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Motivational Interviewingfor
Family Planning Providers
Motivational Interviewingfor
Family Planning Providers
Developed By:Developed By:
DisclosureDisclosure
••I have no real or perceived vestedI have no real or perceived vestedinterests that relate to thisinterests that relate to thispresentation nor do I have anypresentation nor do I have anyrelationships with pharmaceuticalrelationships with pharmaceuticalcompanies, biomedical devicecompanies, biomedical devicemanufacturers, and/or othermanufacturers, and/or othercorporations whose products orcorporations whose products orservices are related to pertinentservices are related to pertinenttherapeutic areas.therapeutic areas.
To provide the underlying spirit and approach ofMotivational Interviewing
To recognize reflective listening responses andapply them appropriately to client situations
To recognize change talk and be able to evoke itusing proper motivational interviewing methods
To list and demonstrate several differentstrategies for eliciting change talk
To provide the underlying spirit and approach ofMotivational Interviewing
To recognize reflective listening responses andapply them appropriately to client situations
To recognize change talk and be able to evoke itusing proper motivational interviewing methods
To list and demonstrate several differentstrategies for eliciting change talk
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Motivational InterviewingMotivational Interviewing
Introduction & PerspectivesIntroduction & Perspectives
Drs. Miller, Rollnick & MoyersDrs. Miller, Rollnick & Moyers
Early approach:
Doctor or therapist seen asexpert whose task wasto… educate persuade cajole confront or coerce
Early approach:
Doctor or therapist seen asexpert whose task wasto… educate persuade cajole confront or coerce
Motivational Interviewing from the work of Miller and RollnickMotivational Interviewing from the work of Miller and Rollnick
Overview of the Spirit of MotivationalInterviewing
Overview of the Spirit of MotivationalInterviewing
Emphasis was on …
conditioning
medicating
punishing
training
humiliating
Emphasis was on …
conditioning
medicating
punishing
training
humiliating
MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING
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MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING
Why Use Motivational Interviewing?
Intuitive
Focused
Helpful with difficult clients / situations
Useful in short, brief encounters
Why Use Motivational Interviewing?
Intuitive
Focused
Helpful with difficult clients / situations
Useful in short, brief encounters
Motivational InterviewingMotivational Interviewing
Central to the efficacy of MIquality of accurate empathy
Blended with other interpersonalskills
Characterized bycollaboration rather than prescription
respect for and honoring client autonomy
evoking motivation rather than trying to install it
Central to the efficacy of MIquality of accurate empathy
Blended with other interpersonalskills
Characterized bycollaboration rather than prescription
respect for and honoring client autonomy
evoking motivation rather than trying to install it
Motivational InterviewingMotivational InterviewingWorks by causing clients to
verbalize their own arguments forchange
Change Talk
client expressing
disadvantages of status quo
advantages of changing
ability to change
intention to change
Works by causing clients toverbalize their own arguments for
change
Change Talk
client expressing
disadvantages of status quo
advantages of changing
ability to change
intention to change
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Evoking Self-Motivational Statements
Problem Recognition (I’ve noticed that lately…)
Concern (I am beginning to feel…)
Intent to Change (I am going to do something, I justdon’t know what)
Optimism for Change (I know I can do better or Iwant to do better)
Evoking Self-Motivational Statements
Problem Recognition (I’ve noticed that lately…)
Concern (I am beginning to feel…)
Intent to Change (I am going to do something, I justdon’t know what)
Optimism for Change (I know I can do better or Iwant to do better)
Change TalkChange Talk
Counsel in a way that invites the person to makethe arguments for change
Common dimensions to ask about (DARN)
Desire - want, prefer, wish, etc.
Ability - able, can, could, possible
Reasons - specific arguments for change - Why do it?
Need - important, have to, need to, matter, got to
Commitment to change
Counsel in a way that invites the person to makethe arguments for change
Common dimensions to ask about (DARN)
Desire - want, prefer, wish, etc.
Ability - able, can, could, possible
Reasons - specific arguments for change - Why do it?
Need - important, have to, need to, matter, got to
Commitment to change
RATIONALE AND BASICPRINCIPLES
RATIONALE AND BASICPRINCIPLES
MOTIVATIONAL INTERVIEWING
• Responsibility and capability for changelies within the client.
MOTIVATIONAL INTERVIEWING
• Responsibility and capability for changelies within the client.
Task to create a set of conditions thatwill enhance the client’s own motivationfor and commitment to change.
Task to create a set of conditions thatwill enhance the client’s own motivationfor and commitment to change.
Mobilize the client’s inner resources,helping relationships, support intrinsicmotivation for change
Mobilize the client’s inner resources,helping relationships, support intrinsicmotivation for change
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Can be used for:
Lessening resistance
Resolving ambivalence
AmbivalenceMixed feelings or emotions; simultaneous and
contradictory attitudes or feelings
Inducing changeeliciting self-motivational statements
Can be used for:
Lessening resistance
Resolving ambivalence
AmbivalenceMixed feelings or emotions; simultaneous and
contradictory attitudes or feelings
Inducing changeeliciting self-motivational statements
MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING
What MotivationalInterviewing is
NOT…
What MotivationalInterviewing is
NOT…
Some of the key signals are:
1. You are speaking slowly.
2. The client is doing much more of the talkingthan you.
3. The patient/client is actively talking aboutbehavior change.
4. You are listening very carefully and gentlydirecting the interview at appropriatemoments.
Some of the key signals are:
1. You are speaking slowly.
2. The client is doing much more of the talkingthan you.
3. The patient/client is actively talking aboutbehavior change.
4. You are listening very carefully and gentlydirecting the interview at appropriatemoments.
How Do You Know When You Got ItRight?
How Do You Know When You Got ItRight?
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Eight Skills in LearningMotivational InterviewingEight Skills in Learning
Motivational Interviewing1. Openness to the underlying
assumptions and spirit of the method• collaborative rather than prescriptive
• eliciting motivation rather than installing it
• honoring client autonomy –non-confrontational
2. Developing proficiency ininterpersonal skills of client-centeredcounseling• accurate empathy
• skill & comfort in forming accurate reflections
1. Openness to the underlyingassumptions and spirit of the method• collaborative rather than prescriptive
• eliciting motivation rather than installing it
• honoring client autonomy –non-confrontational
2. Developing proficiency ininterpersonal skills of client-centeredcounseling• accurate empathy
• skill & comfort in forming accurate reflections
3.Recognizing “change talk”anddistinguishing it from other formsof client’s ways of speaking.
4.Learning to elicit change talk(evocation) and to reinforce it
5.Learning to minimize resistanceand how to respond to “sustaintalk”
3.Recognizing “change talk”anddistinguishing it from other formsof client’s ways of speaking.
4.Learning to elicit change talk(evocation) and to reinforce it
5.Learning to minimize resistanceand how to respond to “sustaintalk”
6.Knowing when client is ready todiscuss a change plan that is theirown.
7.Continuing to elicit client’scommitment to the change plan.
8.Flexibly blending MI with othertherapeutic methods.
6.Knowing when client is ready todiscuss a change plan that is theirown.
7.Continuing to elicit client’scommitment to the change plan.
8.Flexibly blending MI with othertherapeutic methods.
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FOUR BASIC PRINCIPLESFOUR BASIC PRINCIPLES
EXPRESS EMPATHY
DEVELOP DISCREPANCY
ROLL WITH RESISTANCE
SUPPORT SELF-EFFICACY
EXPRESS EMPATHY
DEVELOP DISCREPANCY
ROLL WITH RESISTANCE
SUPPORT SELF-EFFICACY
EXPRESS EMPATHYEXPRESS EMPATHY
Acceptance facilitates change
Understanding client’s feelingsand perspectives withoutjudging, criticizing, or blamingthrough skillful reflectivelistening
Ambivalence is seen as anormal part of change
Acceptance facilitates change
Understanding client’s feelingsand perspectives withoutjudging, criticizing, or blamingthrough skillful reflectivelistening
Ambivalence is seen as anormal part of change
DEVELOP the DISCREPANCYDEVELOP the DISCREPANCY
The client rather than theworker should present the
arguments for change
Change is motivated by a perceived
conflict between present behavior
and important personal goals or
values
The client rather than theworker should present the
arguments for change
Change is motivated by a perceived
conflict between present behavior
and important personal goals or
values
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ROLL WITH RESISTANCEROLL WITH RESISTANCEAvoid arguing for change
Client Should not be directly opposed
New perspectives are invited but notimposed
A signal to change strategy and responddifferently
Includes involving the client actively inthe process of problem-solving
Avoid arguing for change
Client Should not be directly opposed
New perspectives are invited but notimposed
A signal to change strategy and responddifferently
Includes involving the client actively inthe process of problem-solving
SUPPORT SELF-EFFICACYSUPPORT SELF-EFFICACY
Belief in the possibility of change
The client, not the worker, is responsiblefor choosing and carrying out change
Worker’s belief in the client’s ability tochange
A reasonably good predictor of treatmentoutcomes
Enhances a client’s confidence in his/hercapability to cope with obstacles and tosucceed in change
Belief in the possibility of change
The client, not the worker, is responsiblefor choosing and carrying out change
Worker’s belief in the client’s ability tochange
A reasonably good predictor of treatmentoutcomes
Enhances a client’s confidence in his/hercapability to cope with obstacles and tosucceed in change
Counselors’role is not a directive oneof providing solutions, suggestions, or
analysis.
Instead, the counselor need only offerthree critical conditions to prepare
the way for natural change:
Accurate empathy
Non-possessive warmth
Genuineness(Carl Rogers)
Counselors’role is not a directive oneof providing solutions, suggestions, or
analysis.
Instead, the counselor need only offerthree critical conditions to prepare
the way for natural change:
Accurate empathy
Non-possessive warmth
Genuineness(Carl Rogers)
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Phases ofMotivational Interviewing
Phases ofMotivational Interviewing
Phase IPhase IBuilding Motivation to Change
Has implications to the earlier stages of change
Assessing current situation
Identifying problems or issues
Evoking self-motivational statements
Building Motivation to ChangeHas implications to the earlier stages of change
Assessing current situation
Identifying problems or issues
Evoking self-motivational statements
Increasing motivation to change
Recognizing Readiness to Change
Recapitulation
Key Questions
Increasing motivation to change
Recognizing Readiness to Change
Recapitulation
Key Questions
Phases ofMotivational Interviewing
Phases ofMotivational Interviewing
Phase IIStrengthening Commitment to
ChangeMost useful in later stages of change
Phase IIStrengthening Commitment to
ChangeMost useful in later stages of change
Question / Answer Trap
Confrontation / Denial Trap
Labeling Trap
Expert Trap
Premature Focus Trap
Blaming Trap
Question / Answer Trap
Confrontation / Denial Trap
Labeling Trap
Expert Trap
Premature Focus Trap
Blaming Trap
Traps to AvoidPhase I
Traps to AvoidPhase I
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OPEN-ENDED QUESTIONS
AFFIRMATIONS
REFLECTIVE LISTENING
SUMMARIZING
OPEN-ENDED QUESTIONS
AFFIRMATIONS
REFLECTIVE LISTENING
SUMMARIZINGForms the acronym OARSForms the acronym OARS
Motivational Interviewing from the work of Miller and RollnickMotivational Interviewing from the work of Miller and Rollnick
•RepeatingStating exactly what was said
•ParaphrasingStating what was said in your own words
•ReframingPutting an issue in a different context
•Feelings (Deepest Level)
Naming the emotions attached to the content
•RepeatingStating exactly what was said
•ParaphrasingStating what was said in your own words
•ReframingPutting an issue in a different context
•Feelings (Deepest Level)
Naming the emotions attached to the content
Early StrategiesEarly Strategies
Motivational Interviewing from the work of Miller and RollnickMotivational Interviewing from the work of Miller and Rollnick
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OPEN-ENDED QUESTIONS•Questions that do not invite brief
answers of “yes”or “no”
•Used to encourage clients to talk
•Client should do most of thetalking
•Helper listens and encourages
OPEN-ENDED QUESTIONS•Questions that do not invite brief
answers of “yes”or “no”
•Used to encourage clients to talk
•Client should do most of thetalking
•Helper listens and encouragesMotivational Interviewing from the work of Miller and RollnickMotivational Interviewing from the work of Miller and Rollnick
AFFIRMATIONS
•Another way of building rapport
•Compliments or statements ofappreciation and understanding
•To acknowledge and affirm client’sstrengths and efforts
AFFIRMATIONS
•Another way of building rapport
•Compliments or statements ofappreciation and understanding
•To acknowledge and affirm client’sstrengths and efforts
Motivational Interviewing from the work of Miller and RollnickMotivational Interviewing from the work of Miller and Rollnick
REFLECTIVE LISTENINGOne of the most important /
challenging skills in MI
REFLECTIVE LISTENINGOne of the most important /
challenging skills in MI
Simple ReflectionAmplified Reflections
Double-sided Reflections
Simple ReflectionAmplified Reflections
Double-sided Reflections
Motivational Interviewing from the work of Miller and RollnickMotivational Interviewing from the work of Miller and Rollnick
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SUMMARIZING•Used to link together material that has been
discussed.
•Should be done periodically.
•Reinforces what has been said.
•Shows that you have been listening carefully.
•Prepares the client to move on.
•One of the more “directive”applications of MI
SUMMARIZING•Used to link together material that has been
discussed.
•Should be done periodically.
•Reinforces what has been said.
•Shows that you have been listening carefully.
•Prepares the client to move on.
•One of the more “directive”applications of MI
Motivational Interviewing from the work of Miller and RollnickMotivational Interviewing from the work of Miller and Rollnick
COMPONENTS OF A GOOD SUMMARYSTATEMENT
COMPONENTS OF A GOOD SUMMARYSTATEMENT
•Restates client’s statements regardingproblem recognition, concern, reasons forchange, and optimism about the change
•Don’t ramble - be concise
•End with an invitation for client to respond:How did I do? If this is a fair summary, are there other points? Is there anything you want to correct or add?
•Restates client’s statements regardingproblem recognition, concern, reasons forchange, and optimism about the change
•Don’t ramble - be concise
•End with an invitation for client to respond:How did I do? If this is a fair summary, are there other points? Is there anything you want to correct or add?
Motivational Interviewing from the work of Miller and RollnickMotivational Interviewing from the work of Miller and Rollnick
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Empathic ListeningEmpathic Listening
Using the skills of earlystrategies in MI
Using the skills of earlystrategies in MI
• This person OUGHT to change.
• This person WANTS to change.
• This patient’s health is the prime motivating factor for him/her.
• If he or she does not decide to change, the consultation has
failed.
• Clients are either motivated to change or not.
• Now is the right time to consider change.
• A tough approach is always best.
• I’m the expert; he or she must follow my advice.
• This person OUGHT to change.
• This person WANTS to change.
• This patient’s health is the prime motivating factor for him/her.
• If he or she does not decide to change, the consultation has
failed.
• Clients are either motivated to change or not.
• Now is the right time to consider change.
• A tough approach is always best.
• I’m the expert; he or she must follow my advice.
Watch Your AssumptionsWatch Your AssumptionsMany behavior change consultations fail becausethe practitioner falls into the trap of making falseassumptions.
Consider these:
Many behavior change consultations fail becausethe practitioner falls into the trap of making falseassumptions.
Consider these:
CashRegisterActivity
CashRegisterActivity
ACTIVE LISTENINGACTIVE LISTENING
111
222
333
What I meanor feel
What I meanor feel
What Iunderstand
What Iunderstand
What I sayWhat I say What I hearWhat I hear
CLIENTCLIENT PRACTITIONERPRACTITIONER
(Gordon 1970, Miller & Jackson 1985)(Gordon 1970, Miller & Jackson 1985)
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Many statements can have multiple meanings,and your challenge is to identify one meaning
that the client is trying to express
Many statements can have multiple meanings,and your challenge is to identify one meaning
that the client is trying to express
“I wish I were more sociable”“I wish I were more sociable”•“I feel lonely and I want to have more friends”
•“I get very nervous when I have to talk tostrangers”
•“I should spend more time getting to know people”
•“I would like to be popular”
•“I can’t think of anything to say when I’m withpeople”
•“People don’t invite me to their parties”
•“I feel lonely and I want to have more friends”
•“I get very nervous when I have to talk tostrangers”
•“I should spend more time getting to know people”
•“I would like to be popular”
•“I can’t think of anything to say when I’m withpeople”
•“People don’t invite me to their parties”
Active Listening ActivityActive Listening Activity
Not Ready Unsure Ready Trying Done
0 1 2 3 4 5 6 7 8 9 10
Precontemplation Contemplation Preparation Action Maintenance
1
2
3
1
2
3Motivational Interviewing –Phase I Motivational Interviewing –Phase IIMotivational Interviewing –Phase I Motivational Interviewing –Phase II
Readiness Ruler adapted from Stoff et al 1995 & Thomas GordonReadiness Ruler adapted from Stoff et al 1995 & Thomas Gordon
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ASSESS IMPORTANCE,CONFIDENCE AND READINESS
It seems that some people cannotchange and others do not want to.
Having agreed to talk about aparticular behavior there are a numberof directions one could take.
It has been found that the assessmentof “importance”and “confidence”is auseful first step.
ASSESS IMPORTANCE,CONFIDENCE AND READINESS
It seems that some people cannotchange and others do not want to.
Having agreed to talk about aparticular behavior there are a numberof directions one could take.
It has been found that the assessmentof “importance”and “confidence”is auseful first step.
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HIGH IMPORTANCE
HIGH CONFIDENCE
HIGH IMPORTANCE
HIGH CONFIDENCE
LOW IMPORTANCE
HIGH CONFIDENCE
LOW IMPORTANCE
HIGH CONFIDENCE
LOW IMPORTANCE
LOW CONFIDENCE
LOW IMPORTANCE
LOW CONFIDENCE
HIGH IMPORTANCE
LOW CONFIDENCE
HIGH IMPORTANCE
LOW CONFIDENCE
Negotiating a ChangePlan
Negotiating a ChangePlan
1. Setting goals
2. Considering change options
3. Arriving at a plan
4. Eliciting commitment
1. Setting goals
2. Considering change options
3. Arriving at a plan
4. Eliciting commitment
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