Motivational Interviewing and Stages of Change: Integrating

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Title: Motivational Interviewing and Stages of Change: Integrating


1
Motivational Interviewing A Comprehensive
Introduction to Concepts, Strategies
Micro-Skills
  • Presented by
  • William B. Webb, Ph.D., L.I.C.S.W., M.A.C.
  • Director, OASIS Behavioral Health Services
  • 689 Central Ave.
  • P.O. Box 219
  • Barboursville, WV 25504-0219
  • Phone (304) 733-3331
  • Email wwebb56473_at_aol.com
  • Website www.PsychOasis.com

2
MOTIVATIONAL INTERVIEWING A Comprehensive
Introduction to Concepts, Strategies, and
Micro-Skills
TRAINING AGENDA (Tentative) Day 1 900 -
1015 Introduction to Stages of Change 1015
1030 BREAK 1030 1145 Instruction in applying
the stages of change to MI 1215 100
LUNCH 100 215 Presentation on MI theory,
spirit, and concepts 215 230 BREAK 230
400 Practice MI Phase One Intervention
Strategies (Group Work) Day 2 900 -
1015 Review Day One (consolidate relevant
concepts) 1015 1030 BREAK 1030
1215 Examination of MI Phase II Process
Strengthening Commitment to Change 1215 100
LUNCH 100 230 Instruction/Practice in
techniques to sustain motivation for change 230
245 BREAK 245 315 Develop a written change
plan 315 400 Review of basic resources for
further learning
3
Motivational Interviewing (MI) is a directive,
client-centered approach that enhances motivation
for change, by helping individuals clarify and
resolve their ambivalence about change, and by
eliciting change language. It is based on the
principles of collaboration, evocation, and
antonymy while supporting self-efficacy. This
approach has shown good outcome in clinical
research with diverse client populations. It is
especially effective in working with resistant
clients. This two (2) day training is designed to
provide a broad overview of the entire system of
Motivational Interviewing. However, the specific
focus for this introductory session will be on
conveying the spirit and major principles of the
model. Recent research has demonstrated that
retention and proficiency of practical
application of MI is significantly enhanced by
follow-up sessions, which include a review of
work samples and MI coaching. Objectives of
this training
  • To increase participants knowledge of
    Motivational Interviewing.
  • To exhibit the appropriate application of
    stages of change model to the
  • Motivational Interviewing approach.
  • To demonstrate via lecture, video, and group
    activities the spirit, principles,
  • and skill set for the application of
    Motivational Interviewing.
  • To provide in-vivo practice of MI listening
    skills and methods for
  • recognizing and dealing with change talk.

4
Recommended Skill-Development Format
How to Integrate this Training
Study
  • Workshops
  • Readings
  • Tapes
  • Videos
  • Website
  • Review Research

Practice
  • Training
  • Audio/Video critiques
  • Coaching
  • Feedback

Extend
  • In-vivo application
  • Further training
  • Mint
  • List serve
  • Measure effectiveness

5
Initial Training
  • A workshop is only the beginning of learning MI.
  • Learning Goals
  • To understand the underlying spirit and approach
    of MI.
  • 2. To recognize the reflective listening
    responses and differentiate them from other
    counseling responses.
  • 3. To be able to provide at least 50 reflective
    listening responses during a conversation.
  • 4. To recognize change talk and be able to
    differentiate commitment language from other
    types of change talk.
  • 5. To list and demonstrate several different
    strategies for eliciting client change talk.
  • A workshop without follow-up is unlikely to make
    a significant difference in practice.
  • Research indicates that personal feedback and
    performance coaching are necessary to effectively
    integrate MI skills.

6
Principles of Motivational Interviewing
Use this scale to rate your understanding of
motivational interviewing methodology
0
1
2
3
4
5
6
7
8
9
10
None
Moderate
Very High
7
A Motivational Interviewing Parable
  • A traveler in ancient Greece had lost his way
    and, seeking to find it, asked a man by the
    roadside who turned out to be Socrates. How can
    I reach Mt. Olympus? asked the traveler. To this
    inquiry Socrates is said to have gently replied
    Just make sure that every step you take goes in
    that direction.

Source Discover the Power Within You By Jeff
Butterworth (Chapter 3)
8
The Transtheoretical Model of Stages of Change
Prochaska, DiClemente, and Norcross (1994)
9
Stages of Change Model
Precontemplation Increase Awareness
Contemplation Motivate increase self-efficacy
Relapse Assist in coping
Preparation Negotiate plan
Maintenance Reaffirm commitment Active problem
solving
Action Implement Plan F/U
Termination
10
The Spiral of Change
11
As the degree of mismatch increases between
yourself and the client in readiness for change,
the likelihood of resistance increases
proportionately.
Your Viewpoint
Mismatch
Other person
Maintenance
Action
Preparation
Contemplation
Pre-Contemplation
Differing viewpoints on readiness for change.
12
Movement Along the Motivational Continuum
?
?
?
1
10
Not Ready
Unsure
Very Ready
People come in within a certain range of
motivation. What you say influences where they
end up.
13
The Transtheoretical Model of Change A Six-Step
Process
Stage 1 - PrecontemplationWhat, me have a
problem? No way!
Stage II ContemplationMaybe I need to change
something, but Im not sure what to do
Stage III PreparationYes, theres a problem
and Im going to change it
14
Stage IV ActionIm doing something about my
problem.
Stage V MaintenanceIm an old pro now.
Stage VI TerminationIm not even tempted
anymore
Ancillary Stage VII Relapse/RecyclingWhoops!
I slipped back into my old habit!
15
The Stages of Change Model
Precontemplation
Contemplation
Progress
Preparation
Relapse
Action
Maintenance
16
Processes of Change in Correlation to Stages of
Change
Precontemplation Contemplation
Preparation Action Maintenance
1. Consciousness Raising?????????? 2. Social
Liberation????????????? 3. Emotional
Arousal????????? 4. Self
Re-evaluation????????? 5.
Commitment???????????????? 6.
Reward???????????? 7.
Countering?????????? 8.
Environmental Control?????
9. Helping
Relationships?
17
Readiness Levels
18
Stages of Change Therapist Tasks
19
Stages of Change Patient Tasks
20
Summary Stages of Change
  • About the process of change
  • Compatible with different tx. models
  • Change occurs all the time
  • Many people change without help
  • People fluctuate among SOC
  • Emphasizes positive reasons for change
  • People require more motivation in early stages
  • Combined with MI, it helps people decide on their
    own
  • plan of action

21
It is not the strongest of the species that
survives, nor the most intelligent, but the one
most responsive to change. - Charles Darwin
(1809-1882)
22
Motivational InterviewingAn Overview
Miller and Rollnick (2002, 2nd Ed.)
23
Motivation is a fire from within. If someone
else tries to light that fire under you, chances
are it will burn very briefly. - Stephen R.
Covey, (1932-Present)
24
(No Transcript)
25
Why Do People Change?
  • People change voluntarily only when
  • They become interested in or concerned about the
    need for change.
  • They become convinced that the change is in
    their best interests or will benefit them more
    than cost them.
  • They organize a plan of action that they are
    committed to implementing.
  • They take the steps necessary to make and
    sustain the change.

26
Sources of Motivation
External Pressure Internal Motivation External
ly motivated subjects had long term outcomes only
when they also had high levels of internal
motivation (Deci, 2000)
27
Self Determination Theory SDT
  • Internal motivation is enhanced by
  • Autonomy - Freedom to choose
  • Competence - Self efficacy
  • Relatedness - Relationships heal

BEHMS REACTANCE THEORY whenever a particular
behavior is threatened, the desirability of that
behavior increases. Ex You can not use drugs
while on probation! 1. (Brehm 1981) 2.
(Miller, Rollnick 2002) 3. (Hubble Duncan
and Miller, 1999)
28
New Findings on Motivation
  • Motivation predicts action
  • Motivation is changeable
  • Motivation is behavior specific
  • Motivation is interactive
  • Internal motivation lasts longer than external

29
How to Learn MI 8 Skills
  • Openness to underlying assumption and spirit of
    MI.
  • Proficiency in client centered interpersonal
    skills, especially accurate empathy.
  • Recognize change talk and commitment language.
  • Minimize resistance in responding to sustain
    talk.
  • Skill in eliciting and responding to change-talk.
  • Formulate an effective change plan.
  • Enlist commitment to the plan.
  • Blending MI with other therapies.
  • (Explore and resolve ambivalence ongoing)

30
Where people get stuck in MI
1. Underlying Assumptions 2. Reflective
Listening 3. Recognizing Change Talk 4. Evoking
Change Talk 5. Collecting Bouquets
(Summarizing) 6. Responding to Resistance 7.
Evoking and Strengthening Commitment 8. Transfer
to Other Therapeutic Methods
31
Probability of Behavior Change
Clinician talks about why change is important.
Client nods head.
Client thinks about why change is personally
important
Client talks about why change is personally
important
Client makes verbal commitment to change
Low
High
32
Phase I Build Motivation to Change (Why)
  • Opening Strategies
  • A. Use OARS ? Open-ended questions
  • Affirm
  • Reflect
  • Summarize
  • B. Agenda Setting
  • C. Scaling Questions
  • Decrease Resistance
  • A. Reflections
  • 1. Paraphrase
  • 2. Amplified
  • 3. Double-sided

B. Others 1. Shift-focus 2. Reframe 3.
Agree w/twist (Reflect/Reframe) 4.
Emphasize Personal Control 5. Coming Along Side
33
  • Evoke Change-Talk
  • A. Types
  • 1. Disadvantage of Status Quo
  • 2. Advantage of change
  • 3. Optimism for change
  • 4. Intention to change

B. Methods 1. Evocative questions
2. Elaborate 3. Importance/Confidence
rulers 4. Explore decisional balance
5. Query extremes 6. Look behind/look
forward 7. Explore goals (values)
C. Look for DARN-CaT Desire Ability Reason
s Need ---------------- Commitment
And Taking Steps
4. Responding to Change-Talk (EARS) 1.
Elaborate 2. Affirm 3. Reflect 4. Summarize
34
Phase II Strengthening Commitment to Change
(How)
  • Recapitulation (Grand Summary)
  • Ask Key Questions
  • Where do we go from here?
  • What do you want to happen?
  • Whats the next step
  • Where do you see yourself in 2-4 weeks?
  • What might interfere with this?
  • Who are your support people?

3. Provide information/Advise with permission
May I offer some possibilities/options? Are you
interested in some suggestions? Are you open to
other considerations? Would a review of some
options be helpful? Are you looking for helpful
information?
35
  • Negotiate a Change Plan
  • Go to Change Plan worksheet
  • End tasks
  • Summary Reflection
  • Close the deal- Is this what you want to
    do?
  • Helpful Hints
  • 2 Reflections/questions
  • We can dance or wrestle
  • Empathyaccurate reflection of clients meaning
  • Avoid questions or comments that elicit
    resistance
  • Reduce resistance, evoke change-talk
  • Stabilize the changes

36
If a patient wants to go, let him go. If he
wants to stay, let him stay. Do not deny him what
he wants and do not suppress him. If we comply to
his wishes and let him satisfy his needs, then
all of his excessive positive force will be
appropriately discharged and he will consequently
get well. - Zhang Zhongiing Ca. 200 A.D.
37
Least Favorite/Most Favorite Person Exercise
38
Motivational Interviewing Facilitates Change By
  • Reducing resistance
  • Raising discrepancy
  • Eliciting change-talk
  • Responding to change-talk
  • Sustaining change

39
The Spirit of Motivational Interviewing
CollaborationEvocationAutonomy
ConfrontationEducationAuthority
VS.
40
Conditions that Enhance ChangeRollnick and
Miller (2002)
Motivational Interviewing
  • is a client-centered, directive method for
    enhancing intrinsic motivation to change by
    exploring and resolving ambivalence. (p.25)
  • elicits change from within, (not imposed). (p.
    326)
  • makes client responsible for change. (p. 326)
  • avoids direct persuasion. (p.326)
  • is interactive/directive. (p. 327)
  • resolves ambivalence. (p. 327)
  • works through the therapeutic partnership. (p.
    327)

41
Key Assumptions Behind Motivational Interventions
  • Encourage empathy
  • Maintain congruence
  • Promote collaborative spirit
  • Recognize ambivalence is normal
  • Resistance can be altered
  • Support self-efficacy

42
  • Principle 1 Express Empathy.
  • Acceptance facilitates change.
  • Skillful reflective listening is
  • fundamental.
  • Ambivalence is inevitable.

43
(No Transcript)
44
Being empathic is to perceive the internal frame
of reference of another with accuracy and with
the emotional components and meanings which
pertain thereto...it means to sense the hurt or
pleasure of another as he senses it and to
perceive the causes thereof as he perceives
them... - Carl Rogers
45
  • Principle 2 Develop Discrepancy.
  • Client presents argument for change.
  • Discrepancy is the difference between present
    behavior and future goals.
  • Exaggerate discrepancy.

46
Discrepancy (2)
Are your current behaviors leading toward or
away from your goals/values?
Status Quo Sustain-Talk (No Change)
Goals Commitment-Language (Behavior Change)
vs.
Resistance
Motivation
47
  • Principle 3 Roll with Resistance
  • Avoid arguing for change.
  • Avoid direct opposition.
  • Invite new perspectives, do not impose.
  • Client is responsible for finding solutions.
  • Resistance is a signal to respond differently.

48
  • Principle 4 Support self-efficacy
  • Self-efficacy a clients belief in their
    ability to succeed.
  • Reinforce self-efficacy frequently.
  • Individual is responsible for change.
  • Providers view of clients self-efficacy affects
    outcome.

49
Traps to Avoid
  • Question-Answer Trap
  • Trap of Taking Sides
  • Expert Trap
  • Labeling Trap
  • Premature Focus Trap
  • Blaming Trap

50
Communication can go wrong because
  • The speaker does not say exactly what is meant.
  • The listener does not hear the words correctly.
  • The listener gives a different interpretation to
    what the words mean.
  • The speaker does not feel understood.

51
Active Listening (Thomas Gordon, Ph. D.)
Client
Facilitator
2
What is said
What is heard
3
1
What is understood
What is meant/felt
4
52
Not Listening Roadblocks (From the Facilitator)
1. Ordering, directing, commanding 2. Warning,
cautioning, threatening 3. Giving advice, making
suggestions, providing solutions 4. Persuading
with logic, arguing, lecturing 5. Moralizing 6.
Disagreeing, judging, criticizing, blaming 7.
Agreeing, approving, praising 8. Shaming,
ridiculing, labeling 9. Interpreting,
analyzing 10. Reassuring, sympathizing,
consoling 11. Questioning, probing 12.
Withdrawing, distracting, humoring, changing the
subject
Thomas Gordon
53
Non-change Behavior (From the Client)
  • Categories of resistance
  • Arguing
  • Interrupting
  • Negating
  • Ignoring

54
Four Categories of Client Resistance Behavior
  • Arguing
  • Challenging
  • Discounting
  • Hostility

55
  • Interrupting
  • Talking over
  • Cutting off

56
  • Negating
  • Blaming
  • Disagreeing
  • Minimizing
  • Pessimism
  • Reluctance

57
  • Ignoring
  • Inattention
  • Nonanswer
  • No response
  • Sidetracking

58
Using O.A.R.S.
  • Ask open-ended questions.
  • Directly affirm and support the client.
  • Listen reflectively.
  • Summarize periodically.

59
EXERCISE
Is it an open or closed question?
1. What do you like about your current
situation? ___ 2. Is this
strategy effective? ___ 3. What kind of
specific assistance are you looking for?
___ 4. Have you ever
considered just going to AA?
___ 5. Isnt it important to you
to follow your doctors orders?
___ 6. What obstacles do you anticipate in
making the specific changes weve discussed?

___ 7. What
are the most important reasons for making these
changes? ___ 8. Dont you care about your
health?
___ 9. What do you think about coming back
for a follow-up visit? ___ 10. Is this an
open or closed question?
___
60
Open-Ended Questions
  • Stimulates elaboration
  • Asks for more than 1 word responses
  • Examples
  • What would you be doing differently if you
  • had already made the change you're
  • considering?
  • How might you get from where you are today
  • to where you want to be in the near
    future?

61
Affirm/Support
  • Use complements and statements of appreciation
    and understanding
  • Examples
  • I think its great that you want to tackle this
    problem.
  • I appreciate your willingness to discuss this.

62
(No Transcript)
63
Reflective Listening
Techniques That Reduce Resistance Simple
Reflection Amplified Reflection Double-sided
Reflection
64
Simple Reflection
Repeating or rephrasing what a client has said
to you is one way to let the person know that you
heard them.
Client - But I cant quit using. I mean, all of
my friends get high! Facilitator Quitting
seems nearly impossible because you spend so much
time with others who use. Client Right,
although maybe I shouldnt.
65
Amplified Reflection
With this, the facilitator will want to cause
the client to disagree with whats being said.
The facilitator may exaggerate or intensify the
point in order to accomplish this, however, it is
important not to over-embellish. If the client
feels threatened he or she may respond in anger.
Client - But I cant quit using. I mean, all of
my friends get high! Facilitator Oh, I see. So
you already couldnt quit because then youd be
too different to fit in with your friends and
they might not accept the new you. Client
Well, that would make me different from them,
although they might not really care as long as I
dont pressure them to quit.
66
Double-sided Reflection
The facilitator reflects both the current,
resistant statement with a previous,
contradictory statement that the client has made.
Client - But I cant quit using. I mean, all of
my friends get high! Facilitator You cant
imagine how you could not get high with your
friends, and at the same time youre worried
about how its affecting you. Client Yes. I
guess I have mixed feelings.
67
Summaries (1)
  • Three types
  • 1. Collecting
  • The bouquet Putting it all together
  • 2. Linking Phrases
  • On the one hand...on the other
  • At the same time
  • Ex. On the one hand, youre concerned that
    your drinking is affecting your health. On the
    other, youre not sure if you want to stop.
  • 3. Transitional to the next phase
  • Let me see if I have everything so far...
  • (at the end of one session)
  • Lets review briefly where we are...
  • (at the beginning of the next session)

68
Summaries (2)
  • Special form of reflection
  • Selective facilitator chooses what to emphasize
  • Lets client know youre listening
  • Includes Clients concerns about change, problem
    recognition, optimism, and ambivalence about
    change
  • Invite client to respond Have I left out
    anything...?

69
Listening Is An Act of Love
Dave Isay (2007)
70
O.A.R.S. Coding
Listen for examples of the speakers use of each
of the O.A.R.S. responses. As you hear them,
place a hash mark (/) in the appropriate row.
Make notes of examples of each type of O.A.R.S.
response that you heard.
71
Strategic Responses to Diffuse Resistance
  • Shifting focus Move attention away from
    barriers.
  • Reframing A positive interpretation to negative
    info.
  • Agreement w/twist Agree with client, then add
    change of direction.
  • Side w/the negative Take the no-change side
    of ambivalence.
  • Personal choice Its really up to you.
  • Support self-efficacy Emphasize hope,
    feasibility, optimism
  • Coming Along Side Match clients position.

72
Types of Change Talk Self-Motivating Speech
  • Disadvantages of Status Quo
  • Advantages of Change
  • Optimism for Change
  • Intention to Change

73
Recognizing Change TalkDARN-CaT
  • What is Change Talk?
  • How do we know when we hear it?
  • We listen for and strengthen natural language
    expressions of change
  • DDesire to Change (the want to)
  • AAbility to Change (confidence)
  • RReasons to Change (argument for)
  • NNeeds to Change (importance)

CCommitment to change (Ill try Ill
do) and TTaking Steps (Ive done...)
74
Change Talk
  • DARN predicts commitment talk
  • Commitment talk predicts change
  • Taking Steps Change is happening

75
Flow of Change Talk
Commitment And Taking Steps (CaT)
Desire Ability Reasons Need (DARN)
Change
Change


76
The Six Kinds of Change TalkDARN-CaT
Motivates Progress Toward Action (change)
Independent Predictors of Change
77
Relative Strengths of Commitment Language
78
Change Questionnaire
What is the change that you are considering?
to ______________________
Now answer each of the following questions about
this change that you are considering. Wherever
there is a blank _________, think of the change
that you have written above, and then circle the
one number that best describes where you are
right now. For example, if you had written get a
job on the line above, then item 1 would be I
want to get a job and you would indicate how
much you want to get a job.
79
William R. Miller, Theresa B. Moyers, and Paul
Amrhein (2005) Department of Psychology,
University of New Mexico, Albequerque
80
Methods for Evoking Change Talk
  • 1. Asking evocative questions
  • What worries you about this?
  • What problems has this behavior created
  • for you?
  • 2. Elaborating Ask for Clarification
  • Ask for specific examples
  • In what ways?
  • How much?
  • What else?
  • 3. Using the importance ruler
  • 4. Exploring the decisional balance

81
  • 5. Querying extremes
  • Whats the worst that could happen if you dont
    make
  • a change? Whats the best thing that could
    happen?
  • 6. Looking back Compare past to present
  • (Ex.) Do you remember when things were going
    well? What
  • changed?
  • 7. Looking forward Envision a changed future
  • What would be better about your future?
  • 8. Exploring goals and values
  • Compare current behavior with values.
  • Enhance discrepancy.
  • Use positive motivation toward goals.

82
Responding to Change Talk (1)
EARS
Elaborating change talk Affirming change
talk Reflecting change talk Summarizing change
talk
83
Responding to Change Talk (2) (E.A.R.S.)
E Elaborating So youre thinking about
setting a quit date. Tell me a little more about
that. A Affirming I think its great that
youve picked out an AA meeting to attend. R
Reflecting So youve scheduled a time to meet
with a personal trainer, and youre eager to get
going. S Summarize Now let me see if I have
all of this, you have begun...
84
Readiness for Phase II Work
  • Decreased resistance to change.
  • Decreased discussion about the problem and a
    feeling
  • of waiting for the next step.
  • A sense of resolution in which the client may
    seem
  • more relaxed and unburdened about the
    problem.
  • Increased change talk.
  • Increased questions about change.
  • Greater envisioning a future that includes
    the changes.
  • Experimenting with possible change actions
    between
  • sessions.

85
Two Phases of Motivation
Phase 2 Strengthening Commitment
Phase 1 Building Motivation
86
Phase II Activities Strengthening Commitment
to Change (How)
  • Recapitulation (Grand Summary)
  • Ask Key Questions
  • Where do we go from here?
  • What do you want to happen?
  • Whats the next step
  • Where do you see yourself in 2-4 weeks?
  • What might interfere with this?
  • Who are your support people?

3. Provide information/Advise with permission
May I offer some possibilities/options? Are you
interested in some suggestions? Are you open to
other considerations? Would a review of some
options be helpful? Are you looking for helpful
information?
87
  • Negotiate a Change Plan
  • Go to Change Plan worksheet
  • End tasks
  • Summary Reflection
  • Close the deal- Is this what you want to
    do?
  • Helpful Hints
  • 2 Reflections/questions
  • We can dance or wrestle
  • Empathyaccurate reflection of clients meaning
  • Avoid questions or comments that elicit
    resistance
  • Reduce resistance, evoke change-talk
  • Stabilize the changes

88
MI Sandwich
STEP 1
Use OARS
Engage Client
Establish Rapport
10 min.
STEP 2
40 min.
Review any previously collected objective
assessment material. Collect additional
information about use.
STEP 3
Develop change plan
Assess readiness
10 min.
Continue to use OARS
89
Summary Motivational Interviewing
  • Motivation resides in the interaction
  • Motivation can be influenced
  • Clients always respond with motivation toward or
    away from change
  • Resistance informs the therapeutic relationship
  • Resistance can be reduced or increased
  • A collaborative relationship facilitates change
  • Clients are responsible for their progress
  • Ambivalence is normal
  • Resistance is a signal to respond differently
  • The providers and the clients expectations
    affect outcome
  • Arguing for change creates resistance
  • A primary goal of MI is to help the client
    explore and resolve ambivalence

90
(No Transcript)
91
Change Tool Kit
  • Agenda Setting
  • Scaling Question
  • Stepping Stones to Better Health
  • Levels of Reflection Worksheet
  • OARS Coding
  • Six Kinds of DARN-CaT
  • Change Questionnaire
  • Rulers
  • Planning Change
  • A Decisional Balance
  • Decisional Balance Worksheet
  • Change Plan Worksheets
  • BECCI
  • Resources

92
An Agenda-Setting Chart
93
Scaling Question
Most Pressing
Least Pressing
94
Stepping Stones to Better Health
Destination
Possible Obstacles 1. _____________ 2.
_____________ 3. _____________ 4.
_____________ 5. _____________
Possible Solutions 1. _____________ 2.
_____________ 3. _____________ 4.
_____________ 5. _____________
Starting Place
95
Levels of Reflection Worksheet
Listen for reflections the counselor makes. Write
the level in the Reflection Level column. Write
what the counselor actually said in the
Counselors Words column on the line next to the
level of reflection.
  • Level 1 Repeat using the same words.
  • Level 2 Rephrase using similar words.
  • Level 3 Paraphrase capturing meaning and
    emotions.
  • Perhaps adding something implied but not stated.

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O.A.R.S. Coding
Listen for examples of the speakers use of each
of the O.A.R.S. responses. As you hear them,
place a has mark (/) in the appropriate row. Make
notes of examples of each type of O.A.R.S.
response that you heard.
97
The Six Kinds of Change TalkDARN-CaT
Motivates Progress Toward Action (change)
Independent Predictors of Change
98
Change Questionnaire
What is the change that you are considering?
to ______________________
Now answer each of the following questions about
this change that you are considering. Wherever
there is a blank _________, think of the change
that you have written above, and then circle the
one number that best describes where you are
right now. For example, if you had written get a
job on the line above, then item 1 would be I
want to get a job and you would indicate how
much you want to get a job.
99
William R. Miller, Theresa B. Moyers, and Paul
Amrhein (2005) Department of Psychology,
University of New Mexico, Albequerque
100
Change Questionnaire
William R. Miller, Theresa B. Moyers, and Paul
Amrhein (2005) Department of Psychology,
University of New Mexico
The CQ was developed as a brief measure of six
different components of motivation for change,
based on psycholinguistic analyses of natural
language (Amrhein, et. al., 2003). In order to
complete the questionnaire, the respondent must
have a particular change in mind. That change is
specified at the top of the questionnaire, and
the open line (__________) in each item then
represents that same change. It is also possible
to modify the items of the CQ to specify a
particular change. For example, quit drinking
could be substituted for the open line in every
item. Item 1 would then read, I want to quit
drinking. (The instructions at the top of the
questionnaire would also need to be modified.)
The key word in every item is intentionally
emphasized by boldface italic font in order to
focus respondents on the aspect of motivation
that is being queried. Scoring Key There are
six subscales, each of which consists of two
items. Each subscale score is the sum of
responses to the two key items. The six subscale
scores can also be summed to compute a total CQ
score.
Amrhein, P.C., Miller, W.R., Yahne, C.E., Palmer,
M., Fulcher, L. (2003). Client commitment
language during motivational interviewing
predicts drug use outcomes. Journal of Consulting
and Clinical Psychology, 71, 862-878.
101
Rulers
How important is it to you to change this?
How confident are you that you can change this?
How much do you desire to change this?
102
Planning for and Implementing Change
10
A
READINESS
(Motivation)
WILLING
0
0
10
B
ABLE
(Confidence)
Adapted from Health Behavior Change A Guide for
Practitioners by Stephen Rollnick, Pip Mason, and
Chris Butler (Churchill Livingstone 1999) 186,
with permission from Elsevier.
103
Resolving AmbivalenceThe Decisional Balance
Costs of Status QuoBenefits of Change
Costs of ChangeBenefits of Status Quo
104
A Decisional Balance Sheet
105
Decisional Balance Worksheet
Name_____________________

Date____________
106
A Change Plan Worksheet
107
Change Plan Worksheet Outline
108
A Change Plan Worksheet Example
109
(No Transcript)
110
Behavior Change Counseling Index (BECCI)
BECCI is an instrument designed for trainers to
score practitioners use of Behavior Change
Counseling in consultations (either real or
simulated). To use BECCI, circle a number on the
scale attached to each item to indicate the
degree to which the patient/practitioner has
carried out the action described. Before using
BECCI, please consult the accompanying manual for
a detailed explanation of how to score the items.
As a guide while using the instrument, each
number on the scale indicates that the action was
carried out 0Not at all 1Minimally 2To some
extent 3A good deal 4A great extent The
Topic ___________________________________________
_____________
Practitioner BECCI Score ____________________ Pra
ctitioner speaks for approximately More than
half the time ? About half the time ?
Less than half the time ? (University of
Wales College of Medicine, 2002)
111
Blending SOC and MI
Tomlin and Richardson (2004)
112
Matching Motivational Tasks to the Stages of
Change
113
Appropriate Motivational Strategies for Each
Stage of Change
(From Prochaska, DiClemente, Norcross (1992),
adapted by Chris Wagner)
114
(No Transcript)
115
Resources
I. Stages of Change 1. Prochaska, J.O., Norcross,
J.C., and DiClemente, C.C. (1994). Changing For
Good A Revolutionary Six- Stag Program for
Overcoming Bad Habits and Moving Your Life
Positively Forward. New York Avon Books,
INC. 2. Prochaska, J.O., Norcross, J.C. (1994).
Systems of Psychotherapy A Transtheoretical
Analysis, 3rd ed. Pacific Grove, CA.
Brooks/Cole 3. DiClemente, C.C. and Hughes, S.O.,
(1990). Stages of Change Profiles in Alcoholism
Treatment. Journal of Substance Abuse, 2,
217-235. II. Motivational Interviewing 1.
Arkowitz, H., et.al., (2008). Motivational
Interviewing for the Treatment of Psychological
Problems. New York, The Guilford Press 2.
Enhancing Motivation for Change Inservice
Training Based on a Treatment Improvement
Protocol (TIP35). (2006) U.S. Department of
Health and Human Services, (SAMHSA) Pub.
(SMA)06-4190, Rockville, MD. 3. Miller, W.R. and
Rollnick, S. (2002). Motivational Interviewing
Programming People for Change, 2nd ed. New
York The Guilford Press. 4. Miller, W.R.,
Zweben, A., DiClemente, C.C., Rychtarik, R.
(1992). Motivational enhancement therapy
manual A clinical research guide for therapists
treating individuals with alcohol abuse and
dependence (Project MATCH Monograph Series,
Vol. 2.) Rockville, MD National Institute on
Alcohol Abuse and Alcoholism. 5. Substance
Abuse and Mental Health Services Administrators,
Center for Substance Abuse Treatment, U.S.
Department of Health and Human Services. (2003).
Enhancing Motivation for Change in Substance
Abuse Treatment (TIP 35 Publication (SMA)
03-3811). Rockville, MD Miller. 6. Rollnick, S.
Mason, P. and Butler, C. (1999) Health Behavior
Change A Guide for Practitioners. Edinburgh
Churchill Livingstone. 7. Rollnick, S., Miller,
W., and Butler, C., (2008). Motivational
Interviewing in Health Care Helping Patients
Change Behavior. New York, The Guilford Press. 8.
Walters, S., et. al, (2007) A Guide for Probation
and Parole Motivating Offenders to Change.
Washintgon, D.C. National Institute of
Corrections
116
Resources (2)
III. Stages of Change and Motivational
Interviewing 1. Tomlin, K., and Richardson, H.
(2004). Motivational Interviewing and Stages of
Change Integrating Best Practices for
Substance Abuse Professionals. Center City,
Miinn Hazelden. IV. Additional Resources
Video Training Series Motivational
Interviewing Professional Videotape Series 1998 -
A six tape set at 120.00 from University of
New Mexico, Center on Alcoholism, Substance
Abuse, and Addiction (CASAA) 2350 Alamo, S.E.,
Albuquerque, NM 87106 Websites
1. www.motivationalinterview.org 2.
www.CASAA.unm.edu 3. Addiction
Technology Transfer Center www.Nattc.org
4. Substance Abuse and Mental Health Services
Administration www.samhsa.gov Resources on
motivational interviewing, including general
information, links, discussion board, training
resources, and information on reprints and the
latest research.
117
Evaluation Form MOTIVATIONAL INTERVIEWING William
B. Webb, Ph.D.
(For scoring purposes Strongly Agree4, Agree3,
Neutral2, Disagree1, Strongly Disagree0)
Thank you for completing this survey. Return
your survey to the Trainer.