Motivational Interviewing What Is It? Why Use It? How To

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Motivational Interviewing

• What Is It?
• Why Use It?
• How To Learn It?

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Agenda

• What it is and isnt (briefly, more later)
• Dynamics of change
• Why use it
• How it works
• Applying it in clinical practice
• How to learn it

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Motivational InterviewingWhat Is It?
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Motivational Interviewing

• A person-centered,
• goal-oriented
• method of communication
• for enhancing intrinsic motivation to change
• by exploring and resolving ambivalence.

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Phases of Motivational Interviewing

• Phase I Snow Shoeing
• Resolve ambivalence and build motivation
• Snowshoeing up the mountain

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Phases of Motivational Interviewing

• Phase I Snow Shoeing
• Resolve ambivalence and build motivation
• Snowshoeing up the mountain
• Phase II Skiing
• Strengthen commitment and create a plan
• Skiing down the mountain

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What It Is Not

• Skills training
• Confrontive denial breaker
• Simply sitting there listening and reflecting
• The solution to all client issues and clinician
  headaches

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Dynamics of Change
You would think that.
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The Problem With Them Is.

• They dont see (insight, denial)
• They dont know
• They dont know how
• They dont care

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So The Answer is..

• Give them Insightif they just see they will
  change.
• Give them Knowledge.. if they just know they
  will change.
• Give them Skills.. if you can just teach them
  how to change, then they will change.
• Give them Hell.. if you can make them feel bad
  or afraid enough they will change.

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And Yet.. Sometimes Insight, Knowledge, Skills,
And Feeling Bad Or Fearful Is Still Not Enough
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What Is Happening?
Issues of

• Ambivalence
• Motivation
• Readiness
• Confidence

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Stages of Change

• Precontemplation
• Contemplation
• Determination/Preparation
• Action
• Maintenance
• Prochaska, Norcross, DiClemente

Relapse
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Stages of Change

• 80 of substance abusers are in precontemplation
  or contemplation
• Define success by the movement from one stage to
  the next

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Motivational InterviewingWhy Bother Learning
And Using It?
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Evidence Based
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Miller Hester 1995 Alcohol

• Top
• Brief intervention
• Social skills training
• Motivational enhancement
• Community reinforcement approach
• Behavior contracting

• Bottom
• Relaxation training
• Confrontation
• Psychotherapy
• General alcoholism counseling
• Education

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Miller Hester 2003 Alcohol (adapted post
COMBINE)

• Top
• Brief intervention
• Motivational enhancement
• Community reinforcement approach
• Self-change manual
• Opiate Antagonists (Naltrexone)
• BSCT

• Bottom
• Relaxation training
• Confrontation
• Psychotherapy
• General alcoholism counseling
• Education

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Miller, Zweben Johnson 2006

• Cognitive-behavioral treatment
• Community reinforcement approach
• Motivational interviewing
• Relapse prevention
• Social skills training

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Overview of Treatment Methods

• Build client motivation, readiness and engagement
• Cognitive and behavior skills
• Increasing positive rewards for non-use
• Involve family and social networks
• Think outside the skin
• Appropriate medications

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Some Specific Benefits
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Some Benefits of Motivational Interviewing

• A good preparation for more action-oriented
  treatments
• Gains rapport and reduces resistance
• Increases retention and engagement in treatment
• Resolves ambivalence (prepares for change)
• Increases client motivation and change talk

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Some Benefits of Motivational Interviewing

• Can help increase client confidence
• Reductions in use
• Particularly useful with angry clients and those
  in the early stages of change
• Prevents counselor burnout?

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Benefits For Using With Methamphetamine Users

• Helps deal with paranoia and suspicion
• Effective in dealing with cognitive deficits

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How It Works
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Key Assumptions

• Motivation is interpersonal
• Resistance is interpersonal
• Clinician approach and behaviors matter
• Persuasion is usually not an effective method to
  increase motivation and change

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MI How it Works

• Clinician manages important in-session behaviors
  of client using MI spirit, principles and skills

Interaction of clinician and client
Increase Change talk and Decrease Resistance
Leads to
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Change Talk
Desire Ability Reasons Need Taking Steps
Commitment Strength
Behavior Change
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Resistance

• Arguing
• Interrupting
• Denying
• Ignoring

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MI
Pyramid
Strategies
Principles
Spirit
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Components of MI Spirit

• A Autonomy (vs. authority)
• C Collaboration (vs. confrontation)
• E Evocation (vs. education)

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Basic MI Principles

• D Develop Discrepancy
• R Roll with Resistance
• E Express Empathy
• S Support Self-efficacy

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Develop Discrepancy

• Change is motivated by a perceived discrepancy
  between present behavior and important personal
  goals or values
• The person rather than the counselor should
  present the arguments for change

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Roll with Resistance

• Avoid arguing for change
• Resistance is not directly opposed
• Resistance is a signal to respond differently
• The person is a primary resource in finding
  answers and solutions

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Express Empathy

• Acceptance facilitates change
• Skillful reflective listening is fundamental
• Ambivalence is normal

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Support Self-Efficacy

• A persons belief in the possibility of change
  is an important motivator
• The person, not the counselor, is responsible for
  choosing and carrying out change
• The counselors own belief in the persons
  ability to change becomes a self-fulfilling
  prophecy (HARP)

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Strategies
OARS

• Open Questions
• Affirming
• Listen Reflectively
• Summarizing
• Dunn/MINT

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Change Talk

• Original idea from Bems theory
• I learn what I believe from what I hear myself
  say.

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Eliciting Change TalkA Technique For The Road
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Assessing Importance

• How important on a scale of 1-10?
• 1---x--------------y-------------10
• Why X and not 1?
• What would have to happen for you to go from X to
  Y?

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MI What It Looks Like

• Generally quiet and eliciting
• Is anything going on here?

• The Data Says Yes!

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Using MI In The Clinical Setting
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Into Practice

• As a preparation for more action-oriented forms
  of treatment such as
• CBT
• 12 Step
• Matrix Model
• In individual and group sessions
• More data about using in individual sessions
• Reducing resistance and anger upon entry to
  treatment (and throughout)
• When ambivalence crops up at any point

MI plays well with others
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A Time Not To Use MI

• When the client is clearly ready and committed to
  action

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Learning Motivational Interviewing
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How To Learn It

• Workshops typically equivalent of 2-3 days
• (preferably with follow-up and feedback)
• Reading MI material
• Viewing training videos
• Watching or listening to your own taped sessions
• Supervision and consultation
• Peer encouragement

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Stuck Points in Learning

• Openness to change behavior and maintaining old
  behaviors
• Proficiency in reflective listening
• Eliciting and recognizing change talk
• Summarizing
• Transitioning to other therapeutic methods

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MI Resources

• Motivational Interviewing (2002) 2nd Edition,
  Miller Rollnick, Guilford Press
• Complete description of MI and individual
  chapters on various populations, i.e.
  adolescents, corrections clients,
  clients with COD, etc.
• www.motivationalinterview.org
• Information, training announcements, videos,
  bibliography

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Questions, Maybe Answers
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Contact Information

• Steve Brazill
• 316 304-5272
• sbrazill_at_earthlink.net