Motivational Interviewing Preparing People for Change

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1 Motivational Interviewing Preparing People for Change Michaelene Spence MA LADC February 10, 2010 Adapted from Ken Kraybill, MSW Center for Social Innovation

2 Motivational Interviewing A person-centered, goal-oriented, guiding method of communication to enhance motivation to change by exploring and resolving ambivalence Miller & Rollnick, 2002 (adapted)

3 Or Helping people talk themselves into changing "I learn what I believe as I hear myself speak. D. Bem

4 Youtube Video- Stop It! WHAT MI IS NOT

5 2 Key Aspects Ambivalence Uncertainty or Fluctuation Perceived inability to make a choice Simultaneous desire to say or do two conflicting or opposing things The coexistence of positive and negative feelings toward a situation Target Behavior The identified behavior that needs changing Goal behavior Desired behavior

6 Target Behaviors What are examples of Target Behaviors you are currently working on with your clients? Taking meds as prescribed Attending self help groups, therapy, appointments, etc. Getting their children on a bedtime routine Exercising Quitting smoking Eating better Getting a job Enrolling in school More examples.

7 Four principles of Motivational Interviewing Express empathy Develop discrepancy Roll with resistance Support self-efficacy

8 1. Express empathy Acceptance facilitates change Skillful reflective listening is fundamental Ambivalence is normal

9 2. Develop discrepancy Change is motivated by perceived discrepancy between present behavior and important personal goals/values. Client rather than clinician should present arguments for change.

10 3. Roll with resistance Avoid arguing for change Resistance is not directly opposed New perspectives are offered, but not imposed Client is primary resource in finding answers Resistance is a signal to respond differently

11 4. Support self-efficacy Belief in the possibility of change is an important motivator Client, not the counselor, is responsible for choosing and implementing change Provider s own belief in the person s ability to change becomes a self-fulfilling prophecy

12 OARS: Basic skills of Motivational Interviewing Open Questions Affirmations Reflective Listening Summaries Motivational Interviewing is not a series of techniques for doing therapy but instead is a way of being with patients. William Miller, Ph.D.

13 Open questions: Open Questions Encourage people to talk about whatever is important to them, or to elaborate on something Opposite of closed questions that elicit a limited response, or lead in a specific direction Help establish rapport, gather information, increase understanding Demonstrate genuine interest and respect Invite others to tell their story in their own words Affirm autonomy and self-direction Provide opportunity for person to learn what I believe as I hear myself speak."

14 Sound like How have things been going? What was that like? What have you noticed about? What are your concerns about taking these pills? Hmm Interesting Tell me more When would you be most likely to share needles? How would you like things to be different? What will you lose/gain if you give up drinking? How did you manage that in the past? What do you want to do next? How can I help you with that?

15 Guidelines: Open Questions Use open questions to seek to understand, and to guide the conversation Ask twice as many open questions as closed questions Keep questions clear and brief Avoid negating open questions with closed ones e.g. How is it going? Have you been taking your medications?

16 OARS: Affirmations Statements that recognize individual s strengths, personal qualities, core values Build confidence in ability to change Must be congruent and genuine Different from praise which can be useful external tool to reinforce

17 Sound like You were very kind towards I noticed that you You showed a lot of patience You are a courageous person to You really value being I wonder how you found the strength to That took a lot of persistence to Thank you for

18 OARS: Reflective Listening Reflective listening is the key to this work. The best motivational advice we can give you is to listen carefully to your clients. They will tell you what has worked and what hasn't. What moved them forward and shifted them backward. Whenever you are in doubt about what to do, listen. Miller & Rollnick, 2002

19 Reflective Listening A way of checking rather than assuming you know what someone means. Miller & Rollnick, 2002

20 Levels of Reflection SIMPLE Repeating or rephrasing listener repeats or substitutes words or phrases; stays close to what speaker said COMPLEX Paraphrasing listener makes a major restatement that infers or guesses the speaker s meaning Reflection of feeling emphasizes the emotional aspects of communication; deepest form of listening

21 Forming Reflections Appears deceptively easy, but requires practice Statement, not a question, voice turns down at end Common word is you Complete the paragraph You So you It sounds like you You re wondering That would be for you

22 OARS: Summarizing Let me see if I understand thus far Special form of reflective listening Ensures clear communication Use at transitions in conversation Be concise Reflect ambivalence Accentuate change talk

23 Let s try this again... SAME SUBJECT- DIFFERENT TECHNIQUE

24 How do we get people to start thinking about change? Weigh out the costs and benefits, pros and cons (or rather cons and pros) of behavior Don t forget to listen for Change Talk Use Change Talk strategies Ask them to imagine making the change and what steps they think they may need to take if they were serious about change Use Change Talk worksheet Ask if you can make suggestions

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