Table 2.

Example of MET-EA Phase 2: Exploring the Client’s Histories of Distress, Coping, and Treatment, and Any Current Hopes for Treatment

Dialogue	MI Strategy
THERAPIST (T): [Following client’s description of conflict with her friends] So this has been an awful way to feel, so angry and hopeless and just stuck in this situation with your friends. Have there been times in the past when you felt like you’re feeling now?	Asking for history of specific illness
CLIENT (C): Well, sort of. We’ve had lots of fights before, and we always kind of made up. But this is just so much worse, and I don’t want it to keep going like this.	Change talk; desire to change
T: You expect to have difficult times in your life and then for things to get back to normal, but this time they don’t seem to be getting back to normal.	Reflection
C: Yeah, I can usually pull myself out of it.
T: How have you done that?	Asking about past coping
C: Well, I don’t know. I guess I’ve had my friends to talk to, to kind of bounce thoughts off. But I’ve been so alone lately and my friends don’t seem to be around anymore. No one really cares or understands what’s going on.	Identifying interpersonal contributors to current episode
T: You feel like there is no one to turn to at this point when you are feeling the most frustrated and down, and you need someone to understand you or offer you a little support. That’s the big difference between now and before—you don’t have anyone to turn to who could help.	Reflection of meaning and a subtle reframe
C: I hadn’t really thought about it that way. Yeah I don’t have anyone now who I can really talk to.
T: And you miss that and you’re really feeling the need for that now.
C: I’ve got to do something. I can’t go on feeling like this anymore.	Change talk: need to change
T: You said your friends could understand you. What was it about them that seemed to make you feel understood?	Reflection—asking for elaboration
C: Well, you know, they would sit and take time to listen to me vent. They really seemed to care and wanted to know what was going on. They were interested.	Giving therapist information about what client is looking for in therapist
T: You could be yourself with them.	Reflection of meaning
C: Yeah, I guess so.
T: Your friends listened, they wanted to help, and they seemed to care about you. They wanted to help you feel better.	Interim summary
C: Yeah, they wouldn’t be all judgmental and tell me what I should be doing.	Key point about what she does and does not want
T: You want to figure things out yourself.	A specific reflection highlighting the key point
C: Uh huh. I want to make sure no one else decides for me what I should do. Like, I had this friend who went to counseling for depression, and they put him on some kind of meds that made him gain all this weight. He was sort of a zombie. I don’t want to end up like that.	Revealing a barrier—negative treatment expectations
T: So you want to make sure you know what your options are and the possible things that could go wrong.	Reflection of feeling
C: Yeah. Like I wouldn’t want to take meds. They tried to put me on stuff when I was a kid and I flushed it down the toilet.
T: You really felt like it was forced on you. (Client nods.) So you’ve seen two different kinds of help that people get. One is medication, which doesn’t feel right to you. On the other hand, there is having someone to talk to, who understands and seems to care and wants to help, like it was with your friends—that feels like it could be helpful.	Reflection of feeling; linking summary and reframe
C: Yeah, it sounds like it could be.	Change talk
T: So if you were to come to therapy, how long do you imagine it will take for us, like how many sessions or weeks, to get to the point where you’re talking things through in a way that you’re starting to feeling better?	Specific question about client’s perception of how long therapy will be
C: I don’t know . . . like a couple months maybe? I don’t really know what you do here, exactly.
T: Well, what we offer is called “cognitive-behavioral therapy.” It’s a type of talking therapy that focuses on dealing with your specific problems and the thought processes you experience and how that relates to your depression. The therapist will be in your corner, listening to you and helping you figure out what you can do to make things better.	Introducing the treatment
C: That sounds good. I could use some help with my problems.	Change talk
T: Looking down the road months from now, if the therapy works and is really helpful for you, how will things be different?	Looking forward
C: Well, I would really like to have a better relationship with my friends and not be fighting all the time, but that seems so impossible right now.	Expressing ambivalence
T: Having your friends back is something you would really like, but you can’t quite imagine that happening right now.	Double-sided reflection
C: Yeah. I suppose if I weren’t so tired and depressed all the time, my friends wouldn’t be avoiding me so much. And I wouldn’t be picking fights with them about stupid stuff.	Change talk—thinking about possible solutions
T: So if things went really well with the therapy, one change would be that you would somehow be less irritable and your friends would want to hang around you more.	Highlighting a source of hope through reflection
C: Yeah, and I could talk with them and not feel so isolated all the time.	More change talk
T: The way you are feeling now, it doesn’t seem like there is any way you could do this, but if things went well and you had more energy, you could figure out how to be less angry and stop driving your friends away so much.	Reframing from pessimism to hope
C: Yeah, it would be really great if therapy could help with that.	Envisioning help