Motivational Interviewing Part 1: Spirit & Clinical Skills

NATHAN GEHLERT, PH.D.Assistant Professor

Department of CounselingJohn Carroll University

ngehlert@jcu.edu facebook.com/nathangehlert

Learning Topics

I. Defining Motivational InterviewingII. Clinical Efficacy of Motivational InterviewingIII. Spirit of Motivational InterviewingIV. Person-centered Clinical Skills

I. Open-ended questionsII. AffirmationsIII. Reflective ListeningIV. Summarizations

Defining Motivational Interviewing

• Motivational interviewing (MI) is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.

Efficacy of MI• Since 1990, the number of scientific publications

on MI doubles every 3 years• More than 1,000 publications on MI treatment• More than 200 randomized clinical trials• Over 150 current research projects receiving

National Institute of Health support• Used in hospitals, schools, outpatient treatment

centers, etc. for:– alcohol, substance use, smoking, diabetes,

hypertension, diet, treatment adherence, HIV risk, dental health, training physicians, psychologists, social workers, counselors

I. Spirit of MI

If you treat an individual as he is, he will stay as he is, but if you treat him as if he were what he ought to be and could be, he will become what

he ought to be and could be.A JOHANN WOLFGANG VON GOETHE

Spirit of MI

• Think of…– a person in my life (teacher, counselor, coach,

clergyperson, etc) whose influence or help I rejected, around whom I felt defensive, or who I avoided.

– a person in my life who was a profound positive influence on me, who helped me

The Underlying Spirit of MI

Characteristics of Motivational Interviewing

• Guiding, more than directing• Dancing, rather than wrestling• Listening, as much as telling• Collaborative conversation• Evokes from a person what he/she already has• Honoring of a person’s autonomy

NOT Motivational Interviewing

NOT Motivational Interviewing

The Righting Reflex:If following the righting instinct, you will ask:

• Why don’t you want to change?• Why don’t you try… ?• What makes you think you are not at risk?• How can you tell me you don’t have a problem?

NOT Motivational Interviewing

• Argues that person has a problem and needs to change

• Offers direct advice or prescribes solutions (e.g., coping strategies) without actively encouraging person to make his/her choices.

NOT Motivational Interviewing

• Uses authoritative/expert stance and leaves patient in passive role.

• Doing most of talking or acting as “giver of information” (one-way communication)

NOT Motivational Interviewing

• Allows the patient to determine the content and direction of the work.

• Behaves in a punitive or coercive manner.

Video or traditional and MI approaches.

• Tradition approachVs

• MI approach

• How you would describe the difference between these videos?

II. Reflective listening & person-centered skills

The curios paradox is that when I accept myself just as I am, then I can change.

A CARL ROGERS

Skill 1: Open-ended Questions

• Asking open-ended questions helps you understand the patient’s point of view and elicits their feelings about a given topic or situation. Open-ended questions facilitate dialog; they cannot be answered with a single word or phrase and do not require any particular response.

Skill 1: Open-ended Questions

• Avoid closed and leading questions like:1. Would you like to quit smoking?2. Do you know that arguing with your wife is actually bad for

your health?3. Do you know what the university’s policy is about drug use?

• Instead ask:1. What do you think about your use of tobacco?2. What do you know about how arguing with your wife makes

you feel?3. What kind of information do you need to go forward?

Skill 1: Practice Open-ended Questions

• Make a list of 3-4 closed-ended questions.• With a partner, read you question, then your

partner will rephrase the question as an open-ended question.

• Example closed-questions:– Has it been difficult to change your eating habits?– Have you tried to make any changes this week?– Do you think you need to make a change in your life?

Skill 2: Affirmations

• Conveys support, respect, and encouragement to the patient

• Helps person reveal less positive aspects about themselves

Examples of Affirmations:“You’ve tried very hard to find the time to exercise.”“I appreciate you being here today.”“You’ve got a lot of good ideas.”

Skill 2: Practice Affirmations

• What are some strengths you see in people that you work with?– Faculty, what are strengths (positive

characteristics) of students at USSH?– Students, what are strengths of your faculty?

Skill 3: Reflective Listening

• A reflection is a statement by the counselor that mirrors what the patient has said (often, using the patient’s own words)

• Reflections:– create a sense of safety for the client– deepen the conversation– help the patient understand themselves

• When we use reflections, we let the patient know:– “I hear you”– “Please tell me more”– “I’m not judging you”

Skill 3: Reflective Listening

• A reflection starts with:– So…– Sounds like…– You…– What I hear you saying is…

Example of Reflective Listening

• Patient: “I enjoy drinking alcohol because it helps me relax and gives me something to do with my friends.”

• Counselor: “So, drinking helps you relax and have fun with your friends.”

• Patient: “Yes, and I can’t imagine not drinking, but it sure does affect my performance at work”

Practice Reflective Listening

Reflective listening exercise. Pick one:– What it was like growing up in my home – Ways in which I have changed over the years – What I hope to do over the next 10 years – How I came to do the kind of work I am doing

With a partner, take three minutes to talk about one of these topics. As the listener, your job is only to reflect.

Skill 4: Summarizations

• Summarizations:– Recap what has occurred in all or parts of session– Communicate Interest, Understanding, and call

attention to important elements– Used to shift attention or direction and prepare

patient to “move on”

Questions?