Solution-Focused Practice and Motivational Interviewing: Four Points of Departure

Two practitioners meet the same client, to work on the same thing that client wants to change. One uses motivational interviewing. The other uses the Solution-Focused approach. From the very first few utterances, the difference in the approaches can be dramatic.

Dr. Deborah Teplow, our co-founder, describes the difference this way: "Depending on which approach you use, you're asking completely different questions from the very first moment. And that's not a small technical difference. It changes every comment you make, every question you ask after that. It changes what you're listening for. It changes what you respond to, and it changes how effective you are at fostering behavior change."

We're not talking about subtle distinctions here. As Deborah says, MI and Solution-Focused practice "are not just variations on a theme. They're profoundly different."

There are at least four points of departure: the belief about motivation, conversational structure, use of language, and how each approach supports follow-through.

As an introduction, it's important to note that Deborah used MI, and has since stopped.

Over thirty years ago she ran a continuing education institute for health and behavioral healthcare professionals. Bill Miller and Steve Rollnick, the psychologists who created MI, were on her faculty, which, as she puts it, meant "I was exposed to MI right from the source." Her training culminated in an advanced course in MI coding for supervisors and researchers. In 2013, she created the national occupational competency standards for wellness coaching for the US Department of Labor and the curriculum for its two-year wellness coaching apprenticeship, for which MI was a core component.

Her account of why MI was important was because it "shifted helping conversations in an important direction, to respect client autonomy and work with clients in a collaborative way . . . a big improvement over the traditional way of simply telling people what to do."

She goes on to note the unique feature of MI that made it so effective: "MI, for all its usefulness, was built for a specific set of conditions, common to people struggling to make behavior changes: high ambivalence, low confidence, low desire, unclear importance of the change. Moments when someone's stuck, unsure, or aren't yet certain that the benefits of changing outweigh the costs or risks of staying the same." Under those conditions, MI is effective at: "helping someone move from ambivalence to motivated, motivated to committed, and then to taking a first step toward change."

Respect for autonomy, partnership, and compassion aren't unique to MI, nor do they distinguish it from Solution-Focused practice. The two approaches diverge fundamentally, however, in at least four areas.

MI is built to strengthen it. Solution-Focused practice assumes motivation is already present.

In Deborah's words: "The clients are motivated for something or they wouldn't be talking to you. Your job isn't to assess or increase motivation. It's to help clients build a vision of the future they want, which is motivational in itself."

She extends that to the client who didn't choose to be in the room: "Even when someone is talking to you because someone else wanted them to, or they were mandated to, they're still motivated for something, maybe not for what you expect, but motivation is already present. It's up to you to help the client apply it."

MI begins from another premise. Its foundational assumption is that the main barrier to change is inadequate motivation and ambivalence about change, and the practitioner's job is to help the client increase motivation by resolving ambivalence, building commitment, moving to planning, and taking a first step. This starts by making sure that the client has adequate desire, ability, reasons, and need to change.

What's worth noticing is that Solution-Focused practice assumes the client already has the desire, ability, reasons, and need to change. Those four words are MI's own, and as Deborah observes, desire, ability, reasons, and need to change are "the very thing MI's questions are built to draw out of a client, one element at a time. Solution-Focused practice starts by simply assuming all four are already there."

Same client with two different starting points. Solution-Focused practice begins by helping the client define and build a detailed picture of the future they want. MI begins by helping the client work through ambivalence, build motivation to commit, and then take action.

Solution-Focused practice and MI organize the flow of a conversation in very different ways. Every Solution-Focused conversation follows the same structure. MI conversations move flexibly among its four tasks (formerly called "processes").

Every Solution-Focused conversation has three parts, no matter how long the conversation lasts:

Deborah offers this metaphor that makes it easy to understand how essential each part is and why one follows the other in sequence: "It's like driving a car. Think about it. You start it. You drive it. And you park it. You can't skip a part, even if the trip is short."

MI works differently. Its four tasks, engaging, focusing, evoking, and planning, are not a required sequence. Miller and Rollnick are explicit that MI doesn't follow a linear process, and practitioners should move flexibly among the four tasks in response to what's happening in the moment.

Solution-Focused practice doesn't offer that same flexibility, and there's a very good reason why. As Deborah points out: "That's not because the model can't adapt, but because the three parts are crucial for every conversation designed to lead to change. You have to know where the client wants to end up, what they already have going for them that can help them get there, and a map of the journey. Otherwise, where would they go? And how would they get there?"

There is a second structural difference inside this one. In Solution-Focused practice, the client's social connections are part of the structure of every conversation. "Change never occurs to the client outside a social system," Deborah says, "and their future always includes it." She traces this to the founders' orientation: Steve de Shazer and Insoo Kim Berg, who developed the approach, were both trained as social workers, a field grounded in systems thinking, the premise that a person cannot be understood apart from the systems they live within.

It's not that MI ignores relationships, but it brings them in if and when they come up. They aren't built into the structure from the outset the way they are in Solution-Focused practice. As Deborah puts it: "A coach can practice MI with high fidelity and never once ask who else would notice a change. In Solution-Focused coaching, that question isn't optional. It's imperative."

In response to what clients say, Solution-Focused practice either drops or uses the client's exact words as spoken. MI also drops some of what clients say, but reflects, paraphrases, rewords, and reframes much of what's left from what the client says.

This difference in how language is used has a significant effect. As Deborah says, "How a coach responds to a client's own words turns out to matter as much as anything else in this work."

Every time a client speaks, a practitioner does one of three things with those words: keeps them, deletes them, or changes them. Researchers have examined and measured what practitioners from different approaches actually do with a client's words during real sessions. Solution-Focused practitioners kept the client's exact words, or referred back to them directly, in most of their responses. MI and CBT practitioners did so far less often, deleting a large share of what was said and changing much of what was left.

In MI, altering the client's words is deliberate, not accidental. Complex reflections that paraphrase, reframe, amplify, under- or over-state, supply meaning, or fill in the client's thinking are core skills included in every MI training. In fact, a practitioner's MI competence is defined in part by their offering at least two reflections for every question asked, with at least half of those reflections being complex.

Deborah's illustration comes from the most recent edition (the fourth) of Motivational Interviewing. A client says: "I don't really like vegetables. I can eat more of them, but I don't enjoy them." The book's suggested reflection: "You'd be willing to add more vegetables to your diet even though you don't like them."

Here is what she notices: "The client said what they can do. The reflection turns it into what they'd be willing to do, a shift from capability to implied commitment that the client never actually made. And that one word, willing, reveals the power differential in miniature." The professional's read of what the client is ready for has taken the place of what the client actually said.

A Solution-Focused practitioner, working from a curious, not-knowing stance, might ask instead: "So in that better future, what role might vegetables play in your diet?" As Deborah says of that question: "That doesn't assume that eating more vegetables is the answer. The client defines that. Not the coach."

Solution-Focused practice deletes as well, "simply by not following up on whatever doesn't help the client make their better future a reality. There's no correction, reframing or redirection." And what Solution-Focused practice never does is change the client's words, "because changing is not neutral. It's the coach's worldview standing in for the client's."

Solution-Focused practice works a lot on helping the client rehearse hard moments before they arrive. MI works to catch setbacks early and keep them from derailing the plan.

The most common thing that happens is that clients commit to follow through on the day they set a goal and a plan is crafted without any or adequate consideration of what may happen later down the road, when commitment actually gets tested. As Deborah describes it: "A day of craving hits. A holiday celebration is coming up, or it's just been a hard day and they need ice cream."

Solution-Focused practice prepares the client for that day almost from the start because it rests on two assumptions: "First, that the client has what it takes to manage the challenges. And two, challenges and setbacks will occur."

The preparation uses presuppositional language to invite the client into a future in which they have already come through a challenge successfully. Deborah's example: "Suppose that craving for ice cream hit. What would you have done that helped you stick to your eating plan? What would others have noticed about you that told them you were coping well with your cravings and sticking with your eating plan?"

The same process prepares for recovery after a slip: "Suppose it's the holidays and things have gotten off course anyway. What would you have done to find your way back? What's the first thing you would have done to get back on course?"

The client rehearses the before, the during, and the after, before any of it happens. And because the client generates the answers, the solutions are often ones the practitioner could never have imagined. They fit the client's life, and the client owns them.

MI addresses this too. It recommends that practitioners catch a setback early, normalize it, and keep it from derailing the plan, and practitioners can ask about obstacles directly: what do you foresee, and how will you deal with it?

Deborah's distinction is about what those questions build: "These don't necessarily build coping and follow-through skills in advance. Solution-Focused coaching does that explicitly. The client rehearses the hard moment and their successful coping in detail before the moment ever arrives. So when real life tests the plan, they're not just supported through it. They've already been there."

In short, Deborah summarizes the approaches as: "MI can help people get unstuck, strengthen motivation, and take a first step. Solution-Focused coaching focuses on helping clients build a future worth reaching and then discover how they'll actually get there."

Underneath the four departures is a question about authority.

Every helping relationship carries a power differential. One person comes for help, the other is a trained professional. Deborah credits MI and other approaches with recognizing the power differential and working to reduce it through partnership, autonomy, and respect, but she doesn't think that eliminates it: it still shows up in what the professional assumes the client means, what counts as progress, which topics get attention, and what new information gets introduced.

"The moment a professional thinks, 'I know the solution to this, I know what they need to do,' that power differential rises. The client may push back. But just as often they go quiet, not correcting what doesn't fit. They may even begin adopting the professional's wording or ideas as their own."

That has a direct consequence for follow-through. When the meaning, goal, or solution has been supplied at least in part by the professional, rather than discovered and owned by the client, that agreement is far less likely to become follow-through in real life.

Solution-Focused practice takes the not-knowing stance instead. The practitioner genuinely doesn't know what the client means, and doesn't assume. Deborah frames the division of labor as: "Solution-Focused coaching doesn't pretend the power differential disappears. It lowers it deliberately. The coach remains responsible for the conversational process. The client remains the authority on the meaning of their words, the destination they want to arrive at, and the solution that fits their life."

Deborah worked with Steve de Shazer and Insoo Kim Berg, who developed the Solution-Focused approach, and with Bill Miller and Steve Rollnick, who created MI. All were on the faculty of the continuing education institute she ran. In her words, her introduction to the Solution-Focused approach "happened 30 years ago, the same time I first learned MI, because Steve and Insoo were also on the faculty of my institute."

That is the vantage point behind this comparison: not a partisan for one approach who read about the other, but someone who worked with the people who developed both, and used MI in her own practice, before concluding that Solution-Focused practice does a better job on follow-through.

You can also watch Deborah teach this live: Beyond Motivational Interviewing, the full session this series comes from.