Mica V2 1 PDF

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 Unpublished manual.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 Please do not cite or reproduce without express written consent 1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: [email protected]
Ali Hall: [email protected]
Susan Butterworth: [email protected]
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 3
score based on observations over Primarily directing, Primarily wandering around, Attempts a shared
the course of the session. controlling, or mandating following, or subtly directing approach to the client’s
the client goals client goals goals with instances of
wandering, following or
directing
Further Detail–This is where specific The practitioner may: The practitioner may: The practitioner may:
aspects of the Definition are considered
• subtly or overtly sets the • listen to client’s goals, then • elicit the client’s agenda,
and provide additional descriptions to targets or goals irrespective shift to their own agenda but may promote a
delineate between Indicators. of the client’s interests or
• makes few, if any, attempts
secondary agenda they
agenda are trying to insert into the
to establish a shared
conversation
• is in the expert role and leads approach to the client’s
or pushes the client • allow the conversation
Figure 1. Structure of MI Strategies and Intentions.
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.
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.”

“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.”
“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.
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.
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
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 3 4 5
Predominantly elicits, Elicits, explores, and Emerging efforts to Successfully responds to Skillfully responds to
explores, mines for, deepens sustain talk respond to sustain talk sustain talk to the extent sustain talk to express
or deepens sustain talk AND/OR misses, minimizes necessary for validation empathy, build
AND/OR or denies relevant and rapport engagement, and to
denies relevant sustain talk sustain talk cultivate change talk
The practitioner may: The practitioner may: The practitioner may: The practitioner may: The practitioner may:
• use approach that builds, • use approach that maintains, • linger in, gives preferential
• reflect ST in genuine • address ST to enhance
expands, or increases increases, or slightly attention to, or reinforce ST
manner to validate and client engagement,
amount, duration, or strength strengthens ST over the in attempt to express
engage the client encourage self-exploration,
of ST course of the conversation empathy or build rapport
• continue to push agenda and/or facilitate
• be unaware that agenda or • not proactively generate
that generates ST that • acknowledge barriers and consideration or insight
approach generates ST that or linger unnecessarily in ST
challenges when brought regarding change
otherwise wouldn’t be otherwise wouldn’t be before guiding the
up by client but not in
generated by the client generated by the client conversation to move
meaningful way that allows • be aware if response
• discount or negate the • excessively linger on and/or toward change
client to feel heard and generates ST and able to
client’s desire or need to focus on reasons not to understood • be aware if response leverage towards CT
explain challenges, change
• attempt to fix or correct generates ST and
barriers or stuckness • ignore or be oblivious to responds/shifts • strategically shift away from
client’s desire or need to client perceptions about
• communicate that client- challenges and barriers to accordingly ST in order to decrease or
explain challenges, barriers,
identified challenges or change with intention of diminish it over the course of
or stuckness • use an approach that
barriers are invalid or being supportive the conversation
illegitimate excuses • consistently try to fix or decreases and weakens ST
correct client perceptions • have awareness ST is being over the course of the
• install ST where it didn’t about challenges & barriers generated but be unsure conversation
previously exist to change how to respond at times
• create an environment • offer no validation, empathy
• use approach that does
that shuts down all or acknowledgement of ST
not help in weakening ST
avenues for client to • create an environment that over the course of the
express ST discourages ST conversation
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.

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

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

client is expert of their life
and in charge of life choices
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.

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

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

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

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

to their own agenda that
differs from client agenda
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.”
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)
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:

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What is the purpose of MICA?

What is the purpose of MICA?

What does the MICA coding process involve?

What does the MICA coding process involve?

CODING & COACHING TOOL

MICA Coding Process

MICA Coding Training

Fundamentally Inconsistent Generally Inconsistent Client-Centered

Figure 1. Structure of MI Strategies and Intentions.

Coding Verbal Interventions

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

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

“There was nothing you could do.”

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

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

This example would receive two separate question tallies.

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.”

Client: (long pause)

“How come you think you can’t?”

“You’ve thrown in the towel on this whole

Diagram 1. Strategically Responding Examples

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

• clearly acknowledge that

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

Fundamentally Inconsistent Generally Inconsistent Client-Centered Competent MI Proficient MI

• elicit information in relation

- (noted under Strategically Responding to Change Talk)

Practitioner: Email: Agency:

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

Micro Skills: Tallies Totals

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

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

SCORE: SCORE: SCORE: SCORE: SCORE:

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