Free Motivational Interviewing Toolkit: Worksheets, Session Notes, Treatment Plans, and Fidelity Tools
Ten free templates for clinicians who use motivational interviewing, each with a completed example and a PDF.
Last updated: November 11, 2026
Free Therapist Training›Motivational Interviewing Toolkit
Motivational interviewing is a way of talking with people about change, and the paperwork that goes with it is usually left to each clinician to invent: a progress note that records change talk, a treatment plan whose goals are in the client's words, the worksheets a client fills in, and a way for a supervisor to review a recording. Six of the ten templates below cover that paperwork, from a progress note with a SOAP version to a recording review form built on the concepts of the MITI 4 fidelity code. Two support the clinician's skills: a cheat sheet of core MI skills and a set of practice scenarios for rehearsing them. Two more support the conversation itself: a printable Personal Values Card Sort and a Choosing a Path sheet for setting the agenda. Every template comes with a completed example built around a fictional client.
The concepts follow the fourth edition of Miller and Rollnick's Motivational Interviewing (Miller & Rollnick, 2023) and SAMHSA's TIP 35, and the change plan worksheet is adapted from the public-domain Motivational Enhancement Therapy manual. The templates are written for every profession that uses MI, including counselors, social workers, addiction counselors, nurses, physicians and health coaches, along with the students and supervisors who are learning it. Every template appears in full below, ready to copy, with a Google Doc to make your own copy and a PDF to print.
These templates are free aids from Sentio for you to adapt to your setting and to your agency's documentation rules: some helpful ideas, not official forms. The recording review form uses concepts from the MITI 4 but is not the MITI; formal fidelity coding uses the free MITI 4.2.1 coding manual with trained coders.
What Is in the Toolkit?
| Template | Use it for | MI task it serves |
|---|---|---|
| Progress note template | A session note in MI terms, with a SOAP version: the change talk and sustain talk heard, ruler ratings, strategies used and the client's plan. | Engaging, focusing, evoking and planning |
| Treatment plan example | Goals in the client's words, measurable objectives, MI strategies and how progress will be measured. | Focusing and planning |
| Decisional balance worksheet | A four-part worksheet for weighing a decision, with a clinician guide to when it fits and when it does not. | Neutral decisions; use with care in evoking |
| Importance and confidence rulers | Two 0 to 10 rulers with the follow-up questions that draw out change talk. | Evoking |
| Change plan worksheet | The client's own plan: the change, the reasons, the steps, the supports and what to do if the plan stalls. | Planning |
| OARS and change talk cheat sheet | The spirit and tasks of MI, OARS with examples, the types of change talk, and responses to sustain talk and discord. | Engaging and evoking |
| Recording review form | A fidelity checklist built on MITI 4 concepts, for supervisors and for self-review of recorded sessions. | Supervision and self-review |
| Practice scenarios | Original client statements at three levels of difficulty for rehearsing open questions and reflective listening, evoking change talk, and double-sided reflections. | Skill practice for every task |
| Personal Values Card Sort | A printable set of the 83 values from the public-domain card sort, with instructions and questions that link values to change. | Engaging and evoking |
| Choosing a Path sheet | A one-page agenda map for choosing, with the client, what to talk about first when several changes are possible. | Focusing |
Motivational Interviewing Progress Note Template
Use this note after a session that uses MI to record the change the client discussed, the change talk and sustain talk heard, the ruler ratings, the strategies used and the client's next steps, and use its SOAP version where your setting requires that format. The motivational interviewing progress note template page adds guidance on documenting change talk, writing the SOAP version and choosing language that fits MI.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
Motivational interviewing progress note
| Item | What to record |
|---|---|
| Client and session details | Client name or initials, clinician, date, session number, length, format (in person, video or phone) and who attended. |
| Change the client chose to discuss | The behavior or decision the client chose to talk about, in the client's own words. |
| Agenda | What the client brought, anything the clinician raised with permission, and the focus the two agreed on. |
| MI task or tasks | The task or tasks the session centered on: engaging, focusing, evoking or planning. Note any shift during the session. |
| Change talk heard | Brief quotes of the client's own statements in favor of change, with the type where useful: desire, ability, reasons, need, commitment, activation or taking steps. |
| Sustain talk and discord heard | Brief quotes of the client's statements in favor of keeping things as they are (sustain talk) and any signs of strain in the working relationship (discord), with how the clinician responded to each. |
| Importance and confidence | The client's 0 to 10 ratings and the reasons the client gave for each number. |
| Stage of change, if your agency records one | The stage your agency's form asks for, with the client's words that support it. MI itself does not require a stage. |
| Clinician strategies | The strategies the clinician used, such as open questions, affirmations, reflections, summaries, information or advice offered with permission, importance and confidence rulers, and exploring values. |
| Client response | How the client responded to those strategies: more or less change talk, new reasons, changed ratings or a shift in engagement. |
| Plan or next steps | What the client decided, in the client's words, including "no decision yet," and anything the clinician agreed to do. |
| Risk and safety | Screening, safety planning and referrals as the setting and the client's situation require. |
| Next session | Date, time, format and the focus the client wants to start with. |
SOAP version
| Item | What to record |
|---|---|
| Client and session details | Client name or initials, clinician, date, session number, length, format (in person, video or phone) and who attended. |
| S (subjective) | The client's account in the client's words: the change discussed, brief quotes of change talk and sustain talk, importance and confidence ratings with the client's reasons, and relevant events since the last session. |
| O (objective) | What the clinician observed or measured: engagement, affect, any signs of discord, and data such as screening scores, vital signs, lab results or logs the client brought. |
| A (assessment) | The clinician's reading of the session in MI terms: the task the session centered on, the strategies used and how the client responded, the balance of change talk and sustain talk, and what this suggests for the next session. |
| P (plan) | The client's next steps in the client's words, or "no decision yet," what the clinician will do next, referrals and safety steps as needed, and the next session. |
See a completed example
The first example is an MI-format note for Marcus, 46, at his third counseling session about his evening drinking; the second is a SOAP note for Linda, 61, who has type 2 diabetes and sees a nurse health coach at her primary care clinic. Both are fictional.
Example 1: MI-format note, Marcus, session 3
| Item | Note |
|---|---|
| Client and session details | Marcus, 46. Counselor: D.O. Session 3, November 17, 2026, 50 minutes, in person, individual. |
| Change the client chose to discuss | His evening drinking: "I want to get back in control. I'm just not sure that means never having another beer." |
| Agenda | Marcus brought his drink log (filled in 6 of 7 days) and wanted to talk about Saturday, when he drank more than he planned at his brother's house. D.O. asked to save time at the end for the job search goal, and Marcus agreed. |
| MI task or tasks | Evoking for most of the session, moving briefly into planning in the last 10 minutes when Marcus raised trying weeknights without alcohol. |
| Change talk heard | Reasons: "I sleep terrible after the third or fourth one." Taking steps: "I skipped Tuesday and Wednesday and went to bed early." Ability: "If I can do two nights, I can probably do four." Need: "Saturday showed me something has to change." Activation: "I'm willing to try weeknights." |
| Sustain talk and discord heard | Sustain talk: "Saturdays with my brother are the one thing I look forward to," and "Quitting completely seems extreme." D.O. responded with a double-sided reflection ("Saturdays with your brother matter a lot, and they're also when the drinking gets away from you"), and Marcus said, "That's exactly it." Discord: when D.O. mentioned his wife's worry, Marcus said, "Now you sound like her." D.O. reflected his frustration at being told what to do and said the decision was his; Marcus nodded and went back to the log. |
| Importance and confidence | Importance 7 (6 at intake): "Seeing the numbers on my phone made it real." Confidence 5 (4 at intake): "I did two nights without, so it's not impossible." |
| Clinician strategies | Questions about the log; an affirmation of his effort in keeping it most days; complex reflections, including the double-sided reflection above; importance and confidence rulers, each followed by asking why he chose that number and not a lower one; information about alcohol and sleep, offered with permission (Ask-Offer-Ask); a closing summary of his change talk, then "Where does that leave you?" |
| Client response | Change talk increased after the double-sided reflection and the ruler follow-ups. The discord eased once D.O. emphasized Marcus's choice. Marcus proposed weeknights as a starting point on his own. |
| Plan or next steps | "I'll try no drinking Monday through Thursday until our next session, and I'll keep logging." No decision yet about weekends: "Let me see how the weeknights go first." He will think about whether to tell his wife. Time ran short, so at his request the job search check-in moves to session 4. |
| Risk and safety | No new safety concerns. Asked about withdrawal symptoms on the nights without alcohol; Marcus reported none. |
| Next session | November 24, 2026, 4:00 p.m., in person. Marcus wants to start with how the weeknights went. |
Example 2: SOAP note, Linda, health coaching visit 2
| Item | Note |
|---|---|
| Client and session details | Linda, 61, type 2 diabetes. Nurse health coach: K.T. Health coaching visit 2, November 12, 2026, 30 minutes, in person, primary care clinic. |
| S | Linda wants to "get my sugar under control" and is weighing two changes: walking after dinner and taking her evening medication regularly. She misses the evening dose "three or four nights a week, when I fall asleep on the couch." Change talk: "I want to be around for my granddaughter" (reasons); "I can walk, my knees are fine on flat ground" (ability); "I'd like to walk with my neighbor again, like we used to" (desire). Sustain talk: "After dinner I'm wiped out, and it's dark by six." Importance 8: "My numbers keep creeping up." Confidence 4: "I always start strong and quit after a week," and not lower "because I walked every day on vacation in September." |
| O | Alert and engaged; laughed while describing walks with her neighbor; no signs of discord. Brought her pill organizer: four of the past seven evening compartments still full. Most recent A1C (October 2026, from the chart): 8.1%, up from 7.6% in May. |
| A | The visit moved from focusing (Linda weighed the two changes and chose to work on both) to evoking, and into planning near the end. Change talk outweighed sustain talk, which centered on fatigue and early darkness. K.T. used open questions, reflections, both rulers with follow-up questions and a summary; Linda's change talk moved from preparatory (desire, ability, reasons) to mobilizing as she began planning on her own. High importance with low confidence points to confidence as the main barrier, so the plan builds on small steps and her past success with walking. Next visit: review the first week and explore options for evenings when her neighbor cannot walk. |
| P | Linda's plan: "I'll set an alarm for 8:30 and keep the pill box by the TV remote," and "I'll ask my neighbor if I can walk her dog with her after dinner, Monday, Wednesday and Friday." Confidence in this plan: 7. K.T. offered, with permission, information about the clinic's diabetes education class; Linda will decide after the holidays. K.T. will call on November 19, as Linda agreed. Next visit November 24, 2026. |
Motivational Interviewing Treatment Plan Template
Use this plan with a client to set goals in the client's words and, for each goal, measurable objectives, MI strategies and measures of progress, including process objectives for a client who is not yet ready to change. The motivational interviewing treatment plan example page adds guidance on writing goals and objectives, planning with a client who is not ready to change and combining MI with other treatments.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
Plan details
| Item | What to record |
|---|---|
| Client and dates | Client name or initials, clinician, setting, the date the plan was written and the period it covers. |
| The concern in the client's words | A short quote of how the client describes the concern, plus any diagnosis or presenting problem the setting requires. |
| What the client wants | Each goal as the client states it, in the client's words. |
| Why it matters | The values and reasons the client gives for the goals. |
| Readiness at the start | Importance and confidence ratings (0 to 10) with the client's reasons, and the ambivalence in brief: what draws the client toward change and what draws the client toward keeping things as they are. |
For each goal
| Item | What to record |
|---|---|
| Goal | The goal in the client's words. |
| Measurable objectives with target dates | One to three objectives, each an observable action or result with a number and a target date. When the client is not yet ready to change, use process objectives, such as naming personal reasons for change or completing a change plan when ready. |
| MI strategies | The strategies the clinician will use toward this goal, such as reflections and summaries, evoking change talk, importance and confidence rulers, exploring values, information and advice offered with permission, and support for the client's own choices. |
| How progress will be measured | The measure for each objective (a client log, ratings, attendance, or a screening score or lab result the setting uses) and when it will be checked. |
Supports, safety and review
| Item | What to record |
|---|---|
| Strengths and supports | The client's strengths and past successes, and the people and resources the client wants involved. |
| Risk and safety | Risks screened, safety planning and referrals, as the setting and the client's situation require. |
| Review dates | When the plan will be reviewed, as the setting requires, and a note to review it whenever the client's goals change. |
| How the client took part | How the client helped write the plan: the goals and wording the client chose, the measures the client picked, changes the client made, and whether the client has a copy. |
See a completed example
In this fictional example, Marcus, 46, has been drinking most evenings since a layoff eight months ago, and he and his counselor, D.O., write a 12-week plan with two goals at his second session.
Plan details
| Item | Plan |
|---|---|
| Client and dates | Marcus, 46. Counselor: D.O. Outpatient counseling, community clinic. Written November 10, 2026 (session 2); covers 12 weeks, November 10, 2026, to February 2, 2027. |
| The concern in the client's words | "Since the layoff I've been drinking most nights, more than I want to. My wife's worried, and I'm not happy about it either." Diagnosis as recorded in the intake assessment of November 3, 2026. |
| What the client wants | Goal 1: "Get back in control of my drinking." Goal 2: "Get some structure back in my days and get back to work." |
| Why it matters | Being someone his family can count on: "I've always been the steady one." Being the one who decides how his evenings go. Sleeping better and having energy for the job search. |
| Readiness at the start | At intake, importance 6: "It's not wrecking my life, but it's more than I want." Confidence 4: "I've cut back before, and it lasted about two weeks." Ambivalence: beer helps him "shut my brain off" at night and is part of Saturdays with his brother; he dislikes how much he drinks, sleeps poorly and wants his wife to stop worrying. Quitting entirely does not feel right to him yet: "Never drinking again feels like a lot." |
Goal 1
| Item | Plan |
|---|---|
| Goal | "Get back in control of my drinking." |
| Measurable objectives with target dates | 1a. By November 24, 2026, Marcus will log his drinks daily for two weeks and bring the log to session. 1b. By December 8, 2026, Marcus will name at least three personal reasons for change and choose a drinking goal ("a limit or a break, my choice"), recorded on a change plan worksheet. 1c. From December 8, 2026, to February 2, 2027, Marcus will meet his chosen drinking goal on at least five of seven days each week, by his log. |
| MI strategies | Open questions and reflections about what drinking gives him and what it costs him; double-sided reflections for his uncertainty about quitting; importance and confidence rulers each session, asking why he chose his number and not a lower one; exploring his values ("the steady one"); information about alcohol, sleep and low-risk drinking, offered with permission; support for the goal he chooses; a change plan worksheet when he is ready. |
| How progress will be measured | Daily drink log on his phone (drinking days per week, drinks per drinking day), reviewed each session. Importance and confidence ratings each session. His own 0 to 10 rating of feeling "in control" (3 on November 10), at each review. |
Goal 2
| Item | Plan |
|---|---|
| Goal | "Get some structure back in my days and get back to work." |
| Measurable objectives with target dates | 2a. By December 1, 2026, Marcus will set a weekday schedule with job search time on at least three mornings a week. 2b. By January 5, 2027, Marcus will send at least eight job applications or contact at least four people in his field, his choice. 2c. By February 2, 2027, Marcus will plan at least three evenings a week around something other than drinking. |
| MI strategies | Affirming his work history and skills; evoking his own ideas for structuring his days; summaries that connect his evenings, his sleep and his mornings; small steps he chooses, with a confidence check for each; information about the local workforce center, offered with permission. |
| How progress will be measured | A weekly calendar he brings to session (job search mornings, applications and contacts, planned evenings). His own 0 to 10 rating of how much his days "feel like mine again," at each review. |
Supports, safety and review
| Item | Plan |
|---|---|
| Strengths and supports | Nineteen years of steady work before the layoff. Has cut back before (two weeks last spring). His wife, who wants to help and is open to a joint session if Marcus asks her. His brother, who "would back me up if I asked." |
| Risk and safety | At intake, Marcus reported no thoughts of suicide, no drinking and driving and no past withdrawal symptoms. D.O. will screen again at each review and if his drinking increases. If Marcus chooses a break from alcohol, D.O. will suggest he check in with his primary care provider first. |
| Review dates | December 8, 2026 (week 4), January 5, 2027 (week 8) and February 2, 2027 (week 12), and whenever Marcus's goals change. |
| How the client took part | Marcus chose both goals and their wording; he preferred "get back in control" to "cut down." He picked a phone log over a paper one. On reading the draft, he asked that objective 1b say "a limit or a break, my choice," and D.O. revised it. Marcus signed the plan and took a copy. |
Decisional Balance Worksheet
This client worksheet helps a person weigh the benefits and costs of a change and of keeping things as they are, and it fits best when you are helping someone decide and have no stake in the outcome. The decisional balance worksheet guide adds when to skip a decisional balance and what to do instead, how to run one without steering and what the trials found.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
The change I am considering
| Describe the change in a sentence or two |
Benefits and costs
| Option | Benefits | Costs |
|---|---|---|
| Making the change | What could be better if I make the change? | What would be hard, or what would I give up? |
| Not making the change (keeping things as they are) | What is good about keeping things as they are? | What concerns me about keeping things as they are? |
What matters most to me in this decision
| The people, values or hopes that weigh most for me |
Where this leaves me now
| Where I am leaning, or what I want to find out before I decide |
Clinician guide: when a decisional balance fits
- When it fits. Use the full worksheet when you are counseling with neutrality: you are helping the client make a decision and have chosen not to steer it, as with a choice between medical treatments (Miller & Rose, 2015) or about where to live.
- When it does not fit. Skip it when the client is ambivalent about a change you hope to strengthen, such as drinking less. The cell for the benefits of keeping things as they are draws out sustain talk, and with ambivalent clients a decisional balance tends to decrease commitment to change (Miller & Rose, 2015).
- What to do instead. Evoke change talk by asking about the client's own reasons for change, and answer sustain talk with a double-sided reflection that joins the two sides with “and” and puts the change talk second (SAMHSA, 2019).
See a completed example
Harold, 78, is deciding whether to move to an assisted living community or stay in his home with more help. He filled in the worksheet on November 12, 2026, with R.M., a hospital social worker who has no stake in which option he chooses.
The change I am considering
| “Moving to an assisted living community instead of staying in my house.” |
Benefits and costs
| Option | Benefits | Costs |
|---|---|---|
| Making the change (moving to assisted living) | “Someone would be there day and night if I fell again. Meals are made, and I'd have people to eat with. My daughter would worry less.” | “Leaving the house Ruth and I shared for 40 years. Giving up my garden and my workshop. A smaller place, with less privacy. It would cost more each month than I spend now.” |
| Not making the change (staying home with more help) | “My own home, my garden and my routines. The neighbors know me and look in on me. Help a few mornings a week might cost less than moving.” | “The stairs up to the bedroom are getting harder. I'd be alone at night if I fell. I'd have to find aides and keep track of their schedules. My daughter would keep worrying.” |
What matters most to me in this decision
| “Staying independent as long as I can, and not becoming a burden to my daughter. Feeling safe at night matters more to me since the fall.” |
Where this leaves me now
| “I haven't decided. I want to tour the assisted living place with my daughter and get a price for help at home before I choose.” |
R.M. gave each cell the same time and the same depth of reflection, then summarized both options in Harold's words. Harold chose the next step himself, and R.M. treated “not decided yet” as a reasonable place to end the meeting.
Importance and Confidence Rulers
This client sheet holds an importance ruler and a confidence ruler, adapted from two exhibits in SAMHSA's TIP 35 that fall under its public-domain notice, each followed by questions that invite the client's own reasons for change, and it fits once a client has named a change to talk about. The readiness ruler worksheet guide adds steps for using the rulers, how to respond to low and high scores and what studies of readiness rulers have found.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
The change I am thinking about
| Name the change in a few words |
Importance ruler
How important is it to you right now to make this change? Circle a number.
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
|---|---|---|---|---|---|---|---|---|---|---|
| Not important | Extremely important | |||||||||
| Why did you choose this number and not a lower one? |
| What would help move it a point or two higher? |
Confidence ruler
If you decided to make this change, how confident are you that you could do it? Circle a number.
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
|---|---|---|---|---|---|---|---|---|---|---|
| Not confident | Extremely confident | |||||||||
| Why did you choose this number and not a lower one? |
| What would help move it a point or two higher? |
Clinician guide: using the rulers
- Ask about the lower number. Asking why the client chose this number and not a lower one draws out the client's own reasons for change, which is change talk; asking why the number is not higher invites reasons against the change, which is sustain talk.
- If the answer is zero. Reflect it without arguing. Ask what would help the number rise even a point, or return to engaging and focusing to learn what does matter to the client.
- Low importance. Explore the client's values and reasons before any planning, for example with the values conversation TIP 35 describes, which explores what matters to the client and how the current situation fits with it (SAMHSA, 2019).
- High importance, low confidence. Explore past successes, strengths and options, break the change into small first steps, and reflect any confidence talk you hear (SAMHSA, 2019).
See a completed example
Linda, 61, has type 2 diabetes and completed the rulers on November 12, 2026, at her second health coaching visit with K.T., the nurse health coach at her primary care clinic.
| Prompt | Linda's answer |
|---|---|
| The change I am thinking about | “Walking after dinner and taking my evening medication every night.” |
| Importance (0 to 10) | 8 |
| Why did you choose this number and not a lower one? | “My numbers keep creeping up, and I want to be around for my granddaughter.” |
| What would help move it a point or two higher? | “Picturing myself walking my granddaughter to school next fall. When I think about that, it's a 9.” |
| Confidence (0 to 10) | 4 |
| Why did you choose this number and not a lower one? | “I walked every day on vacation in September, and my knees are fine on flat ground.” |
| What would help move it a point or two higher? | “Keeping the pill box by the TV remote, and having my neighbor to walk with now that it's dark by six.” |
With importance at 8 and confidence at 4, K.T. spent the rest of the visit on confidence. K.T. reflected Linda's daily walks on vacation as a past success and asked what would make walking at home feel as doable, and Linda chose her own small steps: asking her neighbor whether she could join her dog walk after dinner on Monday, Wednesday and Friday, and setting an alarm for 8:30 with the pill box kept by the TV remote. Her confidence in that plan was 7.
Change Plan Worksheet
A client worksheet for writing down the client's own plan once the client has decided to change: the change, the reasons, the steps, the people who can help, the signs that it is working and what could get in the way. The change plan worksheet page adds the signs that a client is ready to plan, how to fill in the worksheet together and where the worksheet comes from.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
The changes I want to make are:
| Write here |
The most important reasons why I want to make these changes are:
| Write here |
The steps I plan to take in changing are:
| Write here |
The ways other people can help me are:
| Person | Possible ways to help |
|---|---|
I will know that my plan is working if:
| Write here |
Some things that could interfere with my plan are:
| Write here |
What I will do if my plan stalls:
| Write here |
How confident I am in this plan (0 to 10):
| My number, and what would make it a point or two higher |
Review date:
| The date we will look at this plan together |
Clinician guide: when to use the change plan
- Use it in the planning task, once the client has decided to make a change and the talk has turned to how. Signs of readiness include more change talk and less sustain talk, mobilizing change talk (commitment, activation, steps already taken), small changes the client has already started, and talk about goals.
- Before planning, offer a summary that gathers the client's change talk, then ask a key question such as “Where does that leave you?” If the client is unsure, return to evoking and let the plan wait.
- Fill in the worksheet from the conversation, in the client's words, and give the client the original.
Adapted from the Change Plan Worksheet in the Motivational Enhancement Therapy manual (Miller et al., 1992), a public-domain publication of the National Institute on Alcohol Abuse and Alcoholism. The first six prompts are the manual's; the last three are additions.
See a completed example
Marcus, 46, a fictional client in outpatient counseling at a community clinic, filled in this plan with his counselor, D.O., at his fourth session, on November 24, 2026.
| Worksheet item | What Marcus wrote |
|---|---|
| The changes I want to make are: | Get back in control of my drinking. Starting tonight: no alcohol Sunday through Thursday nights, and no more than two beers on Friday and two on Saturday. On December 8, D.O. and I will look at how it went and decide whether to keep going, change the goal or take a break from drinking. |
| The most important reasons why I want to make these changes are: | My wife is worried, and I want her to trust me again. I want to be sharp for interviews and for whatever job comes next. I sleep badly after I drink. I don't like who I've turned into since the layoff. |
| The steps I plan to take in changing are: | Stop keeping beer in the garage fridge, and buy only the four beers for the weekend, on Friday. Walk the dog with my wife after dinner, when I usually open the first beer. Log every drink on my phone and bring the log to sessions. Go to the Thursday morning job club at the library. |
| The ways other people can help me are: | My wife: walk with me after dinner, and tell me straight if she's worried instead of checking the recycling. My brother: don't push another beer on me on Saturdays, and pick up if I call on a rough night. D.O.: go over the drink log with me each week. |
| I will know that my plan is working if: | My log shows no weeknight drinks and no more than two beers on weekend nights. I'm up by 7 and job hunting. My wife says she's less worried. |
| Some things that could interfere with my plan are: | Getting turned down for a job. Saturdays at my brother's, when I end up drinking more than I planned. Long, empty afternoons. |
| What I will do if my plan stalls: | If I slip, I'll write it in the log, tell D.O. at the next session and start again the next day. Before Saturdays at my brother's, I'll tell him my two-beer limit, bring sparkling water and head home by nine if it gets hard. |
| How confident I am in this plan (0 to 10): | 6. I haven't had a drink on a weeknight since our last session, so I know I can do it. Weekends will be the hard part. Telling my wife the plan tonight would make it a 7. |
| Review date: | December 8, 2026, at my session with D.O. |
D.O. asked for Marcus's own ideas before offering any, and asked permission before mentioning that some people try a stretch without alcohol before deciding about drinking; Marcus kept his weekend limit, and the two-week trial with a review date leaves the larger decision open. When Marcus rated his confidence at 6, D.O. asked why it was not lower, which brought out the weeknights he had just managed, and what would raise it, which added telling his wife.
OARS and Change Talk Cheat Sheet
A reference sheet of core MI skills to keep at hand in sessions, supervision and recording review: the spirit and four tasks of MI, OARS with examples, four kinds of reflection, information and advice with permission, the types of change talk and responses to sustain talk and discord. The motivational interviewing cheat sheet page adds explanations of OARS, change talk and discord.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
The spirit and the four tasks of MI
| The spirit of MI | The four tasks |
|---|---|
| Partnership: work alongside the person, the expert on their own life. Acceptance: respect the person's worth and choices, seek to understand, and notice strengths. Compassion: put the person's well-being first. Empowerment: help the person draw on their own strengths, motivation and resourcefulness. | Engaging: build a working relationship. Focusing: agree on a direction for change. Evoking: draw out the person's own reasons for change. Planning: build commitment and a specific plan, when the person is ready. |
OARS: the core skills
| Skill | What it does | Two examples |
|---|---|---|
| Open questions | Invite answers in the person's own words, at some length | “What would you like to be different by summer?” “What do you notice about your mood on days you get outside?” |
| Affirmations | Recognize a specific strength or effort, genuinely | “You've kept every appointment through a hard month.” “You kept up your walks through two weeks of rain.” |
| Reflections | Mirror, in a statement, what the person said or meant | “You're tired of feeling checked up on.” “Getting your license back matters a lot right now.” |
| Summaries | Draw together several things the person said, then ask what was missed | “You've cut down to half a pack, you're proud of that, and evenings are still the hardest. Did I get that right?” “So the walks lift your mood, your knee limits how far you go, and you'd like three short walks a week. What did I miss?” |
Four kinds of reflection
A client in health coaching says, “I know I need to move more, but by the time I get home I'm wiped out.”
| Reflection | What it does | Example |
|---|---|---|
| Simple | Stays close to the person's words | “You're worn out by evening.” |
| Complex | Adds meaning or feeling the person implied | “Evenings feel like the wrong time for it.” |
| Double-sided | Holds both sides of the ambivalence, change side last | “Your energy is gone by evening, and you also know moving more matters to you.” |
| Amplified | Overstates the sustain side, without sarcasm, so the person may voice the other side | “So there's no time in your week when moving more could fit.” |
Information and advice with permission: Ask-Offer-Ask (called elicit-provide-elicit in Miller and Rollnick's third edition)
| Ask | Offer | Ask |
|---|---|---|
| Ask permission and what the person already knows. “Would it help to hear what others have tried?” | Offer a small piece of information or advice; the person is free to disagree. “Some people set a quit date, and others cut down first.” | Ask what the person makes of it. “What fits for you?” |
Change talk
| Type | Client example | A question that evokes it |
|---|---|---|
| Preparatory change talk (DARN) | ||
| Desire | “I want to stop fighting with my son about his grades.” | “How would you like things to be at home?” |
| Ability | “I could walk at lunch on my office days.” | “What strengths could you draw on to make this change?” |
| Reasons | “If I keep passing my drug tests, I could get off probation early.” | “What would be better for you if you made this change?” |
| Need | “I have to get my blood pressure under control.” | “What makes this important to do now?” |
| Mobilizing change talk (CAT) | ||
| Commitment | “I'm going to tell my roommate I'm taking a month off drinking.” | “What will you do?” |
| Activation | “I'm willing to try leaving the house once a day.” | “What are you willing to try this week?” |
| Taking steps | “I gave my vape to my mom last night.” | “What have you already done toward this?” |
Sustain talk, discord and the fixing reflex
| Pattern | What it is | Sounds like | What helps |
|---|---|---|---|
| Sustain talk | The person's own case for keeping things as they are; it is about the change itself | “Smoking is the one thing I do just for me.” | Reflect it (simple, amplified or double-sided), reframe it, or emphasize that the choice is the person's |
| Discord | Tension in the working relationship; it is about the clinician or the conversation | “You sound just like my doctor.” | Reflect the person's concern, apologize if you contributed to it, and change direction; do not argue |
| The fixing reflex (called the righting reflex in Miller and Rollnick's third edition) | The helper's natural urge to set things right and steer the person toward change, which tends to draw out sustain talk and discord | “You need to cut back before this costs you your marriage.” | Notice the urge and ask instead: “What concerns, if any, do you have about the drinking?” |
See a completed example
In this fictional exchange from an early session at a community clinic, the counselor, D.O., talks with Marcus, 46, and each line is labeled.
| Speaker | What was said | What it is |
|---|---|---|
| D.O. | “Last time you mentioned that your wife has been worried. What's been on your mind about the drinking since then?” | Open question that keeps the focus on the change Marcus raised |
| Marcus | “Part of me thinks it's no big deal. Plenty of guys have a few beers at night. But it's most nights now, and I don't even enjoy it anymore.” | Sustain talk, then change talk (reasons) |
| D.O. | “Part of you sees a few beers as ordinary, and you've also noticed it has turned into most nights without giving you much back.” | Double-sided reflection, with the change side last |
| Marcus | “Right. And I wake up foggy. I've got a phone interview Thursday morning, and I can't show up like that. I need to be sharp.” | Change talk (reasons, need) |
| D.O. | “You've kept looking for work through eight hard months, and you're already thinking about how to give yourself the best chance on Thursday.” | Affirmation of his persistence and his effort to prepare |
| Marcus | “I have to. I don't think I want to quit for good, though. I just want to get back in control.” | Change talk (need), sustain talk, then change talk (desire) |
| D.O. | “Let me pull this together. The drinking has crept up to most nights since the layoff, and it isn't giving you much anymore. You wake up foggy, and you want to be sharp on Thursday. Quitting for good doesn't feel right to you, and getting back in control does. What would being back in control look like this week?” | Summary that gathers his change talk and briefly acknowledges the sustain talk, then an open question that invites mobilizing change talk |
| Marcus | “I'm going to skip the beer tonight and tomorrow, before the interview. I can do that. I cut way back for two weeks last spring.” | Change talk (commitment, ability) |
D.O. reflects Marcus's sustain talk together with his change talk, so Marcus hears both sides in his own words, and the summary ends on what Marcus wants before the question about this week. The question invites a next step without prescribing one, and the step Marcus names is his own.
Motivational Interviewing Fidelity Checklist
Use this recording review form to listen to a 20-minute segment of a recorded session, tally the ten MITI 4 behavior codes, work out the summary figures and give feedback that ends with one skill to rehearse, whether a supervisor is reviewing a supervisee's work or a clinician is reviewing their own. The motivational interviewing fidelity checklist page adds a step-by-step guide to running a review and an explanation of the MITI 4's structure and of how the form relates to it.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting. It uses concepts from the MITI 4 coding system but is not the MITI and does not produce MITI scores.
Make a copy (Google Doc)Download the PDF
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.
See a completed example
In this fictional example, D.O.'s clinical supervisor reviews a randomly chosen 20-minute segment of the third session with Marcus, 46, the same session documented in the progress note example above.
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.
Motivational Interviewing Practice Scenarios
Use these original client statements to rehearse three core MI skills out loud with feedback, in pairs, small groups, classes or supervision: open questions and reflective listening, evoking change talk, and double-sided reflections, each with twelve statements across three levels of difficulty and a matching Practice Time episode. The motivational interviewing practice scenarios page adds guidance on running the exercises, the research on rehearsal with feedback and the matching videos.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
How to run a round
- Take three roles: client, therapist and observer. In a pair, the person playing the client also gives the feedback.
- The client reads one statement aloud with the feeling behind it, the way a real client would say it.
- The therapist answers at once with a single spoken response aimed at the exercise's skill criteria.
- The observer gives brief feedback against those criteria: what the response did well and, if needed, one thing to change.
- The client reads the same statement again and the therapist responds again, until the response comes fluently and meets the criteria.
- Move to the next statement, and rotate roles at the end of each level so that everyone practices as the therapist.
Adjusting difficulty
- Begin each exercise at the beginner level.
- Move up a level when the therapist's responses come easily and meet the criteria within one or two tries.
- Step down a level when the therapist freezes, goes blank or finds the round overwhelming. The client can also lower the difficulty by reading more calmly, or raise it by reading with more feeling.
Exercise 1: Open Questions and Reflective Listening
Pairs with Episode 7 of Practice Time, Reflection and Questions.
Skill criteria
- Offer one reflection or one open question. An open question invites the client to say more and cannot be answered with yes, no or a single fact.
- Say each reflection as a statement, with the voice going down at the end, and let it reach a little past the client's words to the meaning or feeling underneath.
- In this exercise, hold back advice, reassurance and solutions, even when the client seems to invite them.
Beginner statements
- Health coaching. Karen, 45, at her first coaching session: “I signed up for the gym in January. I went maybe six times, and now I'm paying every month for a card I don't use. I feel a little silly about it, honestly.”
- Primary care. Ray, 58, after a high blood pressure reading: “I had no idea it was that high. I feel fine. I guess that's the part that bothers me, that I wouldn't even have known.”
- Mental health, outpatient. Jess, 29: “Work has been a lot lately. I get home, lie on the couch and scroll until midnight, and then I'm wiped out the next day and do it all again.”
- School counseling. Tyler, 16: “My grades aren't great this semester. My mom asks about it every single day. I've got it handled.”
Intermediate statements
- Substance use, outpatient. Monica, 41: “I don't think I drink more than anyone else at work. We all go out on Fridays. It's just that lately I'm the one who can't remember the end of the night.”
- Criminal justice, court-ordered program. Kevin, 24: “The court says I have to be here, so I'm here. The program's fine. Getting across town three times a week while I'm working doubles is the problem.”
- Family therapy. Angela, 44, mother of a 14-year-old: “Every night it's a fight about the phone. I take it away, she slams her door, and I end up feeling like the villain in my own house.”
- Primary care. Walt, 67, who smokes: “I've smoked since I was fifteen. My wife quit last year, and she's been after me ever since. I'm not saying she's wrong.”
Advanced statements
- Substance use, intake. Lorraine, 55: “You people all ask the same questions. I've been in and out of programs since before you finished school. What are you going to tell me that I haven't already heard?”
- Criminal justice, reentry. Ron, 49, two months after release from prison: “I did eleven years. I come out, everything's on a phone, my kids are grown, and my parole officer wants me working in thirty days. I'm trying. Nobody seems to see that I'm trying.”
- Mental health, outpatient. Nadia, 38: “My last therapist said I was catastrophizing, like I was making it all up. The panic attacks are real. I've stopped driving on the freeway because of them. So if you're about to tell me to just breathe, please don't.”
- Health coaching, employer wellness program. Greg, 52: “No offense, but I'm only doing this because HR knocks money off our insurance if we sign up. I've done coaching before. You give me a step goal, I ignore it, and we both pretend it went fine.”
Sample responses
- Beginner, statement 1 (Karen): “What were you hoping for when you signed up in January?”
- Intermediate, statement 7 (Angela): “You keep holding the line, and it hurts to end up as the bad guy every night.”
- Advanced, statement 9 (Lorraine): “You've been through a lot of programs and heard a lot of advice, and you're not convinced this one will be any different.”
Exercise 2: Evoking Change Talk
Pairs with Episode 8 of Practice Time, Eliciting Change Talk.
Skill criteria
- Respond to the change talk in the statement: reflect the client's own desire, ability, reasons or need for change, or ask an open question that invites more of it.
- Let the client make the case for change, with no arguing against the sustain talk, no warnings and no reasons of your own.
- Keep the response short enough that the client does most of the talking.
Beginner statements
- Substance use, outpatient. Teresa, 50: “I've cut back to two glasses of wine on weeknights, and I'm sleeping better. I'm just not sure I want to give it up completely.”
- Primary care. Hank, 71, after a fall at home: “My daughter wants me using the walker around the house. I suppose I'd rather use a walker than end up with a broken hip.”
- Health coaching. Lena, 33: “I want to bring lunch from home more. I spend a fortune on takeout, and I feel sluggish every afternoon.”
- Criminal justice, probation. Evan, 27: “I need to keep this job. Steady work counts for a lot with my probation officer, and honestly, I like having my own money again.”
Intermediate statements
- Mental health, outpatient. Corinne, 40: “I know getting out of the house would probably help. My friend keeps inviting me to walk with her on Saturdays. Most weeks I say yes and then cancel that morning.”
- Family therapy. Doug, 47, father of a 13-year-old: “I yell. I know I yell. My dad yelled, and I swore I'd never be like that. But when my son lies to my face about homework, I lose it.”
- Substance use, outpatient. Jordan, 31: “Smoking weed at night is the only way I fall asleep. Without it I'm up until three. But I'm tired of being foggy at work, and my partner says I'm not really there in the evenings.”
- Health coaching, diabetes prevention program. Bev, 58: “The program says thirty minutes a day. That's not happening with my hours. I could maybe do ten minutes at lunch. Would that even count?”
Advanced statements
- School counseling, after a suspension. Connor, 17: “I'm not ditching my friends just because you think they're a bad influence. They're the only ones who have my back. I just don't want to get kicked out before graduation.”
- Primary care, heart failure clinic. Elaine, 66: “Everyone wants me weighing myself every morning and cutting out salt. My mother lived to ninety eating whatever she wanted. I'll take my chances. Although I would like to see my grandson start kindergarten.”
- Criminal justice, drug court. Tina, 36: “I haven't used in nine months, and the judge still looks at me like I'm about to slip. I do everything they ask. Some days I wonder why I bother. Then I think about getting my kids back.”
- Mental health, psychiatric follow-up. Victor, 44, who has bipolar disorder: “The medication makes me feel flat. I miss the energy. My psychiatrist says that's the illness talking. Maybe. I did lose my last job when I stopped taking it.”
Sample responses
- Beginner, statement 1 (Teresa): “What else have you noticed since you cut back?”
- Intermediate, statement 6 (Doug): “Being a different kind of father than your dad was matters a lot to you.”
- Advanced, statement 11 (Tina): “You've put in nine months of hard work, and getting your kids back is what keeps you going on the hard days.”
Exercise 3: Reflecting Both Sides of Ambivalence
Pairs with Episode 9 of Practice Time, Double Sided Reflections.
Skill criteria
- Name both sides of the client's ambivalence, the pull toward change and the pull away from it, in the client's own terms.
- Join the two sides with “and” or “at the same time” instead of “but,” and put the side that leans toward change last.
- Keep the response a reflection, with no question, advice or reassurance added at the end.
Beginner statements
- Primary care. Ruth, 70: “I know I miss half of what my grandkids say. But hearing aids make me feel old, and they cost a fortune.”
- Mental health, outpatient. Owen, 26: “I want to go to my friend's birthday dinner. I also know I'll spend the whole night worrying about what to say.”
- Substance use, outpatient. Gail, 48: “A drink after work helps me unwind. I've also noticed that one turns into three more often than I'd like.”
- Family therapy. Luis, 39, father of a 10-year-old: “I want my son to be more independent, so I let him walk to school now. Then I check the location app every two minutes until he gets there.”
Intermediate statements
- Health coaching. Simone, 55: “Cutting my hours would probably fix my sleep. I'd finally have my evenings back. Then I think about the money, and how my team would manage without me, and I can't see doing it.”
- Criminal justice, court-ordered anger management group. Jake, 30: “Part of me thinks this class is a waste of my time. Then again, the last time I got that angry I ended up in handcuffs, and I don't want that again.”
- School-based health center. Brianna, 15: “Vaping calms me down before tests. It's also kind of gross that I can't get through first period without it.”
- Primary care, sleep apnea follow-up. Frank, 62: “The machine helps. My wife says I stopped snoring, and I'm not nodding off at my desk anymore. I just hate the mask. I wake up at two and rip it off.”
Advanced statements
- Substance use, opioid treatment program. Carla, 43: “Methadone saved my life. I know that. I'm also sick of standing in that line every morning before work with everybody watching. Some days I think about tapering just to be done with it, even though I remember what happened last time.”
- Mental health, grief counseling. Nathan, 52: “My wife died two years ago. Everyone says I should get out more, maybe start dating. Part of me is lonely. Part of me feels like even thinking about it is betraying her.”
- Health coaching, weight management program. Wendy, 47: “I've tried every plan out there. I want to feel strong again, I really do. And I'm so tired of starting over that part of me would rather just stop trying.”
- Criminal justice, parole. Sean, 38, living in a sober house: “The sober house keeps me out of trouble, I'll give them that. But I'm thirty-eight with a curfew like a teenager, and a caseworker I've met once decides when I get to see my daughter.”
Sample responses
- Beginner, statement 1 (Ruth): “Hearing aids feel like a sign of getting old, and they're expensive. At the same time, you don't want to keep missing what your grandkids are telling you.”
- Intermediate, statement 6 (Jake): “The class feels like a waste of your time, and you also never want to end up in handcuffs again.”
- Advanced, statement 9 (Carla): “That morning line wears you down, and part of you wants to be done with it. And you know methadone saved your life, and you haven't forgotten what happened the last time you stopped.”
See a completed example
In this worked round from Exercise 3, statement 8, one trainee plays the therapist, a second reads Frank's words and a third observes.
The statement. The client reads it with some frustration: “The machine helps. My wife says I stopped snoring, and I'm not nodding off at my desk anymore. I just hate the mask. I wake up at two and rip it off.”
First attempt. The therapist responds: “The machine is working, but you hate the mask. Have you asked your doctor about trying a different one?”
Observer's feedback against the criteria
- Criterion 1 (both sides named) was met. The response held both what the machine gives Frank and what he hates about it.
- Criterion 2 (“and,” with the change side last) was not yet met. “But” set the two halves against each other, and the reflection ended on the mask, which is Frank's reason to stop.
- Criterion 3 (a reflection with nothing added) was not yet met. The question about a different mask shows the fixing reflex, the helper's pull to solve the problem: it moved to a solution before Frank asked for help with one.
Second attempt. The client reads the statement again, and the therapist responds: “You hate that mask, especially at two in the morning, and you're also seeing what the machine gives you: quiet nights for your wife and staying awake at work.”
Observer's feedback. The second attempt met all three criteria and kept Frank's own details. The group runs the statement once more so the response comes without effort, then moves on to statement 9.
Personal Values Card Sort
A values card sort helps a client name what matters most, and the conversation that follows turns to how the change under discussion fits with those values. Treatment Improvement Protocol 35 from the Substance Abuse and Mental Health Services Administration (SAMHSA, 2019) suggests the card sort for clients whose sense of their own values is still vague, since a client has to recognize a value before noticing a gap between it and current behavior.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
How to sort the cards
- Cut the cards apart, or work from the printed list.
- Set the three heading cards side by side: Very important to me, Important to me and Not important to me.
- Place each value card under the heading that fits it best. A value that is missing can go on the blank card.
- From the Very important to me pile, choose the five values that matter most and put them in order, most important first.
- Talk about each of the five: what it means and where it shows up in daily life now.
Follow-up questions for the clinician
- "What does this value mean to you?"
- "When have you lived by it in a way you felt good about?"
- "Where does it show up in your life these days?"
- "How does the change we've been talking about fit with this value?"
- "If you lived a little closer to it over the next month, what would be different?"
These questions explore each value and help the client notice how current behavior fits with it or pulls against it. Earlier editions of Miller and Rollnick's text call this developing discrepancy; the fourth edition calls it planting seeds. Reflect and summarize what the client says, and leave the conclusions to the client.
The cards
| VERY IMPORTANT TO ME | IMPORTANT TO ME | NOT IMPORTANT TO ME |
| ACCEPTANCE to be accepted as I am | ACCURACY to be accurate in my opinions and beliefs | ACHIEVEMENT to have important accomplishments |
| ADVENTURE to have new and exciting experiences | ATTRACTIVENESS to be physically attractive | AUTHORITY to be in charge of and responsible for others |
| AUTONOMY to be self-determined and independent | BEAUTY to appreciate beauty around me | CARING to take care of others |
| CHALLENGE to take on difficult tasks and problems | CHANGE to have a life full of change and variety | COMFORT to have a pleasant and comfortable life |
| COMMITMENT to make enduring, meaningful commitments | COMPASSION to feel and act on concern for others | CONTRIBUTION to make a lasting contribution in the world |
| COOPERATION to work collaboratively with others | COURTESY to be considerate and polite toward others | CREATIVITY to have new and original ideas |
| DEPENDABILITY to be reliable and trustworthy | DUTY to carry out my duties and obligations | ECOLOGY to live in harmony with the environment |
| EXCITEMENT to have a life full of thrills and stimulation | FAITHFULNESS to be loyal and true in relationships | FAME to be known and recognized |
| FAMILY to have a happy, loving family | FITNESS to be physically fit and strong | FLEXIBILITY to adjust to new circumstances easily |
| FORGIVENESS to be forgiving of others | FRIENDSHIP to have close, supportive friends | FUN to play and have fun |
| GENEROSITY to give what I have to others | GENUINENESS to act in a manner that is true to who I am | GOD'S WILL to seek and obey the will of God |
| GROWTH to keep changing and growing | HEALTH to be physically well and healthy | HELPFULNESS to be helpful to others |
| HONESTY to be honest and truthful | HOPE to maintain a positive and optimistic outlook | HUMILITY to be modest and unassuming |
| HUMOR to see the humorous side of myself and the world | INDEPENDENCE to be free from dependence on others | INDUSTRY to work hard and well at my life tasks |
| INNER PEACE to experience personal peace | INTIMACY to share my innermost experiences with others | JUSTICE to promote fair and equal treatment for all |
| KNOWLEDGE to learn and contribute valuable knowledge | LEISURE to take time to relax and enjoy | LOVED to be loved by those close to me |
| LOVING to give love to others | MASTERY to be competent in my everyday activities | MINDFULNESS to live conscious and mindful of the present moment |
| MODERATION to avoid excesses and find a middle ground | MONOGAMY to have one close, loving relationship | NON-CONFORMITY to question and challenge authority and norms |
| NURTURANCE to take care of and nurture others | OPENNESS to be open to new experiences, ideas, and options | ORDER to have a life that is well-ordered and organized |
| PASSION to have deep feelings about ideas, activities, or people | PLEASURE to feel good | POPULARITY to be well-liked by many people |
| POWER to have control over others | PURPOSE to have meaning and direction in my life | RATIONALITY to be guided by reason and logic |
| REALISM to see and act realistically and practically | RESPONSIBILITY to make and carry out responsible decisions | RISK to take risks and chances |
| ROMANCE to have intense, exciting love in my life | SAFETY to be safe and secure | SELF-ACCEPTANCE to accept myself as I am |
| SELF-CONTROL to be disciplined in my own actions | SELF-ESTEEM to feel good about myself | SELF-KNOWLEDGE to have a deep and honest understanding of myself |
| SERVICE to be of service to others | SEXUALITY to have an active and satisfying sex life | SIMPLICITY to live life simply, with minimal needs |
| SOLITUDE to have time and space where I can be apart from others | SPIRITUALITY to grow and mature spiritually | STABILITY to have a life that stays fairly consistent |
| TOLERANCE to accept and respect those who differ from me | TRADITION to follow respected patterns of the past | VIRTUE to live a morally pure and excellent life |
| WEALTH to have plenty of money | WORLD PEACE to work to promote peace in the world | Other Value: |
Adapted from the Personal Values Card Sort by W. R. Miller, J. C'de Baca, D. B. Matthews and P. L. Wilbourne (University of New Mexico, 2001), which is in the public domain.
See a completed example
Marcus, 46, has been drinking most evenings since a layoff eight months ago. In his second session at a community clinic, on November 10, 2026, he sorted the cards with his counselor, D.O., before the two of them wrote his treatment plan. He placed 19 cards under Very important to me and chose these five, in this order.
| Value | What Marcus said | How D.O. responded |
|---|---|---|
| 1. FAMILY to have a happy, loving family | "My wife is the reason I'm here. I want us to be good again, without her worrying every night." | Open question: "What would 'good again' look like?" Marcus: "Me at the table with her after dinner, not on the couch with a beer in my hand." |
| 2. DEPENDABILITY to be reliable and trustworthy | "I've always been the steady one. Nineteen years, and I never missed a shift." | Affirmation: "People could count on you, and you made sure of it." After a pause, Marcus said, "After nine at night, I'm not sure my wife would call me steady." |
| 3. SELF-CONTROL to be disciplined in my own actions | "This one stings. I used to be the one who decided how my evenings went." | Complex reflection: "Getting back in control means being the one who decides again." Then an open question: "What would living by this one look like on a weeknight?" Marcus: "Deciding before dinner what I'll have, and sticking to it." |
| 4. INDUSTRY to work hard and well at my life tasks | "Work gave my days a shape. I want that back." | Simple reflection: "You want your days to have a shape again." Marcus added that he wanted his mornings back for the job search. |
| 5. HEALTH to be physically well and healthy | "I'd like to sleep through the night and not feel foggy in the morning." | Open question: "How does sleep fit with the other four?" Marcus: "If I sleep, I have the energy to look for work, and I'm not snapping at my wife." |
D.O. closed with a summary of the five values in Marcus's words, including the links he had drawn between them and his evenings, and asked, "Where does that leave you?" Marcus said, "Wanting to be the steady one again." D.O. never pointed out a conflict between the values and the drinking; Marcus named each link himself, and his words went into the "Why it matters" row of his treatment plan.
Choosing a Path: An Agenda Mapping Template
In the fourth edition of Miller and Rollnick's text, choosing a path is the name for what the third edition and TIP 35 (SAMHSA, 2019) call agenda mapping: a short conversation about the conversation, in which client and clinician lay out the topics they could take up and agree on where to start. It belongs to focusing, one of the four tasks of MI, and fits the first minutes of a visit when a client brings several concerns or the direction of the conversation is unclear.
An optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
Make a copy (Google Doc)Download the PDF
Topics we could talk about today
| Physical activity | Eating | Sleep |
| Stress | Alcohol | Smoking or vaping |
| Medication | Money or work | Relationships |
| Your own topic | Your own topic | Your own topic |
Questions to open
- "Before we get started, could we take a minute to look at what we might talk about today?"
- "These are some topics people often bring up. Which of them matter to you right now?"
- "What's on your mind that isn't on the sheet? We can write it in one of the empty boxes."
- "There's one topic I'd like to add, if that's all right with you. You can decide whether we get to it today."
Questions to close
- "Let me read back what we have. Did I miss anything?"
- "Which of these matters most to you today, and where would you like to start?"
- "Shall we keep the others on the sheet for another day?"
- Later in the visit: "We have about ten minutes left. Is this still what matters most today, or is something else more pressing?"
See a completed example
Linda, 61, has type 2 diabetes. At her first health coaching visit at her primary care clinic, on November 5, 2026, her nurse health coach, K.T., used the sheet in the first few minutes of the 30-minute visit. Linda circled one topic and wrote in two of her own, K.T. asked to add a fourth, and the boxes Linda left alone stayed unmarked.
| Physical activity Circled. Linda wrote "walking after dinner." Chosen to start. | Eating | Sleep |
| Stress | Alcohol | Smoking or vaping |
| Medication Added by K.T., with Linda's permission: her evening dose. Second, if time allowed. | Money or work | Relationships |
| Checking my sugar at home Linda's own topic, saved for a later visit. | Holiday meals Linda's own topic, saved for a later visit. | Your own topic |
How the conversation went
- K.T. asked, "Before we get started, could we take a minute to look at what we might talk about today?" Linda agreed.
- K.T. read a few topics aloud and asked which mattered to Linda right now. Linda circled physical activity: "I'd like to get back to walking after dinner, like I used to with my neighbor."
- When K.T. asked what was missing, Linda wrote in "checking my sugar at home" and "holiday meals."
- K.T. asked to add one topic: "Your A1C in October was higher than in May. Would it be all right if I added your evening medication? You can decide whether we get to it today." Linda said, "That's fair. I do forget those pills."
- K.T. read back the four topics and asked which mattered most to Linda today. Linda chose walking: "That's the one I keep thinking about." They agreed to start there and to turn to her evening medication if time allowed.
- With ten minutes left, K.T. asked whether walking was still what mattered most or whether Linda wanted to use the time on her medication, and Linda chose the medication. K.T. kept the sheet in Linda's chart and gave her a copy, and they started from the same sheet at her next visit, which appears as the SOAP example in the motivational interviewing progress note template.
Learn and Practice Motivational Interviewing
The templates record and support MI, and the skills themselves grow through rehearsal with feedback. These Sentio resources pair with the toolkit; all but the APA book are free.
Motivational interviewing is also one of the core therapy models taught in the Sentio MFT program, a hybrid master's program in marriage and family therapy built on deliberate practice.
For Supervisors and Faculty
A supervisor can review a recorded segment with the recording review form, choose one skill for the supervisee to rehearse, and run the rehearsal with the practice scenarios in the same hour. Faculty can use the scenarios in class, with students rotating through the client, therapist and observer roles.
The free clinical supervision toolkit holds the session notes, goals worksheet and evaluation forms for the supervision itself, and Sentio's clinical supervisor training teaches deliberate practice supervision over six or twelve months. Clinicians, licensed or unlicensed, can also join the deliberate practice consultation group.
Free Manuals and Measures
These public resources go deeper than the templates, and each is free to download from its official host.
- The MITI 4.2.1 coding manual by T. B. Moyers, J. K. Manuel and D. Ernst, the most commonly used coding system for MI fidelity, hosted by CASAA at the University of New Mexico. The published MITI 4 article describes it as an open-source instrument (Moyers et al., 2016).
- TIP 35, Enhancing Motivation for Change in Substance Use Disorder Treatment (SAMHSA, 2019), a guide to MI and related approaches in substance use treatment, in the public domain except for material it takes from copyrighted sources, with its own importance and confidence rulers.
- The Motivational Enhancement Therapy manual (Miller et al., 1992), the public-domain source of the change plan worksheet.
- The original Personal Values Card Sort (Miller et al., 2001), which is in the public domain; the printable version above is adapted from it.
Videos
- Deliberate Practice in Motivational Interviewing, the webinar with Robert Scholz, Tony Rousmaniere and Alexandre Vaz
- Practice Time, Episode 7: Reflection and Questions
- Practice Time, Episode 8: Eliciting Change Talk
- Practice Time, Episode 9: Double Sided Reflections
Frequently Asked Questions
Are these official motivational interviewing forms?
No. They are free aids from Sentio for you to adapt to your setting. The most commonly used coding system for MI fidelity is the MITI, now in its fourth version, whose coding manual is a free download from CASAA at the University of New Mexico; the recording review form in this toolkit borrows its concepts but is not the MITI.
Can I use these templates in my agency's clinical records?
Yes. Adapt the fields to your agency's documentation rules and to any payer requirements. Each template has a Google Doc version you can copy and edit.
Do I need MI training to use them?
The templates support MI practice, and MI itself is learned through practice with feedback. In a randomized trial with 140 clinicians, a two-day workshop improved MI proficiency compared with a waiting list, and adding feedback or coaching raised proficiency further (Miller et al., 2004). The free MI deliberate practice webinar and the Practice Time episodes are a place to start.
Which template should I start with?
Start with the OARS and change talk cheat sheet and the importance and confidence rulers, which fit an early conversation about change. Use the change plan worksheet when a client is ready to plan, and the progress note and treatment plan for your records.
Is the decisional balance worksheet part of motivational interviewing?
Decisional balance comes from decision-making research (Janis & Mann, 1977), and early MI used it as both a measure and a procedure. Miller and Rose (2015) later concluded that it fits best when a clinician wants to help someone decide without steering, and that with an ambivalent client it can reduce commitment to change. The worksheet comes with a clinician guide to when it fits and when to evoke change talk instead.
Is there a cost?
No. Every template is free to read, copy, adapt and use with any client.
References
Janis, I. L., & Mann, L. (1977). Decision making: A psychological analysis of conflict, choice, and commitment. Free Press. ISBN 0-02-916160-6. https://openlibrary.org/isbn/9780029161609
Manuel, J. K., Ernst, D., Vaz, A., & Rousmaniere, T. (2022). Deliberate practice in motivational interviewing. American Psychological Association. ISBN 978-1-4338-3618-3. https://www.apa.org/pubs/books/deliberate-practice-motivational-interviewing
Miller, W. R., C'de Baca, J., Matthews, D. B., & Wilbourne, P. L. (2001). Personal values card sort. University of New Mexico. https://casaa.unm.edu/assets/inst/personal-values-card-sort.pdf
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., & Rose, G. S. (2015). Motivational interviewing and decisional balance: Contrasting responses to client ambivalence. Behavioural and Cognitive Psychotherapy, 43(2), 129-141. https://doi.org/10.1017/S1352465813000878
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
Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1992). Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence (Project MATCH Monograph Series, Vol. 2; DHHS Publication No. (ADM) 92-1894). National Institute on Alcohol Abuse and Alcoholism. ISBN 0-16-038187-8. Reprinted 1999 as NIH Publication No. 94-3723. https://casaa.unm.edu/tools/met.pdf
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
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
About These Templates
Prepared by Tony Rousmaniere, PsyD, and Alexandre Vaz, PhD, for Sentio's free therapist training. Corrections and suggestions: mabundez@sentio.org.