MOTIVATIONAL INTERVIEWING: FOCUSING ON CHANGE TALK. Trainer Denna Vandersloot, M.Ed.

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1 MOTIVATIONAL INTERVIEWING: FOCUSING ON CHANGE TALK Trainer Denna Vandersloot, M.Ed.

2 The ATTC Network 2

3 HOW MI IS DIRECTIONAL Selective eliciting questions Selective reflections Selective elaboration Selective summarizing Selective affirming (William Miller, 2010) 3

4 Motivational Interviewing: Helping People Change Third Edition What s new.. Primary Source 4

5 A CLINICAL DEFINITION OF MI A person-centered counseling style for addressing the common problem of ambivalence about change. Miller & Rollnick,

6 Change Talk Ambivalence Sustain Talk 6

7 Partnership Evocation Spirit of MI Autonomy Compassion 7

8 FOUR PROCESSES OF MI Engaging Focusing Evoking Planning 8

9 ENGAGING Shall we travel together? 9

10 FOCUSING Where shall we go? 10

11 EVOKING Whether and Why? 11

12 We are usually convinced more easily by reasons we have found ourselves than by those that have occurred to others. Blaise Pascal ( ) 12

13 Recognize Evoke Respond CHANGE TALK 13

14 PREPARATORY CHANGE TALK DESIRE ABILITY REASON NEED

15 WHAT S NEXT? DARN statements by themselves do not trigger change. COMMITMENT is missing: I will I plan to I intend to I am ready to I will think about I will consider

Journal of Consulting and Clinical Psychology.Vol 71(5) Oct 2003, 862-878.

16 Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology.Vol 71(5) Oct 2003, CHANGE TALK Preparatory Desire Mobilizing Commitment Behavior Change Ability Reason Need Activation Taking Steps

17 Recognize Evoke Respond CHANGE TALK 17

18 Eliciting Change Talk Amrhein et al., (2003) 18

19 Can Counselor Influence Change Talk? Glynn & Moyers (2010) 19

20 HOW DO YOU ELICIT/EVOKE CHANGE TALK? Asking evocative questions Exploring the decisional balance Good things/not so good things Elaboration Querying extremes Looking back/looking forward Exploring goals and values Using the Importance Ruler Coming Alongside 20

21 WHAT TO DO IF THE PERSON DOESN T SEEM TO EVEN BE AMBIVALENT? Providing Feedback Exploring other s concerns Exploring goals and values Honoring autonomy Running Start technique 21

22 Recognize Evoke Respond CHANGE TALK 22

23 SNATCHING CHANGE TALK FROM THE JAWS OF AMBIVALENCE Change talk often comes intertwined with sustain talk That s the nature of ambivalence (William Miller, 2010) 23

24 SNATCHING CHANGE TALK FROM THE JAWS OF AMBIVALENCE I know I should keep taking the medication, and the voices do stop when I m taking it, but I can t handle the way it makes me feel. You don t like the way the meds make you feel. You recognize the importance of taking your meds One reason to take the meds is to stop the voices 24

25 SNATCHING CHANGE TALK FROM THE JAWS OF AMBIVALENCE I really don t want to quit cutting altogether, I know I probably should. I ve tried to stop before and it s hard. You really don t want to stop cutting You recognize the importance of not cutting You re not sure if you can quit. 25

26 RESPONDING TO CHANGE TALK ALL EARS E: Elaborating: Asking for elaboration, more detail, in what ways, an example, etc. A: Affirming commenting positively on the person s statement R: Reflecting, continuing the paragraph, etc. S: Summarizing collecting bouquets of change talk 26

27 RESPOND USING YOUR EARS Elaboration/Example Affirm Reflect Summarize 27

28 EVOKING PHASE EXERCISE Practices using Recognizing, Evoking and Responding strategies Work in triads or dyads Speaker plays role of script Listener plays role identified on card Identify change talk (internally) Use evoking strategy followed by EARS 28

29 LISTENER ROLE 1. You are moving from focusing to evoking 2. Listener: Select 2-3 Evoking strategies you want to use from card deck 3. Use one strategy at a time and follow up with EARS before moving to the next strategy 4. Goal: to practice skills and gather change talk 29

30 OBSERVER ROLE Listen carefully to the speaker and using the Change Talk Observer Sheet write-down each piece of change talk you hear.. This is an important role because you can help your team WIN 30

31 EVOKING MENTAL SHIFTS & MI SKILLS Mental Shifts: Evoke don t install motivation Requires a Focus Letting go of gathering the facts first MI Skills: Eliciting change talk strategies OARS Developing Discrepancy Miller,

32 School of Medicine Department of Public Health and Preventive Medicine Northwest Frontier Addiction Technology Transfer Center 3181 SW Sam Jackson Park Rd. CB669 Portland, OR Traci Rieckmann, Ph.D., Principal Investigator Denna Vandersloot, M.Ed., Project Director 32

33 RESOURCES FOR LEARNING MOTIVATIONAL INTERVIEWING Motivational Interviewing (2013), Miller & Rollnick Enhancing Motivation to change in Substance Abuse Treatment, Tip 35 National Clearing House (training tapes, articles, bibliographies, training opportunities) (MI resources ATTC website) Motivational Interviewing in Health Care (2008) Rollnick, Miller, and Butler. 33

34 REFERENCES Miller W. & Rollnick S. (3013) Motivational Interviewing: Helping People Change. Rollnick S., Miller, W. and Butler, C. (2008) Motivational Interviewing in Health Care. Glenn, L.H., Moyers, T. B. (2010) Chasing Change Talk: The clinicians role in evoking client language about change. Journal of Substance Abuse Treatment, 39, Amrhein, P.C. et al. (2003) Client commitment language during MI predicts drug use outcomes. Journal of Consulting and Clinical Psychology, 71 (5), D`Ofrino, G. et al. (2005) Yale Brief Negotiated Interview 34

These core elements are included in three increasingly detailed levels of definition:

These core elements are included in three increasingly detailed levels of definition: A Definition of Motivational Interviewing The definition of Motivational Interviewing (MI) has evolved and been refined since the original publications on its utility as an approach to behavior change.