ImplementingMotivationalInterviewinginYourOrganizationOrganizationalstrategies

DesignateanMISkillsDevelopmentpersonorteamtopromoteongoingtrainingandskillspracticeopportunitieswithintheagencyDevelopanorganizationalphilosophyofcarestatementthatalignswithMIspiritandpracticeIncludeMIexperienceasajobrequirementorpreferencewhenadvertisingfor,screening,andhiringnewstaff,especiallydirect-serviceandsupervisorypositionsInjobinterviews,askapplicantstoprovideMI-adherentresponsestosamplestatements(e.g.HelpfulResponsesQuestionnaire),demonstratetheirMIskillsina“mockinterview”inthemoment,orsubmitasampletapeoftheirpracticetobereviewedlater

EnsurethatclinicalsupervisorsaretrainedinMIandareMI-consistentintheirsupervisorymethodsInsupervisorysessionsmakeitanexpectationforsupervisorstopayattentiontostaffprogressinMIskill-buildingIncludeMIskill-buildingasaprofessionaldevelopmentgoalforallpractitionersintheirjobperformanceplansReviseprogramintakeformsandprogressnotestoreflectandpromoteanMI-consistentapproachParticipateinMI-relatedclinicalresearchstudies(orpossiblyseekoutopportunitiestoconductresearch)CreateMI-relatedvisualreminders(posters,signs,buttons,importanceandconfidencerulers)DevelopanonlineMIdiscussionforumwithinyouragencyProvideopportunitiesforselectstafftobetrainedinusingtheMICA(MotivationalInterviewingCompetencyAssessment)orMITI(MotivationalInterviewingTreatmentIntegrity)tooltocodeMIconversationsforfeedbackandcoachingEncourageselectedstafftobecometrainedasMItrainersthroughtheMotivationalInterviewingNetworkofTrainers(MINT)andparticipateintheMINTcommunityofpractice

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StrategiestoBuildSkills

EstablishMIlearningcircles(akacommunitiesofpractice,coachingcircles)thatmeetregularlytosustainlearningandstrengthenskills

• Groupsof4-8• IdentifyskillfulfacilitatorsandequipthemwithMIpracticeactivities/resources• FocusonpracticingspecificMIskillsandincorporatingthemintopractice

conversationswithaccuratefeedbackandcoachingOfferregularlyscheduledintroductoryandadvancedMItrainingopportunities(ensuringthatparticipantsareassignedtooralreadyapartofanongoinglearningcircle)ContractasneededwithexternalMIcoaches,trainers,andconsultantstopromoteongoinglearningEncourageself-initiatedlearningbyprovidingresourcessuchasMIbooks,ebooks,articles,trainingtapes,skill-buildingexercises,andotherlearningtoolsCodeaudiotapedsegmentsofMIconversationsusingtheMICA(MotivationalInterviewingCompetencyAssessment)orMITI(MotivationalInterviewingTreatmentIntegrity)tooltoprovidefeedbackandcoachingInitiateyourowninspiredideas…

WhatisMotivationalInterviewing?Thedesiretohelppeopleimprovetheirhealthandwell-beingisanoblecalling.However,alltoooftenoureffortstohelparespenttryingtogetpeopletochange,ratherthanusingaguidingapproachtotapintopatient’sownmotivationforchange.Considerwhetheryou’veeverheardyourcolleagues(oryourself)uttersomethinglikethis:

• Igivepeoplemybestadvice,buttheyjustwon’tlisten.• Sheresistsallofmyeffortstoconvincehertogetscreened.• Shejustneedstokeephermedicalappointments.• He’sintotaldenialabouthisheartcondition.• Somefolksjustdon’twanttobehelped.

Manyofushaveampleexperienceintryingtopersuade,educate,entice,cajole,bribe,guilt-trip,oruseothermeanstogetpeopletochange.Itisanaturalhumaninstincttofix,ormakeright,whatweperceiveasmisguidedorharmful.However,sucheffortstopersuadesomeonetochangearetypicallycounterproductive,especiallyifthepersonisnotconvincedthatmakingachangeisdesiredorneeded.Itturnsoutthatpeopledon’tlikebeingpressuredtodosomethingbecausesomeoneelsethinkstheyshoulddoit,evenifit’sintheirbestinterest.Thedesireforself-determinationrunsdeepinthehumanspirit.Motivationalinterviewing(MI)isamethodoftalkingwithpeopleaboutchange.Itis“acollaborativeconversationstyleforstrengtheningaperson’sownmotivationandcommitmenttochange”(Miller&Rollnick,2013).Theindividualdeterminesthefocusorchangegoalwhilethepractitionerservesasaguide.MIassumesthatpeoplealreadypossesswhattheyneedtobemotivatedtochange.Theyarenotemptyvesselsinneedofbeingfilledbyanexternalsource.They’realreadyfilledwithdesires,lifeexperience,values,hopes,knowledge,skills,wisdom,andmore.MIhelpsshinealightonandexploretherichresourcespeoplealreadypossess,inordertohelpthemmakedecisionsaboutnextstepsontheirlife’sjourney.Accordingtopositivepsychology,thisprocessbuildspositiveemotions,whichinturnopenspeopleuptotheirinternalandexternalresourcesthattheycanusetoimprovetheirlives.Whereandwhendiditdevelop?TheconceptofMotivationalInterviewing(MI)grewoutoftheexperienceofprovidingtreatmentforproblemdrinkersandwasfirstdescribedbypsychologist,WilliamR.Miller,inanarticlepublishedin1983.Historicallytheaddictionstreatmentfield,especiallyintheUnitedStates,hasbeencharacterizedbyahighlyconfrontational,shame-basedapproachbelievedtobreakdownpeople’sdenialsotheywillcometotheirsensesabouttheirneedtochange.Thisapproachhasproventobemostlyineffective.Ingeneral,humanbeingstendtoresistotherpeople’sattemptstogetthemtochange,evenwhenthoseeffortsarewellintended.WiththepublicationofWilliamR.MillerandStephenRollnick’sseminalbook,MotivationalInterviewing,in1991,practitionerswereintroducedtoanalternativewaytoengageina

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“helpingconversation”withpeoplemisusingsubstances.Theauthorsdescribedawayofinteractingbasedonaparticularconversationstyleanduseofspecificcommunicationskillsandstrategies.Asecondedition,MotivationalInterviewing:PreparingPeopleforChange,waspublishedin2002.ItfurtherrefinedtheMIapproach,providedanemergingresearchbaseforMI,anddetaileditsspreadtootherareasbeyondsubstanceusedisordersincludinghealth,behavioralhealth,corrections,andschools.Athirdedition,MotivationalInterviewing:HelpingPeopleChange,2013,expandedontheMIapproachandincludedsomenewconceptsincludingthefourprocessesofMIconversations(engaging,focusing,evoking,andplanning)anddistinguishingbetweensustaintalkanddiscord.Today,MIhascircledtheglobe,andsupportandrespectforthepracticeisgrowing.Howdoesitwork?PracticingMIrequiresahealthysenseofhumility.Itbringsusface-to-facewiththerecognitionthatwedon’thavethepowertochangeothers.Intruth,wecanonlychangeourselves.However,weareabletohaveaninfluenceonothersandtheirmotivationtochange.AsMadelineHuntersays:“Theysayyoucanleadahorsetowater,butyoucan’tmakehimdrink.ButIsay,youcansalttheoats.”ThegoalofMIistohelppeoplebecome“thirsty”forchangebycreatingconditionsunderwhichafruitfulconversationaboutchangecanoccur.WhiletheMIapproachisgenerallylow-key,ithasthepotentialtostirupuncomfortablethoughtsandfeelingsforpeopleduetoitsevocativenaturethatinvitesthemtolookatdifficultrealitiesintheirlives.Theaimistohelppeoplelookhonestlyattheirbehaviorswithoutbecomingoverlydefensive.Aspractitioners,weseektocreateasafe,trustingpartnershipwithindividualssothattheyseeusasalliesintheprocessoflookingatdiscrepanciesbetweenwhotheyareandwhotheywanttobe,andbetweentheiractionsandtheirvalues.Ifweconfront,peoplewilltendtodefendthemselves.MIdifferssignificantlyfromadvice-givingorconfrontationalstylesofcounselinginthisway.TheMIstyleisnotflashyor“intheclient’sface.”Thefocusisondrawingouttheperson’sownknowledge,experience,andinnerwisdominagenuine,empathicmanner.Thosewhoareusedtoconfrontingandgivingadvicemayfeelthey’renot“doinganything”whenpracticingMI.Asonepractitioner—moreaccustomedtoaconfrontationalstyleofcounseling—observed,“IfeellikeMItiesmyhandsbehindmyback.”Forsomehelpers,thisapproachcanfeeldangerous,likewe’regivingpermissionforpeopletomaintainriskypositions.But,asMillerandRollnick(2013)pointout,theseaggressivestrategies,typicallydrivenbyadesiretohelp,moreoftenpushthepersonawayfromengagementandretentioninservices,aswellasmisstheirgoalofenhancingmotivationtochangeandimprove.

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TheevidenceforMIAwealthofstudiesindicatethatMIhasastatisticallysignificantpositiveeffectonbehaviorchange,withsomestudiesshowingthatthosechangesaredurableovertime.MIremainseffectivewhenusedasastand-aloneintervention,infusedwithinotherapproachestotreatment,aswellasaprecursortoothertreatment(Lundhaletal.,2013).Anumberofstudieshaverevealedthatpatientsdefinedas“leastreadytochange”experiencethelargestMIeffect(Heckmanetal.,2010).Ofcourse,MIworksonlyaswellasthepractitionerusingitandthequalityofthealliancethatdevelopsbetweenpractitionerandperson.PoorMIpromotespoorresults.StructuralandenvironmentalfactorscanalsoaffectthesuccessofMI,likeanybestpractice.Forexample,housinginstabilitycanhindereffortstoaddresssubstanceuse.Forothers,ahistoryoftraumamaycreateobstaclestoaccessingmentalhealthtreatment.MIseespeople’sstrugglesinthecontextoftheirlivesandworkswiththemtofocusandprioritize.DevelopingcompetenceOngoingpracticewithaccuratefeedbackandcoachingisneededtodevelopMIskills.ResearchshowsthatMIcompetencerequiresexpertfeedbackbasedonobservedpracticeandcoachingtosupportshiftsfromcurrentpracticetoMIproficiency.ManyindividualsandorganizationshaveinstitutedLearningCirclesasawayofincreasingtheirMIknowledgeandskills.Inaddition,manyexcellenttrainingandcoachingopportunitiesexist.ForinformationaboutMIresourcesincludingthelatestMIrelatedresearch,visittheMotivationalInterviewingNetworkofTrainerswebsiteat:https://motivationalinterviewing.org/motivational-interviewing-resources

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IfYouHaveFive,Fifteen,orFiftyMinutes:MIBasicsMiller&Rollnick,2013

Whatisit?

“Acollaborativeconversationstyleforstrengtheningaperson’sownmotivationandcommitmenttochange”...“awayofhelpingpeopletalkthemselvesintochanging"

Thespirit(mindsetandheart-set)ofmotivationalconversations

Partnership–collaboratingwiththeclient’sownexpertise

Acceptance–communicatingabsoluteworth,accurateempathy,affirmation,and autonomysupport

Compassion–promotingtheclient’swelfare,givingprioritytotheclient’sneeds

Evocation–elicitingtheclient’sownperspectivesandmotivation

Fourprocessesthatguidemotivationalconversations

Engaging–establishingtherelationalfoundation

Focusing–clarifyingaparticulargoalordirectionforchangeEvoking–elicitingtheperson’sownmotivationforaparticularchangePlanning–developingaspecificchangeplanthatthepersoniswillingtoimplement

Fourconversationalskills(OARS)

Openquestion–offersclientbroadlatitudeandchoiceinhowtorespondAffirmation–statementvaluingapositiveclientattributeorbehaviorsReflections–statementsintendedtomirrormeaning(explicitorimplicit)ofprecedingclientspeechSummaries–reflectionsthatdrawtogethercontentfromtwoormorepriorclientstatements

Samplequestionstoexploreambivalenceandelicit/strengthenmotivationTellmemoreaboutthisissue/concern/dilemma(that’sbeenidentified)?What’sokayabouthowthingsare?What’snot?Ifyoudecidenottochangeanything,whatwouldbeatstake?Ifyouweretomakeachange,whatwouldbethebenefitsof(oryourreasonsfor)doingso?Themostimportantbenefitorreason?Ifyouweretodecidetochange,howwouldyougoaboutittobesuccessful?Whatdoyouthinkwouldworkforyou?

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Lookingatyourlifecurrently,howimportantorurgentisitforyoutomakethischange?Forexample,onascaleof0-10(0=notatallimportant;10=totallyimportant),wherewouldyouplaceyourself?Whatmakesitalreadya___andnota___(severalnumberslower)?Whatwouldittaketomovefroma___toa___(nexthighestnumber)?Howconfidentareyouthatyoucouldbesuccessfulinchanging?(scalingquestionsworkswellheretoo)HowcanIorothersbehelpfultoyouinsupportingthischange?Whatdoyouthinkyoumightdoasaverynextsteptomovetowardsthischange?

Exchanginginformation

Afewconsiderations• It'sallright,andsometimesimperative,toexpressyourconcerns• Therearemanypathwaystochange• Focusonhelpingthepersonevaluateoptions• Offerinformationandadvice,don'timposeit

Method:Elicit-Provide-ElicitElicit

• Askwhatpersonalreadyknows• Askwhatpersonwouldliketoknow• Askpermissiontoprovideinformation/advice

Provide

• Prioritizewhatpersonmostwantstoknow• Beclear;useeverydaylanguage• Offersmallamountsofinformationwithtimetoreflect• Acknowledgefreedomtodisagreeorignore

Elicit

• Askforperson’sresponse,interpretation,understanding

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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TheUnderlyingSpiritofMotivationalInterviewing

“MIisdonefororwithsomeone,notonortothem.”MotivationalInterviewing,3rdedition

Imaginetakingadrinkofacarbonatedbeveragethathasgoneflat.Itstilltastesvaguelylikeitself,butthefizzhasgoneoutofit.It’snolongerworthdrinking,andyou’llprobablypouritdownthedrain.Thespirit,orthemindsetandheart-set,ofMIisthe“fizz”ofmotivationalconversations.IndescribingMIspirit,MillerandRollnickwrite:“WhenwebeganteachingMIinthe1980swetendedtofocusontechnique,onhowtodoit.Overtimewefound,however,thatsomethingimportantwasmissing.AswewatchedtraineespracticingMI,itwasasthoughwehadtaughtthemthewordsbutnotthemusic…ThisiswhenwebeganwritingabouttheunderlyingspiritofMI,itsmind-setandheart-set.”(MotivationalInterviewing,3rdedition)Thespirit,ormindsetandheart-set,ofhowweprovidecareandservicessignificantlyimpactspeople’swillingnesstoacceptourassistance.Helpingisfundamentallyrelational–takingtheformofapartnership.Ourapproach,mindsetandheart-set,needstobegenuineandreal.It’sembodiedinhowwecarryandconductourselves.It’sconveyedthroughoureyes,non-verbalexpressions,andtoneofvoice.It’scommunicatedinhowweexpressourselves.It’simpartedthroughourattitudesandintentions.Thismindsetandheart-setistheessenceofwhatpeopleexperienceinourpresence.Eachelementisbrieflydescribedbelow.

PARTNERSHIPFormingacollaborativeworkingrelationshipwithsomeone;lettinggooftheneedtobetheexpert;showinggenuinerespectfortheotherperson’slifeexperience,hopes,andstrengths;assumingthatbothofyouhaveimportantexpertiseandideas;“dancingratherthanwrestling”

ACCEPTANCEMeetingaperson“wherethey’reat”withoutnegativejudgement;believingintheperson’sinherentworthandpotential;conveyingempathy–seekingtounderstandwherethey’recomingfrom;shiningalightonthegoodthingsyouseeintheminsteadoffocusingonwhat’swrongwiththem

COMPASSIONComingalongsidepeopleintheirsuffering(e.g.,homelessness,trauma,mentalillness,addiction,grief,stigmatization,racialinjustice,denialofrights);offeringthegiftofasafe,listeningpresence;beinginsolidaritywith;actingforandwithpeople

EVOCATIONInvitingor“callingforth”frompeoplewhattheyalreadypossess–theirhopes,values,desiresandaspirations;learningwhatpeoplearepassionateabout,whattheyalreadyknowandcando,whattheywanttolearn,what’simportanttothem,howthey’dliketheirlivestobedifferent,whatchangesthey’rewillingtoconsidermaking,andmore.

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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FourProcessesofMotivationalInterviewingMIconversationshaveapurposeanddirection.Theyseektohelppeopleidentifyandexploretheirhopes,values,andchangegoalsusinganempathic,guidingapproach.Thisguidingapproachusedinmotivationalconversationsgenerallymovesthroughfourprocesses.Theseprocesses–engaging,focusing,evoking,andplanning–tendtobesequentialinMIconversationsbutsometimeseachrequiresrevisiting.UsingMIissimilartoimprovtheatre;youdon’thaveascript,butthereisabasicstorylinethatyou’retryingtofollow.Belowisasamplingofinquiriesyoumightusewithinineachoftheseprocesses.Engaging–gettingtoknowsomeoneandbuildingtrust

• “Welcome.It’sreallygoodtomeet/seeyou.”• “Howarethingsgoinginyourlifecurrently?”• “Whataresomethingsyou’vebeendoingtosupportyourhealth?”

Focusing–figuringouttogetherwhattotalkabout

• “Whatwouldyouliketofocusoninourtimetogethertoday?”• “Youmentionedsomeconcernsaboutyourweight.Also,aboutoccasionalshortness

ofbreath.Andthatyou’vebeenfeelingmoreanxiouslately.Whereshallwestart?”• “Woulditbeallrightifwetookacloserlookatyouandalcohol?”

Evoking–drawingouttheperson’sowndesire,reasonsandabilitytochange(withafocusondrinking)

• “Howwouldyoudescribetheroleofalcoholinyourlife?”• “Whatdoesdrinkingdoforyou?”• “Whatconcerns,ifany,doyouhaveaboutyourdrinking?”• “Whatimpact,ifany,doesithaveonyou’rethewayyouwanttoliveyourlife?”• “Ifyouweretocutbackorquitdrinking,whatwouldbesomereasonsfordoingso?

Whatbenefitsdoyouthinkitmighthave?”• “Howwouldyougoaboutitinordertobesuccessful?”• “Giveneverythinginyourlife,howimportantisitforyoutomakethischange?”• “Howconfidentareyouthatyoucouldcutbackorquitifyouwantedto?”

Planning–developingaspecificchangeplanthatthepersoniswillingtoputinaction

• “Whatdoyouthinkyou’lldonext?”• “Whoorwhatcouldbeofhelp?””• “Whatmightgetinthewayofyourplan?”• “Howwillyouknowwhenyourplanisworking?”

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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OARS:OpenQuestions

Openquestionsinvitepeopletosayasmuchoraslittleastheywantaboutatopic.Theyallowpeopletodecideforthemselveswhatideas,thoughtsorfeelingstheywanttoshare.Answeringopenquestionstendstohelppeopleunderstandthemselvesbetterandthinkinnewwaysabouttheirsituation.Herearesomeexamplesofopenquestions:

What’sgoingwellinyourlife?What’snotgoingsowell?Whatwouldyouliketotalkabouttoday?WoulditbeallrightifItoldyouabitaboutmyselfandmyrole?What’smostimportanttoyouinyourlifecurrently?Ifyoucouldchangeanythingaboutyourcurrentcircumstances,whatwoulditbe?Whatdoyouvaluemostaboutyourcurrentlivingsituation?Ifyouweretocutbackorquitusingmeth,whatwouldbeyourreasonstodoso?Whatspecificchangesareyouthinkingaboutmaking?

Closedquestions,incontrast,limittheconversation.Theyaremostoftenusedtogatherspecificinformationoraskyesornoquestions.Forexample:

Whatisyourdateofbirth?Whatisyourincome?Whenisthelasttimeyousawadentist?

OpenquestionsareusedthroughoutthefourprocessesofMIandhelptoengagewiththeperson,increaseunderstanding,strengthencollaboration,findafocus,drawoutmotivation,anddevelopaplanforchange.Asageneralguideline,openquestionsshouldbeusedmorethanclosedones.

OARS:Affirmations

Affirmationsarestatementsthatshinealightonwhatisgoodaboutaperson.Theyputemphasisonpeople’sstrengthsratherthantheirdeficits.Strengthscanincludeaperson’sbehaviors,attitudes,qualities,knowledge,skills,efforts,andmuchmore.Affirmationsoftenhelppeoplerecognizestrengthstheyhavedifficultyseeingforthemselves.Affirmationscanalsobuildaperson’sconfidenceinbeingabletomakechanges.

Affirmationstypicallyfocuson:HighlightingpositivetraitsorskillsPrizingofthepersoningeneralEmphasizingintentionsandactionsReframingactionsorsituationsinapositivelight

Anaffirmationmustbegenuineandfromtheheart.Peoplewillknowifitseemsfalseandmightbelesslikelytotrustyou.Affirmingsomeone’sstrengthsisdifferentthancheerleadingorpraising.Praisestatementsputyouina“one-up”positionandareusuallybasedonjudgingsomeone’sperformance.Furthermore,praisecanbebothgivenandwithdrawn.Whenformingaffirmations,it’susuallybesttoavoidstartingwith“I”andinsteadcenterthecommenton“you.”It’salsohelpfultobespecific.Hereareafewexamplesofaffirmation.

Youwereverycourageoustospeakupforyourselfinthatsituation.Youknowwhat’sbestforyouandyouaren’tgoingtobeeasilyswayed.You’reshowingyourcommitmenttogettingbetterbytakingyourmedsasprescribed.Itwashard,yetyoureffortstonotdrinkontheweekendpaidoff.Thankyoufortakingthetimetotalkwithmeaboutthishealthconcern.

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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OARS:ReflectiveListening

“Whatpeoplereallyneedisagoodlisteningto."–MaryLouCasey

“GoodlisteningisfundamentaltoMI.TheparticularskillofreflectivelisteningisonetolearnfirstbecauseitissobasictoallfourprocessesofMI.Ittakesafairamountofpracticetobecomeskillfulinthiswayoflisteningsothatreflectionscomemorenaturallyandeasily.”[p.48]Reflectivelisteningistheskillof“bendingback”topeoplewhatwehearthemsayinginanefforttounderstand“wherethey’recomingfrom.”Inotherwords,toseetheworldthroughtheotherperson’seyes.Thiskindoflisteningmeansgivingapersonyourfullattention.Wedothiswithourwords,actions,andbodylanguage.Reflectivelisteningisaspecialgiftwecanoffertoothersinbothourworkandpersonallives.Reflectivelisteningtakestheconversationtoadeeperlevel.Thisisespeciallytrueofreflectivestatementsthatgobeyondrepeatingwhatwassaidbymakingareasonableguessabouttheperson’smeaning.Suchstatements“havetheimportantfunctionofdeepeningunderstandingbyclarifyingwhetherone’sguessisaccurate.Reflectivestatementsalsoallowpeopletohearagainthethoughtsandfeelingstheyareexpressing,perhapsindifferentwords,andponderthem.Goodreflectivelisteningtendstokeepthepersontalking,exploring,andconsidering.Itisalsonecessarilyselective,inthatonechooseswhichaspectstoreflectfromallthatthepersonhassaid.”[p.34]Formingreflectionsrequirestheabilitytothinkreflectively.Sincewordscanhavemultiplemeanings,andpeopledon’talwayssayexactlywhattheymean,itisusefultoregardpeople’sstatementsasa“firstdraft.”Inotherwords,ratherthanassumingwhatsomeonemeans,checkitout.Becausereflectionsarestatements,notquestions,theinflectionusuallyturnsdownattheend.Forexample,noticethedifferencebetween: Youdon’thaveanyconcernsaboutyoursmoking? Youdon’thaveanyconcernsaboutyoursmoking.Somereflectivestatementsbasicallyrepeatorslightlyrephrasewhatapersonhassaid.Thesesimplereflectionscanconveybasicunderstandingandhelptheflowoftheconversation.However,theyaddlittleornomeaningtowhatthepersonsaidandcanstoptheconversationfromgoingtoadeeperlevel.Forexample:

Statement:Icanneverseemtofindthetimetocheckmybloodsugarregularly.Response:It’shardtofindthetime./It’sachallengetofititin.

Complexreflectionsaddmeaningoremphasistowhatsomeonehassaidbymakingaguessaboutwhatisunspoken.Complexreflectionstendtohelppeoplethinkmoreabouttheirsituation.Whenfirstlearningtousecomplexreflections,itcanfeelabitstrange.However,whenyougetusedtoit,suchreflectionscommunicaterealunderstanding.Forexample:

Statement:Icanneverseemtofindthetimetocheckmybloodsugarregularly.Response:You’vegotalotgoingon./Yourfeelingfrustratedaboutthis./Eventhough

it’sachallenge,youhaveadesiretocheckitregularly./You’rehopingtofindawayto makeitmoreofapriority.

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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CommonSentenceStemsinFormingReflections

Itsoundslike…

AsIlistentoyou,Igetasensethat...

WhatIthinkI’mhearingisthat...

You’rethinkingabout…

Mysenseisthatyou’refeeling…

It’salmostasif…

It’slike…

Itwouldbe...

You’venoticedthat...

Foryou,it’samatterof…

Fromyourpointofview…

You’refeeling…

Asyouseeit…

You…

You’rewondering...

Youreally…

It’sreallyimportanttoyouthat...

Thisisreally…

Youcarealotabout...

You’rehoping...

Ontheonehand...,ontheotherhand...

You’reuncertainabout...

Partofyou...,yetanotherpartofyou...

It’snotthatyou...,it’sthat...

Youbelieve…

Yourconcernisthat…

You’renotreally…

Youfeelasthough…

Yourfearisthat…

Itseemsthatyou…

You’renotterriblyexcitedabout…

You’renotallthatconcernedabout…

Asyoulookback...

Asyoulookahead...

It’shardtounderstandwhy...

Eventhoughothersthink...

Yourheartistellingyouthat...

Yourbestinstinctisto....

Youreallyvalue...

(Others)

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OARS:Summaries

Asummaryisastatementthatdrawstogethertwoormorethingsthatsomeonehassaidpreviously.Itisbasicallyaparagraphofselectedreflectivestatements.Decidingwhattochoosetoincludeinasummarydependsonthesituation.However,usuallyyouwanttopickthethingsthatmoveinthedirectionofchange–kindoflikepickingthetastiestchocolatesfromaboxofcandy.Summariescanbeofferedatvarioustimesinaconversationtodrawideastogetherandguidetheconversation.Summaries,liketheotherOARSskills,areusedthroughoutthefourprocessesofMI.Particularlyintheengagingandfocusingprocesses,summariesshowthatyouhavebeenlisteningcarefullyandthatyouvaluewhatthepersonhassaid.Theyalsoprovideanopportunityforaskingthepersontofillinwhatyouhavemissed.Intheevokingprocess,summariesareoftenusedtoemphasizethingsthatsupportaperson’schangegoal.Summariescanhavedifferentpurposes.Collectingsummariespulltogether“inonebasket”variousstatementsthepersonhasmade.Linkingsummariesconnectwhattheindividualhassaidwithsomethingtheysaidinapriorconversation.Transitionalsummariesareusedasawrap-upattheendofaconversation,ortocreateabridgeforshiftingtheconversation.Inallthreecases,emphasisisplacedonshiningalightonthepersonschangetalk(seemoreonpage9).DuringtheplanningprocessofMI,summariesaregenerallyusedtorecaptheperson’sreasonsforwantingtochangeandwhattheyintendtodo.Thiscanhelpstrengthencommitmenttomakethechange.Belowaresomeguidelinesfordevelopingandofferingsummaries.Remembertokeepsummariesbriefandtothepoint.1.Beginwithastatementindicatingyouaremakingasummary.Forexample:

LetmeseeifIunderstandsofar… HereiswhatI’veheard.TellmeifI’vemissedanything.

2.Ifthepersonis“feelingtwoways”aboutchanging,namebothsidesoftheuncertaintyinthesummary.Forexample: Ontheonehand,you...ontheotherhand...”3.Highlightchangetalkyouheard–statementsindicatingtheperson’sdesire,ability,reasons,need,andcommitmenttochange.Forexample: Youmentionedseveralreasonswhyyouwouldwanttomakethischange,including...4.Endwithaninvitation.Forexample:

Whatwouldyouadd?AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013andhandoutscreated

byDavidB.Rosengren,Ph.D.

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EvokingChangeTalk

Changetalkreferstoanythingsomeonesaysthat“favorsmovementtowardaparticularchangegoal.”Evoking,or“callingforth,”changetalkhelpspeoplecomeupwiththeirownreasonstochange.Thisisfarbetterthansomeoneelsetryingtoconvincethemtochange,whichoftenmakespeopledefensiveandargueagainstchanging.AsaworkeryoucanusetheOARSskills(Openquestions,Affirmations,Reflectivelistening,andSummaries)to“askfor”andrespondtochangetalk.NoticethatchangetalkcomesindifferentflavorsthatformthephraseDARN-CAT.PreparatoryChangeTalk–“thinkingaboutchanging”

Desire–Iwantto,Iwouldliketo,Iwish,IhopeAbility–Ican,Icould,IamabletoReasons–Itwouldhelpme,I’dbebetteroffifNeed–Ineedto,Ihaveto,somethinghastochange

MobilizingChangeTalk–“takingaction”

Commitment–Iwill,Ipromise,IgiveyoumywordActivation–I’mwillingto,Iamreadyto,IampreparedtoTakingsteps–Icutbackonmyweekenddrinking

MethodsforEvokingChangeTalkAskingevocativequestions Whatworriesyouaboutyourcurrentsituation? Whywouldyouwanttomakethischange? Howmightyougoaboutit,inordertosucceed?Usingtheimportanceruler(alsouseregardingperson’sconfidencetochange) Onascaleof0to10,howimportantisitforyoutomakethischange?Tellmeabout beingat___comparedto(severalnumberslower)?Whatwouldittaketomovefrom ___to(nexthighestnumber)?AndhowImightIhelpyouwiththat?

Exploringextremes–Whatconcernsyouabsolutelymostabout____?Whataretheverybest resultsyoucouldimagineifyoumadeachange?

Lookingback–Whatwerethingslikebeforeyou...?

Lookingforward–Howwouldyoulikethingstobedifferentinthefutureregarding____?

Exploringgoalsandvalues–Whatdoyouvaluemostinlife?Whatareyourmostimportantreasonsforwantingtodecreaseyourriskforcancer?Howdoyourcurrenteatinghabitsfitwithyourpersonalgoalsaroundhealthyeating?

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely important important

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ExchangingInformationWhileMIisinherentlyaperson-centeredapproach,itdoesn’tmeanthatthepractitionerneveroffersinformation,suggestions,orevenadvice.InMI,bothpartiesareviewedashavingexpertise;thus,theremaybeoccasionswhenthiskindofinputisvaluable.However,informationandsuggestionsareprovidedsparinglyandwithpermission,notasafirstlineofresponse.TherearetwomaindifferencesinhowinputisofferedinMI,ascomparedtobeingdispensedinanunsolicited,authoritativemanner.Thefirstisthatitisofferedonlywithpermissionfromtheperson.Secondly,itisprovidednotasthe“finalword”butratherinthecontextofhelpingpeoplecometotheirownconclusionsaboutitsrelevanceandvalue.Itisoftenhelpfultoverballyacknowledgethiswithpeople.IntentofprovidinginformationandsuggestionsinMI

• Notanattempttoconvincepeopleofthefollyoftheirways• Providesanopportunitytoexpressconcernsandhelptheindividualmovefurther

alongintheprocessofchange• Canhelpapersoncometoadecision

Afewconsiderations

• It'sallrighttoexpressyourconcerns• Therearemanypathwaystochange;yourwaymaynotbethewayofanother• Focusonhelpingthepersonevaluateoptions• Offerinformationandadvice,don'timposeit

Suggestedmethod:Evoke-Provide-Elicit(E-P-E)

Elicit• Askwhattheindividualalreadyknowsabouttheissueathand• Inquirewhatmoretheindividualwouldliketoknow• Askpermissiontoprovideinput–e.g.,“WoulditbeallrightifIsharesome

ideas/information/possibleoptions/suggestionsforyourconsideration?”Provide

• Offersmalldoseofinformationoradviceinakind,nonjudgmentalmannerElicit

• Askfortheperson’sresponse–e.g.,“Iwonderwhatyouthinkofthat”• Emphasizechangetalk,provideaffirmations,andinstillhope.• Recognizeandaffirmitistheindividual'sdecisiontomake–e.g.,“Ofcourse,you’re

theonlyonewhocanmakethisdecision.”

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013andhandoutscreatedbyDavidB.Rosengren,Ph.D.

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RespondingtoDiscord

Whatdoyoudowhensomeone“pushesback”atyouinawaythatfeelslikeit’spersonal?Maybethepersonsays,“Whoareyoutotellmewhattodo!”or“Youdon’treallycareaboutme!”Or,theindividualrefusestotalk.Or,perhapsagreestodosomething,butthendoesn’tdoit.Whenthesethingshappen,youcanbeprettysurethatsomething’sgonewrongintherelationship.InMI,wecallthisdiscord.Thisriftcanoccurforvariousreasonsasnotedbelow.Ratherthanplacingblameontheindividual,itisimportantforworkerstolookattheirownbehaviortoconsiderwhatmightbepromptingthepersontoreact.Thepresenceofdiscordintherelationshipisasignaltotryadifferentapproach.Commoncausesofdiscordintherelationship

• Thetwoofyouhavedifferentgoals• You’retryingtogetthepersontochange• Wheneitherofyoubringsangerandfrustrationintothesituation• You’renottrulylistening,oryou’remakingassumptionsorinterrupting• There’salackofagreementaboutrolesintherelationship

Practitionerbehaviorsthattendtoincreasediscord• Pushingtoohardonthepersontochange• Assumingyou’retheexpert;notworkingcollaboratively• Criticizing,shaming,blaming;usingnegativeemotionstogetthepersontochange• Labeling;“that’sbecauseyou’reanalcoholic/addict”• Beinghurried• Givingtheimpressionthatyou“knowwhat’sbestfortheindividual”

Practitionerbehaviorsthattendtodecreasediscord

• Usingsimpleandcomplexreflectivestatementso “You’rewonderingifIcanhelpyou”o “You’renotsureyoucantrustme”

• Otherresponseso Apologizing–“Sorry,Ididn’tmeantolectureyou.”o Affirming–“You’vebeendoingthisforalongtimeandknowhowtokeep

yourselfsafe.”o Shiftingfocus–“Maybethere’ssomethingelsethatwouldbemoreusefulto

talkaboutfornow.”o Emphasizingpersonalchoiceandcontrol–“Itisentirelyuptoyou.Thisis

yourdecision.Nooneelsecanmakeitforyou.”

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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MISelf-Appraisal

Astheinterviewer,I…

0-not5-extremelyatallwell

1.Providedasafe,welcomingpresencewithmywordsandactions.Example:

012345

2.Engagedwithandshowedgenuineinterestintheperson,e.g.,whatsheorheenjoys,needs,values.Example:

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3.Foundoutandclarifiedwhatthepersonwantedtofocusoncurrently.Example:

012345

4.Helpedexplorebothsidesoftheperson’sdilemma,e.g.,what’sworkingandwhat’snot;upsidesanddownsides.Example:

012345

5.Avoidedtryingto“fix”theproblemorgetthepersontochangebyadvising,confronting,warning,orteaching.Example:

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6.Elicitedwhatmightbesomepossiblereasonstochangeifthepersonweretodecidetochange.Example:

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7.Learnedaboutpossiblewaysthatheorshemightgoaboutmakingthischange.Example:

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8.Askedhowimportantitisatthistimeforthepersontomakethischange.Example:

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9.Askedhowconfidentsheorhefeelstobeabletomakethischange.Example:

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10.Inquiredaboutwhatsteps,ifany,thepersonmighttakenext.Example:

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11.Askedpermissionbeforeprovidinginformationorsuggestions.Example:

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12.UsedthecoreskillsofMI(openquestions,affirmations,reflectivelistening,summaries)throughouttheconversation.

012345

13.ConsistentlydemonstratedthespiritofMI:>Partnership

>Acceptance

>Compassion

>Evocation

012345012345

012345

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DevelopedbyKenKraybillbasedonMiller,W.R.&Rollnick,S.,MotivationalInterviewing:HelpingPeopleChange,2013

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PossibleBehaviorsforChange

Instructions:Pickachangethatyou’vebeenthinkingaboutmakingbuthaven’tmadeyet.Itcouldbeabehavior,attitude,relationship,situation,orroleaboutwhichyouhavemixedfeelings.Itshouldnotbetoopersonalorprivate(e.g.illegalactivities),nortooinconsequential(whattoeatfordinner).Thedilemmashouldbesomethingthatyoufeelcomfortabletalkingaboutwithyourlearningpartner.

• AcceptingwhatIcannotchange• Alcohol/othersubstanceuse• Allowingotherstotakeadvantageofme• Anger/frustrationmanagement(e.g.,cussing)• Arrivinglate• Avoidingactiononissuessuchasthe

environmentorsocialjustice• Avoidingconflict• Awfulizing;making“mountainsoutof

molehills”• Behaviorsregardingrules/policies• Behaviorswithmysupervisorormanagers• Blaming• Bossy,pushy• Can’tsayno—takeontoomuchresponsibility• Clutteredmind—lackofserenity• Co-dependentbehaviors• Computergames• Controllingothers• Creatingdrama• Criticizingothers• Criticizingotherstothirdparties• Diet,foodchoices• Disorganized• Dominatingconversations• Drivingbehaviors(e.g.,speeding,roadrage)• Exercise,under-exercising• Failuretosetpriorities,goals• Failuretotakerisks• Failuretoreconcilebreachedrelationships• Failuretovolunteer;Alwaysvolunteering• Fearofspeakingup• Fightinglostcauses• Gettingeven• Givingunsolicitedadvice• Gossiping• HardtoadmitI’mwrong• Healthissues• Holdinggrudges• Impulsivespending• Interpersonalcontrolissues• It’sallaboutme• Judgmentalattitudes/behaviors• Jumpingtoconclusions• Know-it-all

• Lackassertiveness• Lackconfidence• Lackgenerosity(e.g.,givingtoworthycauses)• Lackempathy,compassion• Lacktolerance• Leavingundesirabletaskstoothers• Listeningtospouse,partner,teenagechild• Materialistic• Meddling• Moneymanagement• Neglectingtimewithfamilyorfriends• Notstickingtogoals(e.g.,furtheringeducation)• Notdoingmypart• Notlettinggo–“beatingdeadhorses”• Neglectingmyneedsforsakeofothers• Opinionated• Over-eating;Under-eating• Overlyconcernedaboutwhatothersthinkofme• Overlyconfident• Passive-aggressivebehaviors• Pessimism,cynicism• Perfectionistic• Pickingfights• Procrastinating• Smoking• Socialmedia• Solvingotherpeople’sproblems• Spendingemotionalenergyonissuesover whichIhavenocontrol• Spiritualorreligiousdisciplines(e.g.,church

attendance,meditation,study)• Stirringupconflict• Takingmedications• Takingoffenseeasily• Tactless• Takethingstoopersonally• Toocriticalofmyself• ToomuchTV• Timemanagement• Toooutspoken• Tooneat;toomessy• Unforgiving• Wastingtime• Whining• Worrytoomuch

Activity:AGuidedConversationacrosstheFourProcessesofMIInstruction:Findawillingpartner.Astheinterviewerinthisactivity,conducta10-15minuteconversation(orlongerifyouchoose)usingthetemplatebelowtoguideyourconversation.Afteryouconclude,debriefwhatwashelpful(ornot)fromyourownandyourpartner’sperspective.Engaging:Beginwithanopeninquiry:“Pleasetellmeaboutthreecorevaluesorgoalsthatareimportanttoyouinyourlife?”(perhapsrelatedtohealth,integrity,creativity,open-mindedness,competency,family,spirituality,community,autonomy,meaningfulwork,security,fairness,love,andmore)Listen,usingmostlyreflections,affirmationsorsupportivestatements;please,noclosedquestions,noproblemsolvingoradvisingWhenyoufeelyourpartnerhashadanampleopportunitytoself-exploreandexpressher/hisperspectiveregardingthethreecorevalues,summarizeyourunderstandingofwhatyouheard,andthenask,“Whatwouldyouaddtothat?”Focusing:Nowyoumightaskthisquestion:“Ofthesethreevalues,whichonewouldyouliketocontinuetotalkabouttogetherforthenextfewminutes?”Evoking:Belowarepossibleinquiriesyoumightuseintheevokingprocess.Remembertolisten,reflectandaffirmasyourprimaryskills.“Tellmemoreaboutwhythisvalueisimportanttoyou.”(Listen,reflect,affirm)“Inthelastmonthorso,whataresomethingsyouhavebeendoingthatsupportthisvalue?”(Listen,reflect,affirm)“Inthelastmonthorso,whathavebeensomechallengesinsupportingthisvalue?”(Listen,reflect,affirm)“Howimportantisittoyoutocontinuemakingeffortstosupportthisvalue?”(Listen,reflect,affirm)“Howconfidentareyouinbeingabletodoso,ifyouchoose?”(Listen,reflectandaffirm)Planning:Possibleinquiries:“Whataresomewaysthatyoumightyoubeconsideringtomorestronglysupportthisvalue?(Listen,reflect,affirm)“Whatwouldbesomenextstepsyou’dbereadytotake,tosupportthisvalue?”(Listen,reflect,affirm)“Whoorwhatwouldbehelpfultosupportyou?”(Listen,reflect,affirm)

AdaptedfromactivitydevelopedbyAliHall

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ChangeTalkActivityModifiedfromMoyers&Martin,2005

Instructions:Underlineanypartsofthepatientstatementsbelowthatsoundlikechangetalk,includingthelessobviousstatementsthatonlyhintatchange.Thisisnotanexactsciencesodon’tbeconcernedaboutbeingrightorwrong.

1 Interviewer:Tellmeaboutyourdrinking.

2 Client:Well,Ijustlovethewayitmakesmefeel.Itmakesmefeelgreat.Ican’treallyimagineadaywithoutthatfeeling.

3 I: Itsoundslikeadaywithoutalcoholwouldbedifficult.

4 C:Yeah,Idon’tthinkIcouldcope.Imean,Igetreallystressedbymywork,andIneedafewdrinkstocalmdown.

5 I: So,youusealcoholtodealwithstress.

6 C:Yeah,Idon’tthinkI’lleverquitdrinking.Ireallydon’twanttoquit,andImean,whatwouldbethepoint?

7 I: Youdon’tseeanyreasontoquit.

8 C:Yeah,Itellyou,justthisweekIboughtapackofbeersfromaroundtheworld,andIstarteddrinkingadifferentoneeachday,tostarttheeveningouteachnight.

9 I: What,ifanything,doyounotlikeaboutalcohol?

10 C:Wellcertainly,itcostsalotofmoney.Imean,I’msureIcouldspendthemoneyinbetterways.

11 I: Themoneyisanissueforyou.Isthereanythingelseyoudon’tlikeaboutit?

12 C:Yeah,thewayIfeelwhenIwakeup.Istillfeelprettygroggyalldayatwork.Iwouldliketofeelalittlemoreclear-headed.

13 I: You’vebeennoticingthatthegrogginessaffectsyourwork.

14 C:Well,certainlyI’malittlemoreshort-temperedthanImightbe.Ireallygottagetahandleonthat.Imean,I’masalesperson,soifI’mnotpatientwiththeidiotswhocallupwantingsomething,thenIlosethesale.

15 I: So,alcoholhasaffectedyourabilitytodoyourjob.

16 C:Yeah,Iguessso.

17 I: So,onascalefrom0-10,with0beingnotatallmotivated,and10beingextremelymotivated,howmotivatedwouldyousayyouaretocutdownorquitdrinking?

18 C: I’dsaya2.

19 I: Andwhynota0?Whynotthelowestpossiblemotivation?

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C:Well,Ireallywanttofeelbetteratwork.And,Ineedtomakemoresales,whichmeansIneedtodrinkless.AndthingswouldcertainlybebetterfinanciallyifIwasn’tspendingsomuchmoneyonalcohol.Infact,I’dsayI’mmorearounda3thana2.Ijustdon’tthinkIcandoit,youknow.Idon’tthinkIcancutdown.

21 I: So,partofyouisnotsureyou’dbeabletocutdown,andyetanotherpartofyouwantstocutdown,hasreasonstocutdown,andthinksyouneedtocutdown.

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ChangePlanWorksheet

AchangeIwanttomake…ThereasonswhyIwanttomakethischange…Mystrengthsandskillsthatwillhelpmebesuccessful…Specificwaysotherscanassistandsupportme…Person,program,resource WaystoassistandsupportThenextstepsIplantotake…HowI’llknowwhenmyplanisworking…WhoI’llturntoifIgetdiscouraged…HowI’llcelebratesuccessesalongtheway…

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MISelfCheckforPractitionersIndividualsImeetwithwouldsaythatI…

o Believethattheyknowwhat’sbestforthemselves

o Helpthemtorecognizetheirownstrengths

o Aminterestedinhelpingthemsolvetheirproblemsintheirownway

o Amcuriousabouttheirthoughtsandfeelings

o Helpguidethemtomakegooddecisionsforthemselves

o Helpthemlookatbothsidesofaproblem

o Helpthemfeelempoweredbymyinteractionswiththem

AdaptedfromHohman.&Matulich.MotivationalInterviewingMeasureofStaffInteraction,2008

SelectedResources

Arkowitz,H,Westra,H.A.,&MillerWR,RollnickS.(Eds.).(2015).MotivationalInterviewinginTheTreatmentofPsychologicalProblems(2ndedition).NewYork,NY:GuilfordPress.Hohman,M.(2011).MotivationalInterviewinginSocialWorkPractice.NewYork,NY:GuilfordPress.Miller,W.R.,&Rollnick,S.(2013).MotivationalInterviewing:HelpingPeopleChange(3rdEd.).NewYork,NY:GuilfordPress.Miller,W.R.,&Rose,G.(2009).TowardaTheoryofMotivationalInterviewing.AmericanPsychologist,64(6),527-537.Naar-King,S.,&Suarez,M.(2011).MotivationalInterviewingwithAdolescentsandYoungAdults.NewYork,NY:GuilfordPress.Rollnick,S.,Miller,W.R.,&Butler,C.(2008).MotivationalInterviewinginHealthCare.NewYork,NY:GuilfordPress.Rosengren,D.B.(2017).BuildingMotivationalInterviewingSkills:APractitionerWorkbook(2ndEd.).NewYork,NY:GuilfordPress.WagnerCC,IngersollKS.(2012).MotivationalInterviewinginGroups.NewYork,NY:GuilfordPress.Website:www.motivationalinterviewing.orgZuckoff,AllanwithGorscak,B.(2015).FindingyourWaytoChange.NewYork,NY:GuilfordPress.

WhatareCommunitiesofPractice?Communitiesofpracticeareformedbypeoplewhoengageinaprocessofcollectivelearninginashareddomainofhumanendeavor:atribelearningtosurvive,abandofartistsseekingnewformsofexpression,agroupofengineersworkingonsimilarproblems,acliqueofpupilsdefiningtheiridentityintheschool,anetworkofsurgeonsexploringnoveltechniques,agatheringoffirst-timemanagershelpingeachothercope.Inanutshell:

Communitiesofpracticearegroupsofpeoplewhoshareaconcernorapassionforsomethingtheydoandlearnhowtodoitbetterastheyinteractregularly.

Notethatthisdefinitionallowsfor,butdoesnotassume,intentionality:learningcanbethereasonthecommunitycomestogetheroranincidentaloutcomeofmember'sinteractions.Noteverythingcalledacommunityisacommunityofpractice.Aneighborhoodforinstance,isoftencalledacommunity,butisusuallynotacommunityofpractice.Threecharacteristicsarecrucial:

1.Thedomain:Acommunityofpracticeisnotmerelyacluboffriendsoranetworkofconnectionsbetweenpeople.Ithasanidentitydefinedbyashareddomainofinterest.Membershipthereforeimpliesacommitmenttothedomain,andthereforeasharedcompetencethatdistinguishesmembersfromotherpeople.

2.Thecommunity:Inpursuingtheirinterestintheirdomain,membersengageinjointactivitiesanddiscussions,helpeachother,andshareinformation.Theybuildrelationshipsthatenablethemtolearnfromeachother.

3.Thepractice:Acommunityofpracticeisnotmerelyacommunityofinterest–peoplewholikecertainkindsofmovies,forinstance.Membersofacommunityofpracticearepractitioners.Theydevelopasharedrepertoireofresources:experiences,stories,tools,waysofaddressingrecurringproblems—inshortasharedpractice.Thistakestimeandsustainedinteraction.

Itisthecombinationofthesethreeelementsthatconstitutesacommunityofpractice.Anditisbydevelopingthesethreeelementsinparallelthatonecultivatessuchacommunity.Communitiesofpracticearenotcalledthatinallorganizations.Theyareknownundervariousnames,suchaslearningcommunities,learninggroups,orlearningcircles.

Communitiesofpracticecomeinavarietyofforms.Somearequitesmall;someareverylarge,oftenwithacoregroupandmanyperipheralmembers.Somearelocalandsomecovertheglobe.Somemeetmainlyface-to-face,somemostlyonline.Somearewithinanorganizationandsomeincludemembersfromvariousorganizations.Some

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areformallyrecognized,oftensupportedwithabudget;andsomearecompletelyinformalandeveninvisible.

Communitiesofpracticehavebeenaroundforaslongashumanbeingshavelearnedtogether.Athome,atwork,atschool,inourhobbies,weallbelongtocommunitiesofpractice,anumberofthemusually.Insomewearecoremembers.Inmanywearemerelyperipheral.Andwetravelthroughnumerouscommunitiesoverthecourseofourlives.

Infact,communitiesofpracticeareeverywhere.Theyareafamiliarexperience,sofamiliarperhapsthatitoftenescapesourattention.Yetwhenitisgivenanameandbroughtintofocus,itbecomesaperspectivethatcanhelpusunderstandourworldbetter.Inparticular,itallowsustoseepastmoreobviousformalstructuressuchasorganizations,classrooms,ornations,andperceivethestructuresdefinedbyengagementinpracticeandtheinformallearningthatcomeswithit.Adaptedfrom:www.ewenger.com/theory/index.htmMotivationalInterviewingLearningCommunities

Learningtogetherisoftenmorefunthanlearningalone.NoteveryonehasaccesstoanexpertMIcoach,butitmaybeeasiertofindcolleagueswhoarealsointerestedindevelopingtheirskillsinMI.Wehavebeenexperimentingwithsuchlearningcommunitiesasaresourcetosupportcontinueddevelopment.Thereneednotbeanidentifiedexpertinthegroup,althoughsomedoinviteanexperiencedcoachtovisitwiththemoccasionally.Theideaispeer-supportedlearning,topuzzletogetheroverquestionslike:

“HowcouldIapplyMIinthisparticularsituation?”“WhatisagoodnextstepinpracticingMI?”“HowelsemightIhaverespondedatthatpointinthesession?”“ShouldIbetryingMIinthissituation?”“Whatinterviewerresponsesseemmostlikelytoevokechangetalk?”

Webelievethat,aswithcoaching,listeningtoeachother’spracticeisacrucialresourceforlearning.Soispracticingskillstogether.TalkingaboutMIisnotaslikelytopromotelearningasactuallypracticingskillswithinasupportivelearningcommunity.Werecommendthateverymeetingincludesomelisteningtopracticerecordingsandsomeskillpractice.Someclinicianswhohavedevelopedalearningcommunityofthiskindhavetoldusthattheylookforwardtothemeetingsasoneofthemostrewardingexperiencesoftheirweekormonth.Herearesomepracticalsuggestionsforskillpracticewithlearningcommunities.1.Focusonaparticularinterviewingskillortask.Ifyou’retryingtoincreaseyouruseofcomplexreflections,focusonthat.

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2.Tryusing“realplay”insteadofroleplay.Thatis,havethecolleaguewhoisspeakingasa“client”talkaboutsomethingreal,suchasachangethatheorsheisactuallyconsideringorwantingtomake.Wefindthatthistendstopromotelearningbetterthanenactedroleplays.3.Don’tletpracticegoontoolongbeforeyoustopfordiscussion.Usually10minutesisenoughtimetogetinsomegoodpracticewithoutboringobservers.4.Giveobserverssomethingtodowhilewatching.Ifthereismorethanoneobserver,theycouldusedifferentcodingtaskssuchascountingreflections,questions,orboth;listeningforchangetalkandsustaintalk;whenchangetalkoccurs,whatwasthenextthingtheinterviewersaid;listeningforanyresponsesthatmightbeinconsistentwithanMIstylesuchasgivingadvicewithoutpermission,confronting,orarguingwiththeclient.5.Whenapracticeisdone,thefirstpersontocommentonitshouldbetheonewhowaspracticingMI.Whatweretheyexperiencingduringtheinterview?Next,the“client”shouldcomment.Whatdidthe“client”experienceduringtheconversation?Whatwasparticularlyhelpful?Thenobserverscanprovidetheirobjectivefeedbackbasedontheirstructuredcodingtasks.Observersshouldfocusonthepositive.Itisveryeasy(anddemoralizing)forobserverstomakemanyspecificcritiquesandsuggestions.Avoidtherightingreflexheretoo.Focusonwhatwasgoodaboutwhatwasobserved.6.Ifsomeoneistomakearecommendationofsomethingtotry,letitbejustonesuggestion.Changingonethingisplentytotryonsubsequentpractice.Acautionhereisthatwithsolelypeer-ledlearninggroupsitispossibletogetofftrackwithoutrealizingit.Atleastperiodiccheck-inswithawell-trainedobserver/coachareadvisable.AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013(pages327-329)

RecommendationsforanMIPeerSupport

Group/CommunityofPracticeMINT,2009

Developingproficiencyinmotivationalinterviewing(MI)isratherlikelearningtoplayasportoramusicalinstrument(seeCoyle,2009;Milleretal.,2006).Someinitialinstructionishelpful,andrealskilldevelopsovertimewithpractice,ideallywithfeedbackandconsultationfromknowledgeableothers.OnewaytodothisistoformalocalgrouptosupportandencourageeachotherincontinuingtodevelopproficiencyinMI.Whenagrouplikethisiswelldone,participantsenjoycomingandsometimessaythatitisoneofthemostinterestingandrewardingaspectsoftheirjob.Herearesomeideasforsuchagroup.

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1.ScheduleregularmeetingsforthesolepurposeofworkingtogethertostrengthenMIskills.Don’tletadministrativedetailsorotheragendaitemsfillthetime.Anhourmeetingonceortwiceamonthwouldbeonepossibility.

2.Inearlymeetings,itmaybehelpfultodiscussspecificreadings.Thereisarapidlygrowinglistofbooksandarticlesatwww.motivationalinterviewing.org.Periodicallythegroupmayalsowishtowatch"expert"tapes,codinganddiscussingtheskillsbeingdemonstratedinthem.ForthoseparticularlyinterestedinnewresearchonMI,a"journalclub"of20minutesorsomightbeadded.Takeiteasywithanyreadingassignments,though.Peoplelearnalot,andfast,justfrombringinginanddiscussingtapes(see#3).

3.Akeylearningtooltobeincludedinregularmeetingsistolistentogethertoanddiscusstapesofparticipants’MIsessions.Somegroupshaveexperiencedthattheenergyandengagementlevelofthegrouppickedupwhentheybegantolistentoeachother’stapes.Arotationschedulecanbearrangedwherebyparticipantstaketurnsbringinginnewtapes.Werecommendlisteningtoanddiscussingonetapepersession.A20-minutesegmentoftapeisprobablyaboutright.Werecommendusingarecordingdevicewithexternalmicrophone(s)toimprovethequalityofsoundandfacilitatelistening.

4.Writtenpermissionshouldbeobtainedfromclientsforthisuseofrecording,explaininghowthetapeswillbeused,whowillhearthem,andhowandwhenthetapewillbedestroyed.

5.Besuretothankandsupportthosewhobringinatapetoshare.Theyaretakingariskandbeingvulnerable,whichcanbedifficult,particularlyearlyinthelifeofagroup.Bewareofhavinghigh“expert”expectationswhensomeoneisjustbeginning.

6.Ratherthansimplylisteningtoatape,makeuseofsomestructuredcodingtools.Someexamplesare:

• Countingquestionsandreflections• MoregenerallycodingOARS• Codingdepthofreflections(simplevs.complex)• Countingclientchangetalk,andnotingwhatprecededit• Trackingclientreadinessforchangeduringthesession,andkeymomentsof

shift• Codingformscanbefoundonwww.motivationalinterviewing.org.Participants

mayusethesamecodingformandcomparetheirfindings,orparticipantscanusedifferentcodingformstoattendtodifferentaspectsofthesession.

7.Inintroducingasessiontobeheardbythegroup,itisadvisedtoindicatewhattarget(s)forbehaviorchangeisbeingpursued.Withoutthis,itisnotpossibletoidentifychangetalk,whichisgoal-specific.

8.Indiscussingaparticipant’stape,itissuggestedthatthepersonwhodidtheinterviewcommentfirstonitsstrengthsandareasforimprovement.

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9.Indiscussinganytape,focusdiscussiononthewaysinwhichthesessionisandisnotconsistentwiththespiritandmethodofMI.Again,itisusefulforthepersonwhodidtheinterviewtoleadoffthisdiscussion.Participantscanaskeachother,“InwhatwayswasthissessionMIconsistent?”and"WhatmightonedotomakethissessionevenmoreMIconsistent?"Whenprovidingfeedbacktoeachother,adheretothesupportivespiritofMI.AlwaysemphasizewhatyouheardorsawthatseemedparticularlyeffectiveandconsistentwiththestyleofMI.Oneapproachisa“feedbacksandwich”inwhichanysuggestionforfurtherstrengtheningpracticeissandwichedbetweenampleslicesofpositivefeedback.Thegroupatmosphereshouldbefunandsupportive,notpressuredorcompetitive.Groupparticipantsreportthattheyoftenlearnmorefromhelpingothersthanfromreceivingfeedbackontheirowntapes.

10.FocusonwhatisimportantwithinMI.Thereisalwaystemptationtowanderoffintomoregeneralclinicaldiscussionofcases:Focuslearningonthespirit,principles,andpracticesofMI.

11.ThegroupmayfocusonpracticingandstrengtheningspecificcomponentskillsofMI.Onesuchsequenceofskillstobelearnedisdescribedin:Miller,W.R.,&Moyers,T.B.(2006).Eightstagesinlearningmotivationalinterviewing.JournalofTeachingintheAddictions,5,3-17.

12.Somegroupsbeginwitha“check-in”periodinwhichanyonecanbringupanissuefordiscussion.

13.Bringingcoffeeandrefreshmentscanaddtotherelaxedatmosphereofagroup.

14.Considerwhetherthereisaprerequisiteforparticipatinginthegroup.Somegroupshaverequired,forexample,thatparticipantscompleteaninitialtraininginMIbeforebeginningtoattend.OthershaveleftthegroupopenforanywhowishtolearnMIskills.

15.Considerwhetheryouwanttocontractforaspecificlengthoftimeornumberofmeetingstogether.Ifso,attheendofthistimeeachmembercanconsiderwhethertocontinueforanotherperiod.

16.An“MIexpert”inthegroupmightresisttakingonanexpertrole,becausedoingsocanstifleparticipationandlearning.Don’twithholdyourexpertise,particularlyifinvited,butavoidapatternofinteractioninwhichthegroupalwayslookstotheexpertforthe“right”answers.

17.Mostofallenjoythisprivilegedlearningtimetogether.Aswithothercomplexskillslikechess,golf,orpiano,gainingproficiencyinMIisalifelongprocess(seeCoyle,2009).ArealsourceoffunandlearninginthesegroupsisadmirationforthemanyartfulwaysthatpeoplefindtoapplyMIwithintheirownclinicalstyleandthepeoplewithwhomtheywork.

2018

Selected Online MI Resources MI Resources – MINT website http://www.motivationalinterviewing.org/motivational-interviewing-resources MI Learning Activities MI Training for New Trainers Manual 2014 (213 pages - allow extra time to download) http://www.motivationalinterviewing.org/sites/default/files/tnt_manual_2014_d10_20150205.pdf Interactive MI iBook Authors: Ken Kraybill, Jeff Olivet, Scott R. Petersen, Collin Whelley https://itunes.apple.com/us/book/changing-conversation-interactive-tool-to-build-motivational/id627539414?mt=11 MI Podcast series: Changing the Conversation http://us.thinkt3.com/podcast 16 October 2015 What is Motivational Interviewing? Ken Kraybill 24 September 2018 Motivational Interviewing 1: Ali Hall & Ken Kraybill 8 October 2018 Motivational Interviewing 2: Susan Butterworth and Ali Hall (More to come) Podcast: The Power of Motivational Interviewing Revolution Health Radio – podcast #49 Chris Kresser interviews Ken Kraybill (June 2018) https://chriskresser.com/podcasts/ MI Learning and Demonstration Clips William Miller on MI (~ 2 min.) https://www.youtube.com/watch?v=a0chqEXb43w William Miller and MI and Quantum Change (~ 1 hr 25 min – starts at around 8.5 minute mark) https://www.youtube.com/watch?v=2yvuem-QYCo Intro to MI - Bill Matulich (~ 17 min) https://www.youtube.com/watch?v=s3MCJZ7OGRk Empathy: The Human Connection (~ 5 min) https://www.youtube.com/watch?v=cDDWvj_q-o8 Motivational Interviewing in Child Welfare Services (~ 39 min) http://ats.ucdavis.edu/ats-video/?kmid=0_pcc9au5x MI in Dental Practice - How NOT to do Motivational Interviewing in Dental Practice Addressing Tobacco Use with David - Marilyn Herie (~ 3 min) https://www.youtube.com/watch?v=SytVckoox4U - Motivational Interviewing in Dental Practice Addressing Tobacco Use with David - Marilyn Herie (~ 4 min) https://www.youtube.com/watch?v=rFLrDvUexC8 - Motivational Interviewing in Dental Practice: Emily's Oral Piercing https://www.youtube.com/watch?v=HMS6acj3Fjw

2018

MI with Survivors of Intimate Partner Violence (scenarios 1, 2, 3) - Emmy’s first encounter with an IPV counselor (~ 23 min) https://www.youtube.com/watch?v=P3JUXQ4kkHs - Vanessa’s second meeting with a hospital social worker (~ 16 min) https://www.youtube.com/watch?v=lrnkEQRUyJM - Liv’s fourth session with an IPV advocate (~ 18 min) https://www.youtube.com/watch?v=jxNBQKMW1wg MI in a Vocational Rehabilitation Setting (The videos below feature two different VRC’s and follow “William” from intake to the decision to move forward to build a VR plan for employment and the steps he commits to takes.) - Building engagement during the intake process https://youtu.be/Z0mSNm20ZWU - Using agenda mapping to focus the conversation https://youtu.be/b4xqR_gzVXo - Conversation about values to demonstrate sustained reflective listening practice to deepen meaning https://www.youtube.com/watch?v=0DAncPnGOiw - Roadmap for change strategy https://youtu.be/ZlEa6UPLufU - Change planning conversation https://www.youtube.com/watch?v=oZmvfMaEPK4 MI in a Vocational Rehabilitation Setting (The videos below demonstrate a team intake and three picture card sort activities to generate information about “Mike’s” preferences, strengths, priorities, needs and concerns to contribute to a "comprehensive assessment" for development of a VR plan for employment. Mike experiences an intellectual and developmental disability.) - Building engagement with a group during the intake process. Includes Mike, family member and advocate https://youtu.be/RyT6I66jtbI - Strengths Picture Card Sort https://youtu.be/EfPTNZdWYE4 - Values Picture Card Sort https://www.youtube.com/watch?v=miOEme0JL8o - Roadblocks Picture Card Sort https://youtu.be/R0JQVpmTWds MI for the Busy Clinician: Mr. Smith’s Smoking Evolution https://www.youtube.com/watch?v=0z65EppMfHk (~ 10 min) Stop It – Bob Newhart (An example of what MI is not!) https://www.youtube.com/watch?v=n-Tej0297wk (~ 6 min)

OpenQuestionsPracticeSheetConverttheclosedquestionsbelowtoopenones.Remembertherearemanypossibleresponses.Becreative.Comeupwithatleastfiveopenquestionsforeachexample.Youwantyourquestionstoelicittheperson’sthoughts,feelings,concerns,hopes,etc.regardingthetopic.It’susuallywisetoavoidaskingwhyquestions,astheycanhaveanaccusatoryordemandingtone,andthusputpeopleonthedefensive.

Haveyoubeenhomelessalongtime?Istheresomereasonyoucan’tcheckyourbloodsugartwiceaday?Didyoumakeittoyourappointmentattheclinic?Writeatleastthreeopenquestionsforeachofthefourprocessesthatonewouldlikelyaskwhenhavingaconversationaboutchange.ENGAGING

FOCUSING

EVOKING

PLANNING

Activity:ProvidingAffirmations1.Thinkofsomeoneyouconsiderafriend.Writedownoneormoreaffirmingstatementsthatyoumightsaytothispersonundereachofthefourcategoriesbelow.

• Highlightpositivetraitsorskills

• Prizeofthepersoningeneral

• Emphasizeintentionsandactions

• Reframeactionsorsituationsinapositivelight

2.Now,thinkofsomeonewhoisratherdifficultforyoutobearoundorperhaps“pushesyourbuttons.”Writedownoneormoreaffirmingstatementsthatyoumightsaytothispersonundereachofthefourcategorieslistedbelow.

• Highlightpositivetraitsorskills

• Prizeofthepersoningeneral

• Emphasizeintentionsandactions

• Reframeactionsorsituationsinapositivelight3.Whatdidyounoticeaboutprovidingaffirmationsinthesetwoexamples?DevelopedbyKenKraybillbasedonMiller,W.R.,&Rollnick,S.(2013).MotivationalInterviewing:HelpingPeopleChange(3rdEd.).NewYork,NY:GuilfordPress.

FormingReflectionsOverview:Ingroupsof3-6,practiceformingandrespondingwithreflectivestatementstowhataSpeakersays.Choosefromtheactivitiesbelow,ormakeupyourown.1.AdesignatedSpeakerbeginstalkingaboutatopic(favoriteactivity,personwhoinspiresthem,decisionthey’refacing,challengingsituation,dilemma,other)for30-45seconds.Inturns,eachpersoninthecirclerespondswithareflectivestatementchoosingdifferentreflectionstemslistedbelow.Afterseveralrounds,repeattheactivitywithanotherSpeaker.2.Asin#1,adesignatedSpeakerbeginstalkingaboutatopic.ThistimethepersontotheleftoftheSpeakerrespondswithareflectivestatementusingoneofthestemsbelow.TheSpeakerrespondsbrieflytothatstatementandthenthenextpersoninthecircleformsareflectionbasedonwhattheSpeakerjustsaid,thusdeepeningtheconversation.Afterseveralrounds,repeattheactivitywithanotherSpeaker.

StemslistadaptedfromCommunityCareofNorthCarolinaMIResourceGuide

Yourconcernisthat…

You’rehopingfor…

Yourfearisthat…

Itseemsthat…

You’renotterriblyexcitedabout…

You’renotmuchconcernedabout…

Thisreally…

Youfeelso…

It’sreallyimportanttoyouthat...

You’renotreally…

Youfeelasthough…

WhatIheardyousaywas…

(Others)

Soundslike…

You’resayingthat…

You’refeeling…

Almostasif…

It’slike…

Itfeelslike…

Foryou,it’samatterof…

Fromyourpointofview…

Asyouseeit…

You…

You’rewondering

Youreally…

Youbelieve…

UsingReflectiveStatementsStrategically

Foreachclientstatement,respondwithsamplereflectivestatementsthat:• Conveyempathy/understanding,or• Recognizeambivalence,or• Highlightchangetalk

ExampleI’vebeenhavingalotofdizzyspellsandshouldprobablygototheclinic,buttobehonest,Idon’tthinkIevenwanttoknowifthere’ssomethingseriousgoingon.

• Conveyempathy/understanding:“You’reworriedaboutyourhealth.”• Recognizeambivalence:“It’sscarytothinkaboutwhattheymightfind;andat

thesametime,it’skindofscarynotknowingwhyyou’rehavingthesespells.”• Highlightchangetalk:“Apartofyoufeelslikeyou’dliketogetmore

informationaboutwhat’sgoingonwithyourhealth.”IknowIcoulddosomethingsdifferently,butifshewouldjustbackoff,thenthesituationwouldbeawholelotlesstense;thenthesethingswouldn’thappen.I’vebeendepressedlately.Ikeeptryingthingsotherthandrinkingtohelpmyselffeelbetter,butnothingseemstowork,excepthavingacoupleofdrinks.So,I’mnottooworried,butit’sbeenoverayearsinceI’vehadanHIVtest.IknowI’mnotperfect,butwhydotheyhavetoalwaystellmewhattodo.I’mnot3!Iprobablyshould,butIdon’tusecondoms.It’snotmything.Imighthaveaproblem,butwhoareyoutobegivingmeadvice.Whatdoyouknowaboutdrugs?Ibetyou’veneverevensmokedajoint!Idon’tthinkIhaveadrinkingproblem.It’sjustthatmypartnerisoverlysensitivebecauseherdadwasanalcoholic.AdaptedfromRosengren,DB.(2009).BuildingMotivationalInterviewingSkills:APractitionerWorkbook

FormingandOfferingSummaries

Instructions:1.Findaconversationpartnerwithwhomtopractice.Inviteyourpartnertoengageina10-15minuteconversationaboutapersonalconcernordilemmathatthey’dbewillingtoexplore.2.UseyourMIspirit(partnership,acceptance,compassion,evocation)andconversationskills(openquestions,affirmations,andreflections)toexploreyourpartner’sidentifiedissueorconcern.3.Afterapproximately5-7minutes,atapointintheconversationthatseemsfitting,offeracollectingsummaryusingtheframeworkbelow:

4.Continuetocarryontheconversationforanother5-7minutesandnoticewhentheconversationiscomingtoatransitionpoint(forexample,whentheconversationismovingfromthefocusingprocesstoevoking,fromevokingtoplanning,fromtheplanningprocesstowrappinguptheconversation,orperhapssomeothertransitionsuchasmovingtoanothertopicoffocus).Offeratransitionalsummaryatthispointusingtheframeworkdescribedabove.5.Debrieftheactivitytogether,withtheinterviewercommentingfirst.Whatwasyourexperiencelikefacilitatingtheconversation?Whatdidyoudowellinformingandprovidingsummaries?What’sonethingyoumightdodifferentlynexttime?Then,havethe“client”comment.Whatwasyourexperienceduringtheconversation?Whatdidtheinterviewerdowellinprovidingsummaries?What’sonethingyoumightsuggestthattheinterviewerdodifferentlynexttime?6.Switchrolesasyouwishandrepeattheactivity.

1.Inyourownwords,beginbysignalingthatyou’dliketosummarizewhatyou’veheardthusfar.2.Considerwhattoincludeinyoursummarywithaneyetowardsreflectingempathyandunderstanding,notingbothsidesofambivalencethatyouhear,and/orhighlightinglanguagethatfavorschange.3.Offeryoursummary(keepingitrelativelyconcise).4.Endwithaninvitation–e.g.Whatdoyoumakeofthat?Whatwouldyouadd?WhatdidImiss?

RowingwithOARS(withObservers)Purpose:InterviewerspracticehowtouseOARSstrategicallytomovetowardaparticularchangegoal.Overview:OnceoneiscomfortableusingOARSinanondirectivemanner,thenexttaskistolearnhowtouseselectivequestions,affirmations,reflectionsandsummariestoevokechangetalk.Guidelines:Workingroupsoffour:Onespeaker,oneinterviewer,andtwoobserversatatime.Thespeaker’stopicis“Onethinginmylife(oraboutmyself)thatIwouldliketochange…”Thisinstructionistostartwithatopicaboutwhichthepersonalreadyhassomedesiretochange,andthereforesolicitingchangetalkshouldbebotheasierandnatural.Theinterviewer’staskistouseOARStoevokechangetalk(e.g.desire,ability,reasons,need,important,confidence,andcommitmenttochange).Itmaybeusefultodiscussbeforehandvariousmethodsforelicitingchangetalkorhaveamenufromwhichtochoose(seeMethodsforEvokingChangeTalkbelow).Theinterviewershouldrefrainfromgivingadvice,andsticktotheOARS,beingcarefultooffermorereflectionsthanquestions.OneobserverusesanOARSsheetandrecordsoccurrencesofeachoftheseresponses.TheusualprocedureistomakehashmarksnexttoO,A,R,andSastheseoccur,andalsotowritedownwhattheobserverregardedtobeparticularlygoodexamplesofeach.Thesecondobserverlistensforchangetalkfromthespeaker.Youcanassignthiscodertoworkinvariousways,suchas(1)simplecountingofchangetalkstatements,(2)placinghashmarksinDARNandCcategories,(3)writingdownparticularlygoodexamplesofchangetalk,(4)ratingthestrengthofchangetalk,(5)alsotrackingsustaintalk,or(6)alsonotingwhattheinterviewerdidrightbeforeeachchangetalkstatement.Theinterviewermaypauseatanypointintheconversationtoconsultwiththeobservers.Allowtheconversationtoproceedforabout8-10minutes,andthengivea2-minutewarningatwhichtimetheinterviewershouldofferabouquetsummaryofthespeaker’schangetalkandaskwhatthespeakermightaddtothat.Debrieftheexerciseby1)havingtheinterviewertalkaboutwhathe/shedidwellandonethingtoimproveupon,2)havingthespeakertelltheinterviewerallthethingstheinterviewerdidwell,andonesuggestionforimprovement,and3)havetheobserversreportwhattheyobservedusingtheircodingsheetstosummarizetheirobservations,andmentionparticularlygoodexamplesthattheynoted.MethodsforEvokingChangeTalkAskingevocativequestions Whatworriesyouaboutyourcurrentsituation? Whywouldyouwanttomakethischange? Howmightyougoaboutit,inordertosucceed?

Usingtheimportanceruler(alsouseregardingperson’sconfidencetochange) Onascaleof0to10,howimportantisitforyoutomakethischange?Tellmeabout beingat___comparedto(severalnumberslower)?Whatwouldittaketomovefrom ___to(nexthighestnumber)?AndhowImightIhelpyouwiththat?

Exploringextremes–Whatconcernsyouabsolutelymostabout____?Whataretheverybestresultsyoucouldimagineifyoumadeachange?

Lookingback–Whatwerethingslikebeforeyoubegandrinkingmorefrequently?

Lookingforward–Howwouldyoulikethingstobedifferentinthefutureregarding_______?

Exploringgoalsandvalues–What’smostimportanttoyouinlife?Whataretherulesyou’d sayyouliveby?Howdoesdrinkingfitwithyourpersonalgoals?Notes:Thisisquiteacomplexexercise,andbenefitsfromthetrainer/facilitatorcirculating,observing,andcoaching.Theexercisecanberepeatedifdesired,sothateachparticipantgetstoplayeachrole.AdaptedfromDavidRosengrenandBillMiller

0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely important important

ChangeTalkQuizModifiedfromMoyers&Martin,2005

Instructions:Underlineanypartsoftheclientstatementsbelowthatsoundlikechangetalk,includingthelessobviousstatementsthatonlyhintatchange.Thisisnotanexactsciencesodon’tbeconcernedaboutbeingrightorwrong.

1 Interviewer:Tellmeaboutyourdrinking.

2 Client:Well,Ijustlovethewayitmakesmefeel.Itmakesmefeelgreat.Ican’treallyimagineadaywithoutthatfeeling.

3 I: Adaywithoutalcoholwouldbedifficult.

4 C:Yeah,Idon’tthinkIcouldcope.Imean,Igetreallystressedbymywork,andIneedafewdrinkstocalmdown.

5 I: Soyouusealcoholtodealwithstress.

6 C:Yeah,Idon’tthinkI’lleverquitdrinking.Ireallydon’twanttoquitandImean,whatwouldbethepoint?

7 I: Youdon’tseeanyreasontoquit.

8 C:Yeah,Itellyou,justthisweekIboughtapackofbeersfromaroundtheworld,andIstarteddrinkingadifferentoneeachday,tostarttheeveningouteachnight.

9 I: What,ifanything,doyounotlikeaboutalcohol?

10 C:Wellcertainly,itcostsalotofmoney.Imean,I’msureIcouldspendthemoneyinbetterways.

11 I: Themoneyisanissueforyou.Isthereanythingelseyoudon’tlikeaboutit?

12 C:Yeah,thewayIfeelwhenIwakeup.Istillfeelprettygroggyalldayatwork.Iwouldliketofeelalittlemoreclear-headed.

13 I: Thegrogginessaffectsyourwork.

14 C:Well,certainlyI’malittlemoreshort-temperedthanImightbe.Ireallygottagetahandleonthat.Imean,I’masalesperson,soifI’mnotpatientwiththeidiotswhocallupwantingsomething,thenIlosethesale.

15 I: So,alcoholhasaffectedyourabilitytodoyourjob.

16 C:Yeah,Iguessso.

17 I: So,onascalefrom0-10,with0beingnotatallmotivated,and10beingextremelymotivated,howmotivatedwouldyousayyouaretocutdownorquitdrinking?

18 C: I’dsaya2.

19 I: So,whynota0?Whynotthelowestpossiblemotivation?

20

C:Well,Ireallywanttofeelbetteratwork.And,Ineedtomakemoresales,whichmeansIneedtodrinkless.AndthingswouldcertainlybebetterfinanciallyifIwasn’tspendingsomuchmoneyonalcohol.Infact,I’dsayI’mmorearounda3thana2.Ijustdon’tthinkIcandoit,youknow.Idon’tthinkIcancutdown.

21 I: So,I’mreallyhearingtwothings.Youwanttocutdown,youneedtocutdownandyouhavereasonstocutdown,butyou’renotsurethatyouwillbeabletocutdown?

22 C:Yeah,I’mafraiditmightbetoohard.

23 I: Itsoundslikedrinkinghasbeenpartofyourlifeforalongtime.

24

C:SinceIwasfourteen.MyfriendsandIusedtoshopliftitfromtheQuickieMartdownthestreet.Wegotcaughtafewtimes,butwejustkeptdoingit.Thenafterhighschool,Ihadafriendatworkthatwouldbuyitforme,butonlyifIpaidandhegothalfofthebooze.ThatwashardbecauseIwasspendingalmostallmypaycheckjusttogethalfthebooze.

25 I: Soitcostquiteabitbackthen.Howaboutnow?Youmentionedthemoneybefore.

26 C: I’dsayIspendwaytoomuchonitthesedays.But,Igottahavethatbuzzafterwork,likeIsaid.

27 I: Withoutityou’dbetoowounduptofunction.

28 C:Well,Idon’tknowaboutfunction.I’dfunctionOK,Iguess,Ijustwouldn’tbeashappy.

29 I: Whatotherthingsdoyouliketodo?

30 C: IliketowatchTV,hangoutwithmyfriends,buttheyalldrinktoo.AndIliketogoseemovies.

31 I: Andyou’renotdrinkingwhenyouseemovies.

32 C:No,amovieisusuallydistractingenoughthatIcangowithoutuntilIgethome.IsupposeIcouldgoseeamovieeverynight!IthinkI’lltrythat.Twohourswithoutdrinkingislike4lessbeersanight.

33 I: Andcheaperthan4beers,Iwouldimagine.

34 C:NotwhenyoudrinklikeIdo.Igetthecheapestbeerpossible,becauseIdrinksomuchofit.Amoviecosts$10thesedays,but4beersonlycostsmelike2bucks.

35 I: So,seeingamovewouldn’treallyhelpfinancially,butyouwouldprobablyfeelbetterthenextday.

36 C:Yeah,andIwouldprobablybemorepatientonthephonewithcustomers,whichmightmeanmoresales.Thatwouldhelpfinancially.Igetpaidoncommission.

37 I: Arethereperiodsinyourlifewhenyoudidn’tdrink?

38 C:Yes,onceIquitforacoupleofweeks.

39 I: Itwasn’tsomethingyouwantedtokeepdoing.

40 C:Well,Iwasmoreproductive,butthestresswasterrible.Istartedtoexercise,andthathelped.

41 I: So,youwereabletoquitfortwoweeks,andexercisehelpedreducethestressthatyoufeltfromwork.

42 C:Yep.Youknow,IbetIcoulddothatagain.Icouldexercise.

43 I: So,itsoundslikeyouhavetwoplansinmind,togotoamovieeachnightandtoexercisetorelievestress.Doyouthinkyoucoulddoboth?

44 C: Idon’tseewhynot.Itmightevenhelpmetoeventuallyquit.

Instructions:Afterunderliningallofthechangetalk,gobackandnoteintheodd-numberedsquareswhichoftheO-A-R-Stheintervieweruses.Noticehowtheyareusedtobothelicitandrespondtochangetalkthroughouttheconversation.

SnatchingChangeTalkfromtheJawsofAmbivalenceAdaptedfromBillMiller&TerriMoyers

Instructions:I.Underlinethechangetalk(desire,ability,reason,needorcommitment)instatements1-10.II.Formtriads:Client,Listener1,Listener2

• Clientreadsentirestatementofambivalence.Listener1respondstochangetalkwithreflectivestatement.Clientrespondswithmorechangetalk.

• Listener2respondstonewchangetalkwithreflectivestatement.Clientrespondswithevenmorechangetalk.(Rotaterolesandgotonextstatement.)

Example:Ireallydon’twanttostopsmoking,butIknowthatIshould.I’vetriedbeforeandit’sreallyhard.Options:A.Youreallydon’twanttoquit.B.It’sprettycleartoyouthatyououghttoquit.C.You’renotsureifyoucanquit.(OptionBisthereflectionthatreinforcesthechangetalk.)

1 Idon’tdrinkanymorethanmostpeopleIknow.Sure,Isometimesfeelalittlefoggythenextday,butitwearsoffquick.It’snobigdeal.

2 Sure,Iwantmykidsback,andIwanttobeagoodmother,butthecourt’smakingitimpossible.There’snowayIcandoallthosethingsthey’remakingmedo.

3 Iwasn’tdoinganythingwrong!Ijustwentalongfortheride,andIdidn’tknowtheyweregoingtograbthatlady’spurse.Nowthey’resayingthatIviolatedmyprobation.Iguessit’snotsmarttobecruisingaroundat2inthemorningbutithappenedsofast,therewasnothingIcoulddoaboutit.Ididn’tbreakanylaws,andI’mnotgoingbacktojailforthis.

4 It’ssuchahassletotakethosepills.I’msupposedtoremembertotakethem4timesadayandhalfthetimeIdon’tevenhavethemwithme.Iguessthere’sagoodreasonforit,butit’sjustnotpossibleforme.

5 LasttimeItriedtoquitsmoking,Iwasreallybadtobearoundfor5days.Iwasjustgoingoffoneverybody.But,then,afterthatIwasprettycoolandthenafter2weeks,Iwasabletobecoolallthetime.But,Ican’tbelosingmycoolwithpeoplefor5daysyouknow.Inmysituation,ifIgooffonthewrongpeople,itcouldbebadman,realbad.

6 Sometimes,doingmyritualsmakesmewanttoscream.But,thenIthink,ifIdidn’thavemyOCD,I’dprobablybealotlessconscientious.IthinkmyOCDispartofwhatmakesmeagoodperson.

7 Hey,Ican’tgoinpatient.IfI’vegottogosomeplace,whycan’tIgotoAAorsomething?IfIgoinpatientfor28days,I’mgoingtolosemyjob,plusalotofotherbadstuff.YouunderstandwhatI’msaying.

8 Whenyoutakethatfirsthitman,there’snofeelinglikeit.Atthatmoment,youjustdon’tcareaboutallthebadstuffdrugsdotoyourlife;it’sjustthisamazingrushandnothingelsematters.

9 Yeah,Iwasgoingtonightclasses.Iwenteveryday,didmyhomeworkandIadmit,Iwasfeelinggoodaboutthat.But,it’sgottenjusttoohard,youknow,it’scausingmetobetiredatwork,andeventhoughmywifesaysshe’sformefinishing,Icantellsheisgettingtiredofhavingtheextraburdenwiththekidsandall.Man,Iwouldliketohavethatcertificate,though.

10 Ihavenotimetogotocounseling.IreallyhatethatI’msomuchmoreimpatientwithmykidsthanIusedtobebecauseI’msomiserable.But,Ican’tleavethemalone.Idon’ttrustanyoneelsetotakecareofthemthewayIdo.

ChangePlanWorksheet

AchangeIwanttomake…ThereasonswhyIwanttomakethischange…Mystrengthsandskillsthatwillhelpmebesuccessful…Specificwaysotherscanassistandsupportme…Person,program,resourceWaystoassistandsupportThenextstepsIplantotake…HowI’llknowwhenmyplanisworking…WhoI’llturntoifIgetdiscouraged…HowI’llcelebratesuccessesalongtheway…

FourProcessesintheRoundSet-up1.Practiceingroupsofapproximately4-8.2.HavethegroupcomeupwithaclientscenariotopracticeMIskillsthroughthefourprocessesofEngaging,Focusing,Evoking,andPlanning.UselesschallengingscenariosforgroupswhoarenewertoMI,andmorechallengingonesforgroupswithmoreadvancedskills.Choosesomeone,perhapsthepersonwhoidentifiedthescenario,totakeontheclientrole.3.ExplainthatthegroupwillgoaroundthecircleandtaketurnsusingthecoreinterviewingskillsofMI(OARS)tomovethrougheachofthefourprocesses.Beforeeachprocess,thegroupwillfirstdiscusspossiblewaystoapproachthatprocess,andthendebriefwhathappenedaftereachprocessiscompleted.Itmayalsobeusefulinthemidstofpracticetopauseforbriefdiscussion,feedbackorcoaching.ExerciseexampleAfterbrieflydiscussinghowwemightproceedinEngagingwiththis"client,"thepersontotheleftofthe"client"beginstheconversationandstartswithEngaging.Theaimistogoforafewexchanges(usingmorereflectionsthanquestions)beforepassingitontothenextpersontotheleft(aclock-wisemovementaroundthecircle).SeveralpeoplecontinuepracticingEngaginguntilthetrainer/facilitatorcallstimeandthegroupthendebriefs.ThisstructureisfollowedforeachoftheremainingprocessesofFocusing,Evoking,andPlanning.Duringeachprocesspractice,thetrainer/facilitatorallowstheflowtocontinue,ormaychoosetobrieflystopactionandcoachinthemoment,ormayallowthegrouptobrieflydiscussaquestionthatemerges,orsomeonemayofferasuggestiontheyhaveforhowsomeonemightproceed.Thetrainer/facilitatorkeepsaneyeontheclockandmovesthingsalongtoensureallparticipantshaveanopportunitytopractice.AdaptedfromandwiththankstoSandyDowney

MIConversationExerciseInstructions:Considerdoingthisexercisewithalearningpartner.Haveonepersonreadtheclient’spartandonereadthehealthcoach’spart.Initiallyreadthroughtheentireconversationtomakeit“comealive.”ThengobackanddiscussyourobservationsandrespondtothepromptsinColumnB.Key:CLis“client;”HCis“healthcoach.”Assumethatintroductionshavebeenmadeandtheconversationisstarting.ReadtheconversationinColumnAandinColumnBwriteyourobservationsfocusingon:

• Typeofclientspeech:isitsustainorchangetalkoramixofboth• Method(s)usedbythehealthcoachfromOARS+Eandanyspecifictypeof

methodfromtheskillslist:theremaybemorethanoneusedintheexchange,reflection,openquestion,affirmation,summary,exchanginginformation,etc.

• WhatMIprocessisrepresented:Engaging,Focusing,Evoking,Planning• Identifythetypeofsummary(gathering,linkingortransitional)when

instructed:gatheringorcollectinginformationofferedbytheclient;linkingdifferenttopicsexploredtoshineanewlightonthesubject;andtransitional,usuallyaccompaniedbyakeyquestion,whichmovestheconversationfromoneprocesstothenext

• Commentonhowtheclient’schangetalkisacknowledgedandinvitedwhereyounoticeit.

A.Conversation B.ObservationHC:Whatareyourmainconcernstoday?

Method(s):

CL:MydoctorsaidIneededtofocusonmystress,thatthewayIdoordonothandleitiscausingmehealthproblems.

HC:Itwasmoreofyourdoctor’sideaforyoutobeherethanyours.

Method(s):

CL:Well,Iwouldnotbehereotherwise,butIdon’tthinkitisabadidea.

HC:Youhavesomeconcernsyourself.

Method(s):

CL:I’m55yearsold,workatahighstressjobwhereIseeothersmyageoryoungergettinglaidoff.Iworklotsofhourstomakesuretheyseemeasproductive.ThiskeepsmeprettytenseandIguessmydoctorthinksmyhighbloodpressurestaysupbecauseofthisandhowIdoordonothandlethestress.

HC:Youmentionedthatearlier.Tellmewhatgoesonwithyouandstress.

Method(s):

CL:IguessIamlikealotofpeopleIknow.Idon’ttaketimeforlunch,justeatsomethingfast,likeasliceofpizza;Idrinkcoffeeorsomekindofcaffeineallday.OnceIleaveworkandgethome,IhaveafewdrinksatnightandjustsitonthesofaandwatchTVuntilbedtimeandthenIdon’tsleepwell.ThenIgetupanddoitallagain.Ioftenworkonatleastonedayontheweekendandtheotherday,Ijustsitaround,drinksomebeerandwatchsportsonTV.

HC:Averytiring,viciouscycleofyourlifewhereyouareneverquiteoffduty,neverrelaxed.Youdothingsduringthedaytokeepgoingandthenjustcollapseathome.Andyourdoctorhasconcernsaboutyourbloodpressureaswell.

Typeofsummary:

CL:Yougotitright!AtthisrateImaynotevenmakeittoretirement.Imighthaveaheartattackorstrokebeforetheycanevenlaymeoff!

HC:Thisisseriousfromyourpointofview.Whatconcernsyouthemost?

Method(s):

CL:Well,myownfatherdiedwhenhewas59fromaheartattack;hehadhighbloodpressure,nevertookanytimetorelax,andheworkedhimselfintothegrave.

HC:Youcanseeyourselfonthesamepathandthatreallyhasyourattention.

Method(s):

CL:Right!Idon’twantthattohappentomebutIdon’thaveacluewhattodo.Likeyousaid,Iaminacyclehereandjustkeepdoingthesamething.I’mgainingweight,andIfeeltiredallthetime.

HC:Anditseemslikeevenmorethanwhatisgoingonwithyouthathasyouthinkingaboutit;alsowhatyousawhappentoyourfatherhasyouconcerned.Youwanttoavoidthesameoutcomeandarenotsureyetwheretostart.

Typeofsummary:

CL:WhenDr.Jonestoldmeitistimetogetserious,tocometalktoyou,IguessIwasalittlerelieved,thathewassayingIdidn’thavetojustletthishappen,thatmaybeit’snotinevitable.

HC:Yourecognizeitistimetodosomething.Youaretakingresponsibilityandarehopefulwecanfigureoutsomethingthatwouldbehelpful.

Whatistheprocessthusfar?

LetmeseeifIunderstandthusfar,youwanttobehealthierandreducestress,andthewayyouhavebeenhandlingthestressfromyourjobhasn’tbeenhelpingmuch,youfeelevenworse.Youmentionedbeingconcernedaboutyourfoodchoices,sittingaround,notgettingadequateexerciseanddrinkingeachevening.Wheredoyouthinkweshouldstart?

Method(s):Typeofsummary?Whatprocessisnextwiththisquestion?Whydoesthehealthcoachasktheclient,ratherthandecideorbecomedirective?Whatwayofrespondingcouldhavecreateddiscord?

CL:MydoctorthinksIshouldmakeachangeinhowmuchIdrink,kindofashocktome.

HC:Youweresurprised.Whatisyourunderstandingaboutwhyheisfocusingonalcohol?

Method(s):Howisclient’schangetalkacknowledgedorinvited?

CL:Thisiswhathetoldme:alcoholcanraisebloodpressure,disruptsleep,andcauseweightgain.HesaidifIdidbetterwithhowmuchIdrink,thatmighthelp.Nowhedidn’tsayIamanalcoholicandIdon’tthinkIam,justthatsomechangeswouldhelpmeinalotofways.

Typeofclientspeech:

HC:Youdon’twanttobelabeledandatthesametime,youarepayingattentiontowhatyourdoctorsaid.

Whatspecifickindofreflectionisthis?Howcoulddiscordhavebeencreated?

CL:IlikedrinkingbutIdon’twanttomakethingsworseformyself.

Typeofclientspeech:

HC:Youfeeltwowaysaboutthis,notwantingtogiveupapleasureandalsonotwantingtoriskyourhealth.

Whatprocessisstartingnow?Howisclient’schangetalkacknowledgedorinvited?

CL:Drinkinghelpsmerelax,unwindsoifIdon’tdothatasmuch,whatwillIdo?

Typeofclientspeech:

HC:Youdon’twanttobeleftwithnowaytounwind,sinceyourlifeisprettystressful.Ifyouwereconsideringchanginghowyouusealcoholandlookingatsomeotherwaystorelax,whataresomeideasyouhave?

Method(s):

Howisclient’schangetalkacknowledgedorinvited?

CL:InthepastIexercisedandthathelpedinlotsofways:weight,stress,evensleep.Ijuststoppedwhenthisjobbecamesostressful.IgotsoworriedaboutbeinglaidoffatmyagethatIjustletmyselfgo.

Typeofclientspeech:

HC:Notlosingyourjobisanimportantpriorityandyouareaseriousworker.Youhaveusedexerciseinthepasttoreducestress;tellmewhatyoudidandhowthatworkedforyou.

Method(s):

CL:Afterwork,IhadseveralthingsIcoulddointhepast.Iusedtoenjoytennis,goingonavigorouswalk,ridingmybikeintheneighborhood,orevenayogaclasseverynowandthen.

Typeofclientspeech:

HC:Quiteavariety!Ifyouwereconsideringanythingnow,whatmightyouwanttodo?

Method(s):

Howisclient’schangetalkacknowledgedorinvited?

CL:Iguessgettingbacktoanyofthosebutitseemsveryhardtothinkabout.

Typeofclientspeech:

HC:Whatgetsintheway,outsideoftheworryaboutthejobsecurity?

Method(s):

CL:Ithinkjuststartingback;ithasbecomesoeasytogohome,openabeerormakeadrinkandturnonthetelevision.

Typeofclientspeech:

HC:Easytoslideintohabitsthatarenotsogood,you’vegotaccustomedtoitandatthesametimeyouarerecognizingthatthismightbeatimetoconsiderwhathasworkedforyouinthepast.LetmeseeifIhaveitright,theconversationwithyourdoctorgotyourattention,youareconcernedaboutyourhealthandhowthewayyouhandlestressisnothelpingyou,thatyoudon’twanttoenduplikeyourfatherandarestartingtolookatthepatternsyouhavedevelopedwithdrinkingandenjoyingthesofaandTVafterwork.Wheredoyouthinkyouareinbeingreadytoplanonsomechanges?

Method(s):Typeofsummary:Movingintowhatprocess?Howcoulddiscordhavebeencreated?

ThankstoAliHallforthisexercise.

ObserverSheet:SpiritofMI

ListenforhowtheinterviewerconveysthespiritofMIinbodylanguage,wordsandactions.Writedownexamplesintheappropriaterow.Rateeachelementfrom1(low)to5(high). ElementsofMISpirit

Examples

PartnershipDemonstratingprofoundrespectfortheother;bothpartieshaveexpertise;dancingratherthanwrestling12345(low)(high)

AcceptancePrizingtheother’sinherentworthandpotential;providingaccurateempathy;supportingautonomy;affirmingstrengths12345(low)(high)

CompassionComingalongsideinaperson’ssuffering;activelypromotingtheother’swelfare;givingprioritytotheother’sneeds12345(low)(high)

EvocationElicitingtheperson’sownknowledge,wisdom,strengths,andmotivation;“youhavewhatyouneedandtogetherwewillfindit”12345(low)(high)

ObserverSheet:FourProcessesofMI

Listenforhowtheinterviewerguidestheflowoftheconversationamongthefourprocesses.Writeexamplesofwhattheinterviewersaysanddoeswithineachprocess.

FourProcessesofMI

Examplesofwhatinterviewersaysanddoes

EngagingProvidingwarmwelcome,establishingsafetyandtrust,demonstratinggenuineinterest,offeringhopefulpresence

FocusingClarifyingaparticulargoalordirectionforchangetoexplorefurther

EvokingElicitingtheperson’sownmotivationforchange,exploringambivalence,drawingoutdesire,reasons,need,ability,commitmenttochange;askingaboutimportanceandconfidencetochange

PlanningDevelopingaspecificchangeplanthatthepersoniswillingtoimplement

ObserverSheet:OARS+I

Asyouhearexamplesoftheinterviewer’suseoftheOARS+Iskills,placeahashmarkinthatrowandwritedownexamplesofeach.Alsonoteanyroadblocksyoumighthear.InterviewerResponses

Count

Examples

Questions

Open

Closed

Affirmations

ReflectiveStatements

Simple

Complex

Summaries

ProvidingInformationandSuggestionswithpermission

Roadblocks–advising,confronting,teaching

ObserverSheet:ChangeTalk

Listenforexamplesofthefivekindsofclientchangetalk.Asyouhearthem,placeahashmarkintheappropriaterow.Writedownexamplesofeachtypeofchangetalkyouhear.

ChangeTalkType

Count Examples

DesireWant,wish,wouldliketo

AbilityCan,could,wouldbeableto

ReasonsSpecificargumentsorreasonstochange

NeedUrgency,importantto,haveto(withoutstatingspecificreasons)

CommitmentWill,planto,intendto,goingto,willing,ready

MISelf-Appraisal

Astheinterviewer,I…

0-not5-extremelyatallwell

1.Providedasafe,welcomingpresencewithmywordsandactions.Example:

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2.Engagedwithandshowedgenuineinterestintheperson,e.g.,whatsheorheenjoys,needs,values.Example:

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3.Foundoutandclarifiedwhatthepersonwantedtofocusoncurrently.Example:

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4.Helpedexplorebothsidesoftheperson’sdilemma,e.g.,what’sworkingandwhat’snot;upsidesanddownsides.Example:

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5.Avoidedtryingto“fix”theproblemorgetthepersontochangebyadvising,confronting,warning,orteaching.Example:

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6.Elicitedwhatmightbesomepossiblereasonstochange,ifthepersonweretodecidetochange.Example:

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7.Learnedaboutpossiblewaysthatheorshemightgoaboutmakingthischange.Example:

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8.Askedhowimportantitisatthistimeforthepersontomakethischange.Example:

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9.Askedhowconfidentsheorhefeelstobeabletomakethischange.Example:

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10.Inquiredaboutwhatsteps,ifany,thepersonmighttakenext.Example:

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11.Askedpermissionbeforeprovidinginformationorsuggestions.Example:

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12.UsedthecoreskillsofMI(openquestions,affirmations,reflectivelistening,summaries)throughouttheconversation.

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13.ConsistentlydemonstratedthespiritofMI:>Partnership

>Acceptance

>Compassion

>Evocation

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DevelopedbyKenKraybillbasedonMiller,W.R.&Rollnick,S.,MotivationalInterviewing:HelpingPeopleChange,2013