Using

Motivational Interviewing to
Enhance the Professional Behaviors of Fieldwork Students

Jeni Dulek, OTD, OTR/L, CFWE
jdulek@americancareercollege.edu

Stage/ Description Educator’s Role Useful Approaches Questions to Ask

Precontemplation • Help student consider if • Establish rapport, ask • What concerns have
he/she has a problem. permission, build trust. others had about your
Provide information • Elicit the student’s behavior?
Student is unaware or •
linking problem perceptions of the • Would it be OK if I
under-aware of behaviors and real-life problem. offered some
problems. No intention OT practice. • Offer factual information observations from our
to change behavior. • Raise awareness and about the consequences of interactions?
doubt. behavior on grades, • Would it be OK if I
Key issues: Reluctance, • Remember that the practice, etc. offered some concerns
rebellion, resignation, goal is NOT to help • Explore the pros and cons about how this might
them change of change with the student. affect you in the
rationalization immediately, but to future?
• Express concern and “keep
help move them to the door open” • What are some of the
contemplation. • Be aware that the student benefits to (describe
may be aware of the the behavior) that you
problems his/her behavior see?
causes, but still not looking • What are some of the
to change it. drawbacks to (describe
the behavior) that you
see?

Contemplation • Help student explore • Normalize ambivalence. • What would life be like
feelings of ambivalence • Elicit and guide student to if you changed (the
and the conflicts he/she weigh the pros and cons of behavior)?
Student is aware of the
feels about changing the status quo and possible • What do you see
problem and is his/her behavior. change. happening if you
considering a change, • Move motivation from • Help the student to continue to (describe
but has no commitment extrinsic to intrinsic. examine his/her the behavior)?
professional goals in • Times when you have
to take action.
relation to the change (describe the change;
he/she is contemplating. examples: “related well
Key issue: Ambivalence
• Emphasize the student’s to instructors,” “been
free choice, responsibility, on top of your
and self-efficacy. homework,” etc.), what
• Remember that interest in did you do to make
change does not mean that that happen?
one is committed to • If you were to make
change. Do not confuse this change, how might
these. you go about it?
• How important is this
change to you right
now? Why is it not less
important to you?
 Preparation • Help student work to • Assess strength of • How important is this
strengthen commitment. change to you right
commitment to change. • Examine barriers and elicit now? Why is it not less
Student intends to
• Help student explore solutions. important to you?
change and is preparing his/her resources and • Acknowledge the • If you were to make
to do so. May make strategies to support significance of the decision this change, what
small behavioral the change. to change. would the first week be
• Help student decide on • Affirm the student’s ability like for you?
changes.
appropriate, achievable to be successful. • What do you think you
Key issue: Gathering action. • Remember that change is will do?
not automatic, and • What is your next step?
ideas, resources, ambivalence is still present. • If you were to make
confidence • Explain that relapse will not this change, what
disrupt your relationship might get in your way?
with the student. How can you address
it?
• Would it be OK if I
offered some possible
ideas to help you make
this change?
• Who might support you
in this?
Action • Help student execute • Acknowledge student’s • What is working for you
his/her action plan. feelings and experiences. right now?
• Help student problem- • Support a realistic view of • What hasn’t worked so
Student takes decisive
solve new barriers. change through small far? What might you
action to change. • Be a source of steps. do about this?
encouragement and • Acknowledge difficulties. • How are you handling it
Key issue: Small steps support. • Help student assess and call when things don’t go as
• Reinforce the benefits on resources and support. you had planned?
of the change. • Reaffirm student’s • Who or what is
commitment to change. supporting you in
making this change?
• What resources or
support do you wish
you had that you don’t
currently have?
Maintenance • Help student with • Support self-efficacy. • What have you found
relapse prevention. • Evaluate present actions to be most effective for
and long-term plan for you in making this
Student works to
change. change?
consolidate gains and • Anticipate difficulties and • What do you anticipate
prevent relapse. address them. becoming difficult for
• Remember that you in the future? How
Key issue: Stability maintenance takes more might you handle that?
action and planning than • What has worked
you’d think. Relapse is before that you might
possible. try again?
 Relapse • Help student cope with • Help student re-enter the • What did you learn as a
the consequences of change cycle. result of the process?
relapse. • Determine where he/she is • How are you feeling
Student returns to
• Help student decide re-entering the cycle so you now?
previous behaviors. what to do next. can provide appropriate • Prior to (the relapse),
Usually returns to support. what was working for
contemplation stage. • Commend any willingness you?
to reconsider positive • Prior to (the relapse),
Key issue: What next? change. what wasn’t working so
• Explore the relapse as a well?
learning opportunity. • What other skills or
• Emphasize the positive resources do you think
aspects of the student’s you might benefit
attempts to change. from?
• Express concern and • Would it be OK if I offer
disappointment about the my views on where
relapse. you’re at right now?
• Support the student’s self-
efficacy.

Key Concepts in Motivational Interviewing

Four Principles
Spirit Micro-Skills
Processes

Roll with Open-ended

Collabora]on Engaging
resistance Ques]ons

Express
Evoking Focusing Affirma]ons
empathy

Develop
Autonomy Evoking Reflec]ons
discrepancy

Support self-
Compassion Planning Summaries
efficacy





Sample Script for MI with a FW Student

FW Educator: I asked to meet with you today to talk about how things are going for you so Open-ended question
far on this placement. What are your thoughts about your performance so
far?
Student: I think it’s good. My patients like me. Things are good.
FW Educator: You’ve worked hard to build rapport with your patients. Affirmation
Student: Yes, I like them and they like me.
FW Educator: What other things are you noticing in your performance so far? Open-ended question
Student: Nothing else really. I think I’m doing pretty good.
FW Educator: I agree that you’re doing well with your patients so far. How are you feeling Open-ended question
about your time management?
Student: Well, sometimes I have really busy days, like on Tuesdays. And other days
there aren’t as many patients scheduled. Or they cancel.
FW Educator: Sometimes you have a lot going on, and other times you have a little break. Reflection
Yes. Those busy days really make me tired.
Student: You work really hard on those days.
FW Educator: Yeah. I go home and I’m exhausted. Affirmation
Student: And what about the days when you don’t have as many patients scheduled?
FW Educator: How do you feel about how you use your time on those days? Open-ended question
Student: Pretty good. I try to help around the clinic when I can. I get my notes done,
then I clean up or find something else to do to help.
FW Educator: Staying busy and contributing to the clinic is important to you. Reflection
Student: I want to contribute. And I get bored when I don’t have much to do.
FW Educator: I can understand that. Do you mind if I offer an observation about your use (Asking permission)
of unscheduled time?
Student: Sure, I guess. I mean, I try to help out. I don’t see why we would need to
talk about that. But go ahead.
FW Educator: You contribute a lot around here. It doesn’t seem that important to talk Reflection
about the other ways you use your free time.
Student: Right. But go ahead.
FW Educator: Well, I’ve noticed that sometimes when you have a cancellation or some (Sharing objective data)
unscheduled time, we can’t find you when we’re looking for you. Other staff
have reported that they’ve seen you taking breaks outside.
Student: Yeah, I take breaks every so often. I don’t know why we need to talk about
that, though.
FW Educator: Taking an extra break during the day doesn’t seem like a big deal, as long as Reflection
you get all your work done.
Student: Well, yeah. I mean, what else am I supposed to do? Plus, it’s stressful here
sometimes. I need to get outside.
FW Educator: You take breaks because this work is difficult sometimes, and you just need Reflection
to get away and collect your thoughts. And you’re getting all your work
done.
Student: Right. And it’s not like anyone needs me at that time.
FW Educator: What might happen if someone did need you? Open-ended question
Student: I guess they’d have to go outside to find me. But that isn’t that difficult.
FW Educator: When a staff member needs your help or you get a call from a patient, we Amplified Reflection
should go out to the parking lot to call you in.
Student: Well, I can see where that could be difficult…