Motivational Interviewing (MI) MI Definition. Rationale for MI Style. MI Theory. Spirit of MI. Motivational Interviewing May 6, 2010

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1 Motivational Interviewing () A little background Chris Dunn, Ph.D. University of Washington Kari Stephens, Ph.D. University of Washington Definition iti Rationale for style Learning Definition Rationale for Style client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Miller and Rollnick, 2002) If not listened to: Secretive Angry, annoyed Avoidant Oppositional Discounting If listened to: Frank Understood, accepted Exploring Cooperative Concerned Reactance Self-perception Value Avoid client pushback When clients argue for change, they come to believe in their argument Clients will change if the status quo violates their deep values of Do Draw out What would you would like to change about your drinking? Allow the freedom not to change How ready are you to change? Don t Implant the right ideas You really need to stop drinking. Push for commitment If you delay getting sober, you could die. Humanistic Clients will change under conditions of positive regard, acceptance, and empathy Collaborate What do you think you ll do? Dictate I would urge you to quit drinking. 1

2 Cullum, L. The New Yorker. May 9, cowboy Ambivalence Feeling two ways about something Both sides already there Common prior to habit change (common during habit change). Common with respect to alcohol. Of course we can t make you do anything you don t want to do But we re all headed to Dodge City and we d like you to join us. A communication trap! Argue one side, person defends the other Defense of status quo makes change less likely Ambivalence Example Inconsistent My client struggles with ambivalence about change. One moment, she wants to take the plunge, and the next moment, she s stuck again. She s working hard to resolve this. She s manipulative. She tells me she wants to change, because she thinks it s what I want to hear. But she s really not motivated. Learning Techniques Listening i Skills Motivationalinterview.org 2

3 Ask for Change Talk and highlight g it Share assessment results relevant to target Explore options for changing target Try for a commitment to do something about target Target Behavior: Example There are a couple of things we could talk about, like taking your meds, doing BA, substance use, or looking for work. Would it be okay if we discussed? Inconsistent Today, we are going to talk about your drug abuse... Microskills Openended Questions OARS Affirmations Reflections Summaries ***Use at All Times Open-ended Questions **Rule of thumb: 3 reflections for every question Open-Ended Questions: Examples Of all the issues we have discussed, which one would you like to talk about? Tell me how alcohol fits into your typical lifestyle? Sets the tone for work Creates momentum Focus broadly Avoids Question & Answer Trap What are some of your concerns about using meth? Share assessment results relevant to target What do you think about the feedback that this questionnaire suggests your symptoms of depression are worse? Explore options for changing target What sorts of things have you thought of trying? Try for a commitment to do something about target What barriers might come up, and how would you deal with them? 3

4 Affirmations Affirmations: Examples Why we use them Clients are often demoralized Orients people to their strengths What to do Hard to do genuinely, be genuine Probe partial successes Reframe resistance into an affirmation (find the good news in resistance) I appreciate your honesty about not wanting to discuss that. You ve been working hard on this for a long time! You have been doing some pretty serious thinking about this. Share assessment results relevant to target One of your strengths that showed up on the assessment was your drive to protect other people. Explore options for changing target I believe that when you make up your mind to take action, you will be successful. Try for a commitment to do something about target You re doing a great job of thinking through this. Reflections Reflections: Examples Those who can t reflect can t do Can be: Used to attend selectively Used to focus session Used to highlight Change talk Hypothesis testing More than paying attention More than repeating words It sounds like you are feeling It sounds like you are not happy with It sounds like you are a bit uncomfortable about So you are saying that you are having trouble So you are saying that you are no so sure about You re not ready to You re having a problem with You re feeling that Way of thinking It s been difficult for you You re struggling with What a pisser! Summaries What - special, compound reflections Structure: Indicate you re about to summarize Be selective Note ambivalence & attend to change statements Be concise! End with the good news When Use to change directions or ask a key question Use to end Use when you don t know what else to do! Summaries: Examples So, if I ve got it right, there are some things you enjoy about drinking, and at the same time, you have some pretty strong reasons for wanting to change. Try for a commitment to do something about target Let me see if I understand you correctly. You re really not ready to quit drinking entirely, but you would like to try cutting down to no more than two drinks per day. Is that about right? 4

5 What is Change Talk I really need to talk about quitting smoking, because that s going to kill me. I don t want to get cancer like my mother did. Hmm, I didn t realize it was that bad Share assessment results relevant to target I think I d like to try quitting for a while. Explore options for changing target I think I d like to try quitting for a while. Try for a commitment to do something about target I am definitely going to do this; I have no choice. Finding Change Talk in Ambivalence Client Therapist I really don t want to stop smoking, but I know that I should. I ve tried before and it s really hard. You really don t want to quit. It s pretty clear to you that you ought to quit. You re not sure if you can quit. Eliciting Change Talk: Examples ***Just ask for it! I d like to hear you opinions about What are some things that bother you about drinking? What role do you think alcohol played in your arrest? How would you like your drinking to be 5 years from now? Eliciting Change Talk: Pros/Cons What do you like about? What Else? What to do when you hear Change Talk Elaborate What else? What makes you say that? What makes you feel that way? What do you see as the downside of? What Else? Affirm I admire your open-mindedness You re doing some serious thinking here Summarize both pros and cons On the one hand you said, on the other hand you said Reflect Sounds like you re thinking about making a change 5

6 Assessment Results Share assessment results relevant to target Why share them? To make it more important to client that he/she change To increase his/her concern with the status quo To show client that target is not normal Tips Compose a sound bite to convey your message. Expect push-back. Don t argue with yeah, buts. Don t defend the assessment process. Just deliver the message and reflect client s responses. Explore Options Ask for Change Talk and highlight g it Offer a menu What have you considered trying? What have you done before? Would you like to hear any ideas from me? Share assessment results relevant to target Explore options for changing target Try for a commitment to do something about target In the hypothetical If you wanted to If you decided to If the time were right How would you do it? How would you go about it? What would you do? Menu of Options: Drinking Example Giving Advice: Example Make no change whatsoever Inconsistent Cut down Don t cut down but never drive after Quit entirely See a counselor There s something that concerns me. Would it be ok if I shared my concerns with you? OK if I offer a suggestion? The best thing for youtodoistoquit right away. Don t do that, because it will. (Others that the client thinks of?) 6

7 Giving Advice: Without Telling Someone What to Do Giving Advice Provide Clear Information or Feedback The results of your test suggest that What happens to some people is that My recommendation would be that Elicit their reaction What do you think? What are your thoughts? Ask: What do you know about the effects of What concerns do you have about? Tell: The results of your tests suggest that What happens to some people is that As your doctor/counselor/ nurse, I strongly urge you to Ask: What do you think? How does that sound to you? Closing on Good Terms S E W Summarize patient s views Encouraging remarks What agreement was reached is repeated Especially the prochange part of what they said References If you would like more information about Motivational Interviewing, please go to: Motivationalinterview.org 7