CODING & COACHING TOOL

Version 2.1
C. Jackson1, S. Butterworth2, A. Hall3, & J. Gilbert1

1
The Institute for Individual and Organizational Change (IFIOC)
2
Q-consult, LLC
3
Ali Hall Training & Consulting

Recommended citation:

Jackson, C., Butterworth, S., Hall, A., Gilbert, J. (2015) Motivational Interviewing Competency Assessment (MICA). Unpublished manual.

Acknowledgments: We are extremely grateful for all of the years of concentrated research and continued efforts by the authors of the MI
assessment tools that preceded this coding tool. We especially appreciate, honor, and thank the authors of Motivational Interviewing: Helping
People Change, 3rd Edition – William Miller and Stephen Rollnick; and the authors of the Motivational Interviewing Treatment Integrity (MITI)
scale – Theresa Moyers, Jen Manuel, and Denise Ernst.

MICA v.2.1. Please do not cite or reproduce without express written consent 1
 Purpose of MICA
Does the communication method of this practitioner demonstrate a level of competency representative of Motivational Interviewing (MI)?
The Motivational Interviewing Competency Assessment (MICA) addresses this question in a way that upholds integrity to the intent of MI by
drawing upon a variety of evidence-informed and evidence-based tools, theories, and practices. There are well-respected tools, such as
1 2
the MISC and MITI , that are used to effectively evaluate clinical samples for fidelity to MI for research projects, as well as to discover the
underlying dynamics of MI. As MI continues to evolve, there is an increasing demand for a coding tool solely focused on providing practical
feedback to professionals in any service field on how to build their skill-set in MI.

We developed the MICA to evaluate a sample of a practitioner’s clinical conversation to assess baseline competence in MI from a quality
assurance perspective. In addition, we wanted to provide a quality improvement process for practitioners who want to move from a
competent use of MI to a more proficient application of MI intentions and skills. Ultimately, our goal is that MICA will give professionals easily
digestible, structured, and specific feedback regarding their effort to use MI with their clients.

Any professional conversation can be coded (i.e., assessed) using MICA whether it is a brief, yet complete, conversation (i.e., 10 minutes total
from beginning to end), or a selected 20-minute sample from a longer conversation.

MICA Coding Process

Coding professional sessions using MICA requires a working knowledge of Motivational Interviewing. While other tools are amenable to non- MI
trained coders, MICA works hand-in-glove with coaching based on the insights of the coder. While the primary focus is to provide readily
applicable feedback to the practitioner, the secondary focus of MICA is to provide clear instructions and decision trees for coders to ensure an
effective and efficient coding experience.

There are two categories coded in the MICA: Verbal Interventions (microskills and MI strategies) and MI Intentions. The microskills in the Verbal
Interventions are simply tallied each time they occur. The two MI strategies and the five MI Intentions each are structured with a Definition,
Indicator, and Further Detail (see Figure 1).

1
MISC: see http://casaa.unm.edu/download/misc.pdf
2
MITI: see http://casaa.unm.edu/download/MITI4_1.pdf

MICA Coding Training

The MICA manual is provided to the MI community with no licensing fee. We do respectfully request that you receive adequate training from one
of the co-developers of the tool to ensure that the system can be applied appropriately, as it was intended. For more information on training or
results from our reliability/validity testing, go to www.micacoding.com or email one of us:
Casey Jackson: casey.jackson@ifioc.com
Ali Hall: mi.consult.ahall@gmail.com
Susan Butterworth: butterwo@qconsulthealthcare.com

MICA v.2.1. Please do not cite or reproduce without express written consent 2
 GUIDING
Definition–This is the description This measures the practitioner Intention to navigate the conversation towards the goal
or topic of concern. The client is the captain whose ship may be stuck, off course, strug
and the scope of the item
course. The client provides information, feedback and insights while the practitioner he
to be rated. course by skillfully navigating the conversation towards a path of insight/solution/resolu

Fundamentally Inconsistent Generally Inconsistent Client-Centered

Indicator–This is where the
coder derives a representative 1 2
score based on observations over Primarily directing,
the course of the session. controlling, or mandating
the client goals
Further Detail–This is where specific The practitioner may:
aspects of the Definition are considered
• subtly or overtly sets the
and provide additional descriptions to targets or goals irrespective
delineate between Indicators. of the client’s interests or
agenda
• is in the expert role and leads
or pushes the client
Primarily wandering around,
following, or subtly directing
client goals
The practitioner may:
• listen to client’s goals, then
shift to their own agenda
• makes few, if any, attempts
to establish a shared
approach to the client’s
3
Attempts a shared
approach to the client’s
goals with instances of
wandering, following or
directing
The practitioner may:
• elicit the client’s agenda,
but may promote a
secondary agenda they
are trying to insert into the
conversation
• allow the conversation

Figure 1. Structure of MI Strategies and Intentions.

MICA v.2.1. Please do not cite or reproduce without express written consent 3
 Coding MI Strategies and Intentions
The two MI Strategies and each MI Intention has a Definition, Indicator, and Further Detail. The
coder listens to the session while coding the Verbal Interventions. While question and reflection MI Strategy and Intention
tallies are occurring, the coder is gathering an impression of the overall session. There is no one
Coding Sequence
verbal exchange between the practitioner and the client that determines the MI Intention
score. Rather, the coder should listen to the session and gather an overall assessment of the
exchange. 1. Read the Definitions of the
two MI strategies and five
MI Intentions prior to coding
We advise that the coder read the Definition of each MI Strategy and Intention each time a
new session is coded. To uphold coding integrity, the coder grounds, reorients, and refocuses the session.
on each Definition prior to coding the session. This cues the coder’s listening and provides a 2. Listen to the audio session.
contextual framework for the conversation. This is the coding protocol regardless of the
coder’s experience in coding, coaching, or training MI. 3. As you consider each Strategy
and Intention, start by re-reading
Once the segment of the session being coded ends, the coder moves through each of the the Definition of each.
Definitions and provides a score based on the Indicators. The protocol is to read the Definition, 4. Then for each Intention and
then identify which of the Indicators most accurately reflects the practitioner’s demonstration
Strategy you are considering, ask
of that MI Strategy or Intention. If it is difficult to determine a score based off of the discrete
Indicators, the coder then reads the Further Detail provided in the bulleted section below each yourself if the interaction is client-
Indicator. While the Indicators for each Definition are tailored to that specific Intention, it is centered [for this Intention or
helpful to have a base understanding of the target threshold of each Indicator. These are the Strategy only]
fundamental thresholds to distinguish each score from the next:
5. If yes [client-centered] , start
at #3 for baseline scoring
1 Fundamentally inconsistent with MI. Absence of MI Intentions and skills. Missing most elements and assign/adjust higher on
of MI, and the conversation being coded has no Indicators representing a client-centered scale accordingly; if no [not
approach.
client-centered], start at #2.5
2 Generally inconsistent with MI. Attempts toward MI are missing the underlying Intentions and and assign or adjust lower on
skills. May naturally, intentionally, or unintentionally hit elements of MI, yet the conversation scale accordingly
coded does not represent a client-centered approach.
6. If unable to assign a score
3 Consistencies and inconsistencies with notable attempts to align with MI Intentions and skills based on the Indicator, read
at a ‘do no harm’ level. Naturally, intentionally, or unintentionally hits elements of MI, yet the Further Detail.
conversation being coded represents a client-centered approach .

4 Competent MI. Primarily consistent with MI Intentions and skills. Intentionally and purposefully
focuses on elements of MI, which is solidly a client-centered approach.

5 Proficient MI. Adept and consistent with MI Intentions and skills. Deftly orchestrates elements of
MI, and the conversation coded embodies a client-centered approach.

MICA v.2.1. Please do not cite or reproduce without express written consent 4
 Coding Differentials
There are instances where it is difficult to distinguish the most accurate Indicator score. We provide Further Detail to help clarify and distinguish
the quality of the Indicator. If the coder cannot distinguish with relative certainty between two Indicator scores that appear to have equal
merit, then a .5 decimal may be added to the score to increase accuracy. For example, if there are elements of Further Detail of a “2”
Indicator that are accurate and Further Detail of a “3” Indicator that are also accurate, then the coder can assign a score of a “2.5”. This
allows the practitioner to see that they are beyond the elements of a “2”, although not quite to the elements of a “3”. This can be helpful
feedback to the practitioner as well as helpful insight and targets for improvement from a coaching perspective.

Again, this coding differential is to increase accuracy of scoring. It is NOT appropriate to assign a .5 decimal because a coder does not want
to mark a score too low or as a default.

Coding Verbal Interventions

Motivational Interviewing continues to explore and expand linguistics and the impact on behavior change. A MI practitioner is mindful as to
the words being used and the immediate impact on the client. Each time the practitioner chooses to speak, there is an awareness of
potential impact on the client’s perspective. In the MICA, those skills and strategies are called “Verbal Interventions.” Verbal Interventions
include the skills of mindful questions and strategic reflections used by the practitioner to facilitate an effective and efficient exchange. MI
strategies focus on the types of language and selective responses that promotes the client’s progression toward a goal or preferred change.
Both microskills and specific MI skills are the two types of Verbal Interventions coded in the MICA.

Coding Microskills
Microskills are basic communication skills that practitioners intentionally apply when working with clients. Miller and Rollnick (2002) found that
clinicians asked questions significantly more than they used reflective statements in traditional therapy sessions. Reflections were markedly
outnumbered by questions with a ratio of one to ten (1:10). They found a notable contrast with clinicians skilled in MI who tend to reflect more
often than ask questions. Those skilled in MI had a reflection to question ratio of 3:1.

Over the length of the segment of audio session being coded, the coder listens to and tallies both questions and reflections coming from the
practitioner. There is no differentiation of types or quality of questions or reflections in tallying the microskills section of MICA, although quality
will be captured in the Intentions.

Coding Questions
There is no distinction between open and closed questions; however, coders can take note of the quality of the questions to provide
feedback to the practitioner (i.e., primarily closed questions, predominantly fact-finding, exploratory, evocative, etc.). If the practitioner starts
out with a statement, yet the voice inflection turns the statement into a question, the Verbal Intervention is coded as a question. Coders
distinguish voice inflections and hear differences when these responses are read out loud:

“You are worried about how you will explain it to him?”

“You are worried about how you will explain it to him.”

MICA v.2.1. Please do not cite or reproduce without express written consent 5
 “There was nothing you could do?”

“There was nothing you could do.”

This is a crucial distinction, and a primary reason to code audio sessions rather than coding transcripts. Coders assess what the practitioner
provides, NOT how the client responds. Although a statement may start out as a reflection, if the voice inflection changes and sounds like a
question, it is coded as a question. This includes when there is that questioning or inquisitive tone, or a tone of checking for accuracy. If it is
provided as a statement, or a tone of acknowledgment, it is coded as a reflection.

It is common that a practitioner may ask a series of questions in one Verbal Intervention. Here are common types of examples where there
are two or more questions in the Verbal Intervention:

Question: “What are you planning for the weekend? There is a group of people going out to the lake to have a BBQ and go boating, is
that something you would be interested in?”

Question: “What are you planning for the weekend? You feel depressed on weekends and disconnected and alone. What thoughts
have you had to increase your activity on the weekends?”

Question: “What are you planning for the weekend? Are you going to the lake? Spending time with your family? Going to a s h o w ?”

These examples would receive one question tally. The client typically responds to the overall thought, question, or concept, and most likely will
not respond to each of the questions independently. This protocol increases inter- rater reliability by preventing over-coding. There would be
two distinct codes if the practitioner asks a question, the client responds, and another question is asked.

Question: “What are you planning for the weekend?”

Response: “We are heading out to the lake with some friends.”

Question: “Are you going to be spending time with your family?”

This example would receive two separate question tallies.

Coding Reflections
A reflection – whether simple, complex, or a series in one intervention – is coded as one reflection. If reflections are summarizing, long, wordy,
or even convoluted, they still receive one reflection tally if it is part of one Verbal Intervention. It is also a series of reflections (coded as one
reflection) if there is a question or giving information scattered throughout the Verbal Intervention.

“It sounds like you have been struggling with this for a while… and still aren’t sure what you might do, since your children are involved,
and the court has their agenda, it all seems so overwhelming, which is why you are feeling so stuck right now… and not quite sure of
your next step.”
MICA v.2.1. Please do not cite or reproduce without express written consent 6
 “It sounds like you have been struggling with this for a while. I’ll tell you that is really normal for someone in your situation. And it seems
like you are not sure of your next steps.”

“It sounds like you’ve been struggling with this for a while… is that right? That’s pretty normal. And it seems like you’re not sure of your
next steps.”

Each of these examples are considered one Verbal Intervention, so would receive one reflection code (the last example would also receive
one question code). If there is a response by the client, and a new reflection by the practitioner, then there would be two separate codes.

Practitioner: “It sounds like you have been struggling with this for a while… and still aren’t sure what you might do, since your children are
involved, and the court has their agenda, it all seems so overwhelming, which is why you are feeling so stuck right now.”

Client: “It is overwhelming. I don’t think anything I do will make a difference.”

Practitioner: “You’re not quite sure of your next steps.”

Each of these Verbal Interventions would receive a separate tally as a reflection. If there is a clear and obvious pause and there appears to
be a separate and distinct Verbal Intervention, then there would also be two separate reflection tallies.

Practitioner: “It sounds like you have been struggling with this for a while… and still aren’t sure what you might do, since your children are
involved, and the court has their agenda, it all seems so overwhelming, which is why you are feeling so stuck right now.”

Client: (long pause)

Practitioner: “Yet you do have some ideas of possible next steps from here.”

If there are two clearly notable Verbal Interventions, they would receive two separate codes. If it is unclear, the default is to code a singular
reflection code.

MICA v.2.1. Please do not cite or reproduce without express written consent 7
 Coding MI Strategies
In 1983, William Miller hypothesized a relatively straightforward implicit causal chain: Behavior change
would be promoted by causing clients to verbalize arguments for change. This was specifically
Types of Sustain Talk
designated as “change talk” by William Miller and Stephen Rollnick in 2002. Conversely, evoking sustain
talk would favor behavioral status quo. Desire for status quo
This is a technical hypothesis regarding the efficacy of MI: that proficient use of the techniques of MI Inability to change
will increase clients’ in-session change talk and decrease sustain talk, which in turn will predict behavior Reason for Status Quo
change (Miller & Rose, 2009).
Need for Status Quo
Beyond questions and reflections, it is a MI skill to distinguish types of client language, and a more
advanced strategy to respond to them effectively. The crux of distilling out ambivalence is identifying
client language expressing why change is difficult as well as identifying client language explaining why Preparatory Change Talk
change may be beneficial. Resolving ambivalence toward change is the focal point of MI. MI identifies
the change half of ambivalence as Change Talk (CT), and the stuck half of ambivalence as Sustain Talk
Desire for change
(ST). If a client initially only presents one half of the ambivalence, ST, MI makes an assumption that CT Ability to change
still exists – the flip side of the ambivalence. Based on that assumption, CT can be reflected even if not
explicitly stated by the client. Coders assess the skill and strategy of how practitioners respond to either
Reason for change
or both sides of ambivalence to most effectively assist clients toward their desired outcome/goal. Need for change
In coding a MI-based conversation, the coder can readily identify ST in hearing a client’s desire for status
quo, the client’s belief in an inability to change, their reasons for feeling stuck, or their need for status Mobilizing Change Talk
quo. The coder listens for any form of ST in the conversation and assesses how the practitioner responds.
Commitment to change
The coder also listens to client speech and will hear a multitude of types of CT. There is Preparatory CT:
desire for change, the ability to change, reasons for change, or a need for change. Coders may also Activation of change
hear Mobilizing CT: commitment to change, activation for change, and specific steps that the client is Taking Steps of change
currently taking toward change. When identifying CT, the coder assesses how the practitioner responds
to this client language.

It is NOT required nor expected that a coder would identify any of the specific types of ST or CT;
although it is helpful for the coder to actively listen for and identify language (i.e. I don’t know, I want to,
need to, should, have been thinking about, I will). This is the foundation for scoring how the practitioner responds.

Every time a client provides ST and/or CT, the practitioner has a choice of how to respond. Fundamentally, MI practitioners facilitate
movement toward the client’s desired change over the course of the conversation. If there is resistance, discord, or limited engagement
between the client and practitioner, there should be more initial focus on the client’s feelings, barriers, sense of “stuckness”, or reluctance to
change. Once the client feels heard and understood, practitioner efforts and emphasis should shift toward moving forward in the direction of
change. The following examples illustrate a basic decision tree of how a coder assesses the practitioner’s skillfulness in responding to types of
client talk.

MICA v.2.1. Please do not cite or reproduce without express written consent 8
 Strategically Responding...

{
“Tell me some things that have worked for you.”

CT
“And there is still part of you that wishes you
SUSTAIN TALK
could get a handle on your weight issues.”
“I’m telling you, dieting just
does not work for me.”
“Why do you think it doesn’t work for you?”

ST
“You know that you’re just not successful trying to control
your diet.”

{
“What makes it important for you to lose weight?”

CT
CHANGE TALK
“Your health continues to be important to you.”
“Of course I want to, I’d love
to lose weight.”

“How come you think you can’t?”

ST
“And that’s been difficult for you in the past.”

{
“Of all the diets you’ve tried, which one seemed to be
CT
the best fit for you?”
CHANGE TALK & SUSTAIN TALK
“Losing weight is still really important for you.”
“I would love to lose weight, but no diet I
have ever been on has worked.”
“So why won’t you just try this new one then?”
ST

“You’ve thrown in the towel on this whole

diet thing.”

Diagram 1. Strategically Responding Examples

MICA v.2.1. Please do not cite or reproduce without express written consent 9
 STRATEGICALLY RESPONDING TO SUSTAIN TALK
This scale is intended to measure how well the practitioner understands the role of sustain talk (ST) in the change process and strategically
responds to it during the conversation. Sustain Talk is the clutch on a manual transmission, and behavior change can be an easy country
drive, a congested city street, or a treacherous mountain road. The mastery with the clutch/ST is to smoothly and efficiently transition to
the open road towards change. There are situations where the client has a need to explain the reluctance to change, obstacles related
to change, concerns regarding change, ‘stuckness,’ or desire for status quo. The practitioner responds to ST to express empathy, provide
validation, or build engagement/rapport so that the client feels heard, seen, and understood. When managed successfully, the amount,
strength, and duration of sustain talk decreases or diminishes and there is significantly less (if any) response to ST other than as a source to
find/identify and cultivate change talk (CT).

**This Intention can be coded ‘NA’ in the rare instances where the client provides zero Sustain Talk and practitioner has no opportunity to strategically respond to Sustain Talk

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

1 2
Predominantly elicits,
explores, mines for,
or deepens sustain talk
AND/OR
denies relevant sustain talk
The practitioner may:
• use approach that builds,
expands, or increases
amount, duration, or strength
of ST
• continue to push agenda
that generates ST that
otherwise wouldn’t be
generated by the client
• discount or negate the
client’s desire or need to
explain challenges,
barriers or stuckness
• communicate that client-
identified challenges or
barriers are invalid or
illegitimate excuses
• install ST where it didn’t
previously exist
• create an environment
that shuts down all
avenues for client to
express ST
MICA v.2.1. Please do not cite or reproduce without express written consent
Elicits, explores, and
deepens sustain talk
AND/OR misses, minimizes
or denies relevant
sustain talk
The practitioner may:
• use approach that maintains,
increases, or slightly
strengthens ST over the
course of the conversation
• be unaware that agenda or
approach generates ST that
otherwise wouldn’t be
generated by the client
• excessively linger on and/or
focus on reasons not to
change
• ignore or be oblivious to
client’s desire or need to
explain challenges, barriers,
or stuckness
• consistently try to fix or
correct client perceptions
about challenges & barriers
to change
• offer no validation, empathy
or acknowledgement of ST
• create an environment that
discourages ST
3 4
Emerging efforts to
respond to sustain talk
The practitioner may:
• linger in, gives preferential
attention to, or reinforce ST
in attempt to express
empathy or build rapport
• acknowledge barriers and
challenges when brought
up by client but not in
meaningful way that allows
client to feel heard and
understood
• attempt to fix or correct
client perceptions about
challenges and barriers to
change with intention of
being supportive
• have awareness ST is being
generated but be unsure
how to respond at times
• use approach that does
not help in weakening ST
over the course of the
conversation
Successfully responds to
sustain talk to the extent
necessary for validation
and rapport
The practitioner may:
• reflect ST in genuine
manner to validate and
engage the client
• not proactively generate
or linger unnecessarily in ST
before guiding the
conversation to move
toward change
• be aware if response
generates ST and
responds/shifts
accordingly
• use an approach that
decreases and weakens ST
over the course of the
conversation
5
Skillfully responds to
sustain talk to express
empathy, build
engagement, and to
cultivate change talk
The practitioner may:
• address ST to enhance
client engagement,
encourage self-exploration,
and/or facilitate
consideration or insight
regarding change
• be aware if response
generates ST and able to
leverage towards CT
• strategically shift away from
ST in order to decrease or
diminish it over the course of
the conversation
10
 STRATEGICALLY RESPONDING TO CHANGE TALK
This scale is intended to measure how well the practitioner understands the role of change talk (CT) in the change process and strategically
responds to it during the conversation. The practitioner strategically evokes, listens for, responds to, and strengthens client statements of
desire, ability, reasons, need, commitment, or movement towards change. Change talk increases, strengthens, and deepens over the
course of the conversation. There is curiosity and exploration about why change would occur that increases the exploration of, readiness for
and, possibly, commitment to change.

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

1 2 3 4 5
Oblivious to or ignores Misses change talk Emerging efforts to elicit Successfully elicits and Skillfully elicits, responds
change talk AND/OR and respond to responds to change talk to, and evolves/advances
AND/OR sporadic or tepid efforts to change talk change talk
predominantly tries to elicit and respond to CT
install CT AND/OR
tries to install CT

The practitioner may: The practitioner may: The practitioner may: The practitioner may: The practitioner may:

• focus on information-
gathering, fact finding,
giving advice
• focus primarily on ST
• seem unaware of
importance of CT and/or of
CT provided by the client
• not respond to CT initiated
by the client
• provide or try to install
reasons for change
• demonstrate little skill or
interest in identifying CT
• miss many opportunities to
respond to CT initiated by
the client
• ask questions that
incidentally elicits CT
• consistently give solutions
and/or reasons for change
• seem aware of the
importance of exploring the
benefits of change
• ask some questions to elicit
CT
• be inconsistent in
responding to CT
• miss multiple opportunities to
explore and deepen CT
• give preference to ST
• default to giving solutions or
reasons for change when
stuck
• skip over preparatory
(DARN) CT to jump to
mobilizing (CAT) CT
• be aware of the importance
of evoking and exploring CT
• elicit preparatory (DARN) CT
• elicit mobilizing (CAT) CT if
appropriate
• consistently responds to CT
when offered by the client
• rarely miss opportunities to
explore and deepen CT
• validate ST but give
preference to CT
• proactively work to evoke
and explore CT
• elicit and cultivates
preparatory (DARN) CT
• elicit and cultivate
mobilizing (CAT) CT if
appropriate
• consistently responds to and
deepens CT when offered
by the client
• strategically leverage ST to
advance movement
towards change

MICA v.2.1. Please do not cite or reproduce without express written consent 11
 MI Intentions
Working from a clinical perspective, we want to assess if a practitioner is operating with the intention of Motivational Interviewing. Beyond the
necessary technical skills, a practitioner should embody the purpose or Intention of an MI- based conversation. We recognize that there is
no way, currently, to objectively access and measure what is actually going through a practitioner’s mind by listening to an audio tape. The -
MICA is unique in that it is fostering a natu*rally prospective approach to coding and coaching based on comprehensive MI training. The MI
coach guides the practitioner in ‘connecting the dots’ and having clear intention heading into a MI based session. The measures, at baseline,
are derived from the simple and powerful question, “Are you operating from a client-centered approach.” If a practitioner fundamentally
operates from a client-centered approach, then it reinforces Dr. Terri Moyers famous quote, “There is definitely more than one right way”
to get there. In having numerous conversations with practitioners (the end users of coding tools), they felt more freed up to have a clear
intention going into a session with multiple ways stylistically they could get there versus feeling bound up by making sure they were hitting
specific verbal marks and phrasings to pass the test. This further clarifies how the MICA is a coaching and feedback tool intended for guiding
practitioners towards accurate and improved MI, and is not intended for research purposes. There are several well researched and well
regarded tools developed specifically for research purposes.

Much has been written about the “Spirit of MI”, and the concerted efforts of many individuals (most notably Moyers, Martin, Manuel, Miller,
and Ernst) who produced a method to measure MI Spirit. Spirit in MI is currently comprised of Partnership, Acceptance, Compassion and
Evocation, per the Miller & Rollnick Third Edition of MI. They surmise that practitioners can be highly skilled at the technical components of
MI, yet still not be proficient in MI. As research has progressed, the measurement of Spirit has been modified, condensed, and ultimately
shifted into the current iteration of MITI 4. The Definitions of the Intentions in MICA represent aspects of the original MI Spirit plus those of Self-
Affirmation Theory and Self-Determination Theory, which all are invaluable in constructing a client- centered approach. While the MICA does
not capture all of those perspectives in their entirety, it does focus on measurable elements that flesh out a quality MI approach. Once coders
assess microskills and MI strategies, they then assess the extent to which the overall conversation embodies the key inter-relational aspects of
MI.

The coding structure and protocol of the MI Intentions is identical to the MI Strategies in terms of Definitions, Indicators, and Further Details (see
diagram on p. 3), distinguishing Indicator thresholds (p. 4), and coding differentials (p. 4).

As with the MI Strategies, the coder is encouraged to read the Definition of each MI Intention at the start of every coding session. To uphold
coding integrity with respect for the practitioner seeking accurate assessment and feedback, the coder grounds, reorients, and refocuses on
each Definition prior to coding the session. This cues the coder’s listening and provides a contextual framework for the conversation. This is the
coding protocol regardless of the coder’s experience in coding, coaching, or training MI.

Once a coder has listened to the audio session, the coder sets the framework for coding each of the Intentions by first asking, “Was this
conversation a client-centered approach?”. This has the coder starting at “3” (a baseline client centered approach), assessing if session
is most representative of that score, or adjusting higher or lower on the scale for the most accurate score of that MI Intention based on
aggregate observations over the course of the segment being coded.

MICA v.2.1. Please do not cite or reproduce without express written consent 12
 SUPPORTING AUTONOMY & ACTIVATION
This scale is intended to measure the extent to which the MI practitioner encourages and supports the client’s autonomy and freedom to
choose, as well as empowering, addressing, and affirming the client’s self-efficacy and personal agency. The practitioner works from an
assumption that individuals have an innate desire and capacity for evolution and growth. The practitioner operates from a strength-based
approach that elucidates and supports the actuation of the client’s goals, values, and choices.

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

1 2 3 4 5
Primary focus is on the Cursory or paternalistic Emerging efforts to Successfully focuses on Skillfully empowers
practitioner or agency focus on client focus on client client goals/values and client through focus on
goals/values for the goals/values and goals/values with self-efficacy while values/ goals and
interaction with no superficial attention to, attempts to support fostering and markedly enhances
interest in or support for or support for, client and acknowledge supporting client sense of
client choice/control choice/control client choice/control informed choice/control
choice/control

The practitioner may: The practitioner may: The practitioner may: The practitioner may: The practitioner may:

• drive interaction by
predetermined or standard
goals of the practitioner or
agency/clinic
• express or convey the client
has little or no choice
• use potential
consequences as tool to
eliminate client sense of
choice or options
• focus on what the client is
not doing or doing
incorrectly, ignoring strengths
• offer no affirmations or
statements of support
• elicit client goals/values, but
exhibit little sense that it has
value or merit
• genuinely want to help, but
leans towards a paternalistic
or expert approach
• passively or tacitly
undermines any sense of
control of choice
• provide information or
advice in a way that seems
coercive or condescending
• provide superficial praise
• have a sense the client’s
goals/values have merit
• seem to struggle between
pushing own agenda and
insights while attempting to
provide client with a sense
of control/choice
• imply or express that client
has choice, but little
exploration, clarification, or
follow-up
• provide support and
affirmations, but they are
mostly limited to agreement,
approval, or praise
• clearly acknowledge that
client goals/values are
critical for sustained
behavior change
• elicit client ideas/insights
when searching for solutions
• when client is stuck, ask for
permission before providing
viable menu of options or
sharing own
ideas/insights/perspective
• focus on strengths
• provide genuine
affirmations and expressions
of support for the target
behaviors
• verbalize support of client
autonomy in a concrete
and genuine manner when
appropriate
• clearly embrace client
goals/values in the change
process
• work to activate client
desire for growth and
evolution
• only provide ideas and
insights to foster client
activation, and only offer
with client permission
• consistently focus on
strengths and provide
multiple statements of
support
• express meaningful
affirmations that address
client mastery, self-
efficacy, and actuation

• clearly acknowledge that

client is expert of their life
and in charge of life choices
MICA v.2.1. Please do not cite or reproduce without express written consent 13
 GUIDING
This measures the practitioner’s Intention to navigate the conversation towards the goal of the referral, presenting problem, target
behavior, or topic of concern. The client is the captain whose ship may be stuck, off course, struggling to maintain a course, or have no
specified course. The client provides information, feedback and insights while the practitioner helps determine, chart, correct, and
maintain a clear course by skillfully navigating the conversation towards a path of insight/solution/resolution.

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

1 2 3 4 5
Primarily directing, Primarily wandering Emerging efforts toward Successfully identifies Skillfully delineates a
controlling, or around, following, or a shared approach to a shared approach to shared approach to
mandating the client subtly directing client client goals client goals client goals
goals goals

The practitioner may: The practitioner may: The practitioner may: The practitioner may: The practitioner may:

• not work at all towards
establishing a shared
approach to client goals
• subtly or overtly sets the
targets or goals irrespective
of client interests
• take the expert role and
lead or push the client
• have overt or underlying
expectations regarding
compliance
• make no legitimate
attempts to seek client’s
targets or goals
• discount client targets or
goals
• create an environment
during the discussion that
shuts down any opportunity
for client
insight/solution/resolution
• listen to client’s goals, then
shift to their own agenda
• make few, if any, attempts
to establish a shared
approach to client goals
• be overly passive in their
approach
• fail to elicit and shape the
conversation toward an
agenda or goal
• allow the conversation to
wander off topic with the
client telling stories,
discussing history, or sharing
random events or
information
• not work to actively
encourage client
insight/solution/resolution
• have instances of
wandering, following, or
directing
• elicit the client’s agenda,
but may promote a
secondary agenda they are
trying to insert into the
conversation
• allow the conversation to
wander off course
• attempt to shift the
conversation back on
course
• make sporadic course
corrections
• grasp to find direction or
default to taking charge by
becoming directive
• attempt in an unsuccessful
way to encourage client
insight/solution/resolution
• have brief episodes of
wandering, but no
instances of directing
• maintain an orientation
and focus on client’s
agenda towards a
solution/resolution without
forcing a plan
• regain focus and shape
discourse towards
intended goal if the
conversation loses course
• not seem to have any
secondary agenda
• creates an environment
that actively encourages
client
insight/solution/resolution
• respectfully follow, but have
no instance of wandering or
directing
• assist the client in finding a
clear path or approach that
aligns with the client’s
ultimate goals or interests
• clarify potential paths or
approaches if presented
with multiple or complex
goals, or if extra issues arise
• be committed to finding and
supporting ultimate client
destination beyond the
target behavior
• be adept at shaping the
conversation towards
insights/ solutions/ resolution
based on client needs and
preferences

MICA v.2.1. Please do not cite or reproduce without express written consent 14
 EXPRESSING EMPATHY
This measures the practitioner’s Intention to actively listen without judgment; grasp the client’s thoughts, feelings, experiences, and perspective;
and, to convey that understanding to the client. This includes reflective listening, validating the client’s reality, and all of the efforts the practitioner
makes to understand the client’s inner experience and effectively communicate that to the client. Successfully expressing empathy generates
positive client responses such as “yes,” “exactly,” “that’s it,” and “right.”

Do not include practitioner self-disclosure, agreement with client stance, sympathy, warmth, or advocacy in this measure.

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

1 2 3 4 5
Dismisses, ignores, or Random, sporadic, or Emerging efforts to Successfully Skillfully conveys a
has little interest in tepid efforts to understand client communicates an multifaceted
client perspective, understand client perspective with understanding of client understanding of
feelings, or perspective moderate success perspective client’s perspective
experiences

The practitioner may: The practitioner may: The practitioner may: The practitioner may: The practitioner may:

• make no effort to
understand client
• actively dismiss the client’s
perspective
• not leave own world view
• have no grasp on the
client’s perspective
• have a grasp but indifferent,
annoyed, or irritated with
the client’s reality or
perspective
• make a few shallow efforts
to understand client reality
• make minimal attempts to
access client world view
• have little grasp of client
perspective
• have efforts that appear
shallow, halfhearted or
generated from a sense of
obligation
• provide reflections that tend
to miss the mark, be
inaccurate or manipulative,
or detract from the client’s
implicit meaning
• attempt to grasp client
reality throughout session
with sporadic success
• use some accurate
reflections, along with some
inaccurate ones
• have a tendency to parrot
back client statements or
reflect explicit content
rather than add significant
meaning
• exhibit some grasp of client
perspective, but never goes
deeply enough to elicit and
understand client inner
experience
• demonstrate accurate • consistently communicate a
understanding of client deep understanding of
reality client reality
• provide multiple reflections • use reflections effectively to
that go beyond explicit convey explicit client
content and/or add experiences, perspectives,
significant meaning and implicit inner
experience/world view
• have reflections effectively
communicate the client’s
• consistently provide
thoughts, feelings, and
reflections that go beyond
explicit world view
content to unspoken
• elicit client inner experience emotions, values, desires,
and meanings
• exhibit a solid grasp of client
perspective • exhibit deep understanding
of client perspective
• successfully move beyond
the technical aspects of
reflecting, demonstrating a
deep and clear
communication of the
client’s perspective

MICA v.2.1. Please do not cite or reproduce without express written consent 15
 PARTNERING
This scale measures the extent to which the practitioner fosters a collaborative process with the client as two equal partners who are working
together towards the client’s goals. There is a shared balance of power, wherein the client is the acknowledged expert regarding his life.
The MI practitioner provides relevant and appropriately timed observations, knowledge, insights, and expertise that supports and advances
client outcomes.

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

1 2 3 4 5
Exerts the expert role Leans towards expert Emerging efforts to Successfully fosters Skillfully collaborates
by defining the client role and consistently collaborate and share collaboration and and empowers client
problem and misses or unaware of decision making power sharing as the lead
prescribing/developing opportunities to
the goals and/or plan collaborate

The practitioner may: The practitioner may: The practitioner may: The practitioner may: The practitioner may:

• take a hierarchical
approach
• show no attempts to build
rapport
• rely on dominance,
expertise, or authority
• give advice or suggestions
without permission
• assume the role of fixing the
problem
• relegate client to following
their lead
• exhibit righting reflex in a
condescending and
patronizing way
• be indifferent or unaware
they are generating or
perpetuating discord
• build some rapport
• talk at the client more than
talking with client
• seem unaware client can
legitimately contribute to the
conversation and the
process/outcome
• have a tendency to give
advice or suggestions
without permission
• try to persuade the client
• exhibit the righting reflex as
wanting to direct or fix
• be aware of discord or
resistance, but have little, if
any, recognition how their
approach contributes to or
reduces it
• build good rapport
• have a sense that client can
contribute to the process
• provide knowledge,
expertise, or stall when the
client is unsure where to go
or what to do
• ask permission before giving
advice or suggestions
• attempt to persuade with
permission
• show efforts to manage the
righting reflex
• seem more to take turns
than structure a
collaborative process
• be aware of discord or
resistance with some
attempts to reduce it
• seek and value client
contribution
• work towards client's goals
as a shared outcome
• engage client perspective
in mutual problem-solving
• ask permission before giving
advice, suggestions, or
sharing insights
• demonstrate no evidence
of the righting reflex
• manage any discord that
surfaces, shifting the focus
back towards collaborative
resolution
• defer to client as the
expert on their own life
explicitly or implicitly
• act as a key consultant
working with the client
• appear to effortlessly resist
the righting reflex
• elicit/evoke client’s insights
and ideas
• augment client process
with relevant knowledge
and expertise when
requested or if first asks
permission
• re-engage the client in
problem-solving if the client
stalls

MICA v.2.1. Please do not cite or reproduce without express written consent 16
 EVOKING
This measures the extent to which the practitioner elicits the client’s perspective on his own thoughts, barriers, knowledge, feelings, ideas,
motivators, goals, values, and solutions regarding the target behavior and change. The practitioner operates both from a place of genuine
curiosity and from a belief that the motivation for change and the ability to change exists within the client and focuses efforts to skillfully elicit,
explore, and expand those client perspectives.

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

1 2 3 4 5
Absence of curiosity Minimal curiosity and Emerging efforts to elicit Successfully elicits and Skillfully elicits, explores,
and exploration of incomplete efforts to and explore client explores client and expands client
client perspective elicit client perspective perspective perspective perspective

The practitioner may: The practitioner may: The practitioner may: The practitioner may: The practitioner may:

• gather facts
• give information and
unsolicited advice
• instill/install their
agency/clinic/service
perspective or
personal perspective
• adhere to a standardized
intake, assessment process,
or follow a predetermined
script
• not attempt to elicit or
explore client perspective
• demonstrate little effort to
elicit client perspective
• seem inattentive to
perspective offered by the
client
• rarely expand or explore
what client offers
• inquire about client
perspective, but fail to
follow-up and explore OR
respond with information,
opinion, or problem solving
• lean on the question/
answer approach
• seem interested in client
perspective
• attempt to follow-up in a
superficial or fleeting
manner
• have instances of
exploring or expanding
on client perspective
• miss opportunities to
follow-up
• seem unsure how to
follow-up
• fall into the question/
answer trap
• be interested in client
perspective
• be curious and often follows
up to deepen or draw out
• not fall into the
question/answer trap
• explore/expand relevant
sustain talk and change talk
• rarely miss opportunities to
follow-up
• be deeply interested in
client perspective
• be curious with active and
consistent efforts to follow-
up to deepen or draw out
• explore client ideas,
insights, solutions, and steps
towards change
• not miss significant
opportunity to explore/
expand on relevant client
perspective

• elicit information in relation

to their own agenda that
differs from client agenda

MICA v.2.1. Please do not cite or reproduce without express written consent 17
 MICA Coding Worksheet
The MICA coding worksheet was developed for coders to tally the microskills and take notes on the other items within the MICA. The layout
supports a one-time coding of a session. As a coder listens to a session, the microskills are tallied. While identifying the microskills, the coder
takes notes on impressions and specifics about the session that support skills, Definitions, or Indicators. Those notes and rationale are the
foundation for the direct coaching provided to the practitioner based on the session they submitted.

Timestamps
The coder writes down the minutes and seconds into the session where various examples of either missed opportunities or quality MI are
occurring. These time stamps are noted under the MI Skills section and each of the MI Intentions section of the coding sheet. Time stamps and
the associated notes help support the coder rationale for scores that are determined after listening to the session. A coder marks at least one
time stamp of quality MI or a missed opportunity under each of the MI Strategies and Intentions. It is preferable that multiple timestamps are
noted under each.

5:42 - Overstated reflection of sustain talk generated change talk. Practitioner further explored that change talk

- (noted under Strategically Responding to Change Talk)

7:19 – “In the past, where have you found support you needed to move forward.” (noted under Evoking)

Strengths
These are instances or approaches where the coder is struck by notable examples representative of a MI approach. The coder writes any
other potent approaches or effective strategies used by the practitioner that further supports the rationale for scoring.

“Practitioner has a natural style of high empathy that permeated the entire session. The client seemed astonished that the practitioner listened
so intently and understood her issues so deeply (10:49).”

“Several examples of resisting the righting reflex (5:07, 8:53, 14:34), and instead deferred to asking the client what she knew about managing
her blood sugars (5:24).”

“It was amazing how the practitioner never stumbled over all of the issues that were presented, she was able to effortlessly sort through the
stack of concerns that helped the client prioritize the next steps (9:33). The client really had clarity when it was all said and done and seemed
genuinely relieved.”

MICA v.2.1. Please do not cite or reproduce without express written consent 18
 Opportunities for Improvement
The coder writes down instances/time stamps where MI congruent strategies could have assisted in the behavior change process. These are
moments in the session where there was a potential to apply a MI approach to increase practitioner awareness. In no way is this intended
to tell practitioners what they should have done, rather as opportunities in the session where MI could have been effectively applied.
While the coder identifies these as missed opportunities on the coding sheet, they are reframed on the coding report as ‘Opportunities for
Improvement.’ Time stamps would be used to identify specifically where the opportunities occurred.

1:54 - The client identified he had concerns about his drinking when the session started. That could have a been an opportunity to work
toward a shared agenda for the session versus sharing all of your concerns with his drinking. (noted under Guiding)

11:08 - The client was frustrated she hadn’t lost any weight, but identified she had been managing her blood pressure and staying on her
medications exactly as prescribed. This is prime opportunity for affirmations or a show of support. (noted under Autonomy and Activation)

6:37 - When the client mentioned she was thinking about starting to exercise, that is a great opportunity to evoke her thoughts about the
benefits of exercise versus it being used to continue to tell the client why it was necessary. (noted under Evoking)

MICA v.2.1. Please do not cite or reproduce without express written consent 19
 Motivational Interviewing Competency Assessment (MICA)
CODING WORKSHEET

Practitioner: Email: Agency:

Coder: Date Received: Date Coded: Start time: Stop time:

Micro Skills: Tallies Totals

Motivational Interviewing Skills: Notes/Rationale (i.e. time stamps, strengths, opportunities for improvement)

Questions: Strategically Responding to Sustain Talk: Strategically Responding to Change Talk:

Reflections:

SCORE: SCORE:

Motivational Interviewing Intentions: Notes/Rationale (i.e. time stamps, indicators, strengths, opportunities for improvement)

Supporting Autonomy and Guiding: Expressing Empathy: Partnering: Evoking:

Activation:

SCORE: SCORE: SCORE: SCORE: SCORE:

MICA v.2.1. Please do not cite or reproduce without express written consent 20