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What Motivational Interviewing Looks Like in Real Life

Motivational Interviewing (MI) is sometimes described as a ‘conversation about change.’

That description is accurate — but it doesn’t capture what MI looks like when a client arrives in genuine crisis: overwhelmed, ashamed, and convinced the whole world is against them. This post draws on a recent session with a client I’ll call Jamie (all identifying details have been changed). It is one of the most vivid illustrations I’ve encountered of why MI works — and why it works especially well in the moments when a textbook approach would fail.

When a Client Arrives in Pieces

Jamie is in his thirties, living in supported accommodation, and navigating one of the most complex situations I encounter in my work: active involvement with the Family Drug and Alcohol Court (FDAC) programme, a long history of cannabis use, and a desperate desire to rebuild his relationship with his children. When we spoke, he had just come from a contact session with his kids that had fallen apart. One of his children had left early in tears, the other was distressed, and Jamie had said something impulsive in front of them that he instantly regretted. He was beside himself.

But what struck me most wasn’t the crisis itself. It was what Jamie said underneath it:

“I don’t like myself. That’s one of my biggest issues. I don’t care in the world about myself. I hate myself.”

He had sent a friend the same words the night before. This — the shame that runs deeper than any single incident — is exactly the territory MI is built for.

Not Fixing — Accompanying

One of the foundational principles of MI is that the counsellor’s job is not to fix, convince, or rescue. It is to walk alongside. When Jamie arrived in that state of shame and overwhelm, every instinct might suggest reassuring him (“It wasn’t that bad”), problem-solving (“Here’s what you should have said”), or challenging him (“You knew that was the wrong thing to do”). MI asks us to resist all of those.

Instead, I stayed with him in it. “All these bits together are just nailing you, man. They’re just overpowering you.” That is a complex reflection — naming the cumulative weight of everything Jamie was carrying, without minimising any of it. The goal is not to move the client on. It is to let them feel genuinely heard. From that place of feeling heard, movement becomes possible.

The Eye of the Storm

Early in the session, a metaphor emerged that anchored everything that followed: the eye of the storm. Jamie was furious at the social worker, at his ex-partner, at the court system. Some of that fury was completely legitimate. MI doesn’t ask us to pretend otherwise. “You’re legitimately angry,” I told him. “Your reasons for feeling the way you do are legitimate.”

But legitimate anger, expressed in the wrong context, causes damage. The image I offered was a tornado: the people and systems in conflict with Jamie spinning at high velocity on the outside. If he stepped into that wind — if he fought back, argued, or lost his temper in front of the children — it would pull him apart. His job, our shared work, was to find the eye: the still centre where he could hold himself together while the storm raged around him.

“We can’t beat this system. All we can do is find a way around it, underneath it, or over it.”

MI is not passive. But it understands that the counsellor’s alliance sits with the client, not with the institution. I am not there to defend a broken system. I am there to help Jamie navigate it.

The Flickering Light: Recognising Change Talk

Somewhere in the middle of the session, with Jamie still raw and tearful, something shifted. He began talking about what he wanted — not just what was being done to him.

“I want to become that better person, that better dad. I really, really do.” “I want to do this. I do. I want to.”

These are what MI calls change talk — statements of Desire, Ability, Reason, and Need that signal genuine movement toward change. The counsellor’s job is to notice them, reflect them back, and amplify them without applying pressure. The moment you push too hard, you risk generating resistance. The moment you ignore them, you miss the opening.

I offered a second metaphor: a flickering light. Not extinguished — still burning, just flickering. Jamie’s response was immediate and came entirely from him:

“In nine months’ time, it’s going to be massive.”

That is the moment MI practitioners work toward. The client is not agreeing with you. They are generating their own vision of change. You did not put it there. You simply created enough space for it to surface.

The Second Session: Small Wins, Real Pride

When we met again a few days later, something had genuinely shifted. Jamie arrived telling me he had woken up and waited two and a half hours before having his first cannabis of the day. For twenty-nine years, his pattern had been to smoke within minutes of waking. He described this with something I had not heard from him before: pride.

“I’m proud of myself with that, really.” He had set mindfulness alarms four times a day, started tracking his steps, begun doing breathing exercises, and was actively encouraging a friend to break her own substance routine. He was planning to put money he would previously have spent on cocaine toward an electric bike — giving him independence to visit his children without relying on public transport.

In MI terms, this is ‘taking steps’ — the most powerful form of change talk, because it is change already in motion. The counsellor’s role here is not to celebrate loudly or take credit, but to reflect it back clearly and let the client own it: “You’ve broken a routine you’ve had for nearly thirty years. That is not nothing.”

And then something extraordinary. Jamie mentioned he’d had two nights of unexpected thoughts about death — not suicidal ideation, but a sudden, unfamiliar fear of dying. He was surprised by his own reaction. He paused, and then asked quietly:

“Is that actually a start of me starting to care about myself? Because before, I’ve never thought like that.”

That question — uncertain, wondering, just beginning to form — is exactly what early recovery looks like in MI. Not a declaration. A question. A green shoot breaking through the clay.

What Jamie’s Sessions Teach Us About MI

There are a few things these sessions illustrate that do not always appear in the textbooks.

MI works in chaos, not just calm. Some of the most important MI conversations happen not in a quiet consulting room, but in the middle of a genuine crisis — when the client is furious, ashamed, or hopeless. The techniques (open questions, reflections, affirmations, summaries) are not a formula. They are relational. They require the counsellor to be genuinely present, not merely technically correct.

Carefully used self-disclosure is a legitimate MI tool. Sharing my own experience of navigating broken systems, of learning new things imperfectly, of understanding how institutions can feel dehumanising — these were not digressions. They were ways of normalising Jamie’s experience without pulling focus away from him.

Change does not announce itself. Jamie’s first sign of recovery was waiting two and a half hours for a bong. His second was being afraid to die. Neither looked like what we typically expect change to look like. MI trains us to recognise the signal in both.

And above all: the locus of change must belong to the client. “You don’t have to prove anything to anybody. The only person you’re proving this to is yourself.” That principle — autonomy, self-determination, intrinsic motivation — is not simply a technique. It is the engine of the whole approach.