tally | Example from the segment |
|---|---|---|
| Giving Information (GI) | 3 | 26:50, after Marcus agreed to hear it, information about how alcohol affects sleep. |
| Questions (Q) | 18 | 13:05 to 14:40, six questions in a row about the drink log: which days, how many drinks and what time. |
| Simple Reflection (SR) | 10 | 15:40, “You sleep badly after the third or fourth one.” |
| Complex Reflection (CR) | 7 | 18:00, “Saturdays with your brother matter a lot, and they're also when the drinking gets away from you.” |
| Affirm (AF) | 3 | 14:50, “Six days out of seven, through a hard week. You stuck with the log.” |
| Emphasize Autonomy (EA) | 2 | 21:00, “What you do about Saturdays is your call.” |
| Confront (C) | 0 | None in this segment. |
| Seek Collaboration (Seek) | 2 | 12:20, “You know these numbers better than I do, so I'd like your read on them first.” |
| Persuade with Permission (PwP) | 1 | 28:30, “Some people add their sleep to the log next to their drinks. You'd know whether that would be useful for you.” |
| Persuasion (Per) | 1 | 20:30, “And with your wife this worried, now seems like the time to make that change.” |
Summary arithmetic
| Item | What the supervisor recorded |
|---|---|
| Total reflections | 10 simple + 7 complex = 17 |
| Reflection-to-question ratio | 17 reflections ÷ 18 questions = 0.94 |
| Percent complex reflections | 7 ÷ 17 = 0.41, or 41 percent |
| Total MI Adherent | 2 Seek Collaboration + 3 Affirm + 2 Emphasize Autonomy = 7 |
| Total MI Non-Adherent | 1 Persuasion + 0 Confront = 1 |
Questions slightly outnumbered reflections, and about two in five reflections added meaning or emphasis. The supervisor treats these informal figures as D.O.'s baseline for the next review.
Notes and feedback
| Item | What the supervisor recorded |
|---|---|
| Cultivating Change Talk | 16:20 to 16:30: Marcus said he skipped Tuesday and Wednesday, and D.O. asked what made those nights possible, which drew more about going to bed early. 19:10: “Saturday showed me something has to change” went unreflected, and at 20:30 D.O. supplied a reason for change. 22:10: the importance ruler follow-up (“Why a 7 and not a 4?”) drew his reason. |
| Softening Sustain Talk | 17:45 to 18:00: “Saturdays with my brother are the one thing I look forward to” drew a double-sided reflection that ended on the drinking getting away from him, and Marcus said, “That's exactly it.” 29:10 to 30:15: “Quitting completely seems extreme” drew a simple reflection and then an autonomy statement, and the conversation moved on without dwelling there. |
| Partnership | 12:20: D.O. asked for Marcus's read on the log before offering one. 26:50: D.O. asked before offering information about alcohol and sleep. 20:30: bringing in his wife's worry as a reason to change put D.O. in the persuader's role, and Marcus answered, “Now you sound like her.” |
| Empathy | 20:45: D.O. reflected Marcus's frustration at being told what to do, the discord eased, and Marcus went back to the log. |
| Change talk | 15:30, “I sleep terrible after the third or fourth one” (reasons). 19:10, “Saturday showed me something has to change” (need). 24:30, “If I can do two nights, I can probably do four” (ability). |
| Sustain talk | 17:45, “Saturdays with my brother are the one thing I look forward to,” answered with a double-sided reflection. 29:10, “Quitting completely seems extreme,” answered with a simple reflection and an autonomy statement. |
| Strengths | 14:50, the affirmation of the log. 18:00, the double-sided reflection about Saturdays. 20:45 to 21:00, the recovery from discord with a reflection and an autonomy statement. |
| One skill to rehearse next | Answering change talk with a reflection before adding anything, as at 19:10, when Marcus named a need for change and D.O. followed with an argument for it. D.O. will rehearse Exercise 2 of the practice scenarios, intermediate statements 5 to 8, holding to its second criterion: no reasons of your own. |
| Next review | November 25, 2026, with a 20-minute segment chosen at random from the recording of session 4 (November 24). |
In supervision, the supervisor played the 18:00 reflection first, named the other two strengths, and then agreed with D.O. on the single skill to rehearse.
What Does a Motivational Interviewing Fidelity Checklist Measure?
A motivational interviewing fidelity checklist measures how closely a clinician's responses in a recorded session match MI. This form takes its structure from the MITI 4, the current version of the Motivational Interviewing Treatment Integrity code, which pairs four global ratings with counts of ten clinician behaviors (Moyers et al., 2016). SAMHSA's TIP 35 describes the MITI 4 as a reliable way to assess a counselor's fidelity to MI (Substance Abuse and Mental Health Services Administration, 2019).
The four global dimensions are Cultivating Change Talk, Softening Sustain Talk, Partnership and Empathy. Coders rate each on a scale from 1 (low) to 5 (high) and then average them in pairs: Cultivating Change Talk and Softening Sustain Talk give a technical score, and Partnership and Empathy give a relational score. The two technical dimensions were new in the MITI 4, which has four global ratings where the MITI 3 had five (Moyers et al., 2016).
The ten behavior codes are Giving Information, Questions, Simple Reflection, Complex Reflection, Affirm, Emphasize Autonomy, Confront, Seek Collaboration, Persuade with Permission and Persuasion. The MITI 4 counts open and closed questions together and adds codes for persuasion, with and without an emphasis on collaboration or the client's autonomy. Four summary scores come from the counts: the reflection-to-question ratio (total reflections divided by questions), the percent complex reflections (complex reflections divided by all reflections), Total MI Adherent (Seek Collaboration, Affirm and Emphasize Autonomy added together) and Total MI Non-Adherent (Persuasion plus Confront).
In the article's preliminary study, four coders rated a random 20-minute segment of each of 50 recorded sessions. Agreement among the coders was good to excellent for most measures and lower for Emphasize Autonomy and percent complex reflections (Moyers et al., 2016), so a reviewer's split between simple and complex reflections on an informal form is best read as an estimate.
How Do You Review a Recording with the Form?
A review follows the same five steps each time, so that one review's results can be compared with the next.
- Confirm consent. Check that the client's informed consent to recording is on file, as law and agency policy require, and follow agency rules for storing and deleting the recording.
- Choose the segment before listening. Pick a 20-minute segment at random, as the MITI 4 study did (Moyers et al., 2016), so that the review samples the session as it usually goes.
- Tally as you listen. Mark each of the ten behaviors as you hear it, pausing or replaying when unsure, and note the time stamps of moments worth playing back.
- Do the arithmetic and write the notes. Work out total reflections and the four summary scores, then add notes on the four global dimensions and, where useful, on the client's change talk and sustain talk.
- Give feedback in order. Start with two or three strengths and play one of them back, then agree on one skill to rehearse, how it will be rehearsed and the date of the next review.
Regular reviews help skills last. In a meta-analysis of 21 training studies, MI skills held steady over six months when training was followed by feedback or coaching and eroded when it was not, and three to four sessions over six months were enough to sustain them (Schwalbe et al., 2014). In a randomized trial, adding practice feedback, coaching or both to a workshop raised clinicians' MI proficiency further, and clinicians' own ratings of their skill were unrelated to their observed proficiency (Miller et al., 2004), which is why the review rests on the recording itself.
How Does This Form Relate to the MITI?
The form uses concepts from the MITI 4 (its ten behavior codes, the names of its four global dimensions and its summary formulas, as published by Moyers and colleagues in 2016), but it is not the MITI and does not produce MITI scores. It leaves out the global ratings and the detailed coding rules of the MITI manual, and its tallies come from a single reviewer, so its figures serve as a guide for feedback and a baseline for later reviews.
Formal coding uses the MITI 4.2.1 coding manual and trained coders. The article describes the MITI 4 as open source and available from the CASAA website at the University of New Mexico. Results meant for research, program fidelity reports or decisions about a clinician's competence call for formal coding.
The form also makes room for three things that support feedback: optional notes on the client's change talk and sustain talk, a short list of strengths to play back, and one skill to rehearse before the next review. Change talk and sustain talk are the client's own speech in favor of change and in favor of the status quo (Miller & Rollnick, 2023), and noting them beside the clinician's responses shows what each response drew from the client.
Practice the Skill Behind This Template
Reflective listening is the skill this form tracks most closely: the reflection-to-question ratio rises as reflections take the place of some questions, and the percent complex reflections rises as reflections add meaning or emphasis. Rehearse it with the motivational interviewing practice scenarios, watch Episode 7 on Practice Time, and use the exercises in Deliberate Practice in Motivational Interviewing (Manuel et al., 2022).
Keep reading
Free Motivational Interviewing Toolkit, every template in the set with a completed example.
Motivational Interviewing Practice Scenarios, client statements for rehearsing the skill a review points to.
Motivational Interviewing Progress Note Template, a session note that records change talk and the client's plan.
Free Clinical Supervision Toolkit, free forms for running clinical supervision.
Clinical Supervisor Training, Sentio's six- or twelve-month deliberate practice supervision training.
Frequently Asked Questions
What is the MITI?
The Motivational Interviewing Treatment Integrity code (MITI) is a coding system for measuring how closely a clinician's practice matches MI. Its current version, the MITI 4, pairs four global ratings (Cultivating Change Talk, Softening Sustain Talk, Partnership and Empathy) with counts of ten clinician behaviors, from questions and reflections to persuasion and confrontation (Moyers et al., 2016). Formal coding uses the MITI 4.2.1 manual and trained coders.
Is there a free motivational interviewing fidelity tool?
The MITI 4, the current version of the Motivational Interviewing Treatment Integrity code, is described by its developers as an open-source instrument, and its 4.2.1 coding manual can be downloaded from the CASAA website at the University of New Mexico (Moyers et al., 2016). Formal coding with it is done by trained coders. The recording review form on this page is a free aid built on the same concepts for supervision and self-review.
What is a good reflection-to-question ratio in motivational interviewing?
The MITI 4 article defines the ratio as total reflections divided by total questions and sets no threshold for it (Moyers et al., 2016). With informal tallies like this form's, the most useful comparison is with the clinician's own earlier reviews, where a rising ratio shows reflections taking the place of some questions. Formal MITI coding uses the MITI 4.2.1 coding manual and trained coders.
Can I use a motivational interviewing fidelity checklist to review my own sessions?
Yes. Choose a 20-minute segment before listening, tally as you go, and note the time stamps of moments to keep and moments to change. In a randomized trial, clinicians' ratings of their own MI skill were unrelated to their observed proficiency (Miller et al., 2004), so a self-review should rest on the recording and the tallies. Bring the completed form to supervision or consultation when you can.
Do clients need to consent to having sessions recorded?
Yes. Clients give informed consent before a session is recorded, as law and agency policy require, and the consent explains who will hear the recording and why, for example for supervision. Agency policy also governs how recordings are stored and deleted. Confirm that consent is on file before starting a review.
References
Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press. ISBN 978-1-4625-5279-5. https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781462552795
Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72(6), 1050-1062. https://doi.org/10.1037/0022-006X.72.6.1050
Moyers, T. B., Rowell, L. N., Manuel, J. K., Ernst, D., & Houck, J. M. (2016). The Motivational Interviewing Treatment Integrity Code (MITI 4): Rationale, preliminary reliability and validity. Journal of Substance Abuse Treatment, 65, 36-42. https://doi.org/10.1016/j.jsat.2016.01.001
Schwalbe, C. S., Oh, H. Y., & Zweben, A. (2014). Sustaining motivational interviewing: A meta-analysis of training studies. Addiction, 109(8), 1287-1294. https://doi.org/10.1111/add.12558
Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation for change in substance use disorder treatment (Treatment Improvement Protocol [TIP] Series No. 35, SAMHSA Publication No. PEP19-02-01-003). https://library.samhsa.gov/product/tip-35-enhancing-motivation-change-substance-use-disorder-treatment/pep19-02-01-003
