MOTIVATIONAL INTERVIEWING

SOUTHERN JERSEY FAMILY MEDICAL CENTERS – SANDY BEHAVIORAL

MOTIVATIONAL INTERVIEWING (MI):• AN EFFECTIVE WAY OF TALKING WITH PEOPLE ABOUT CHANGE. • A FORM OF COLLABORATIVE CONVERSATION FOR STRENGTHENING A

PERSON’S OWN MOTIVATION AND COMMITMENT TO CHANGE.• DESIGNED TO STRENGTHEN AN INDIVIDUAL’S MOTIVATION FOR AND

PROGRESS TOWARDS A SPECIFIC GOAL.

WHY DON’T PEOPLE DO WHAT’S BEST FOR

THEM?

SO WHY DON’T PEOPLE CHANGE?• DOESN’T SEEM ALL THAT IMPORTANT• HASSLE• ENJOY CURRENT WAYS• TAKES TIME TO DEVELOP NEW HABITS• REACTANCE• DEMORALIZED• AMBIVALENCE

AMBIVALENCE

• WHEN CHANGE IS HARD IT IS OFTEN DUE TO AMBIVALENCE. AMBIVALENCE IS UNCOMFORTABLE AND LEADS TO PROCRASTINATION. MOST MISTAKE THIS FOR RESISTANCE. AMBIVALENCE IS NOT RESISTANCE.

AMBIVALENCE

AMBIVALENCE

COGNITIVE: KEEP THINGS THE SAME………….TRY SOMETHING NEW

EMOTIONAL:

DREAD/ANGER/GRIEF/SHAME………..EXCITEMENT/CONFIDENCEBEHAVIORAL:

HALTING OR RUSHING……………………CAREFULLY CONSIDERED AND STEADY

STAGES OF CHANGE

MISTAKES PROFESSIONALS MAKE• “THE PROBLEM IS, IF YOU DON’T CHANGE, YOU MAY END UP LOSING YOUR

TOES. AND IF THAT DOESN’T DO IT AND YOU KEEP GOING, WE MAY HAVE TO AMPUTATE AT THE ANKLE. THEN…”• “YOUR KID IS NEVER GOING TO CHANGE IF YOU KEEP LETTING HIM GET AWAY

WITH EVERYTHING”• “I DON’T THINK YOU’RE REALLY READY TO DO ANYTHING DIFFERENTLY YET.

COME BACK WHEN YOU’RE READY TO TAKE THIS SERIOUSLY AND I’LL BE HAPPY TO WORK WITH YOU.”

SKILLS

CORE SKILLS – “OARS”• OPEN ENDED QUESTIONS• AFFIRMATIONS• REFLECTIONS• SUMMARIES• *YOU WILL NOTE THESE ARE BASIC COUNSELING SKILLS

OPEN ENDED QUESTIONS• WHAT WAS THAT LIKE FOR YOU?• WHAT DO THINK ABOUT THAT?• WHAT WOULD YOU LIKE TO DO?• HOW DO YOU SEE THAT?• HOW COULD YOU GO ABOUT ACCOMPLISHING THAT?• HOW MIGHT YOU MAKE THINGS DIFFERENT?• WHAT MIGHT CAUSE YOU SOME SETBACKS?• HOW CAN YOU GET PAST ANY OBSTACLES?

CLOSED ENDED QUESTIONS• SHORT YES/NO QUESTIONS• WERE YOU UNHAPPY ABOUT THAT?• DO YOU THINK HE UNDERSTANDS?• DON’T YOU THINK YOU SHOULD APOLOGIZE?• AREN’T YOU JUST AVOIDING DOING IT?• HOW MANY TIMES A WEEK DO YOU….?

REFLECTIONS

• REFLECTIONS- UNDERSTANDING WHAT THE CLIENT IS THINKING AND FEELING THEN SAYING IT BACK TO CLIENT. NO QUESTIONS HERE!

CLIENT: I DON’T THINK I HAVE PTSD!

COUNSELOR: YOU’RE NOT SURE ABOUT THE DIAGNOSIS OF PTSD?

REFLECTIONSSIMPLE

SLIGHTLY REPHRASE OR CHOOSE ONE WORD THAT SUMMARIZES MEANINGCOMPLEX

MAKE A GUESS ABOUT DEEPER MEANING THAT THE CLIENT HASN’T DIRECTLY STATED…UNDERLYING FEELINGS, VALUES, METAPHORS, ETC.

FOUR PROCESSES OF MI

ENGAGE

• TO ESTABLISH A HELPFUL CONNECTION• TO BUILD RAPPORT• TO OFFER A RELATIONSHIP

FOCUS

• TO DEVELOP A SPECIFIC AGENDA• TO DEVELOP CHANGE GOALS• TO ADD DIRECTION

EVOKE

• FIND THE PERSON’S MOTIVATION FOR SPECIFIC CHANGE• RESPOND TO CHANGE TALK• ELICIT THE PERSON’S RATIONALE FOR AND STRATEGIES FOR CHANGING

PLAN

• OPTIMAL! NOT ALWAYS PART OF MI.• HELP DEVELOP A PLAN• FOR SELF CHANGE• FOR SUPPORTED CHANGE

MI ALWAYS INCLUDES

• EMPATHY• ACCEPTANCE• OPTIMISM• COMPASSION

MI INVOLVES A CHANGE OF ROLE• YOU DON’T HAVE TO MAKE CHANGE HAPPEN• YOU CAN’T ANYWAY

• YOU DON’T HAVE TO COME UP WITH ALL THE ANSWERS• YOU PROBABLY DON’T HAVE THE BEST ONES

• YOU’RE NOT WRESTLING• YOU’RE DANCING

CHANGE TALK (DARN-CAT)• DESIRE (I MIGHT LIKE TO…)• ABILITY (I COULD…)• REASONS (IT WOULD BE SMART TO…)• NEED (I HAVE TO…)

• COMMITMENT (I WILL…)• ACTIVATION (I AM BEGINNING TO…)• TAKING STEPS(I AM…)