Motivational

Interviewing (MI)
Presented by: Cheryl Rischer
Cheryl@CherylRischer.com

Learning Objectives

Understand the basic principles of

motivational
interviewing

Learn strategies for evoking change talk

Understand resistance and how to respond

Learn how to negotiate a change plan


How Does Behavior Change?


think of behavior you have tried to change


How Much Time Elapsed Between
the first time you engaged in that
behavior and
the first time you realized negative
consequences

How Much Time Elapsed

Between
the first time you realized
negative consequencesand the
first time you tried to change
thebehavior

MI: What is it?

Definition: Motivational interviewing is a
collaborative, person-centered evidence-based,
guiding method of communication for
enhancing and strengthening intrinsic
motivation for change.
Spirit: Collaboration, Autonomy, Respect,
Compassion

Simple Definition
An effective way of talking to people about
change.

Why is it necessary?

Shouldnt people just naturally want to

change their behavior when they know how
important it is for them if they change?

A lot of times counselors or medical

professionals give people information or
advice and then expect them to change their
behavior without telling them how.

CORE SKILLS
O
A

PEN QUESTIONS
FFIRMATIONS

R EFLECTIONS
S UMMARIES

Motivational
Interviewing...
assumes motivation is fluid and can be
influenced
motivation is influenced in context of a
relationship
principle task: to guide conversation
towards eliciting motivation for change
goal: to influence change in the
direction of health

Communication is
hard...
Here are the places it can break down.

1. What the speaker means

2. What the speaker says
3. What the listener hears

Speaker

4. What the listener

thinks the speaker
means

Listener

What is listening?
Focus all purpose, attention, and energy
on understanding
What is the person experiencing right
now?
Hearing what they are NOT

saying

What People
Seek/Need

*Power/Control
*Connection

Motivational
Interviewing Process:
The Structure
Lower

CHANGE
CHANGE
TALK
TALK

Ambivalenc
Ambivalenc
ee

Desire
Desire
Ability
Ability
Reason
Reason
Need
Need

Notice
COMMITMENT
COMMITMENT
LANGUAGE
LANGUAGE
1

Increas
e
desires

10

CHANGE
CHANGE
BEHAVIOR
BEHAVIOR
TOWARDS
TOWARDS
and/or
and/or HEATLH
HEATLH

Observ
e

Five General Principles

Express accurate empathy
Amplify ambivalence
Avoid arguments
Support self-efficacy
Roll with resistance

Expressing Empathy

Acceptance facilitates change

Skillful reflective listening is fundamental to

expressing empathy

Ambivalence is normal.
Source: Miller and Rollnick, 1991.

Self-Efficacy

Belief in the possibility of change is an

important motivator.

The individual is responsible for choosing

and carrying out personal change.

There is hope in the range of alternative

approaches available.
Source: Miller and Rollnick, 1991.
Reprinted with permission.

Avoiding Arguments

Arguments are counterproductive.

Defending breeds defensiveness.

Resistance is a signal to change strategies.

Labeling is unnecessary.
Source: Miller and Rollnick, 1991.
Reprinted with permission.

Rolling With Resistance

Momentum can be used to good advantage.

Perceptions can be shifted.

New perspectives are invited but not

imposed.

The individual is a valuable resource in

finding solutions to problems.
Source: Miller and Rollnick, 1991. Reprinted
with permission.

Four Types of individual

Resistance

Arguing
The individual contests
the accuracy, expertise,
or integrity of the
counselor.

Resistance Continued
Interrupting
The individual breaks in
and interrupts the
counselor in a defensive
manner.

Resistance Continued
Denying
The individual expresses
unwillingness to recognize
problems, cooperate,
accept responsibility, or
take advice.

Resistance Continued
Ignoring
The individual shows
evidence of ignoring or
not following the
counselor.

Affirmations
Can be simple statements about the student

Awards
Attempts
Achievements
Accomplishments

Sample Affirmations

You really care about your

grades/family/friends

This is hard work you are doing

You were successful when you studied with

your group

It took a lot of courage

Reflections
Understanding what the individual is thinking
and feeling then saying it back to them.

I dont think I can pass my test.

You dont feel like youre prepared for todays
test.

Simple Reflection
The simplest approach to
responding to resistance is with
nonresistance, by repeating the
individual's statement in a neutral
form. This acknowledges and
validates what the individual has
said and can elicit an opposite
response.

Amplified
Reflection
Another
strategy is to reflect
the individual's statement in an
exaggerated form--to state it in
a more extreme way but
without sarcasm. This can move
the individual toward positive
change rather than resistance.

Double-sided
Reflection
A third strategy entails

acknowledging what the

individual has said but then also
stating contrary things she has
said in the past. This requires
the use of information that the
individual has offered
previously, although perhaps not
in the same session.

Summary
A long reflection of more than one
student/teacher statement.

The Four Processes

Planning
Evoking
Focusing
Engaging

ENGAGING
The process of establishing a trusting and
mutually respectful relationship.

Dis-Engaging

You want to avoid assessing the individual

right from the beginning.

Do not ask a bunch of questions

Telling: avoid telling the individual how to fix

their problem

Power differential

Labeling

What is engaging?

Anything that helps them feel welcome

Anything that helps them feel comfortable

Feeling understood

Exceeding expectations

Having mutual goals

Feeling hopeful

FOCUSING
An ongoing process of seeking and maintaining
direction.

EVOKING
Eliciting an individuals own motivation for
change.

Eliciting change talk. The individuals

speech that favors movement in the
direction of change.

PLANNING
Developing a specific change plan that the
individual agrees to and is willing to implement.
The plan needs to be a SMART plan.
Specific
Meausrable
Achievable
Relevent
Timely

Appropriate Motivational Strategies for

Each Stage of Change
individual's Stage of
Change

Precontemplation

Appropriate Motivational
Strategies for the
counselor

Establish rapport,
ask permission, and
build
trust.
The individual is not
Raise doubts or
yet considering
concerns in the
change or is
unwilling or unable individual about.
substance-using
to change.
patterns
Express concern
and keep the door
open.

individual's Stage of Change Appropriate Motivational

Strategies for the counselor

Contemplation

Normalize
ambivalence.
Help the individual
"tip the decisional
The individual
balance scales"
acknowledges
toward change.
concerns and is
Elicit and
considering the
possibility of change summarize selfmotivational
but is ambivalent
statements of intent
and uncertain.
and commitment
from the individual.
Elicit ideas
regarding the

individual's Stage of Change

Preparation
The individual is
committed to and
planning to make a
change in the near
future but is still
considering what to
do.

Appropriate Motivational
Strategies for the
counselor

Explore
expectations and
the individual's
role.
Clarify the
individual's own
goals.
Negotiate a
change plan and
behavior contract.
Consider and
lower barriers to
change.

individual's Stage of Change Appropriate Motivational

Strategies for the counselor

Action

Acknowledge
difficulties for the
individual in early
stages of change.
The individual is
Help the individual
actively taking steps identify high-risk
to change but has
situations through a
functional analysis
not yet reached a
and develop
stable state.
appropriate coping
strategies to
overcome these.

individual's Stage of Change Appropriate Motivational

Strategies for the counselor

Maintenance

Support lifestyle
changes.
Affirm the
The individual has
individual's resolve
achieved initial goals and self-efficacy.
such as consistency,
Help the individual
and improvement.
practice and use
new coping
strategies to avoid a
return to undesired
behavior. .
Review long-term
goals with the
individual.

individual's Stage of Change

Recurrence

The individual has

experienced a
recurrence of
symptoms and must
now cope with
consequences and
decide what to do
next.

Appropriate Motivational
Strategies for the counselor

Help the individual

reenter the change
cycle and commend
any willingness to
reconsider positive
change.
Explore the meaning
and reality of the
recurrence as a
learning opportunity.
Assist the individual
in finding alternative
coping strategies.
Maintain supportive

Skills

Express EMPATHY
through reflective
listening.
Develop discrepancy
or inconsistencies
between individual
goals and current
behavior.

Avoid argument and

direct confrontation.

Adjust to individuals
resistance rather than
opposing it directly.

Support self-efficacy
and optimism.

Develop
Discrepancy
Motivation
for change is enhanced when

individuals perceive discrepancies between

their current situation and their hopes for
the future.

One useful tactic for helping a individual

perceive discrepancy is sometimes called
the "Columbo approach" (Kanfer and
Schefft, 1988).

Developing
Discrepancy
Developing
awareness of consequences helps
individuals examine their behavior.

A discrepancy between present behavior and

important goals motivates change.

The individual should present the arguments for

change.
Source: Miller and Rollnick, 1991.

The Columbo
Approach

Using the Columbo approach, the

counselor plays the role of a
detective who is trying to solve a
mystery but is having a difficult time
because the clues don't add up. The
"Columbo counselor" engages the
individual in solving the mystery.

Shifting Focus
You can defuse resistance by
helping the individual shift focus
away from obstacles and barriers.
This method offers an opportunity
to affirm your student's personal
choice regarding the conduct of
his own life.

Agreement With a
Twist
A subtle strategy is to
agree with the
individual, but with a
slight twist or change of
direction that propels
the discussion forward.

Reframing
A good strategy to use when a
individual denies personal problems
is reframing--offering a new and
positive interpretation of negative
information provided by the
individual. Reframing "acknowledges
the validity of the individual's raw
observations, but offers a new
meaning...for them" (Miller and
Rollnick, 1991, p. 107).

Listen Reflectively
"Reflective listening is a
way of checking rather
than assuming that you
know what is meant"
(Miller and Rollnick, 1991,
p. 75).

Summarize
"Summaries reinforce what
has been said, show that
you have been listening
carefully, and prepare the
individual to move on"
(Miller and Rollnick, 1991,
p. 78).

Affirm
When it is done
sincerely, affirming
your individual
supports and
promotes self-efficacy.

Four types of
Motivational Statements

Cognitive recognition of the problem (e.g., "I

guess this is more serious than I thought.")

Affective expression of concern about the

perceived problem (e.g., "I'm really worried
about what is happening to me.")

A direct or implicit intention to change

behavior (e.g., "I've got to do something about
this.")

Optimism about one's ability to change (e.g., "I

know that if I try, I can really do it.")

Sample Questions To Evoke

Self-Motivational Statements
Problem

Recognition

Concern
Intention
Optimism

to Change