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Motivational Interviewing

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Title: Motivational Interviewing Author: KMeechan Last modified by: KMeechan Created Date: 1/20/2014 10:13:19 AM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Motivational Interviewing


1
Motivational Interviewing
  • Dr Karen Meechan
  • Karen.Meechan_at_slam.nhs.uk
  • Msc Addictions 28/01/2014

2
Aims of Session
  • To
  • Understand the spirit of MI
  • Understand the fundamental skills required for MI
  • Understand the four foundational processes of MI

3
Opening Exercise
  • Think of something (that you dont mind
    disclosing) that you feel in two minds about
    changing
  • Split into pairs
  • Person 1 Share your dilemma with your partner
  • Person 2 Argue strongly in favour of change.
    Whatever the person says - do not deviate from
    this position

4
Issues Raised?
  • Ambivalence about change is normal
  • Motivation fluctuates it is dynamic
  • Motivation can be influenced by the way we are
    talked to, and talk about it it is interpersonal
  • Resistance can be generated in the interaction
  • The Righting Reflex influences us as therapists
  • The more we say something the more we believe it
    (Self-Perception Theory, Bem 1967)
  • Confidence to change is crucial (Self-Efficacy)

5
  • People are generally better persuaded by the
    reasons which they themselves have discovered,
    than by those that have come into the minds of
    others
  • Blaise Pascal 17th century

6
Motivational Interviewing Origins
  • Key people William Miller and Steve Rollnick
  • USA Culture of conflict in treatment
  • Resistance attributed to the pathology of
    patients, ie.
  • Addicts lack motivation and always deny the
    severity of the problem
  • William Miller was interested in how the
    behaviour of counsellors might influence their
    clients behaviour
  • Direct persuasion elicits resistance and denial
    can be experimentally manipulated

7
A Definition of MI
  • A client-centred, directive method for enhancing
    intrinsic motivation to change by exploring and
    resolving ambivalence
  • Miller, W.R. and Rollnick, S. (2002).
    Motivational Interviewing
  • Preparing People for Change (2nd edition). NY
    Guilford Press
  • Having a quiet and constructive discussion about
    change in which the client drives the process as
    much as possible
  • Rollnick, S. and Allison, J. (2004) Motivational
    Interviewing in N. Heather and T. Stockwell
    (Eds), Treatment and Prevention of Alcohol
    Problems. Chichester Wiley

8
The Spirit of MI
  • Fundamental approach of MI
  • Collaboration. Counselling involves a partnership
    that honours the clients expertise and
    perspectives. The counsellor provides an
    atmosphere that is conducive rather than coercive
    to change.
  • Evocation. The resources and motivation for
    change are presumed to reside within the client.
    Intrinsic motivation for change is enhanced by
    drawing on the clients own perceptions, goals
    and values.
  • Autonomy. The counsellor affirms the clients
    right and capacity for self direction and
    facilitates informed choice.
  • Compassion MI-3
  • Mirror-image opposite approach to counselling
  • Confrontation. Counselling involves over-riding
    the clients impaired perspectives by imposing
    awareness and acceptance of reality that the
    client cannot see or will not admit.
  • Education. The client is presumed to lack key
    knowledge, insight, and or/skills that are
    necessary for change to occur. The counsellor
    seeks to address these deficits by providing the
    requisite enlightenment.
  • Authority. The counsellor tells the client what
    he or she must do.

9
Summary of MI
  • Not just a set of techniques. It is a clinical
    style a way of being with clients
  • Provides way of having conversations about
    behaviour change
  • These conversations can be inherently thorny
  • Aims to resolve ambivalence (which is normal not
    pathological)
  • Minimises resistance
  • Builds clients internal motivation for change

10
Motivation Ready, Willing and Able
Willing Importance of change - Why?
Ready A matter of priorities
Able Confidence for change - How?
11
Principles of MI
  • Express empathy
  • Roll with resistance
  • Support self-efficacy
  • Develop discrepancy

12
Four Foundational Processes in MI
  • The Bridge to Change

Planning
The Transition to MI
Evoking
The Strategic Focus
Guiding
The Relational Foundation
Engaging
13
Engaging
  • Therapeutic Empathy
  • The OARS Fundamental strategies used in MI
    (also basic conversation, communication and
    counselling skills)
  • Ask Open Questions
  • Affirm
  • Listen Reflectively
  • Summarise

14
Guiding
  • The strategic (directional) focus of MI
  • Finding a direction and developing changes or
    goals
  • Agenda setting
  • Giving information and advice (ask-provide-ask)
  • MI is a guiding style, but not all guiding is MI
  • Engaging and Guiding are MI-consistent
  • practice, but not yet (in themselves) MI

15
Evoking
  • The bridge to MI
  • There is a clear change goal
  • Selective eliciting (OARS)
  • Recognizing change talk
  • Eliciting change talk (e.g., selective
    questions)
  • Responding to change talk (e.g. selective
    reflection)
  • Summarizing change talk
  • Using the importance and confidence ruler

16
Change Continuum (Prochaska and DiClemente,
1982) (if you assume the client is more to the
right then they are - you are likely to encounter
sustain talk)
No change
Change
Precontemplation
Contemplation
Decision
Action
17
What is Unique to MI?
  • Attuned to and guided by certain types of natural
    language (change talk)
  • Intentional, differential evoking and
    strengthening of change talk
  • Strategic-directional use of client-centered
    counseling methods (reflection, summary)

18
Applications in the Research
  • Substance misuse, sexual health, dietary change,
    weight loss, voice therapy, gambling, physical
    activity promotion, medication adherence,
    diabetes, depression, anxiety, OCD, eating
    disorders, dual diagnosis, chronic leg
    ulceration, criminal justice, vascular risk,
    stroke rehabilitation, chronic pain, self-care,
    domestic violence, child health, oral health
  • Whole issue of 2009 Journal Clinical Psychology
    (65, 11) about MI, including how it can be
    integrated with other psychotherapeutic
    approaches to treat mental health problems

19
Evidence Base
  • A lot of research (700 Psychinfo citations
    2000-2009), using variations of MI (eg. MET) and
    combined with other therapies, elements of MI
    only
  • Applied to many clinical problems
  • Lundahl et al. (2010) Meta Analysis of MI.
    Significantly better than TAU/no treatment, as
    good as other approaches (eg CBT, 12 step),
    shorter treatment, effects are durable over time,
    severity of problem does not affect effectiveness
  • Ashton (2005) Consistently beneficial for less
    committed clients but can worsen outcomes to
    those already committed
  • Moyers et al. (2009) Client change talk, once
    mobilised by therapist behaviour during MI
    sessions (eg. reflecting change talk when occurs)
    leads to reduced drinking

20
References
  • Ashton, M. (2005). The motivational hallo. Drug
    and Alcohol Findings, 13, 23-30.
  • Bem, D.J. (1967). Self-perception theory an
    alternative interpretation of cognitive
    dissonance phenomena. Psychological Review 73,
    183-200.
  • Lundahl, B.W, Kunz, C., Brownell, C. et al.
    (2010). A meta analysis of motivational
    intervewing twenty five years of empirical
    studies. Research on Social Work Practice, 20
    (2), 37-160.
  • Miller W.R. and Rollnick, S. (2002). Motivational
    Interviewing Preparing People to Change (2nd
    Ed). New York Guilford Press.
  • Prochaska, J.O. and DiClemente, C.C. (1982).
    Transtheoretical therapy Towards a more
    integrative model of change. Psychotherapy
    Theory, Research and Practice, 19, 276-288.
  • Rollnick, S. and Allison, J. (2004) Motivational
    Interviewing in N. Heather and T. Stockwell
    (Eds), Treatment and Prevention of Alcohol
    Problems. Chichester Wiley
  • Moyers, T. B., Martin, T., Houck, J.M. et al.
    (2009). From in-session behaviors to drinking
    outcomes a causal chain for motivational
    interviewing. Journal of Consulting and Clinical
    Psychology, 77, 6, 1113-1124.

21
Further Reading
  • Website resource www.motivationalinterview.org
  • Miller, W. (1998) Why do people change addictive
    behaviour? The 1996 H. David Archibald Lecture
    Addiction 93 (2), 163- 172.
  • Miller, W.R. and Rollnick, S. (2009) Ten things
    that motivational interviewing is not.
    Behavioural and Cognitive Psychotherapy 37,
    129-140.
  • Pilling, S., Hesketh, K. and Mitcheson, L.
    (2010). Routes to Recovery Psychosocial
    Interventions fo Drug Misuse. London BPS and
    NTA.
  • http//www.nta.nhs.uk/uploads/psychosocial_toolki
    t_june10.pdf
  • Rollnick, S., Miller, W. and Butler, C. (2008).
    Motivational Interviewing in Health Care Helping
    Patients Change Behaviour. London Guildford
    Press.
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