Motivational Interviewing

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Motivational Interviewing

• The Basics

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Clinician role Persuasion

• Explain why s/he should make this change
• Give 3 specific benefits of making the change
• Tell him/her how to change
• Emphasize importance of the change
• Tell the client to do it!

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Debrief

• Readiness is not static
• Importance of matching strategies to readiness
• Role of Ambivalence

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Ambivalence

• Is normal
• Occurs throughout the change process
• Reflects costs and benefits of change and status
  quo
• Is uncomfortable
• May become chronic
• Resolved by client

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Righting Reflex

• Born of concern and caring
• Theres a problem? Lets fix it!
• Fails to consider ambivalence in change process
• May engender resistance

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Therapeutic Traps

• Question-Answer Trap
• Trap of Taking Sides
• Expert Trap
• Labeling Trap
• Premature Focus Trap
• Blaming Trap

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• Talk about something real that you
• Want to change
• Need to change
• Should change
• Have been thinking about changing
• But, havent yet changed.
• Not your deepest, darkest secret!

• Listen carefully - goal to understand the dilemma
• Ask these four questions
• Why would you want to make this change?
• How might you go about it, in order to succeed?
• What are the three best reasons to do it?
• On a scale of 1-10, how important would you say
  it is to make this change? And why are you a ___
  and not zero?

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Change

• Change is more similar than different across
  behaviors
• Change is a process that is continuous like a
  dimmer switch, not discrete like an on/off switch
• Change depends on MOTIVATION which is a state not
  a trait. Its a probability, a likelihood.
• Because of this, there are multiple ways and
  times that change can derail
• Fortunately, there are multiple ways and times to
  facilitate the process

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Stages of ChangeProchaska DiClemente
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Stages of Change Model
Precontemplation Awareness of need to change,
increased concern
Contemplation Increasing the Pros for Change and
decreasing the Cons, Confidence
Preparation Commitment Planning
Relapse and Recycling
Maintenance Integrating Change into Lifestyle
Action Implementing and Revising the Plan
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Processes of Change
Activities initiated or experienced by an
individual in modifying thinking feeling and
behavior related to a particular problem
COGNITIVE/EXPERIENTIAL BEHAVIORAL Consciousness
Raising Self-Liberation
Self-Revaluation Counter-conditionin
g Environmental Reevaluation Stimulus
Control Arousal/Dramatic Relief Contingency-
Management Social Liberation

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To Sum Up

• Change is continuous
• This continuity can be broken up into stages
• Assessment is about getting a sense of stage
• People rely on change process to move through
  stages
• Counselors can help and hinder
• Multiple spirals are the rule
• Motivation is the fuel

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Motivation

• The probability of engaging in and maintaining a
  behavior over time.
• What are the three key words?
• Probability (0 1) not (0 or 1).
• Engage
• Maintain
• Motivation is continuous not dichotomous
• Fluctuating motivation can increase or decrease
  based on your behavior

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Factors Influencing Motivation

• Client Factors
• Health
• Perseverance/Task Persistence
• Task difficulty
• Belief in the efficacy of the program
• Interest level
• Importance
• Confidence
• External barriers
• Values
• Counselor Factors
• Much The Same.

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Motivational Interviewing A Definition

• MI is a collaborative, goal oriented style of
  communication with particular attention to the
  language of change. It is designed to strengthen
  personal motivation for and commitment to a
  specific goal by eliciting and exploring the
  persons own reasons for change within an
  atmosphere of acceptance and compassion.
• http//www.motivationalinterview.org/

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Spirit of MI

• Autonomy
• Personal responsibility
• Neither imposition nor coercion
• Collaboration
• Meeting of aspirations
• Neither exhortation nor persuasion
• Evocation
• Drawing out
• Neither instilling nor installing

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MI Principles

• Express Empathy
• Empathy alone is predictive of change
• Roll w/Resistance
• Verbal judo
• Develop Discrepancy
• Goals and values contrasted with current behavior
• Support Self-Efficacy

• R Resist the righting reflex
• U Understand you clients motivation
• L Listen to you client
• E Empower your client

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MI Fundamental Processes

• These are the phases of the overall process of
  engaging in MI with a client. These phases are
  not rigid and we often move back and forth
  between the phases as we work with clients.
• Engaging The Relational Foundation
• Focusing The Strategic Focus
• Evoking The Meat and Potatoes
• Planning The Bridge to Change
• Often MI is about knowing how to skillfully and
  artfully move back and forth between each process

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How Does MI Work

• Empathy allows clients to reduce resistance and
  resolve ambivalence
• Looking at the situation from their perspective
• People feel understood less resistant
• Selective reinforcement of change talk
• Focus on change talk
• We learn what we believe when we hear ourselves
  speak
• Therapist reinforces change talk that is
  consistent with therapeutic goals (persons
  values)
• Reinforcement further increases change talk and
  allows of client to experience build in
  motivation to change

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Empathic Counseling Style and Patient
ResponseMiller, Benefield Tonigan (1993) JCCP
61 455-461
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Change Talk

• Client utterances that favor change, are linked
  to a specific behavior(s), come from client (in
  most cases), and are in the present tense.
• Preparatory Language (DARN)
• Desire
• I want
• Ability
• Im able
• Reasons (for change)
• Heres why
• Need (disadvantages of status quo)
• If I dont

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Change Talk

• Implementing Language (ACT)
• Activation (prepared, willing)
• Commitment
• Im going to
• I will
• I plan to
• Taking Steps
• I did
• I went
• I started
• It is the change in this talk over the course of
  the session that predicts change

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Commitment Language Pattern A
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Outcomes for Pattern A Group
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Commitment Language Pattern B
Amrhein et al., Journal of Consulting Clinical
Psychology 2003 71862-878
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Outcomes for Pattern B Group