Disclosure. Learning Objectives. Motivational Interviewing. Christian Hopfer, M.D. University of Colorado Health Science Center Denver, CO

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1 Motivational Interviewing Christian Hopfer, M.D. University of Colorado Health Science Center Denver, CO Based on the work by: W. R. Miller, Ph.D. S. Rollnick, Ph.D. and Colleagues Thanks also to Steve Martino, Ph.D. Disclosure Source AACAP Consultant Advisory Board Stock of Equity >$10,000 Speaker Bureau Research Support Honorarium for this talk or meeting X Expenses Related to This talk or meeting X Other Honorarium National Institute on Drug Abuse X Learning Objectives At the conclusion of this presentation participants should be able to: Recognize some basic theoretical principals of motivational interviewing; Identify a framework of how to apply basic Motivational micro-techniques ; and Become interested enough to pursue further training.

2 What is Motivational Interviewing (MI)? A client-centered counseling style focused on building motivation for change It does this by allowing patients to articulate reasons for change Developed to treat patients with Substance Dependence Useful in discussing behavior change in general Complements other treatments Effective with adolescents Why is it Popular? Carefully and rigorously studied Brief Positive impact on treatment engagement and retention Broadly applicable Many clinicians are already using MI techniques What is Motivation? The probability that someone will be ready to change i.e., engage and continue to adhere to a change strategy or treatment A state, not a trait An interpersonal event

3 Confrontation The issue is not whether to confront But, how to confront effectively Effective confrontation reduces psychological reactance MI Model/Concepts Ambivalence Resistance Change Talk Importance Confidence/Optimism Principles of Motivational Interviewing Express Empathy Develop Discrepancy Roll with Resistance (try not to argue with the patient) Support Self-Efficacy Focused on: building motivation and strengthening motivation

4 Change Talk vs. Resistance Desire to Change Opposite Ability to Change Reason for Change Commitment for Change Stage of Change Pre-contemplation Contemplation Preparation Action Maintenance Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol Sep;47(9): Elicit Self-Motivational Statements in Four Areas Problem Recognition Concern Intention to Change Optimism for Change

5 Pros and Cons Evocative Questions Elaboration of the Four Areas Imagining Extremes Looking Forward Looking Back Communication Process Client Has an idea May not be clear Clinician Hears what was said May not hear it right Puts words on idea May not say it right Guesses meaning May misinterpret meaning Communication Process Goals: Create a collaborative environment Listen carefully Make best guess about meaning Reflect carefully Check out if client feels understood Miller and Rollnick (2002) and materials provided for NIDA Clinical Trial protocols 0004 and 0005 (Carroll et al. 2002) Miller WR, & Rollnick S. Motivational interviewing: Preparing people for change (2nd ed.) (2002). New York: Guilford Press.

6 Resistance Arguing Disagreements Ignoring Denial Minimizing Interrupting Reflective Approaches Simple Reflection Amplified Reflection Double-Sided Reflection Strategic Approaches Shift Focus Reframe Agreement with a Twist Emphasize Personal Control Side with the Negative

7 Recognizing Readiness to Change Patient is Quieter, Resigned, Less Argumentative Questions Envisioning How to Transition to Action Don t Forget Motivation Don t Give a Simple Solution Give a Summary Reflection Key Question Negotiate a Plan for Change Give a Range of Options Giving Feedback After an Assessment - FRAMES Feedback - Personal Emphasize Personal Responsibility Advice Menu of Options Empathy Self-Efficacy

8 Conclusion Motivational Interviewing is an empirically based psychotherapy technique, useful in a wide range of clinical circumstances, and particularly helpful in assisting adolescents develop the critical motivational tools to participate in substance use treatment To obtain more training, go to: References 1. Miller WR, & Rollnick S. Motivational interviewing: Preparing people for change (2nd ed.) (2002). New York: Guilford Press. 2. Carroll KM, Farentinos C, Ball SA, Crits-Christoph P, Libby B, Morgenstern J. et al. (2002). Met Meets the Real World: Design Issues and Clinical Strategies in the Clinical Trials Network. Journal of Substance Abuse Treatment, 23, Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol Sep;47(9): Thank You Please click continue to proceed to the next section or click the main menu button above to return to the main menu. Continue

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.