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Motivational Interviewing

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Motivational Interviewing Chapter 6 Phase 1: Building Motivation for Change Phase one of MI involves building intrinsic motivation for change. Phase two involves ... – PowerPoint PPT presentation

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Title: Motivational Interviewing


1
Motivational Interviewing
  • Chapter 6
  • Phase 1 Building Motivation for Change

2
  • Phase one of MI involves building intrinsic
    motivation for change.
  • Phase two involves strengthening commitment to
    change and developing a plan to accomplish it.
  • The amount of work to be done will depend on the
    person's starting point

3
Importance and Confidence
  • It is useful in understanding a person's
    ambivalence to know his or her perceptions of
    both importance and confidence

4
Importance and Confidence
  • You can asses importance and confidence using the
    scaling questions method
  • "How important would you say it is for you to
    __________? One a scale from 0-10, where 0 is not
    at all important and 10 is extremely important,
    where would you say you are?"
  • "How confident would you say you are, that if you
    decided to ________, you could do it?   On the
    same scale from 0-10 where 0 is not at all
    confident and 10 is extremely confident, where
    would you say you are?"

5
  • Phase 1 can involve either importance work or
    confidence work, or both.  In essence, you are
    helping the client to become ready, willing and
    able to change.

6
Some Early Traps to Avoid
  • 1) Question-Answer Trap - Using a QA format,
    even if it's open ended questions, affords little
    opportunity for a person to explore motivation
    and to offer change talk. 

7
Some Early Traps to Avoid
  • 1) Question-Answer Trap - The optimal approach is
    usually to ask an open-ended question, then to
    respond to the client's response not with another
    question but with reflective listening. 
  • As a general clinical guideline, avoid asking
    three questions in a row.

8
Some Early Traps to Avoid
  • 2) Trap of Taking Sides - If people usually enter
    counseling in a state of ambivalence, they feel
    two ways about their current situation they want
    it and they don't want it.  If the counselor
    argues for one side of the conflict, it is
    natural for the client to give voice to the other
    side.  Few people enjoy losing an argument or
    being proved wrong.

9
Some Early Traps to Avoid
  • 3) Expert Trap - There is an appropriate time for
    expert opinion but the focus of Phase 1 is first
    on building the client's own motivation. 
  • Within motivational interviewing, in a real sense
    it is the client who is the expert. 

10
Some Early Traps to Avoid
  • 3) Expert Trap - No one knows more about his or
    her situation, values, goals, concerns and
    skills. 
  • No one is in a better position to anticipate how
    change will fit into the person's life. 
  • Motivational Interviewing is about collaboration
    not installation.

11
Some Early Traps to Avoid
  • 4) Labeling Trap
  • Can evoke a power struggle. 
  • Counselors need to assert control and expertise.
  • A form of judgmental communication. 
  • Can evoke feelings of being cornered. 

12
Some Early Traps to Avoid
  • 4) Labeling Trap - The danger, of course, is that
    the labeling struggle evokes dissonance, which
    descends into side-taking and, in turn hinders
    progress. 
  • Problems can be fully explored without attaching
    labels that evoke unnecessary dissonance.

13
Some Early Traps to Avoid
  • 5) Premature-Focus Trap - Resistance may result
    if client and counselor wish to focus on
    different topics. 
  • The trap here is to persist in trying to draw the
    client back to talk about your own conception of
    "the problem". 

14
  • 5) Premature-Focus Trap - Starting with the
    client's concerns, rather than those of the
    counselor, will ensure that this does not
    happen. 

15
  • 5) Premature-Focus Trap - Spending time listening
    to the client's concerns is useful, both in
    understanding the person and in building the
    rapport that is the basis for later exploration
    of other topics.  Get a broader understanding of
    the client's life situation before coming back
    around to the topic.

16
Some Early Traps to Avoid
  • 6) Blaming Trap - If this issue is not dealt with
    properly, time and energy can be wasted on
    needless defensiveness. 
  • Counseling has a 'no-fault' policy.

17
  • Rapport - a feeling of commonality or being
    'in-synch' with another person. Harmonious
    communication.
  • You are providing a service and you cant provide
    it if you dont listen to the clients needs.

18
Five Early Methods
  • Building Motivation for Change Using OARS
  • 1. Ask Open Questions
  • 2. Listening Reflectively
  • 3. Affirm
  • 4. Summarize
  • 5. Eliciting Change Talk
  • The first four are derived largely from
    client-centered counseling.  The fifth method is
    more clearly directive and is specific to
    motivational interviewing

19
O Open Ended Question
  • 1. Ask Open Questions - The client should do most
    of the talking at this stage. Use questions that
    elicit elaboration.

20
R Listening Reflectively
  • 2. Listening Reflectively -   The essence of a
    reflective listening response is that it makes a
    guess as to what the speaker means.  It's a
    statement vs. a question.  A well-formed
    reflective statement is less likely to evoke
    resistance. 

21
  • 2. Listening Reflectively -   In the dynamics of
    language, a question requires a response. 
    Reflective statements are statements of
    understanding. 
  • Keep a continual awareness that what you believe
    or assume people mean is not necessarily what
    they really mean.  Reflective listening is a way
    of checking, rather than assuming that you
    already know what is meant. 

22
  • Skillful reflection moves past what the person
    has already said and can include reflection on
    non-verbal communication such as a smile on the
    persons face, the tone of their voice or their
    body language. 

23
  • Note If you overstate the intensity of what a
    person is saying or doing the person will tend to
    deny and minimize it. 
  • If you slightly understate the expressed
    intensity of emotion, however, the person is more
    likely to continue exploring and telling you
    about it. 

24
  • The counselor decides what to reflect and what to
    ignore. 
  • Change talk is preferentially reflected, so that
    people hear their own statements at least twice. 
  • Reflection is particularly important after
    open-ended questions.
  • See page 68 for 12 kinds of responses that are
    not listening.

25
A - Affirming
  • 3. Affirm - This can be done in the form of
    compliments or statements of appreciation and
    understanding.  The point is to notice and
    appropriately affirm the client's strengths and
    efforts. 

26
S - Summarize
  • 4. Summarize - Summary statements can be used to
    link together and reinforce material that has
    been discussed. 

27
S - Summarize
  • Summary statements
  • 1. Reinforce what has been said
  • 2. Show that you have been listening carefully
  • 3. Prepare the client to elaborate further
  • 4. Allow a person to hear his or her own change
    talk for a third time.

28
S - Summarize
  • At least three kinds of summaries are useful in
    motivational interviewing
  • 1. Collecting Summaries
  • 2. Linking Summaries
  • 3. Transitional Summaries

29
S - Summarize
  • Collecting Summary - Usually short, just a few
    sentences.  Should continue rather than interrupt
    the person's momentum.  It is useful to end them
    with "What else?" or some other invitation to
    continue.  "What else?" is open-ended where as
    "Is there anything else?" is a closed-ended
    question.  It's like collecting flowers one at a
    time and giving them back to the person as a
    bouquet. 

30
S - Summarize
  • Linking Summary - Linking summaries are meant to
    encourage the client to reflect on the
    relationship between two or more previously
    discussed items.  A linking summary is one way to
    allow a person to examine the positives and
    negatives simultaneously, acknowledging that both
    are present. 

31
S - Summarize
  • Linking Summary - To help a person see the two
    sides of ambivalence yet to highlight the desired
    change, you can use conjunctions like "yet",
    "but".  As in, "On the one hand you enjoy smoking
    weed because it helps you feel calm, yet it costs
    a lot of money and you could probably find better
    ways to feel calm without having to spend all
    that money."

32
S - Summarize
  • Transitional Summary - Marks and announces a
    shift from one focus to another.  At the end of
    the first session it can be helpful to offer a
    substantial transitional summary, pulling
    together what has transpired thus far. 

33
Eliciting Change Talk
  • 5. Eliciting Change Talk - The fifth method is
    consciously directive.  Evoking change talk is
    one of the key motivational interviewing skills.

34
8 Methods for Evoking Change Talk
  • 1. Asking Evocative Questions
  • 2. Using the Importance Ruler
  • 3. Exploring the Decisional Balance
  • 4. Elaborating
  • 5. Querying Extremes
  • 6. Looking Back
  • 7. Looking Forward
  • 8. Exploring Goals and Values

35
8 Methods for Evoking Change Talk
  • 1. Asking Evocative Questions - Evoke - To call
    forth or up. Use open-ended questions that cause
    a person to think and reflect on their answer

36
8 Methods for Evoking Change Talk
  • 2. Using the Importance Ruler - (i.e. Scaling
    Questions) "Why are you at a ______ and not a
    zero?"  Note that one should not ask, "Why are
    you at a _____ and not a 10?"  because to answer
    that question is to argue against change.

37
8 Methods for Evoking Change Talk
  • 3. Exploring the Decisional Balance - Exploring
    the pros and cons
  • 4. Elaborating - Have the client elaborate or
    expand on the change talk before moving
    forward. (see examples on next slide)

38
Ways to elicit elaboration
  • 1. Asking for clarification In what ways? How
    much? When?
  • 2. Asking for a specific example Can you give me
    an example?
  • 3. Asking for a description of the last time this
    occurred Tell me about a time when this happened
    in the past
  • 4. Asking "What else?" within the change topic.
    This is a form of an Open-Ended Question.

39
8 Methods for Evoking Change Talk
  • 5. Querying Extremes - Ask people to describe the
    extremes of their (or others') concerns, to
    imagine the extreme of consequences that might
    ensue. Best case and worst case scenarios

40
8 Methods for Evoking Change Talk
  • 6. Looking Back - Have the client remember times
    before the problem emerged and to compare these
    times with the present situation

41
8 Methods for Evoking Change Talk
  • 7. Looking Forward - Helping people envision a
    changed future.  Ask the client to tell you how
    it might be after a change.  Similarly, you can
    invite the client to look ahead in time and
    anticipate how things might be if no changes are
    made

42
8 Methods for Evoking Change Talk
  • 8. Exploring Goals and Values - Ask the client to
    tell you what things are most important in his or
    her life.  Discover ways in which current
    behavior is inconsistent with or undermines
    important values and goals for the person

43
Summary
  • Eliciting change talk is a primary method for
    developing discrepancy.  Hearing oneself state
    the reasons for change tends to increase
    awareness of the discrepancy between one's goals
    and present actions.  Evoking change talk can
    serve as a continuing reminder of the reasons for
    commitment to change. 
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