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1 Presented by: Thomas Wood, PhD, LPC

2 Compassion is the wish to see others free from suffering. -The Dalai Lama when you are listening to somebody, completely, attentively, then you are listening not only to the words, but also to the feeling of what is being conveyed, to the whole of it, not part of it. - Jiddu Krishnamurti Miller, William R.; Rollnick, Stephen P. (2012)

3 Layperson s definition: Motivational interviewing is a collaborative conversation style for strengthening a person s own motivation and commitment to change. Practitioner s definition: Motivational interviewing is a personcentered counseling style for addressing the common problem of ambivalence about change. Technical definition: Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person s own reasons for change within an atmosphere of acceptance and compassion. Miller, William R.; Rollnick, Stephen P. (2012)

4 MI is not a way of manipulating people into doing what you want them to do. MI cannot be used to manufacture motivation that is not already there. MI is to be used to promote others welfare and best interests, not one s own. Miller, William R.; Rollnick, Stephen P. (2012)

5 Four Central Aspects: Partnership Acceptance Compassion Evocation Miller, William R.; Rollnick, Stephen P. (2012)

6 Collaboration vs. Confrontation Evocation vs. Exhortation Autonomy vs. Authority Compassion is the wish to see others free from suffering. -The Dalai Lama Motivational Interviewing, Miller and Rollnick, 1991

7 Precontemplation Contemplation Preparation Action Maintenance Prochaska & DiClementi, Norcross (1992)

8 Express empathy Develop Discrepancy Roll With Resistance Support Self-efficacy Motivational Interviewing, Miller and Rollnick, 1991

9 Developing Discrepancy Ambivalence is normal and 1st step toward Change Acceptance vs. Denial of the condition (at any stage of change this can occur) Ambivalence intensifies as Discrepancy increases Let the consumer voice Arguments for Change Motivational Interviewing, Miller and Rollnick, 1991

10 Engaging Focusing Evoking Planning Miller, William R.; Rollnick, Stephen P. (2012)

11 Establishing Rapport: a helpful connection, a collaborative working relationship MI is like dancing rather than wrestling not a process of overpowering and pinning an adversary. This is important because when the goal is for another person to change, the counselor can t do it alone. Miller, William R.; Rollnick, Stephen P. (2012)

12 Focusing is the process by which clinican develops and maintains a specific direction in the conversation about change The Client s agenda and Clinician s agenda May or may not involve a behavior change, might be an internal decision (decision to learn how to counter automatic negative thoughts) Miller, William R.; Rollnick, Stephen P. (2012)

13 Involves eliciting the client s own motivations for change Occurs when there is a Focus on a particular change or goal We harness the client s own ideas and feelings about why and how they might do it. Miller, William R.; Rollnick, Stephen P. (2012)

14 Developing a commitment to change Formulating a concrete plan of action Miller, William R.; Rollnick, Stephen P. (2012)

15 OARS Open-ended questions Affirming statements Reflections Summarizations Motivational Interviewing, Miller and Rollnick, 1991

16 Open-ended questions Reflective Listening Affirm Summarize Listen for and reinforce change talk Motivational Interviewing, Miller and Rollnick, 1991

17 Client identifies-- Disadvantages of the status quo Advantages of change Optimism for change Intention to change (aka Commitment Talk) Motivational Interviewing, Miller and Rollnick, 1991

18 Expert trap Closed-ended questions Taking sides Labeling trap Premature focus Blaming trap Motivational Interviewing, Miller and Rollnick, 1991

19 1. Ordering, directing, or commanding 2. Warning, cautioning or threatening 3. Giving advice, making suggestions, or providing solutions 4. Persuading with logic, arguing or lecturing 5. Telling people what they should do; moralizing 6. Disagreeing, judging, criticizing, or blaming 7. Agreeing, approving, or praising 8. Shaming, ridiculing, or labeling 9. Interpreting, or analyzing 10. Reassuring, sympathizing, or consoling 11. Questioning or probing 12. Withdrawing, distracting, humoring, or changing the subject. Miller & Rollnick (2013)

20 Stress is a major trigger Survival system activated Stress-tolerance, adaptive emotional coping and resiliency decrease as prefrontal lobe activity decreases Decreased access to reason, rational thinking, values, ability to weigh consequences vs. benefits Stress/anxiety can be both a consequence and a trigger for hypomania and depression Impulsivity/compulsivity can increase Motivational Interviewing, Miller and Rollnick, 1991

21 Blaming Placating Passive Aggressive vs. Straightforward Super Reasonable Irrelevant

22 Following Listening predominates ex. Patient in tears following delivery of bad news Guiding A good guide knows what is possible and can offer you alternatives from which to choose. Directing Implies an uneven relationship; sometimes this approach saves lives.

23 Natural Tendency as Helpers (and support team/encouragers Persuade Counsel Argue for Change Provide Alternative Solutions ( fix ) Inhibit the righting reflex Motivational Interviewing, Miller and Rollnick, 1991

24 Many benefits of integrating MI into everyday communication Follow-through from assessment to attendance (and your support of these activities) Increase in self-generated investment in wellness & wellness maintenance & thus self-efficacy Reduction of support system distress (exhaustion) Fosters harm reduction and likelihood of return to treatment if interrupted or disrupted

25 Miller, William R., & Rollnick, Stephen. (2013). Motivational Interviewing: Helping People Change 3 rd edition) Motivational Interviewing in Health Care, Helping Patients Change Behavior (Rollnick, Miller, Butler, 2008) Motivational Interviewing: Preparing People for Change (2 nd edition) (Miller/Rollnick) (April 2002) Burke, B.L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, Lundahl, B.W., Tollefson, D., Kunz, C., Brownell, C., & Burke, B. (in press). Metaanalysis of Motivational interviewing: Twenty five years of research. Research on Social Work Practice. Vasilaki, E., Hosier, S., & Cox, W. (2006). The efficacy of motivational interviewing as a brief intervention for excessive drinking: A meta- analytic review. Alcohol and Alcoholism, 41,

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