CCSP Motivational Interviewing:

Skills Building Webinar and Workshop

Denise Barnes, MA, LPC

Member of the Motivational

Interviewer Network of Trainers

Motivational Interviewing (MI)

Why is MI a hot topic these days?

• It can be hard to change

• If you force change, you get push back

• MI helps understand ambivalence

• This can make navigation easier

• It often helps client understand themselves

Learning Objectives At the conclusion of the webinar and

workshop, you will be able to:

• Describe motivational interviewing (MI).

• Identify the four key MI principles and SPIRIT.

• Understand how conversation can facilitate change

• Demonstrate the four MI Skills (OARS)

• Demonstrate basic strategies that will enhance patient readiness to change.

What is MI?

Motivational Interviewing

in a Nutshell

Motivational interviewing is a client-

centered, guiding communication

style for enhancing a person’s

intrinsic motivation for change.

Motivational Interviewing

Developed by William Miller

(University of New Mexico),

Stephen Rollnick (University of

Wales College of Medicine), and

their colleagues over the past two

decades.

MI Spirit - A key foundation

MI Spirit

• Autonomy

• Honoring and supporting client’s personal responsibility for change

• Collaboration

• Meeting of the client’s and professional’s hopes

• Sharing power and respecting dual expertise

• Evocation

• Drawing out client’s concerns, wishes, hopes, strengths, goals, values, and intention

• Compassion

• Demonstrating genuine concern for the wellbeing of your client

MI Spirit from a long time ago…

Out beyond ideas of wrongdoing and

rightdoing, there is a field.

I’ll meet you there.

Rumi, 13th Century poet

Characteristics of an MI Practitioner

• Able to listen with heart and mind

• Genuinely warm and caring

• Respectful of client autonomy

• Collaborative (doesn’t need to always be in charge or take the expert role)

• Appreciate the complexity of your client’s lives and the difficulty of behavior change

Basketball Perception Test

What are the Four Processes of MI

Four Processes of MI

1. Engaging

2. Focusing

3. Evoking

4. Planning

Engaging

Engaging is laying the relational foundation.

Engaging is that beginning process where

you let them know the agenda and how

things works. If an ongoing session, this

might be where you summarize last work

and check in about the current focus.

You can try adding MI spirit in.

Focusing

Focusing involves steering the course of the

conversation in a strategic – and

collaborative - manner.

Evoking

Evoking is drawing out the client views,

beliefs and values – what is important to

them.

The client’s “change talk” , their words that

express interest in changing, are what you

spotlight in your responses.

Planning

Planning in an MI framework is negotiating

goals and plans that name the necessary

actions and commitment needed.

A Final Note on the Processes

• Using all the principles together defines MI

• Using only one or two of them will not

necessarily be MI

• For the best outcome, work toward using

all of these principles with clients

• It does take practice, but with MI spirit and

intention, you can’t go wrong

Not the MI Way

Group Discussion

1 2 3 4 5 6 7 8 9 10 Not Somewhat Highly

at all motivated motivated

motivated

Group Discussion

How motivated was this patient at the beginning of the session?

How motivated was she at the end?

What happened in between?

What specifically did the health care provider do to increase or decrease motivation?

The MI Way

Group Discussion

1 2 3 4 5 6 7 8 9 10 Not Somewhat Highly

at all motivated motivated

motivated

Group Discussion

How motivated was this patient at the beginning of the session?

How motivated was she at the end?

What happened in between?

What specifically did the health care provider do to increase or decrease motivation?

What is Motivation Anyway?

Motivation Is:

An ever changing state (not trait)

Fundamental to change

Fluctuates in response to the influence of others, especially helping professionals and peers

Strongly influenced by the interpersonal “style” of helping professionals

Stages of Change – a process

Precontem-plation

(start here)

Contemplation

Preparation

Action

Maintenance

Relapse is common

Adapted from DiClemente & Prochaska, 1982

Banksy The Dog

Demonstrates…

The Six Stages of Change

1) Pre-contemplation

Perhaps more exercise would do me good

2) Contemplation

To get ready I went shopping for the right work out gear!

3) Preparation

Let’s play ball – I’m ready to go!!!

4) Action

Look at me – I’m still ready for more!!!

5) Maintenance

6) Relapse

Stages of Change – a process

Precontem-plation

(start here)

Contemplation

Preparation

Action

Maintenance

Relapse is common

Adapted from DiClemente & Prochaska, 1982

Why Don’t People Want To Change?

Ambivalence is a normal

part of the process of change.

Successfully addressing

ambivalence is a crucial MI

skill.

The Two Sides of Ambivalence MI model: A schematic…

Ambivalence

ResistanceChange Talk

Importance Confidence

“Resistance”

“Advantages of Status quo”

“Disadvantages of change”

“Pessimism about change”

“Yes, but…”

“Change Talk”

“Disadvantages of Status quo”

“Advantages of change”

“Optimism about change”

“I want to do something different…”

Change Talk = Importance & Confidence

Resistance & Change Talk

Yellow Toadflax

(Butter 'n Eggs)

(WEEDS! )

Yellow

Daffodils

Two Sides of Ambivalence:

=sustain talk

It is not the professional, but the

client who has to make an

argument for change.

MI for pre-contemplation

Let’s practice

Write out any change talk

Analyze the Situation

• Amy is your client.

• What is her Stage of Change

• What are your goals based on

SOC?

• What small seeds of change talk, if

any, did you hear?

• How might you engage Amy and

elicit change talk?

How Best to Enhance Motivation?

ROLL WITH RESISTANCE:

• Avoid getting stuck in a tug-of-war

• Don’t drive into the ditch

• MI is more like dancing than wrestling

• Reflect, Reflect, Reflect…..

Argument Trap

How Best to Enhance Motivation?

Facilitate Change Talk – DARN-C

Disadvantages of not getting screened for cancer

Advantages of being screened

Reasons for screening

Need to be screened

Commitment to be screened

Four MI Skills

Open ended Questions

Reflective Listening

Affirmations

Summary

Can You Recognize Change Talk?

LET’S TAKE THE

CHANGE TALK QUIZ!

(Next 2 slides attached as worksheets

too, so you can bring to training.)

Change

Talk

Quiz

CHANGE TALK QUIZ

1) I’ve been doing better on my blood sugars but I don’t know what my AIC is. Sometimes I cheat on my diet, so I know it’s not as good as it could be.

2) I don’t need to stop drinking soda. I need to cut down for sure, but I don’t

need to stop.

3) This heart-healthy diet is too hard. I can’t figure out all these different kinds of oils and fats. It’s all grease to me.

4) What about exercise? Well, I used to swim every week and I liked it.

5) Yeah, I know I need to get a pap smear but I’ve got a lot of other more

important things to think about right now.

6) You might be good at helping some people, but not me. I need to help myself.

7) Yeah, yeah, yeah … I know smoking is bad for my health. I feel it

sometimes when I run to catch the bus. I can’t breathe like I used to. But cigarettes can be my best friend sometimes, like when I get in from a hard day. There’s nothing that settles me down like a cigarette.

8) Colonoscopies may detect cancer early but just the thought of getting one

makes me sick. I’d much rather try another test, instead, or just take my chances.

9) If I had a symptom, I’d be screened; but I feel fine. I’m not the kind to go

looking for trouble.

10) I like sweets but I’m not crazy about the weight gain.

Coding

Sheet

Change Talk Observed What Occurred Just Before?

Where is the change talk in these statements? Sometimes it

can be more implied than explicitly stated.

You might use your empathy sills to try on the shoes of the

speaker, to see what occurs to you about their situation, and

if any additional aspects of change talk become clearer.

Optional exploration

Two key MI skills are using Open-ended

questions, and Reflections (reflecting back

what you hear).

Over the next weeks, in casual

conversations say at the work water cooler,

try using these skills instead of the usual

way you might converse.

Make notes of what you notice, if anything.

Additional MI

training and

supervision

just ahead