Motivational Interviewing

Basics of Motivational Interviewing

Module # 1

Objectives of Training

• To be able to

demonstrate reflective

listening & open

ended questions, and

understand the

importance of these

techniques

• To begin to learn the

stages of change

• To have a basic

working knowledge of

Motivational

Interviewing

• To understand the

principles of

Motivational

Interviewing

“When given a choice between

changing and proving that it is not

necessary, most people get busy

with the proof”John Galbraith

What is Motivation & How is it

Instilled?

Have the audience list several ideas of

their definition of motivation & what

motivates people to change

What is Motivational

Interviewing?

It is an approach designed to

help clients build commitment

& reach a decision to change

It is one approach, not the only

approach to work with clients

What is Motivational

Interviewing?

1 An approach designed to help members

build commitment & reach a decision to

change

2 It appears to be member-centered, yet the

staff maintains a strong sense of purpose &

direction- and chooses the right moments to

interject

What is Motivational

Interviewing?

A person-centered, directive method of

communication for enhancing intrinsic

motivation of change by exploring and

resolving ambivalence.

What is Motivational

Interviewing?

• It is a style:

– Non-Authoritarian

– Responsibility for change is ultimately left with

the client, but the case manager plays a critical

role

It’s a style

• By changing their therapeutic style between

confrontational & client-centered, the

therapist can drive client resistance rates up

& down. (Miller, Benefield & Tonigan,

1993)

• Client resistance behavior, in turn, is

predictive of failure to change

• Empathy is associated with more favorable

client outcomes

What is Motivational

Interviewing?

• It is strategies:

– It is supportive, not argumentative

– Timing plays a crucial role

– Emphasis is on the reasons to change, rather

than on how to change

What is Motivational

Interviewing?

• The goals are:

– Resolve ambivalence

– Develop discrepancy

– Increase intrinsic motivation

– Increase the client’s self-perception, regarding

the ability to change

– Encourage the client to present the argument to

change

Which Statements are True?

• Being resistive & unmotivated for change is

an inherent characteristic, especially of

addicts

• It is crucial for a person to admit their

problems

• The only way to get through to someone is

to confront them, especially if you want

results fast

Ambivalence

• Conflict between two courses of action

• Unsure of the action that one wants to take

• Ambivalence must be resolved to move

forward with change and reduce the

probability of relapse

Contributors of Ambivalence

• Attachments

• Fear of Change

• Is the payoff worth the work to change

• Lack of reaching a decision

• Pat predicators

• Unique to the individual

• Pressuring often produces resistance

Principles of Motivational

Interviewing

• Express empathy

• Develop discrepancy

• Avoid argumentation

• Roll with resistance

• Support self-efficacy

Principles of Motivational

Interviewing

Review of the MI poster

Five Early Strategies

1) Ask Open Ended

Questions

2) Listen reflectively

3) Affirm- (to build

relationship)

4) Summarize- (to check

that on the same track)

5) Elicit change- (try to

get them to talk

change, and them

argue for change)

Reflective Listening as a Process

& as an Empathetic Strategy

Reflective Listening

• Characteristic of Motivational Interviewing

• Understand the member’s feelings &

perspectives w/o judging or criticizing

• It’s not only about how you listen or keep

quiet - it is about how you respond

Reflective Listening Goals

• Allow the member to explore ambivalence

• To make a guess as to what the member

meansmeans

• The guess is most often in the form of a

statement- a well-informed reflective

statement is less likely to evoke resistance

than a well-informed question

Reflective Listening Goals cont.

• Clarify the member’s own experiences

• Elicit self-motivational statements

• Become genuinely interested in the member

• Change is more a process than an outcome

It is important to remember

• Acceptance is not the same thing

as agreement or approval. It is

possible to accept and understand a

member’s perspective but not

agree with it.

5 Types of reflective statements

1) REPEATING:

The simplest form of reflection, the

listener repeats a portion of what

was said.

5 Types of reflective statements

2) REPHRASING:

The listener stays close to what the

person said but substitutes synonyms or

slightly rephrases what was said.

5 Types of reflective statements

3) PARAPHRASING:

Major restatement. The listener infers the

meaning in what was said and reflects this

back in new words. This adds to and

extends what was actually stated.

5 Types of reflective statements

4) REFLECTION OF FEELING:

The deepest form of reflection, this is a

paraphrase that emphasizes the

emotional dimension through feeling

statements, metaphor, etc.

5 Types of reflective statements

5) SUMMARIZING:

Major summaries made to pull together

what has taken place to that point.

Allows another opportunity for the staff

to check the understanding of what the

person was saying and to hear their own

words again.

The Caseworkers Response

Reflective Listening Exercise # 1

Let the member be the member

they are

• Let’s not make

them imitate others.

Let them find

themselves and be

themselves

• Cultivate an

atmosphere of

change

Poor reflective listening techniques

(roadblocks)

• Order, direct or command the member what

to do

• Warn & threaten the member of what they

did wrong

• Providing solutions, giving advice

• Persuading with logic, arguing or lecturing

• Moralizing, preaching “should do”

• Disagreeing, judging or blaming

Poor reflective listening techniques

(roadblocks)

• Agreeing, approving or praising

• Shaming, ridiculing, labeling

• Sympathizing, reassuring

• Questioning or probing

• Withdrawing or distracting

Reflective Listening

Exercise #2

Roadblocks: Responses of Poor

Reflective Listening Statements

AVOIDING PITFALLS

Remain as positive and

nonjudgmental as possible and

rely on brief open-ended

questions to elicit the member’s

concerns and exploration of

feelings.

Ask open-ended questions

Use questions that will

elicit an informative

answer.

Example:

Tell me more about

these difficulties

versus

Have you had any

difficulty with this?

The optimal approach is to ask an

open-ended question, then to

respond to the member’s

response with reflective listening

strategy- not another question.

Too many questions will lead

into a “passive” question/answer

trap.

Open Ended Questions

goals

• Establish an atmosphere of openness,

acceptance and trust

• The member should do most of the talking

• Let the member explore their thoughts

Open Ended Question Role Play

• Role Play Activity

Stages of Change

• Precontemplation

• Contemplation

• Preparation

• Action

• Maintenance

Stages of Change

Precontemplation

The person has no intention to

change behavior in the foreseeable

future. Individuals in this stage are

unaware or underaware of their

problems

Stages of Change

Contemplation

A person is aware that a problem

exists and are seriously considering

changing, but have not yet made a

commitment to take action.

Contemplators perform a risk-

reward analysis.

Stages of Change

Preparation

Individuals are intending to take

action and may practice some of

the behaviors necessary to

change, but have yet to make a

full commitment.

Stages of Change

Action

In this stage individuals

modify their behavior,

experiences or environment

in order to overcome their

problems.

Stages of Change

Maintenance

Individuals in this stage work

to prevent relapse and

consolidate gains.

Role Play

• More advanced role plays: reflective

listening/open ended questions

Summary

• Review of the objectives and the main

points of the training