CBHCM Motivational Interviewing — Questions and Answers
Question 1: Motivational Interviewing (MI) is best described as:
- A confrontational technique designed to break through client denial
- A collaborative, person-centered counseling style that elicits and strengthens a client's own motivation for change (Correct answer)
- A structured therapy model used exclusively for substance use disorders
- A psychoeducational approach that provides clients with information about the risks of their behavior
Correct answer: A collaborative, person-centered counseling style that elicits and strengthens a client's own motivation for change
MI is a collaborative, person-centered counseling approach developed by Miller and Rollnick. It draws out the client's own motivations for change rather than imposing reasons from the outside, and is applicable across many behavioral health conditions — not only substance use.
Question 2: The acronym OARS in Motivational Interviewing stands for:
- Observe, Assess, Reflect, Summarize
- Open questions, Affirming, Reflective listening, Summarizing (Correct answer)
- Organize, Advise, Reframe, Support
- Outcome goals, Ambivalence, Resistance, Stages of change
Correct answer: Open questions, Affirming, Reflective listening, Summarizing
OARS represents the four core MI communication skills: Open-ended questions (encourage elaboration), Affirmations (recognize client strengths), Reflective listening (demonstrate understanding), and Summarizing (link and reinforce what was shared).
Question 3: In Motivational Interviewing, 'change talk' refers to:
- The case manager explaining why the client needs to change their behavior
- Statements made by the client that favor moving toward change (Correct answer)
- A structured conversation held during a formal treatment planning session
- Confronting the client about the negative consequences of their current behavior
Correct answer: Statements made by the client that favor moving toward change
Change talk is any client speech that expresses desire, ability, reasons, need, or commitment to change. Recognizing and selectively reinforcing change talk is a central MI skill, as research shows it predicts positive outcomes.
Question 4: A case manager using MI hears a client say, 'I know I should stop drinking but I enjoy it and I'm not sure I'm ready.' The MOST appropriate MI response is:
- 'The health risks of alcohol are serious — you need to commit to sobriety now.'
- 'It sounds like part of you recognizes a problem, while another part values what drinking does for you.' (Correct answer)
- 'Let's set a quit date together for next week.'
- 'You will not make progress until you are fully committed to stopping.'
Correct answer: 'It sounds like part of you recognizes a problem, while another part values what drinking does for you.'
This client is expressing ambivalence — a normal part of behavior change. The MI response reflects both sides of the ambivalence without judgment, validating the client's experience and keeping the conversation open rather than pushing for premature commitment.
Question 5: Rolling with resistance in Motivational Interviewing means:
- Persisting with the same argument until the client accepts the case manager's perspective
- Documenting client resistance as non-compliance in the clinical record
- Avoiding argument and redirecting or reframing rather than confronting the client's pushback (Correct answer)
- Suspending MI and transitioning to a more directive counseling approach
Correct answer: Avoiding argument and redirecting or reframing rather than confronting the client's pushback
Rolling with resistance (now called 'discord' in updated MI) means not arguing against the client's pushback. Instead, the case manager sidesteps, reframes, or reflects back the client's perspective, preserving the relationship and keeping the client engaged.
Question 6: Which of the following client statements is an example of 'sustain talk' that a case manager using MI should NOT selectively reinforce?
- 'I think I might be ready to try cutting back on my drinking.'
- 'My kids need me to be more stable.'
- 'I have managed fine without medication for years — I do not see why I need it now.' (Correct answer)
- 'I know things have to change eventually.'
Correct answer: 'I have managed fine without medication for years — I do not see why I need it now.'
Sustain talk is client speech that argues for maintaining the status quo. 'I have managed fine without medication' argues against change. MI practitioners selectively reinforce change talk while not reinforcing sustain talk, which would strengthen resistance.
CBHCM Motivational Interviewing
Motivational Interviewing (MI) is best described as: