Table 1.

Example of MET-EA Phase 1: Eliciting the Story

Dialogue	MI Strategy
THERAPIST (T): Thanks for filling out our intake information. This will be helpful—we’ll go over these a little later so we can consider it together and I can understand your background info and history a little better. Before that, it would help me a lot if we could talk about how things are going for you in the present.	Beginning with an affirmation, then an open-ended question to draw out the story
CLIENT (C): My mom was the one who wanted me to come here today. I guess that’s okay. But she’s driving me crazy and doesn’t get me at all. She thinks I’m using my anxiety as an excuse and she tells me I need to get my act together and I need to get over it. Meanwhile, I’m trying to finish school and start a new job. It’s a lot to do, and to make me even more anxious, I now have to come to therapy too, and therapy never really helps.
T: You feel your mother doesn’t really understand the stress you’re facing and that you’re working on accomplishing a lot of important things despite feeling pretty anxious.	Therapist reflects meaning and feelings
C: Yes, it’s really pissing me off. I don’t even want to talk to my mom sometimes.
T: This is really useful in helping me understand where you’re coming from. I was wondering if you could tell me what else you have been feeling and doing during this time when things seem so stressful.	Asking for elaboration and problem recognition
C: Well I’m anxious like all the time, so I’m trying to ignore my mom. I try to use so-called coping skills that counselors have told me to use, but none of it works, you know. The other day I had a panic attack and my mom actually yelled out “Call 911, she’s going to have a heart attack and die!” Is that helpful?! You’re not supposed to say something like that when someone is having a panic attack! Come on!
T: You’re feeling frustrated about not getting support. Your mom sometimes makes you feel more anxious by not doing the right thing when you need her help.	Reflective summary of complaints
C: Yes, my mom is making it worse. My anxiety is horrible; I can’t stand it.
T: And this is a change from how things have been in the past?	Looking back
C: It’s gotten worse this year when I started trying to finish school and start a job. I really want to get into nursing school.
T: And here you are, doing your best with a lot of new challenges, and people who are supposed to help aren’t feeling very helpful to you.	Affirmation and identification of possible engagement barrier
C: And before that things weren’t too great either. I’ve always had problems with anxiety, but it feels worse now. Then my mom’s intolerable. Maybe she should be in therapy instead of me!
T: You are really doing your best to manage your anxiety—getting your school and work goals accomplished all by yourself—but you are feeling misunderstood by your mom and you would really like some more support.	Affirmation and complex reflection
C: Yeah, exactly. No one seems to understand what this is like for me, except maybe some friends.
T: You feel alone dealing with this stress.	Empathizing
C: My mom thinks I should just get over it, and therapists just give you these cute little coping skills. But I need to get my anxiety under control.
T: So how did you make a decision to come here today? Dialogue	Eliciting the ambivalence and possible barriers to treatment MI Strategy
C: My mom told me to come. I should just get a job and get over this anxiety . . . I don’t know if I’m ready to work, but I really want to . . . There’s just too frickin’ much.
T: How did you make your decision to start your new job?	Eliciting more detail and possible dilemma
C: Well, even though I’ve been struggling with anxiety for a long time, I want to be a nurse. I love working with the elderly and that makes me feel good; I enjoy it. It gets my mind off my problems. I want my mom and others to take me seriously.
T: Let me see if I understand the situation. You’ve been dealing with anxiety for a long time and even before the past year. You’ve had counseling for anxiety before, but it really hasn’t been helpful. But now you’re really interested in starting a job and finishing school so you can achieve your ultimate goal of becoming a nurse. What gets in the way is that you’re struggling with the stress and anxiety, and your mom doesn’t understand it is a real problem and that you’re doing your best. You want to move forward with your goals because they’re important to you. It would be nice to have some support and to feel understood.	Transitional summary including acknowledgment of feelings, personal goals, and interest in receiving help
C: Yep, you got it. Jeez, no matter what I do I can’t win.
T: And you are at a point now where you would like some help with your anxiety. At least, you want to make sure you get some help with some of the challenges you’re facing right now.	Implicit recognition of need for change
C: Yes, I’m worried everything is going to be too much.
T: You’re not sure you can succeed at all of the things you want to do.	Acknowledgment of feelings
C: Right. I don’t know how I’m going to keep it all going in the right direction.