Fact Sheet

Motivational Interviewing 101

Why Use Motivational Interviewing?

Motivational Interviewing is a collaborative, person-centered counseling style. It is done with the goal of drawing out and strengthening motivation for behavior change. This style of interviewing can create space to explore and resolve mixed feelings about change.

  • Proven to be an effective method
  • Assists clients in making informed decisions about change
  • Motivation to change is elicited from the individual making the change

The Stages of Change

Pre-Contemplation: Not thinking about change

Establishes quality of individual and community life and wellbeing as the criteria for successful interventions and policies.
Contemplation: Considering change

Calls for nonjudgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
Preparation: Getting ready for change

Ensures participants and communities impacted have a real voice in the creation of programs and policies designed to serve them.

Action: Creating change

Affirms participants as the primary agents of change, and seeks to empower participants to share information and support each other in strategies which meet their actual conditions of harm.
Maintenance: Keeping up the change

Recognizes that the realities of various social inequalities affect both people’s vulnerability to and capacity for effectively dealing with potential harm.
Return: Change is hard

Does not attempt to minimize or ignore the real and tragic harm and danger associated with drug use or other risk behaviors.

Harm Reduction Interventions

  • Risk Reduction: Tools and services to reduce potential harm
  • (h)arm (r)eduction: The approach and fundamentals to reduce potential harm
  • (H)arm (R)eduction: A philosophical and political movement focused on shifting power and resources to people most vulnerable to structural violence

Understanding Risk, Set and Setting

Nothing and no one exists in a vacuum. Understanding risk, set, and setting can give clinicians, harm reductionists, outreach workers, and other service providers more tools to support risk and harm reduction for participants.


The risk itself (e.g. related to drug use or sex work) that you’re discussing.

  • What issue is being presented?
  • What other possible sources of harm might be connected to the main issue?
  • What drug is being used? What is the risk of overdose?


The “mindset” that someone brings to the situation, including thoughts, mood and expectations.

  • How are they feeling? Confident? Angry? Anxious?
  • Are they physically in pain or hurt? Do they need to get well?
  • Can they engage with you fully? Are their basic needs being met?


The physical and social environment of where the person is, and their perception of how that can promote/reduce risk.

  • What is the physical environment where the potential harm is occuring? In a home? At work? On the street?
  • Who is around them? Police, bystanders, other participants? How does the person present to these people? How will they react?

Case Study: Jessica

Jessica has been using heroin on and off for the past 10 years. Jessica stopped using for a few months while she was with her ex, but they recently broke up. She is feeling depressed and anxious and is looking to use again. She buys a bag and heads to the syringe exchange for some new points and heads to her encampment in a rush.

Using the questions above, how would Motivational Interviewing inform the way you would approach Jessica?