Motivational InterviewingPart 2: June 19, 2017

Pam Pietruszewski, MA

Integrated Health Consultant

National Council for Behavioral Health

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We don’t see things as they are, we see things as we are.

– Anais Nin

How Are We Doing?

Common Tendencies

to Helping People Change

“That kid is doomed.”

“I can rescue

her.”

“He just doesn’t get it.”

Just

do

it!

Don’t Have Time for MI?

Resistance …or discrepancy?

The MI Shift

From feeling responsible for changing another

person’s behavior to supporting them in thinking

and talking about their own reasons and means

for behavior change.

Addiction Technology Transfer Center (ATTC)

The person’s own arguments for change!

What are we especially listening for?

Desire

Ability

Reasons

Need

Commitment

Action

Taking steps

Listening for Change Talk

I need to get

my life back in

control

I can’t live like

this anymore

I want to get

out of this

hospital bed

I don’t want my kids

to pick up my

smoking habit

I know I’m overweight

Which of the following is an example of “change talk”?

a. I tried giving up alcohol.

b. I don’t understand why I have to take these meds.c. This is a waste of time.

Polling question #1

Sustain Talk

I won’t…It’s too hard…I don’t know…

Change Talk

I could…What if…Maybe…

Ambivalence is Normal

Amount of change talk is more predictive than amount of readiness.

(Because you’re talking yourself into changing!)

Preparatory Mobilizing

Desire - Ability - Reasons - Need - Commitment - Action - Taking Steps

OARS: Listening Style that Motivates Change

• Open-Ended Inquiry

• Affirmations

• Reflections

• Summaries

• What would need to happen for you to want to make

a change? (Desire)

• How would you do it if you decided? (Ability)

• What are the three best reasons? (Reason)

• What’s most important to you? (Need)

Open-Ended Inquiry to Enhance Change Talk

I’ve been coming to this clinic for 10 years, ever since I found

out I have diabetes. When the panic attacks started a few

months ago, I didn’t think I could handle another health problem.

I’m still seeing the therapist but I don’t know if it’s helping. I’m

overwhelmed and just want to get back in control.

Affirmations & Reflections

to Enhance Change Talk

I’ve been coming to this clinic for 10 years, ever since I found

out I have diabetes. When the panic attacks started a few

months ago, I didn’t think I could handle another health problem.

I’m still seeing the therapist but I don’t know if it’s helping. I’m

overwhelmed and just want to get back in control.

Affirmations & Reflections

to Enhance Change Talk

Client/Patient:

“It all went downhill when I got kicked out of my apartment. I want to get back on track but getting a little high and having

drinks with friends are the only things I have left to enjoy.”

Which is the most optimal reflection of this person’s change talk?

a. You were kicked out of your apartment.

b. You enjoy getting high.

c. You want to get back on track.

d. You know you need help.

Polling question #2

4 Fundamental Processes

Engaging

Focusing

Evoking

Planning

Find What Fits

“Experiment”

“Something different”

“Goal”“Trial run”

Partnership

Evocation

Compassion

Acceptance

Advice

The MI Sandwich

1. Elicit

Would you like to hear more about …? What do you know about…?2. Advise

That’s partially correct…In addition…3. Elicit

What do you think?

How, if at all, has this impacted your thinking?

Decisional Balance

Good Not so good

No change

Change

1 2

4 3

Readiness Rulers

On a scale of 0 to 10, how important is it for you to do X?

On a scale of 0 to 10, how confident are you that you can do X?

Setting a Plan

• Details, details

• Identify potential

barriers

• Start small

• Do a walk through

• Get in writing

Yeah, I know I should get more sleep.

Type in the chat box what

you might ask or say next to

help me with goal setting

Close on Good Terms

Summarize the patient’s statements in favor of change.

Emphasize the patient’s strengths.

What agreement was reached?

1. Miller & Rollnick. Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing) 2012.

2. Rollnick, S, Mason, P, Butler, C., Health Behavior Change, A Guide for Practitioners, Churchill Livingston, NY, 1999.

3. Rosengren, David B. Building Motivational Interviewing Skills: A Practitioner Workbook. Guilford Press, 2009.

4. Motivational Interviewing Network of Trainers: www.motivationalinterviewing.org

5. National Council for Behavioral Health: www.thenationalcouncil.org/motivationalinterviewing

6. MI in Brief Consultations: https://www.youtube.com/watch?v=bTRRNWrwRCo

Questions & Comments

Thank you!