Trainer

Denna Vandersloot, M.Ed.

MOTIVATIONAL

INTERVIEWING:

FOCUSING ON

CHANGE TALK

The ATTC Network

2

Selective eliciting questions

Selective reflections

Selective elaboration

Selective summarizing

Selective affirming

(William Miller , 2010)

HOW MI IS DIRECTIONAL

3

Motivational Interviewing:

Helping People Change

Third Edition

Primary Source

What’s

new…..

4

“A person-centered counseling style

for addressing the common problem

of ambivalence about change.”

A CLINICAL DEFINITION OF MI

Miller & Rollnick, 2013 5

Sustain

Talk

Change

Talk

Ambivalence

6

Partnership

Autonomy

Compassion

Evocation Spirit

of

MI

7

Engaging

Focusing

Evoking

Planning

FOUR PROCESSES OF MI

8

EN

GA

GIN

G

“Shall we travel together?”

9

“Where shall we go?”

FO

CU

SIN

G

10

Whether and Why?

EV

OK

ING

11

“We are usually convinced more

easily by reasons we have found

ourselves than by those that

have occurred to others.”

Blaise Pascal (1623-1662)

12

Recognize

Evoke

Respond

CH

AN

GE

TA

LK

13

PREPARATORY CHANGE TALK

DESIRE

ABILITY

REASON

NEED

WHAT’S NEXT?

COMMITMENT is missing:

“I will…”

“I plan to…”

“I intend to…”

“I am ready to…”

“I will think about…”

“I will consider…”

DARN statements by themselves do not

trigger change.

CHANGE TALK

Preparatory

Desire

Ability

Reason

Need

Mobilizing

Commitment

Activation

Taking Steps

Behavior Change

Am

rhe

in, P.

C., M

ille

r, W

. R

., Y

ah

ne

, C

. E

., P

alm

er,

M.,

& F

ulc

he

r, L

. C

lien

t co

mm

itm

ent

lan

gu

age d

urin

g m

otiva

tio

nal in

terv

iew

ing p

red

icts

dru

g u

se

ou

tco

mes.

Jo

urn

al o

f

Co

nsu

ltin

g a

nd

Clin

ica

l P

sych

olo

gy.V

ol 7

1(5

) O

ct

20

03

, 8

62

-87

8.

Recognize

Evoke

Respond

CH

AN

GE

TA

LK

17

Eliciting Change Talk

Amrhein et al., (2003) 18

Can Counselor Influence

Change Talk?

Glynn & Moyers (2010) 19

Asking evocative questions

Exploring the decisional balance

Good things/Not so good things

Elaboration

Querying extremes

Looking back/looking forward

Exploring goals and values

Using the Importance Ruler

Coming Alongside

HOW DO YOU ELICIT/EVOKE

CHANGE TALK?

20

Providing Feedback

Exploring other’s concerns

Exploring goals and values

Honoring autonomy

“Running Start” technique

WHAT TO DO IF THE PERSON DOESN’T

SEEM TO EVEN BE AMBIVALENT?

21

Recognize

Evoke

Respond

CH

AN

GE

TA

LK

22

Change talk often comes

intertwined with sustain talk

That’s the nature of ambivalence

(Wil l iam Miller, 2010)

SNATCHING CHANGE TALK FROM THE

JAWS OF AMBIVALENCE

23

“I know I should keep taking the medication,

and the voices do stop when I’m taking it, but I

can’t handle the way it makes me feel.”

You don’t like the way the meds make you feel.

You recognize the importance of taking your meds

One reason to take the meds is to stop the voices

SNATCHING CHANGE TALK FROM THE

JAWS OF AMBIVALENCE

24

“I really don’t want to quit cutting altogether, I

know I probably should. I’ve tried to stop

before and it’s hard.”

You really don’t want to stop cutting

You recognize the importance of not cutting

You’re not sure if you can quit.

SNATCHING CHANGE TALK FROM THE

JAWS OF AMBIVALENCE

25

RESPONDING TO CHANGE TALK

ALL EARS

E: Elaborating: Asking for elaboration, more

detail, in what ways, an example, etc.

A: Affirming – commenting positively on the

person’s statement

R: Reflecting, continuing the paragraph, etc.

S: Summarizing – collecting bouquets of

change talk

26

Elaboration/Example

Affirm

Reflect

Summarize

RESPOND USING YOUR EARS

27

Practices using Recognizing, Evoking and

Responding strategies

Work in triads or dyads

Speaker plays role of script

Listener plays role identified on card

Identify change talk (internally)

Use evoking strategy followed by EARS

EVOKING PHASE EXERCISE

28

LISTENER ROLE

1. You are moving from focusing to

evoking

2. Listener: Select 2-3 Evoking strategies

you want to use from card deck

3. Use one strategy at a time and follow

up with EARS before moving to the

next strategy

4. Goal: to practice skills and gather

change talk

29

30

OBSERVER ROLE

• Listen carefully to the speaker and

using the Change Talk Observer

Sheet write-down each piece of

change talk you hear…..

• This is an important role because

you can help your team “WIN”

Mental Shifts:

• Evoke don’t install motivation

• Requires a Focus

• Letting go of gathering the facts first

MI Skills:

• Eliciting change talk strategies

• OARS

• Developing Discrepancy

EVOKING MENTAL SHIFTS & MI SKILLS

31 Miller, 2012

School of Medicine

Department of Public Health and Preventive Medicine

Northwest Frontier Addiction Technology Transfer Center

3181 SW Sam Jackson Park Rd. CB669

Portland, OR 97239

Traci Rieckmann, Ph.D., Principal Investigator

Denna Vandersloot, M.Ed., Project Director

32

Motivational Interviewing (2013), Miller & Rollnick

Enhancing Motivation to change in Substance Abuse

Treatment, Tip 35 www.samhsa.gov National Clearing

House

www.motivationalinterview.net (training tapes,

articles, bibliographies, training opportunities)

www.motivationalinterview.org (MI resources ATTC

website)

Motivational Interviewing in Health Care (2008)

Rollnick, Miller, and Butler.

RESOURCES FOR LEARNING

MOTIVATIONAL INTERVIEWING

33

Miller W. & Rollnick S. (3013) Motivational Interviewing:

Helping People Change .

Rollnick S., Miller, W. and Butler, C. (2008) Motivational

Interviewing in Health Care .

Glenn, L.H., Moyers, T. B. (2010) Chasing Change Talk: The

clinicians role in evoking client language about change.

Journal of Substance Abuse Treatment , 39, 65-70.

Amrhein, P.C. et al. (2003) Client commitment language

during MI predicts drug use outcomes. Journal of

Consulting and Clinical Psychology, 71 (5), 862-878.

D`Ofrino, G. et al. (2005) Yale Brief Negotiated Interview

REFERENCES

34