Motivational interviewing is a carefully researched model for change conversations. One of the parameters measured is the counselor’s ratio of reflections to questions. (For more on the skill of reflecting, see Tips #6 and #95.) For example, if a counselor reflects 8 times and asks 19 questions during a session, the ratio is 0.42. A ratio of 1 or higher is considered appropriate for a motivational interview.
Problems cannot be solved at the
same level of awareness that created them.
Change is not made without inconvenience.
When MI sessions are coded for each type of utterance made by the counselor and by the client, interesting patterns emerge. We often ask questions in hopes of eliciting change talk (Tips #69 and #110) and movement toward positive change. The research shows that more change talk follows reflections than follows questions.
How can you measure your R/Q? First, audio-record a typical session (see Tip #73 for more on how to do this while maintaining client confidentiality). Carefully listen to the recording and tally all the reflections and all the questions you uttered. You may wish to jot down a few keys words from each utterance to note patterns. If you have an intern or student shadowing, you could share the Tips on reflecting and ask her to listen carefully and tally reflections and questions. It is not easy to focus on doing this for a full session, so you might suggest the student pick a random 10-minute section to tally.
If your ratio is 1 or higher, give yourself a pat on the back. If your R/Q is significantly lower than 1, you are not alone. Many health professionals and counselors struggle to get a ratio as high as 1. You could choose this as a focus for a few weeks and then measure again. Here are some ideas for practice:
- Remind yourself at the beginning of each session to stretch yourself to use reflections whenever possible.
- Find a friend or colleague who is willing to practice with you. Begin a conversation about something your partner would like to talk about and limit yourself to reflections. Even if it seems awkward to stick with only reflections, keep it up. It’s good practice.
- Listen to a recording of one of your sessions and stop it at certain points to practice making a reflection out loud that you didn’t during the session. For practice, you can even push it to an extreme and form several different types of reflections (Tip #95) for each moment you find.
Practice, practice, practice.