MOTIVATIONAL INTERVIEWING

MOTIVATIONAL INTERVIEWING IS A STYLE FOR:

Avoiding Resistance

Resolving Ambivalence

Inducing Change

MI is not primarily a “nondirective” approach. Although client-centered strategies are employed, the process of eliciting self-motivational

statements is intentional and “directive”

RATIONALE AND BASIC RATIONALE AND BASIC PRINCIPLESPRINCIPLES

Motivational InterviewingMotivational Interviewing• Assumes that responsibility and Assumes that responsibility and

capability for change lies capability for change lies within the clientwithin the client

• Therapist’s task is to create a Therapist’s task is to create a set of conditions that will set of conditions that will enhance the client’s own enhance the client’s own motivation for and motivation for and commitment to changecommitment to change

• Mobilize the clients inner Mobilize the clients inner resources, helping relationships, resources, helping relationships, support intrinsic motivation support intrinsic motivation for changefor change

FIVE BASIC PRINCIPLESFIVE BASIC PRINCIPLES

• Express EmpathyExpress Empathy

• Develop DiscrepancyDevelop Discrepancy

• Avoid ArgumentationAvoid Argumentation

• Roll with ResistanceRoll with Resistance

• Support Self-efficacySupport Self-efficacy

FIVE GENERAL PRINCIPLES OF MOTIVATIONAL INTERVIEWING

EXPRESS EMPATHY

by communicating acceptance of clients as they are, they are freed to change.

Seek to compliment not denigrate (build up)

More listening, not telling

Gentle persuasion

DEVELOP DISCREPANCY

to help clients see and feel how their current behavior threatens important personal goals or is inconsistent with more central personal values.

FIVE GENERAL PRINCIPLES OF MOTIVATIONAL INTERVIEWING

AVOID ARGUMENTATION

counterproductive makes clients

defensive resistance may

indicate a need to change strategies

ROLL WITH RESISTANCE

use resistance to help build motivation

reframe statements acknowledge

ambivalence as natural

FIVE GENERAL PRINCIPLES OF MOTIVATIONAL INTERVIEWING

SUPPORT SELF - EFFICACY

explore past successes in other problem areas and apply to present situation.

Client is responsible for choosing and carrying out personal change.

THOUGHTS FROM RESEARCHTHOUGHTS FROM RESEARCH

This treatment strategy does This treatment strategy does not guide a client step-by-not guide a client step-by-step through recoverystep through recovery

It employs motivational It employs motivational strategies to mobilize the strategies to mobilize the client’s own change client’s own change resourcesresources

It looks at motivating clients It looks at motivating clients through short/brief through short/brief encountersencounters

There is evidence that the There is evidence that the therapeutic “style” forms therapeutic “style” forms the core of Motivational the core of Motivational InterviewingInterviewing• Accurate empathy (Rogers)Accurate empathy (Rogers)

There are six elements that There are six elements that have been described as have been described as active ingredients of the active ingredients of the relatively brief interventions relatively brief interventions that have been shown to that have been shown to induce change in problem induce change in problem behaviors: behaviors: F.R.A.M.E.SF.R.A.M.E.S

F R A M E S

FEEDBACK

very persuasive

use information from an objective intake evaluation as a basis for feedback to build motivation

should be personal, not about general dangers of substance abuse

RESPONSIBILITY

emphasis on client’s personal responsibility and freedom of choice

F R A M E S

ADVICE

giving client clear and direct advice as to the need for change and how it might be accomplished

should be given in a supportive, not authoritarian (domineering) way

MENU to facilitate choice

there must be alternatives from among which to choose

there’s more than one “right way” to change

F R A M E S

EMPATHY maintain a client-

centered approach, listening to and reflecting feelings.

the opposite of confrontation

SELF - EFFICACY communicating

optimism that change can be achieved.

Helping clients develop necessary skills to change

encourage client to feel s/he can change.

PHASE IBUILDING MOTIVATION FOR

CHANGE

ASSESS CLIENT’S CURRENT SITUATION

IDENTIFY PROBLEMS OR ISSUES

EVOKE SELF-MOTIVATIONAL STATEMENTS

PHASE IBUILDING MOTIVATION FOR

CHANGE

FIVE EARLY STRATEGIES IN MI:

OPEN-ENDED QUESTIONS

REFLECTIVE LISTENING

AFFIRMING

SUMMARIZING

ELICITING SELF-MOTIVATIONAL

STATEMENTS

AFFIRMING

Compliments and statements of appreciation and understanding

Shows respect for client and their efforts

“I appreciate how hard it must have been for you to …”

“I think it is great that you…”

“That must have been difficult for you”

“You’re certainly a resourceful person, to have…”

“That’s a real good question”

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

COMPONENTS OF A GOOD SUMMARY STATEMENT

Restates client’s statements regarding problem recognition, concern, reasons for change, and optimism about the change

If client is ambivalent, it is useful to capture both sides (double-sided reflections)

It is legal to include information from other sources (I.e., family, courts, other counselors, etc.)

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?

GOALS FOR EVOKING SELF-MOTIVATIONAL STATEMENTS

How client sees the problem What the client’s concerns are about

the problem Intention to change Belief in their ability to change

(optimism)

STRATEGIES AND TECHNIQUES FOR EVOKING SELF-MOTIVATIONAL

STATEMENTS

EVOCATIVE QUESTIONS using open-ended

questions to ask for statements

DECISIONAL BALANCE discussing pros and

cons

ELABORATION asking for examples

or clarifications

USING EXTREMES imagining the worst

consequences

LOOKING BACK remembering times

before the problem, and comparing to present situation

STRATEGIES AND TECHNIQUES FOR EVOKING SELF-MOTIVATIONAL

STATEMENTS

LOOKING FORWARD envisioning a changed future

EXPLORING GOALS discussing client’s most important values and/or

goals

PARADOX agreeing with client’s perception of “no

problem” in order to evoke the opposite behavior

USING ASSESSMENT / FEEDBACK TO BOOST MOTIVATION

WHAT ASSESSMENT RESULTS TO COVER IN FEEDBACK?

Choose parts of the assessment / evaluation package already used, e.g.

Results of any medical tests Results of diagnostic interview / checklist Any test scores / results that compare clients to others (the

general population / norms) Problem areas that are related to substance use (e.g.

Employment, family problems)

USING ASSESSMENT RESULTS / FEEDBACK

WITH WHAT STYLE TO GIVE FEEDBACK?

Empathy - check in with client to see their reaction to feedback. Try to keep resistance down to they can “take in” feedback and use it

Developing Discrepancy

Avoid Argumentation

Roll With Resistance don’t insist the client accept everything you’re saying

Self-Efficacy encourage client; be optimistic about change

PHASE IISTRENGTHENING COMMITMENT

TO CHANGE

SIGNS OF READINESS FOR CHANGE Decreased resistance Decreased questions about the problem Resolve Self-motivational statements Increased questions about change Envisioning Experimenting

PHASE IISTRENGTHENING COMMITMENT

TO CHANGE

Client is ready to change

Client has not made a firm commitment to change

Contemplation / Preparation

PHASE IISTEPS TO STRENGTHENING COMMITMENT TO CHANGE

RECAPITULATION

summarize the client’s current situation based on your interaction in order to evaluate what to do next

KEY QUESTIONS

ask clients what they want to do

use open-ended questions

encourages client to reflect and talk about change

PHASE IISTEPS TO STRENGTHENING COMMITMENT TO CHANGE

INFORMATION AND ADVICE

in response to client questions, provide the information or ideas

wait for invitation from client to provide advice

do not fall prey to the “yes, but” pattern

NEGOTIATING A PLAN

set goals

consider change options

arrive at a plan

PHASE IISTRENGTHENING COMMITMENT

TO CHANGE

HAZARDS Understanding Ambivalence

does not disappear quickly

Overprescription developing a plan that is unacceptable to the

client

Insufficient direction providing too little guidance / direction

NON-VERBAL ROLES

What it was like growing up in my home

Ways in which I have changed as a person over the years

The good things and not so good things about my high school years

What I hope and plan to do over the next ten years

Describe one of your parents, or someone else close to you

How I came to do the kind of work I am doing