Motivational Interviewing in Crisis Response: Practice Lessons from Casey Jackson

Talking to Change: MI Practice Companion

In Episode 88 of Talking to Change: A Motivational Interviewing Podcast, Glenn Hinds and Sebastian Kaplan welcome Casey Jackson to explore the use of Motivational Interviewing in crisis response, including work with first responders and law enforcement.

This Practice Companion focuses on what the conversation can teach practitioners about using MI when urgency, distress and safety concerns increase the pull towards directing, persuading or taking control. Casey’s examples highlight accurate empathy, guiding, autonomy support, practitioner mindset and the importance of remaining purposeful under pressure.

MI under pressure

One of the most useful themes in this episode is that crisis can change the practitioner as well as the person in distress. Urgency can intensify the Fixing Reflex. The helper may become increasingly focused on getting a particular outcome, giving instructions or saying what they desperately want the person to do.

Casey repeatedly returns to the practitioner’s mindset. His argument is not that technique becomes irrelevant, but that the quality of our language is strongly influenced by how we are thinking about the person in front of us.

Empathy and direction can coexist

Early in the conversation Casey describes what attracted him to Motivational Interviewing as a kind of marriage between empathy and direction. This is important in crisis settings. Empathy does not mean becoming passive, and direction does not have to mean taking control of the person’s decision-making.

MI offers a guiding position between following and directing: listening closely to the person’s experience while also keeping sight of the purpose, risks and possible next steps in the conversation.

Explore further: The Spirit of Motivational Interviewing and Partnership in Motivational Interviewing.

The person remains captain of their own ship

Casey uses a captain-and-navigator metaphor to describe autonomy and guiding. The person remains captain. The practitioner may have expertise, information and responsibility, but does not become owner of the person’s life.

For Casey, the navigator needs to attend to two things at once: the person’s wider destination and the immediate crisis. Focusing exclusively on the crisis can narrow the conversation to today’s problem. Ignoring the crisis in favour of long-term goals can miss what needs attention now.

Mindset shapes language

Casey makes a striking observation: when practitioners become too preoccupied with producing the correct MI technique, their attention can shift away from the person. Open questions, reflections and other skills still matter, but technique should serve the conversation rather than become the practitioner’s main focus.

His teaching emphasis is therefore on mindset first. When the practitioner is genuinely oriented towards autonomy, empathy, partnership, guiding and evoking, MI-consistent language is more likely to follow.

Accurate empathy is more than repeating what someone says

The bridge example takes the discussion further. Casey distinguishes accurate empathy from simply reflecting spoken words. In his example, the person initially says very little. A practitioner who equates empathy only with reflective listening may respond by asking more and more questions because there is little verbal material to reflect.

Casey’s formulation is that accurate empathy involves attempting to understand the person’s worldview and putting that understanding into words. In a crisis, this can require the practitioner to tolerate hearing and naming intense distress without immediately moving to reassurance, persuasion or problem solving.

Why naming the person’s experience can feel uncomfortable

Casey notes that accurately putting distress into words can trigger the helper’s Fixing Reflex because it may sound, to the practitioner or observer, as though the helper is agreeing with hopelessness or despair. His distinction is important: acknowledging the person’s experience is not the same as endorsing a harmful action or conclusion.

In the bridge example he describes the movement towards engagement beginning when the person feels understood. Only then does the conversation begin to open towards possibilities and change.

Explore further: Reflective Listening in Motivational Interviewing and The Fixing Reflex.

From frozen to ambivalent

Perhaps the most distinctive learning point in the episode is Casey’s description of moving a person from a frozen state to an ambivalent state. In many MI conversations, practitioners think of ambivalence as something to help resolve. Here, becoming ambivalent can itself represent movement.

When a person’s experience has narrowed to a single apparent option, beginning to recognise another possibility can be meaningful progress. In Casey’s example, the practitioner first works towards engagement and understanding, then begins to name the possibility that the person both feels trapped and wishes there could be another way.

This connects closely with the broader MI understanding that ambivalence is a normal part of change rather than evidence of resistance.

Explore further: Working with Ambivalence in Motivational Interviewing and Practice lessons on ambivalence from Dr Allan Zuckoff.

The five intentions in Casey’s framework

Casey discusses five intentions used in the Motivational Interviewing Competency Assessment (MICA): activation, guiding, expressing accurate empathy, partnership and evoking. In this episode he presents these as mindsets that influence what practitioners notice and how they respond, rather than as a checklist of phrases to use.

The wording belongs to Casey’s MICA framework and should not be confused with the four elements of MI Spirit described elsewhere in the Knowledge Centre. The value for practice is in asking what intention is organising our response in a difficult moment.

Managing the Fixing Reflex in crisis

Crisis naturally creates urgency. Casey’s examples show why that urgency deserves attention. A practitioner can unintentionally contribute to escalation when their own fear, need for resolution or desire to help begins to dominate the interaction.

This does not mean avoiding necessary safety action. It means noticing when a legitimate safety responsibility is being joined by an additional urge to persuade, correct or make the person’s decision for them.

Deliberate practice: responding under pressure

1. Mindset before words

Before responding to a difficult statement, pause for five seconds. Decide what you want your stance to communicate: autonomy, accurate empathy, partnership, guiding or evoking. Only then formulate your response.

2. Captain or navigator?

Listen to a short practice scenario and notice whether your first response tries to steer the person’s ship for them. Rework it so that you remain an active navigator while the person retains ownership of the decision.

3. Empathy without a question

Practise with a speaker who gives very little information. Instead of immediately asking another question, formulate a tentative statement about what the situation may be like from their perspective. Keep it humble and correctable.

4. Notice your own urgency

After a demanding conversation, ask: What outcome was I hoping for? What did I fear might happen? How did those feelings shape my language?

Practice takeaways

1. MI under pressure depends on practitioner stance as well as communication technique.
2. Empathy and direction can coexist within a guiding style.
3. Supporting autonomy does not remove legitimate safety responsibilities.
4. Accurate empathy is broader than simply repeating or reflecting spoken words.
5. When people say very little, repeated questioning can become a trap.
6. Naming distress is not the same as agreeing with a harmful conclusion.
7. In some crisis conversations, moving from a frozen position to ambivalence may represent progress.
8. The practitioner’s Fixing Reflex can intensify when risk, urgency or strong emotion are present.
9. Mindset influences what we notice, what we ask and what we reflect.
10. Deliberate practice can help practitioners remain purposeful when conversations become emotionally demanding.

Episode guide

• 0:00 – Episode introduction
• 6:25 – Casey’s introduction and early MI story
• 10:30 – “How do we help people help people?”
• 13:45 – Bridging law enforcement and mental health
• 19:50 – De-escalating the brain with MI
• 29:15 – Helping police officers respond to people in crisis
• 34:15 – Casey’s five intentions
• 43:05 – Beyond reflective listening
• 58:30 – Opening an MI-based clinic
• 1:03:16 – End of episode

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About this series

Talking to Change: MI Practice Companion turns selected podcast conversations into practice-focused learning resources, connecting guest discussions with established Motivational Interviewing principles, the Knowledge Centre and deliberate practice.