Motivational Interviewing Questions to

Identify and Shift Stage of Change

Adapted from the work of Kate Becker (2010)

Therapist clinical decision points: resources can be identified and enhanced, and barriers/deficits can be
addressed with Standard EMDR Protocol, when clinically appropriate. The “two handed interweave”
resource protocols, and future rehearsal to manage blocks can also be helpful.

IDENTIFY IMPORTANCE TO CHANGE “Your answer is a ______ (#), what makes you confident
“HOW IMPORTANT IS IT TO YOU THAT YOU you can make this change?”
MAKE A CHANGE ON A SCALE OF 0-10, 10 BEING
Resources that can be enhanced:
THE MOST?”
_______________________________________
“Your answer is a _____(#), what makes it important
to you?”
_______________________________________

Resources that can be enhanced:

__________________________________________________________________ “Regarding your answer to how confident you are
that you can make a change—what makes your
_______________________________________________________________ answer not a 10? Take notes on the negative thoughts
or memories that may present as barriers.
Possible EMDR targets to process:
“What makes your answer about importance to
change not a 10?” Take notes on the negative
thoughts and memories that may present as barriers.
Possible EMDR targets to process: ____________________________________________________________________

________________________________________________________________

IDENTIFY COMMITMENT TO CHANGE

“HOW COMMITTED ARE YOU TO MAKE THIS
If client’s answer was less than a 7 ask: “I would like CHANGE ON A SCALE OF 0-10, 10 BEING THE
you to imagine how things will look for you if you MOST?”
don’t change anything for the next year?”
“Your answer is a _____(#), what is it that makes you
Do up to 3-4 sets of fast BLS, sets. Asking, “What are committed?”
you noticing now?” between sets. Resources that can be enhanced:

Then ask, “Go inward for a moment, how important

is it now that you make a change?”

If the Client cannot get past an “5” consider working on “What makes your answer about importance to
Barriers to increase the number before moving commitment not a 10?” Take notes on the negative
forward. thoughts or memories that may present as barriers.
Possible EMDR targets to process:

IDENTIFY CONFIDENCE FOR CHANGE

“HOW CONFIDENT ARE YOU THAT YOU CAN
MAKE THIS CHANGE ON A SCALE OF 0-10, 10
BEING THE MOST?

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 ADDICTION/COMPULSION ASSESSMENT WORKSHEET

Addiction/Compulsion:

________________________________

AVOIDANCE (LEVEL OF URGE TO AVOID

INTERNAL OR EXTERNAL TRIGGERS PROTOCOL-LOUA):
(DeTUR PROTOCOL): “Do you use ___________(addictive/compulsive
“Reviewing past episodes of _________(name the behavior) as a way to avoid anything else?” “For
addictive/compulsive behavior), what triggers or example, certain emotions, body sensations (eating
urges have you noticed? As you consider each or drinking to avoid feeling stress or to numb out)
trigger what is the level of urge related to each or behaviors/tasks (playing video games to avoid
where 0=no urge and 10= completely triggering or exercise, watching TV to avoid work)? Can you
strong urge?” measure the urge to avoid for each, where 0=no
People, places, time of day/week/holidays, images, urge, 10= intense urge to avoid?”
smells, music, situations like family gatherings, being
LIST WHAT PROMPTS AVOIDING/LEVEL OF URGE
alone, work stress? Emotional states?
TO AVOID (LOUA)
TRIGGER/LEVEL OF URGE ___________________________ LOUA _____
___________________________ LOUA _____
____________________________
LOU _____ ___________________________ LOUA _____
____________________________
LOU _____
____________________________
LOU _____ UNDERLYING TRAUMA (STANDARD EMDR
____________________________
LOU _____ THERAPY PROTOCOL):
____________________________
LOU _____ “Do you see any connection between __________(the
____________________________
LOU _____ addictive/compulsive behavior) and experiences
___________________ LOU _____ from your past? For example, do you engage in
addictive behaviors to cope with nightmares or
flashbacks?”
MALADAPTIVE POSITIVE AFFECT (LEVEL
OF POSITIVE AFFECT PROTOCOL--LOPA): Record responses below:
______________________________________
“What are the positive aspects of engaging in ______?” ______________________________________
“What are you hoping to feel?” What would you miss ______________________________________
if you let it go?” “Are there rituals that you do as you ______________________________________
prepare to do the behavior that have positive ______________________________________
aspects?”
ANYTHING WE MISSED?
As you consider each positive feeling how intense is
each one, where 0=no intensity and 10=very “Other patterns you have noticed that contributes to
intense? relapsing into addictive behaviors? Hopelessness,
fear of failure, past failed attempts at recovery?”
POSITIVE FEELING/LEVEL OF POSITIVE AFFECT

___________________________ LOPA _____

___________________________ LOPA _____
___________________________ LOPA _____
___________________________ LOPA______
___________________________ LOPA______

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 Choosing and Enhancing Healthy Coping Skills and the
Positive Treatment Goal: Part 1 of the DeTUR Protocol
Adapted from Popky’s DeTUR Protocol (2005)

CHOOSING AND ENHANCING HEALTHY CHOOSING AND ENHANCING THE POSITIVE

COPING SKILLS: TREATMENT GOAL This process is similar to the
“Calm/Safe Place” procedure.
“What are some alternative behaviors that you
would like to do instead of the CHOOSING THE POSITIVE TREATMENT GOAL:
addictive/compulsive behavior” “Adaptive”
behaviors that bring up the desired feelings states, “Imagine you wake up tomorrow and you have
such as running on the beach, journaling, calling a completely resolved your issue with
good friend. List below: ________________(name the additive/compulsive
_______________________________________________ behavior)
_______________________________________________
_______________________________________________ “What does life look like?”

“Pick one of these alternative behaviors and run a __________________________________________________________________

movie in your mind of a future challenge with the “What are you doing instead?”
addictive/compulsive behavior and imagine doing
this instead”. Use long, fast sets of BLS to desensitize _______________________________________________________________
any disturbance that arises, don’t expect complete “How do you feel emotionally?”
comfort as they may need to practice and succeed
first, the goal is to decrease the disturbance and
increase access to the alternative coping skill. “What body sensations do you feel or how does your
body posture change having achieved your goal?”
IDENTIFY AND ENHANCE AN INTERNAL
RESOURCE: __________________________________________________________________
“Pick a memory when you felt resourceful, “Is there a word that comes to mind that represents
powerful and in control OR any other resource that this achieved goal?”
you think would be helpful in addressing your
___________ (the addictive/compulsive behavior the _____________________________________________________________
client has chosen). If they cannot think of a
memory, look for an image, another person or an ENHANCING THE POSITIVE TREATMENT GOAL
aspect of nature that represents the needed resource. WITH BLS:
“Bring __________________ (whatever resource the client “Now, I would like you to bring up all aspects of your
has chosen) to mind and focus on the images, Positive Treatment goal—what you see, how you feel,
experiences, feelings and body sensations what you are doing, all the positive thoughts,
associated with this memory” Apply slow, short sets emotions, and the word you picked that represents
of BLS until they can access this resource. Enhance as this state. Imagine yourself fully in this experience of
you would “Calm/Safe Place”. success and confidence.” Apply fast sets of BLS as in a
future template OR do 2-3 slow, short sets to enhance
access to this positive state.
“Bring up a mild stressor that might challenge
your recovery and focus on that for a moment.
Now, try to switch gears and bring to mind your “I would like you to practice accessing this positive
resource.” state by thinking of your goal and cue word on a
daily basis to stay with your goal.”

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 Desensitizing a Trigger, Urge or Craving Script: Part 2 of the
DeTUR Protocol
Adapted from AJ Popky’s DeTUR Protocol(2005)

What trigger would you like to work on? (choose a trigger that was identified on the
assessment worksheet)

_____________________________________________________________________________________

“Bring up the trigger along with any words, tastes, smells emotions or body sensations
related to it. What is the level of urge on a scale of 0-10, 0 being neutral or no urge and
10 being completely triggering?”_______________ “Now, notice where you feel the urges in
your body as you think about the trigger and follow my fingers or the taps.”

Long, fast sets of BLS. Once they report that the LOU (Level of Urge) is a 0, move on to the
next step. Contain underlying traumatic material that comes up, or if client has the affect
tolerance and there is time in the session, use standard protocol to target underlying
trauma.

“Bring up the trigger again and bring up the Positive Treatment Goal and your cue
word and hold them together in your mind.”

Apply long, fast sets of BLS until the client reports a positive or neutral state.

“Imagine a time in the future when __________(mention issue that was triggering). What
is the level of urge (LOU) as you think of this? Where do you feel that in your body?
Notice that urge as you think of your cue word”.

Apply long, fast sets of BLS until they report a positive or neutral state.

Process all triggers that the Client endorsed using this process.

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 Level of Positive (maladaptive) Affect and
Level of Urge to Avoid Protocols
Adapted from Jim Knipe (2005)

LEVEL OF POSITIVE (MALADAPTIVE) LEVEL OF URGE TO AVOID PROTOCOL

AFFECT PROTOCOL Choose one of the avoidance targets identified
Choose one of the maladaptive positive feeling on the assessment worksheet.
states identified on the assessment worksheet.

Take a moment to focus on any positive images, “Take a moment to focus on the desire to avoid
emotions, thoughts and sensations you are have and notice any emotions, thoughts and
when you think about (engaging in behavior)” sensations you are having.” Give client a
and/or “What are you hoping to feel?” Give moment to go inward.
client a moment to go inward and record any
image/cognition/emotion/ sensations below. Next ask, “How strongly do you want to avoid on
(Client may not have all of these; there may be just a scale of 0-10, 10 being the most?’
a visceral sensation).
Level of Urge to Avoid (LOUA)__________________
“Is there positive self-reflective statement that
describes the positive affect such as “I “Focus on those sensations and the feeling of
am….strong, in control, powerful?” Finish this avoidance/not wanting to.” Process, using fast
sentence…I am…..”_______________________ Clinician sets of BLS. Asking between sets, “What are you
can offer possible maladaptive positive cognition noticing now?” And every couple of sets, “How
statements strong is the avoidance now?”

“How strong is this positive feeling on a scale of Underlying trauma or NC’s may arise—record or
0-10, with 0 being neutral and 10 being very contain them, (to target later).
intense?”
Perform sets of BLS until the level of urge to
Level of Positive Affect (LOPA)__________________ avoid is a 0.

“Now, focus on those intense positive sensations ADDRESSING THE FUTURE

(and the words “I am…..”) and follow my
fingers”. Process with fast sets of BLS until they “Now, I would like you to visualize doing what
report a 0. you would like to do instead of avoiding.”
Similar to the future template, do BLS until they
Between sets ask, “What are you noticing now?” can imagine doing the behavior they’ve been
About every 3 sets return to the target and ask for avoiding with no (or less) resistance. Use fast BLS.
the level of intensity.

“How intense does it feel now, 0-10?”

Underlying trauma or NC’s may arise suddenly and
unexpectedly in the process—record and contain
them. Target them after reducing maladaptive
feeling.

Perform sets of BLS until the intensity level of

the target is a 0.

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