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Motivational Interviewing

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Title: Motivational Interviewing


1
Motivational Interviewing
  • An Introduction to Spirit and Style

2
A taste of Motivational Interviewing
3
What is Motivational Interviewing?
  • It is a communication style that is
  • Evocative
  • Collaborative
  • Supportive of autonomy
  • Exploratory
  • Empathetic
  • Directive

4
What else?
  • Motivational Interviewing is evidenced based
  • 3 decades of research
  • More than 200 published clinical trials
  • Effective for an array of targeted problems
  • Cardiovascular rehabilitation
  • Diabetes management
  • Dietary change
  • Smoking
  • Gambling
  • Drug use / problem drinking
  • Management of chronic mental disorders
  • And others

5
What else?
  • MI is a Method that is
  • Teachable
  • Observable
  • Measurable
  • Learnable by a broad range of helping
    professionals
  • Complementary to other treatment methods

6
Goals of Motivational Interviewing
  • Lack of motivation is often ambivalence
  • The person feels 2 ways about the proposed change
  • Resistance is often the argument why not to
    change
  • MI attempts to help the individual resolve the
    ambivalence, so that it no longer hinders the
    process of change.

7
How?Combining Spirit and Technique
  • MI Spirit is ACE
  • Autonomy rather than authority
  • Affirms the persons right and capacity for
    self-direction
  • Collaborative rather than confrontational
  • Counseling is a partnership that honors the
    persons experiences and ideas
  • Evocative rather than educating
  • The resources and motivation to change are
    presumed to reside within the person

8
MI Spirit
9
Four Principles that are part of Spirit
  • Express Empathy
  • Acceptance facilitates change
  • Skillful reflective listening is fundamental
  • Ambivalence is normal
  • Develop Discrepancy
  • The client rather than the counselor should
    present the arguments for change
  • Change is motivated by a perceived discrepancy
    between present behavior and important goals or
    values

10
Four Principles that are part of Spirit
  • Roll with Resistance
  • Avoid arguing for change
  • Resistance is not directly opposed
  • New perspectives are invited but not imposed
  • Resistance is a signal to respond differently
  • Support Self-Efficacy
  • A persons belief in their ability to change
    matters
  • The client is responsible for choosing change
  • The counselors belief in the persons ability to
    change is a self-fulfilling prophecy

11
Technique OARS
  • Open questions
  • Not short-answer, yes/no, or rhetorical
  • Affirm
  • Comment positively on strengths, effort,
    intention
  • Reflective Listening
  • Summarizes meaning
  • A statement, not a question
  • Summarize
  • Draw together the persons own perspectives on
    change

12
Reflections
  • Levels of reflection
  • Repeat direct restatement of what the person
    said
  • Rephrase saying the same thing in slightly
    different words
  • Paraphrase Making a guess about meaning
    continuing the paragraph usually adds something
    that was not said directly. Takes it to the
    next level
  • Other types of reflection
  • Double-sided reflection states both sides
  • Amplified reflection overstates what was said

13
What if you could predict the potential that the
person will change?
  • Change Talk (DARN)
  • Desire want, prefer, wish
  • Ability able, can, could, possible
  • Reason specific arguments for change
  • Need important, have to, need to
  • Commitment Language
  • This predicts actual change

14
Eliciting Change Talk
  • Ask for it use open questions to elicit desire,
    ability, reason and need
  • In what ways would it be good for you to ____?
  • If you decide to ____, how would you do it?
  • What would be good about ____?
  • Why would you want to ____?
  • Dont forget about ambivalence
  • What would be good / what would be not-so-good?

15
Eliciting Change Talk
  • Use of Importance and Confidence rulers
  • On a scale of 0-10, how important is it for you
    to ___?
  • Why are you at a ____ and not zero? (Change
    talk)
  • On a scale of 0-10, how confident are you that
    you could ____?
  • Why are you at ____ and not zero? (Ability talk)
  • Looking Forward
  • If you dont make change, what do you think will
    happen?
  • Where would you like to be in ____ years?
  • What do you hope would be different?
  • How does ____ fit into that?

16
Responding to Change Talk
  • When you hear it
  • Reflect what was said
  • Ask for elaboration
  • Attempt to elicit more
  • Affirm the change talk
  • Use Summaries to gather together the pieces of
    change talk
  • Strengthen Commitment Language

17
Strength of Commitment Language
  • HIGH
  • I will / promise / swear / guarantee
  • I intend to / agree to / am ready to
  • I plan / expect / resolve / aim to
  • I hope to / will try to / will see about
  • I guess / think / suppose I will
  • LOW

18
Giving Advice
  • The person is more likely to hear and accept
    advice if you have permission to give it
  • Three forms of permission
  • The person asks for it, your opinion
  • You ask permission to give it
  • Preface your advice with permission to
    disagree/disregard it

19
Responding to Resistance
  • Remember that Resistance is just a side of
    ambivalence
  • Dont argue against it if you push they will
    push back
  • Rolling with resistance helps decrease it

20
Rolling with Resistance
  • Use of reflection as a response
  • Simple reflection
  • Amplified
  • Overstating the reflection
  • Double-Sided
  • Naming both sides of the ambivalence
  • Shifting the focus
  • Acknowledge the concerns and move the discussion
    in a less stressful direction
  • Reframing
  • Validate from a slightly different angle

21
Rolling with Resistance
  • Emphasize the persons
  • Ability to choose
  • Control of the situation
  • Autonomy
  • Come along side
  • Defend the status-quo side of your clients
    ambivalence to minimize defensiveness and
    encourage him to make the case for change.

22
Counselor responses that may elicit resistance
  • Arguing for change
  • Carry the banner for change, and seek to persuade
  • Assuming the expert role
  • The counselor has the answers
  • Criticizing, shaming, blaming
  • Attempting to instill negative emotions about the
    status quo

23
Counselor responses that may elicit resistance
  • Labeling
  • Pushing acceptance of a specific label or
    diagnosis to characterize the persons behavior
  • Being in a hurry
  • If you act like you only have a few minutes, it
    can take all day. Monty Roberts
  • Claiming preeminence
  • I know what is best

24
Traps to Avoid
  • Question Answer Trap
  • Pattern of questions followed by short answers
  • Taking Sides
  • Identifying the problem and the need to change it
  • Expert Trap
  • Responsibility falls on the counselor to have all
    the answers

25
Traps to Avoid
  • Labeling Trap
  • Counselor naming vs. individuals naming
  • Premature-Focus Trap
  • Attempting to draw the person to the problem area
    as defined by the counselor
  • Blaming Trap
  • Whose fault is the problem? Whos to blame?

26
The Transtheoretical ModelStages of Intentional
Change
  • By, DiClemente and Proskaska, 1985
  • Not Motivational Interviewing
  • Developed independently
  • Developed around the same time
  • Fits well with Motivational Interviewing
  • Stages of changes is a way of looking at where a
    person is at
  • Motivational Interviewing addresses what to do
    about it

27
Stages of Change
  • Pre-contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance

28
Pre-contemplation
  • HAS no awareness of the connection between a
    particular self-defeating behavior and the
    negative consequences it is causing them.
  • NEEDS help focusing on personal values and life
    goals - things he wants and doesnt want in his
    life - an accepting person to hear him without
    judging, advising, or directing.
  • TO . Raise his awareness and create a safe
    interpersonal space

29
Intervention
  • Establish rapport, build trust (OARS)
  • Offer factual information without judgment
  • Express concern
  • Dont push into action
  • Dont give up

30
Contemplation
  • HAS a growing awareness of the connection
    between the problem behavior and its negative
    consequences - cognitive dissonance and
    emotional turmoil.
  • NEEDS to more clearly see the discrepancy
    between her personal values and goals and the
    consequences of her current behavior -
    non-judgmental support.
  • TO facilitate movement toward change.

31
Intervention
  • Normalize ambivalence
  • Discuss the pros and cons of change
  • Emphasize freedom of choice
  • Support self-confidence

32
Preparation for Action
  • HAS a growing readiness and willingness to
    eliminate the problem behavior along with some
    experimentation with replacement behaviors.
  • NEEDS help planning, refining, and monitoring
    small, meaningful, measurable goals - respectful
    advise, a menu of options, and support.
  • TO foster success and boost confidence.

33
Intervention
  • Clarify the persons goals
  • Collaboratively develop a menu of options
  • Consider and lower barriers (e.g. child care,
    transportation, etc)
  • With permission, offer advice

34
Action
  • HAS developed and practiced alternatives to the
    problem behavior.
  • NEEDS the benefits of adopting the new
    behavior to remain more powerful and meaningful
    than the costs of letting go of the old
    behavior.
  • TO sustain momentum while keeping the memory
    green

35
Intervention
  • Acknowledge difficulties in putting the plan into
    action
  • Identify high risk situations and develop coping
    skills
  • With the person assess social and material
    supports

36
Maintenance
  • HAS succeeded in establishing replacement
    behaviors - an ongoing need for modifications in
    the action plan.
  • NEEDS positive reinforcement - relapse
    prevention strategies.
  • TO protect against loss of focus, courage, and
    hope - increase self-confidence.

37
Intervention
  • Affirm their resolve and self-efficacy
  • Help the person practice and use new coping
    strategies
  • Maintain supportive contact
  • Re-view them long-term goal/s

38
To Learn More
  • Read the book
  • Miller, WR. Rollnick, S. Motivational
    Interviewing Preparing people for change. Vol.
    2nd ed.. New York Guilford Press 2002.
  • Check out the Website
  • www.motivationalinterview.org
  • Get the Training Tapes
  • Miller, WR. Rollnick, S. Moyers, TB.
    Motivational Interviewing (7 videotape series).
    Albuquerque University of New Mexico 1998.
  • Get more training
  • MINT Members
  • Consult with others
  • Chad Hale, LMSW, CAAC
  • Pathways, CMH. (906) 226-0024
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