motivational interviewing stratis workshop 2017 final · for cme, cne, cphq, nasw, dietit ian, or...

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Motivational Interviewing

Motivational Interviewing

Mia Croyle, MA

Fall 2017

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Continuing Education Disclosures Commercial Support or Sponsorship-None

Speaker or planner conflicts of interest – None

If off-label use, speakers will announce during presentation.No products or services are endorsed by MetaStar

or any accrediting agency.

For CME, CNE, CPHQ, NASW, Dietitian, or attendance certificate -Full session attendance and completion of one on-line evaluation.

Evaluation link –Will be sent to you via email within 24 hours of the session

Or, you can use the QR Code or link on handout.

Thank you!

About Me

Using MI since 2007• Primary Care• Phone coaching• Groups

Training & Coaching MI since 2009

• Healthcare• Social Services• Criminal Justice

Member of Motivational Interviewing Network of Trainers (MINT)

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Objectives

Following this educational opportunity, participants will be better able to:

• Identify the four key domains of the spirit of MI

• Employ the core skills in MI at a basic level• Utilize one MI strategy in current practice• Design a plan for future development

towards proficiency in MI

For Today

– Quiet phones

– Take breaks

– Share our experiences

– Learn from one another

– Adopt a beginner’s mind

– Be willing to “try it on”

– Create a safe space for all

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Comfort Zone

Growth Zone

Shutdown Zone

Best Space for Change

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What do you already know?

(about MI)

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Definition

Motivational interviewing is a

collaborative, 

person‐centered, 

guiding method designed to

elicit and strengthen

motivation for change

Another Definition

• a way of structuring conversations 

• Goal: help other person hear 

themselves talking about their own 

arguments for making changes

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Key Concepts

Reducing resistance

1

Addressing ambivalence

2

Raising discrepancy

3

Eliciting change talk

4

AN EXERCISE

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Without MI

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Spirit of MI

Partnership

Evocation

Compassion

Acceptance

Most people do not listen with the intent to understand; they listen with the intent to reply. 

‐Unknown

Empathy

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Listening

MIND

An Exercise

–Find a partner – someone you don’t know 

well

–Two roles: – Speaker

– Listener

–Decide who will be in which role first

–This is not yet MI – but will stretch some 

needed muscles

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MI Skills

Open QuestionsAffirmationsReflectionsSummaries

Open Questions

yes/no or set responseDon’t ask

for more context, perspectiveAsk

what the question asks for, not the response you getFocus on

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Questions

What brings you here today?

Are you exercising regularly?

Will you try this for one week?

How are you today? 

Did you follow‐up?

How often did you test your sugar?

Are you willing to come back in about a month? 

Can you tell me about that? 

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Open Questions

What…

How….What was that like... Give me an example…

Tell me more about that…..

Are you exercising regularly?

Will you try this for one week?

Did you follow‐up?

Are you willing to come back in about a month? 

Can you tell me about that? 

Opening Up Closed Questions

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Supports enhanced understanding

01Directly ask for change talk

02Maintains engagement

03

Useful Asking

Affirm a person’s struggles, 

achievements, values, and feelings

Emphasize strength Notice and appreciate a positive action

Express positive regard and caring

Not a compliment or praise

Description vs. appraisal

Affirmations

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– Non‐threatening

– Keeps focus on other person’s 

content

– Deepens the conversation

– Helps people better 

understand themselves

– Shapes direction

Reflective Listening

Expand

Refine

Correct

Verify

Etc… 

Reflections offer opportunity for the other person to…

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Repeat

Rephrase

What was said 

• Stabilizing• Empathy• Understanding

• Direction• “I’m listening”• “Go on…”

Simple Reflections

“I don’t know what I’m going to do. Sure, drinking has caused some big hassles lately, but I just really like beer.”

Try It

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Goes beyond what was said

Aims to capture meaning– Feelings– Intent– Interpretation– Metaphor– The next thing

Forward movement

Complex Reflections

“I don’t know what I’m going to do. Sure, drinking has caused some big hassles lately, but I just really like beer.”

Try It

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Questions vs Reflections

–Research says…

–Through the MI Spirit 

perspective...

–And....

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Questions vs Reflections

I had an awful day… My meeting ran late, my husband left the car with an empty gas tank, and then I got a parking ticket!

Q:  How frustrating was that for you?

R: That must have been frustrating.

Questions vs Reflections

I’m very worried about my diabetes. It runs in my family… I’ve lost many relatives to it, and I want to break that cycle.

Q: How many relatives of yours have had diabetes?

Q: How have you thought about breaking the cycle?

Reflections:  

– There is a lot of diabetes in your family.

– You might have some thoughts about how to break that 

cycle.

– You are scared about your diabetes getting worse

(It’s scary to think about your diabetes getting worse)

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Questions vs Reflections

I’ve tried to quit many times in the past…I think I’ve tried just about everything…but it just doesn’t work.

Q: How many times have you tried to quit in the past?Q: What methods have you used in the past?

Simple Reflections:  – You have tried to quit many times in the past– You’ve tried several approaches to quit.

Complex Reflections: – You’ve tried several approaches but they haven’t seemed to work.

– You want to find something that is going to work for you this time.

• Support direction

• Choose  content wisely!

Use strategically

• Capture key ideas & themes

• Change talk

Transitions

• “What’s next?” 

Pair with Key Question

Summary

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Questions

Reflections

Putting the Pieces Together

Sharing Information in the Spirit of MI

Explore

• Existing knowledge

• Interest

• Permission

Offer

• Affirmation

• Information in small bits

• Menu of options

Explore

• Reactions

• Ideas

• Next Steps

• Questions

Ask permission!

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Possible Next Steps

Read, view videos, online 

learning

Experiment on your own

MI Workbook

Join a learning community of 

peers

Record yourself practicing and listen back

Attend an advanced training

Engage a coach

Resources

–Motivational Interviewing Network of Trainers www.motivationalinterviewing.org

–Guilford Press – Applications of 

Motivational Interviewing Series

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Online Resources

– British Medical Journal:  Learning Motivational 

Interviewing

– American Academy of Pediatrics: Change Talk 

– National Institute on Drug Abuse: Blending 

Initiative Motivational Interviewing

– Indiana Prevention Resource Center: 

Introduction to Motivational Interviewing 

– Addiction Transfer Center Network: Tour of 

Motivational Interviewing

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miacroyle@gmail.com

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This material was prepared by Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MN-G1-17-86 101717

Follow us online @LakeSuperiorQIN

Thank you