Motivational Interviewing

Preparing People for Change

Michaelene Spence MA LADC

February 10, 2010 Adapted from Ken Kraybill, MSW

Center for Social Innovation

Motivational Interviewing

A person-centered, goal-oriented, guiding method of communication to enhance motivation to change by exploring and

resolving ambivalence

Miller & Rollnick, 2002 (adapted)

Or…

Helping people talk themselves into changing

"I learn what I believe as I hear

myself speak.“ D. Bem

WHAT MI IS NOT… Youtube Video- Stop It!

2 Key Aspects • Ambivalence

Uncertainty or Fluctuation

Perceived inability to make a choice

Simultaneous desire to say or do two conflicting or opposing things

The coexistence of positive and negative feelings toward a situation

• Target Behavior

The identified behavior that needs

changing

Goal behavior

Desired behavior

Target Behaviors

• What are examples of Target Behaviors you are currently working on with your clients? – Taking meds as prescribed – Attending self help groups, therapy, appointments, etc. – Getting their children on a bedtime routine – Exercising – Quitting smoking – Eating better – Getting a job – Enrolling in school – More examples….

Four principles of Motivational Interviewing

• Express empathy

• Develop discrepancy

• Roll with resistance

• Support self-efficacy

1. Express empathy

● Acceptance facilitates change

● Skillful reflective listening is fundamental

● Ambivalence is normal

2. Develop discrepancy

● Change is motivated by perceived discrepancy between present behavior and important personal goals/values.

●Client rather than clinician should present arguments for change.

3. Roll with resistance

● Avoid arguing for change

● Resistance is not directly opposed

● New perspectives are offered, but not imposed

● Client is primary resource in finding answers

● Resistance is a signal to respond differently

4. Support self-efficacy

● Belief in the possibility of change is an important motivator

● Client, not the counselor, is responsible for choosing and implementing change

● Provider’s own belief in the person’s ability to change becomes a self-fulfilling prophecy

OARS: Basic skills of Motivational Interviewing

• Open Questions

• Affirmations

• Reflective Listening

• Summaries

Motivational Interviewing is not a series of techniques for

doing therapy but instead is a way of being with patients.

William Miller, Ph.D.

Open Questions

Open questions:

• Encourage people to talk about whatever is important to them, or to elaborate on something

• Opposite of closed questions that elicit a limited response, or lead in a specific direction

• Help establish rapport, gather information, increase understanding

• Demonstrate genuine interest and respect

• Invite others to “tell their story” in their own words

• Affirm autonomy and self-direction

• Provide opportunity for person to “learn what I believe as I hear myself speak."

Sound like…

How have things been going?

What was that like?

What have you noticed about ____?

What are your concerns about taking these pills?

Hmm… Interesting… Tell me more…

When would you be most likely to share needles?

How would you like things to be different?

What will you lose/gain if you give up drinking?

How did you manage that in the past?

What do you want to do next?

How can I help you with that?

Guidelines: Open Questions

• Use open questions to seek to understand, and to guide the conversation

• Ask twice as many open questions as closed questions

• Keep questions clear and brief

• Avoid negating open questions with closed ones – e.g. How is it going? Have you been taking your medications?

OARS: Affirmations

● Statements that recognize individual’s strengths, personal qualities, core values

● Build confidence in ability to change

● Must be congruent and genuine

● Different from praise which can be useful external tool to reinforce

Sound like…

• You were very kind towards…

• I noticed that you…

• You showed a lot of patience…

• You are a courageous person to…

• You really value being…

• I wonder how you found the strength to…

• That took a lot of persistence to…

• Thank you for…

OARS: Reflective Listening

Reflective listening is the key to this work. The best motivational advice we can give you is to listen carefully

to your clients. They will tell you what has worked and what hasn't.

What moved them forward and shifted them backward. Whenever you are in doubt about what to do,

listen.

Miller & Rollnick, 2002

Reflective Listening

A way of checking rather than assuming you know what

someone means.

Miller & Rollnick, 2002

Levels of Reflection

SIMPLE Repeating or rephrasing – listener repeats

or substitutes words or phrases; stays close to what speaker said

COMPLEX Paraphrasing – listener makes a major

restatement that infers or guesses the speaker’s meaning

Reflection of feeling – emphasizes the emotional aspects of communication; deepest form of listening

Forming Reflections

• Appears deceptively easy, but requires practice

• Statement, not a question, voice turns down at end

• Common word is “you”

• Complete the paragraph

You…

So you…

It sounds like you…

You’re wondering…

That would be…for you

OARS: Summarizing “Let me see if I understand thus far…”

● Special form of reflective listening

● Ensures clear communication

● Use at transitions in conversation

● Be concise

● Reflect ambivalence

● Accentuate “change talk”

SAME SUBJECT- DIFFERENT TECHNIQUE

Let’s try this again...

How do we get people to start thinking about change?

• Don’t forget to listen for Change Talk

Weigh out the costs and benefits, pros and cons (or rather cons and pros) of behavior

Use Change Talk strategies

Ask them to imagine making the change and what steps they think they may need to take if they were serious about change

Use Change Talk worksheet

Ask if you can make suggestions