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Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 1
Motivational InterviewingIn Small Moments for Impactful Change
Marty Weems, LCSW, LCASMINT Trainer
September 20-21, 2018
UNC SCHOOL OF SOCIAL WORK CLINICAL LECTURE INSTITUTE
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 2
What is Motivation?
The probability that a person will enter into, continue, and adhere to a specific change strategy.
A Working Definition of MI
“Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.”
(Miller & Rollnick, 2013)
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 3
Core Concepts
Motivational Interviewing is comprised of…
MI
Spirit
Principles
Change Talk
OARS
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 4
Spirit of MI
• Collaboration
• Acceptance
• Compassion
• Evocation
Four Points of Acceptance
Absolute Worth
Affirmation Autonomy
Accurate Empathy
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 5
MI Principles
1. Express Empathy
2. Develop Discrepancy
3. Roll with Resistance
4. Support Self Efficacy
Embodying the Spirit & Principles of MI
• Understand the person’s frame of reference
• Accept and affirm
• Elicit self-motivational statements (change talk)
• Monitor readiness to change
• Support client’s autonomy
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 6
Understanding Ambivalence
• Ambivalence is feeling two ways about something.
• Types of ambivalence:
• Approach-Approach X Y
• Avoidance-Avoidance X Y
• Approach-Avoidance X
• Double Approach-Avoidance X Y
• Ambivalence is feeling two ways about something.
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 7
Inviting the Client to Change
Facilitating Change- MI ProcessesEngaging
Establish a working relationship
Focusing
Focus on what the person came to talk about
Evoking
Eliciting the client’s own motivation for change
Planning
The when and how change will take place
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 8
Change Talk vs. Sustain Talk
Sustain talk is language in support
of the status quo
Change talk is any language about
change
MI Hinges on Change Talk
•Desire
•Ability
•Reasons
•Need
•Commitment
•Activation
•Taking Steps
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 9
Sign of Readiness to Change
•Decreased resistance
•Decreased questions about the problem
•Resolve
•Change talk
• Increased questions about change
•Envisioning
•Experimenting
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 10
An In Depth Look at MI Processes
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 11
Engaging Skills
Key MI Skills
•Open-ended questions
•Affirmations
•Reflections
•Summaries
“Rowing with OARS”
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 12
Focusing Skills
• Sources of focus include:
• The client
• The setting
•Clinical expertise
•Styles of focusing:
•Directing
•Guiding
• Following
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 13
Focusing Techniques
• Agenda mapping
• Menu of options
• Providing feedback
• Summarizing
• Offering a concern
• Top three concerns
Easy as 1-2-3
• Write down 3 or 4 statements about some change that you are thinking about making within the next six months:
• D: Why do you want to make this change?
• A: How might you be able to do it?
• R: What is one good reason for making the change?
• N: How important is it, and why? (0-10)
• C: What do you intend to do?
• A: What are you ready or willing to do?
• T: What have you already done?
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 14
Providing Feedback
• Elicit-Provide-Elicit
• Elicit- ask permission to give information
• Querying interest in what information you have to provide
• Provide- impart information
• Elicit- ask client about understanding of information/how or she he feels about information
• MI Sandwich
Giving Advice
• Engage first
• Ask permission
• Emphasize personal choice
• Offer a menu of options
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 15
Evoking Skills
How Do We Elicit Change Talk?
• First use OARS
• Ask evocative questions
• Decisional balance
• Use rulers
• Ask for elaboration
• Querying extremes
• Looking forward
• Looking back
• Exploring goals and values
Focusing and Evoking Using Values
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 16
Responding to Change Talk?
• Elaborate (ask for an example)
• Affirm
• Reflect
• Summarize
• Clarify ambivalence
• Clarify values
Only reflect what you want to hear more of!
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 17
Planning Skills
Questions to Consider in Planning
• What are some specific areas or ways in which you want to change?
• What are some positive goals that you are thinking about? What do you hope will
• happen as a result of the change?
• What benefits can you expect from the change?
• Which motivations for change seem most important to you?
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 18
More Questions to Consider
• Within the general plan, what are some specific first steps you might take?
• When, where and how will you take these steps?
• What are some specific ways that others can help support you in your change attempt?
• How will you go about eliciting others’ support?
Planning Techniques
• Testing the waters
• Recapitulation
• Key question
• Recognizing and evoking CATs
• Change plan worksheet
Change Plan Worksheet
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 19
Dealing with Discord
Traps to Avoid
• Assessment
• Expert
• Premature Focus
• Labeling
• Blaming
• Chat
https://www.youtube.com/watch?v=RZWf2_2L2v8
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 20
A Good RULE
• Resist the righting reflex
• Understand your client
• Listen to your client
• Empower your client
(Beware of the “righting reflex”)
Signs of Discord in the Relationship
• Defending
• Squaring off
• Interrupting
• Disengagement “Smoke signals” are a cue
For YOU to change course!
Also, be aware of what you
bring to the table.
Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018
UNC Chapel Hill School of Social Work Clinical Institute 21
Strategic Responses
• Reframing
• Shifting focus
• Apologizing
• Affirming
• Emphasizing personal choice
• Running head start
• Coming along side
(metaphor of Batting Practice)
• Review of learning
• Questions, comments, concerns
Thank you so much for your participation in the workshop!
Summary