Motivational Interviewing

Introductory Workshop – part 1

Anya Sheftel, M.S.

University of Oregon

Member of international

Motivational Interviewing Network of Trainers

www.motivationalinterview.org

Purpose:

The purpose of this presentation is to give you a “taste” of MI. After this presentation you will be able to describe MI. You also will be familiar with basic MI concepts.

Should you want an in-depth training in MI, please contact me.

Agenda:

Definition of MI Ambivalence Motivation for Change MI Spirit MI Principles OARS Debrief

Motivational Interviewing

Client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Miller & Rollnick, 2002).

What Does It Mean?

“We emphasize that MI is a method of communication rather than a set of techniques. It is not a bag of tricks for getting people to do what they don’t want to do. It is not something that one does to people; rather, it is a fundamental way of being with and for people - a facilitative approach to communication that evokes natural change” (Miller & Rollnick, 2002).

Applications of MI

Alcohol and Drug Abuse and Dependence

Co-Occurring Disorders

Eating Disorders Behavioral

Medicine Medical Settings

(Practice, ER, Hospital)

Medication Adherence Weight Management Sexual Risk Reduction

(HIV, STD, Pregnancy) Criminal Justice Psychiatric Disorders

(Depression, Anxiety, Psychosis)

Why MI?

Brief

Additive

Effective

Why Don’t People Want To Change?

Positives of Positives of Current BehaviorCurrent Behavior

Coping with stress

Social connections

Stable sense of self

Negatives of Negatives of

ChangeChange

Increased frustrationSocial isolationPainful self-

recognition (guilt and shame)

You will come to a place where the streets are not marked.Some windows are lighted. But mostly they're darked.

A place you could sprain both you elbow and chin!Do you dare to stay out? Do you dare to go in?

How much can you lose? How much can you win?

And IF you go in, should you turn left or right...or right-and-three-quarters? Or, maybe, not quite?

Or go around back and sneak in from behind?Simple it's not, I'm afraid you will find,

for a mind-maker-upper to make up his mind.

You can get so confusedthat you'll start in to race

down long wiggled roads at a break-necking paceand grind on for miles across weirdish wild space,

headed, I fear, toward a most useless place.The Waiting Place...

- Dr. Seuss

Ambivalence

Exercise

Think of a change that you’ve been thinking about (health, lifestyle, education, etc), but haven’t made yet.

For how long have you been thinking about making this change?

By the end of the hour you have to tell me how exactly you are going to make this change.

How did it feel to hear me say this? What did you want to say to me?

If ambivalence is not overcome through education, persuasion, or pressure, how it is resolved?

It is not the professional, but the client who has to make an argument for change

Motivation for Change“Ready, Willing & Able”

WillingImportance of Change

AbleConfidence for Change

ReadyRelative Priority for Change

What would be helpful and supportive

to YOU?

MI Spirit

AutonomyHonoring and supporting client’s personal

responsibility for change

CollaborationMeeting of the client’s and professional’s

aspirations

EvocationDrawing out client’s concerns, wishes, hopes,

strengths, goals, values, and intentions

MI Principles Express Empathy:

Intra-view – understand where the client is coming from; understand their story and their ambivalence.

Develop Discrepancy: Help the client see that the current behavior does not fit in with

his/her goals and values. “On one hand, going to college is very important to you. On the

other hand, you keep missing classes. Help me understand how these two things fit together.”

Roll with Resistance: Wrestling versus Dancing. Don’t get stuck in a tug-of-war. Drive into the ditch.

Support Self-Efficacy: The client is the expert on change. He/She has accomplished

change in the past. Build on it.

How to do it?

Resist the Righting Reflex! Comes from a helpful place: We have a problem? Let’s fix it. It shuts out the client.

You know that this is the right thing for you.Here is how you should do it.This is extremely important!What do you mean you don’t want to? Don’t you want what’s

best for you?

Instead, IntraView Want to understand the client’s point of view. Collaboration.

What are some of the good things about change?Tell me why you think this is important.Tell me more about what you think.What do you want to do?

Core Skills – “OARS”

Open-ended questions

Affirmations

Reflections

Summaries

Close-Ended Questions

Yes/No responseDid you apply to this job?Did you miss class?Do you like chocolate?

Limited range of informationHow many classes are you taking this term?Was were your SAT scores?

Open-Ended Questions

Wide range of responses Seek information, invite client’s perspective,

encourage self- exploration

Where do you see yourself in 5 years?Tell me more.What else?What do you make of that?What do you like about coming here?

Open-Ended Questions: Exercise

Is there anything you like about school?

Did you miss class?

Do you want to go to college?

Did you do your homework?

Did you fill out your job application?

Did you call U of O to see if they offer classes in the summer?

Is there anything else?

Core Skills – “OARS”

Open-ended questions

Affirmations

Reflections

Summaries

Affirmations

Express appreciation of who the client is, or what s/he has done

Provide supportStrengthen rapportSupport self-efficacy

I really appreciate your willingness to be so honest with me.

It’s not easy to keep trying when things aren’t going so well, and yet you haven’t given up.

Affirmations are like salt – a little goes a long way.

Affirmations: Exercise

I really like your shoes.

Thank you for coming in to see me even though you’ve had a rough day.

You missed class again??

You worked really hard and succeeded.

Thank you for sharing this with me.

I know that this math class is hard and I am impressed with how well you’ve done in it.

Cute hair!

Oh, I am soooo happy for you! You are such a rock star! Go you!

Your preparation for this job interview really showed.

Core Skills – “OARS”

Open-ended questions

Affirmations

Reflections

Summaries

Listening Reflectively

Reflections can:Check meaningReflect both sides of the ambivalenceReflect the meaningReflect the feeling

Used to move the conversation forward

Create an intimate dialogue and rapport

Listening Reflectively

Form a reasonable guess as to what the person meant

Give voice to that guess in the form of a statement

A well formed statement is less likely to evoke resistance

Vocal tone should go gently down at the end of a statement (not up like a question)

Hot Potato Reflections: Exercise

I will say a statement and throw the ball to one of you. (Example: School is just too hard).

The person who catches the ball, will reflect my statement (Example: You feel frustrated).

She/he will say a different statement (something that one of her/his clients might say) and throw the ball to another person. (Example: I don’t think college is for me).

Everyone will have a turn reflecting.

Debrief.

Core Skills – “OARS”

Open-ended questions

Affirmations

Reflections

Summaries

Summaries

Collecting SummaryBouquet metaphor: Draws together change

talk and invites continued talk

Linking SummaryTies together current and previously said

ideas to encourage reflection of relationship between concepts

Transitional SummaryMarks and announces shift of topic

Summaries: Exercise

Break up into dyads: The Speaker and The Listener

The Speaker will talk for 3 minutes about an area in which they would like to make change.

The Listener will listen and not say anything.

After The Speaker is done, The Listener will summarize.

Switch roles. Debrief.

Traps

Question-Answer Trap

Taking Sides Trap

Expert Trap

Labeling Trap

Premature Focus Trap

Sentence Stems

I learned __________

I relearned ____________

I gained ______________

I appreciated ____________

One thing that surprised me was _________

I could use MI to _____________

One thing I hope to cover before the training is over is ____

I am more confident now that I can ________________

I can’t wait to try _________

Debrief