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Motivational Interviewing (MI)

What it is and why you


should be using it
Debbie Nieri, MS
Center for Health Services and Policy Research
University of South Carolina

Reference

Miller, WR and Rollnick, S (2012).


Motivational Interviewing: Helping People
Change (3rd Ed.). New York: Guilford Press.

Part I

G OA L :
Yo u w i l l o b t a i n a c o n c e p t u a l
u n d e r s t a n d i n g o f t h e P ro c e s s e s a n d
Core Skills of Motivational
Interviewing, beginning with an
appreciation of the research which
has enabled it to be considered an
evidence-based practice.

Evolution of MI and contributors


William R. Miller and Stephen Rollnick
Carl Rogers

Non-directive client-centered psychotherapy principles


Rogers protgs: Truaxx and Carkhuff: measuring
degree of proficiency in demonstrating Rogerian clientcentered responses

Miller & Rollnicks Summary of the Outcome Research


Currently more than 1200 publications
200 of which are Random Control Trials
Primary focus has been on addictive

behaviors
Research base is broadening into the areas of
healthcare, corrections, and working with
youth

Hypotheses and conclusions proposed by M&R

Notable and replicated findings


Small to medium effect sizes across a variety
of behavioral outcomes.
There are substantial effects on client
outcomes based on relationship with and
characteristics of the therapist.
Empathy, a key construct of MI, has been
found to promote positive client outcomes

Hypotheses and conclusions proposed


by M&R
Within well controlled studies using treatment

manuals, substantial therapist effects remain.

Also, variability by site occurs, more as the norm than


exception:

Client response is significantly effected by


counselor traits and contextual aspects of
delivery, factors that arent easily
standardized by following a treatment
manual.

Hypotheses and conclusions proposed


by M&R
MI is intended to influence client factors that

are associated with positive outcomes

The instillation of hope, supporting self-efficacy, and


active engagement

MI may benefit from the contrast effect:


Clients may have experienced more directive and
confrontational approaches and thus find MI relieving
Cultural differences may exist:

There were more substantial effect sizes with minority


clients as compared to the majority white population

Hypotheses and conclusions proposed


by M&R
Training in MI may help suppress counter-

therapeutic responses

Findings suggest it takes few directive and confrontational


responses by the counselor to lead to resistance and selfdefensiveness in the client.

Effectiveness of MI is linked to aspects of language:


Specific forms of language presage greater behavior change
and can be demonstrated as directly related to counselor
responses:
Change talk is the precursor to change.
Sustain talk is the hallmark of ambivalence- maintaining the
status quo.

Hypotheses and conclusions proposed by M&R


Training in MI may help suppress counter-

therapeutic responses

A counselor who is focused on responding to clients


using CORE skills is less likely to insert their own
opinions and views

Client characteristics may moderate the

measured degree of effectiveness of MI

Clients in action typically have already resolved


ambivalence

What is Motivational Interviewing?

D e fi n i t i o n o f M o t i v a t i o n a l
Interviewing
What we know about change
C o m m u n i c a t i o n Tr a p s a n d h o w t h e y
i n fl u e n c e c o n v e r s a t i o n s a b o u t
change

Miller and Rollnicks Definition of MI

MI is a collaborative, goal-oriented
style of communication with particular
attention to the language of change. It is
designed to strengthen personal motivation
for and commitment to a specific goal
by eliciting and exploring the
persons own reasons for change

atmosphere of
acceptance and compassion
within an

Wait!
Before we talk about MI, it is helpful to
first talk about what is known about
how people change.

The Transtheoretical Model of Change


Prochaska and DiClementes
Transtheoretical Model of Change
Stages of Change:

Pre-contemplation
Contemplation
Preparation
Action
Maintenance

Relapse to prior stages is entirely possible, if not


probable, even following extensive periods of
abstinence

How many clients are ready


for treatment when they enter
care?
Action

Preparation

PreContemplation

Contemplation

Pre-Contemplation Stage of Change

The person is unaware there is a


problem or under-aware of
consequences of the problem.
I am here because THEY made me come, its
their problem, not mine

Contemplation Stage of Change

Beginning awareness and early understanding


there may be a problem yet is uncertain of
what to do or not fully understanding the
nature of the dilemma.

I know I lost control again and did things I regret, but I


only go overboard with the drinking because she
makes me angry

Ambivalence is

the hallmark of the Contemplation Stage


of Change

Ambivalence is

Simultaneously wanting and not


wanting something

or
wanting both of two incompatible things

Ambivalence is

a normal part of the change process

Ambivalence
Common to hear two kinds of talk mixed
together:
Change talk: the persons own statements that favor
change, self-motivational statements.

&
Sustain talk: the opposite of change talk, the persons
own arguments for not changing, for maintaining the
status quo.
Sometimes in the same sentence

I want to quit smoking but


every time Ive tried I gain weight
then start again.

I know its bad for my health


yet I cant imagine not smoking.

The path out of


ambivalence is to choose
a direction, follow it, and
keep moving in the
chosen direction.

Mind Committees: Our personal internal debate teams

We trust ourselves and our


own opinions more so than
others
When the internal debate team is in conflict
there is no change.
When the internal debate team settles on a
direction change occurs.

The Righting Reflex

Miller & Rollnick (2012, pg. 6)

A natural and instinctive response of


trained care providers is to fix the
problem, make things right, to use
knowledge acquired from training and
experience to help the individual seeking
care to overcome their problems.

What happens when these two meet?


Professional operating
from the Righting Reflex
says to the:

Client feeling
ambivalent, who
says/thinks in response:

You need to stop ______


You havent been compliant with the

treatment plan
You have to take this to get better
Tell me something I dont already

know
Ive tried numerous times and
cant seem to stick with it
You sound like my wife/husband

Who do we listen to most?


Which side of the ambivalence debate is the
professional likely to side with?

Which side of the ambivalence debate is left


for the client to side with (internally or
verbally)?

Sustain Talk opportunity wins!


= No Change

Change Talk opportunity lost!

Preparation Stage of Change


The person has an appreciable understanding
of the nature of the problem; can express
desires, reasons, abilities, and needs;
discusses making or considering plans to
change however; sustain talk remains.
I know I need to manage what I eat and exercise to
help control my diabetes yet every other time Ive tried
Ive gone right back to the same ole-same ole. I just
dont know if I have what it takes to go the long haul.

Action
The client is actively taking steps to change
but has not yet reached a stable state
Ive been testing my glucose levels and am
keeping track of what Ive been eating
Yea, I quit smoking!
I started exercise boot camp last week!

Maintenance
The client has achieved initial goals (such as
abstinence) and is now working to maintain
gains.
I have so much more energy now Im
thinking of joining the YMCA and taking
exercise classes

So, why discuss Stages of Change?

Understanding the process of change and


being able to identify where your client is in
the change process facilitates choice in use of
MI techniques and practices.

The Spirit of Motivational


Interviewing
The Practitioner and
Practice Characteristics
that provide the
foundation for
Motivational Interviewing:
Habits of the Heart

MI Spirit

Partnership

Compassion

Acceptance

Evocation

Partnership

Dancing as opposed to wrestling


The willingness to suspend the reflex to
dispense expert advise is a key element in
establishing collaboration necessary to build
partnership

Acceptance

(Miller &Rollnick, 2012, p. 19)

A professional exhibiting Acceptance as intended


in the MI spirit:
Honors each persons absolute worth and
potential as a human being;

Recognizes and supports the persons


irrevocable autonomy to choose his or her
own way;

Seeks through accurate empathy to


understand the others perspective; and,

Affirms the persons strengths and efforts

Compassion

To actively promote the others welfare by


giving priority to their individual needs

Evocation
A strengths-focused premise rather than a
deficit-focused model
People already have within themselves much
of what is needed and your task is to evoke it
A clients own arguments for change are more
persuasive than whatever arguments you
might be able to provide

The Method of Motivational


Interviewing

MI Processes and Core Skills

Four Overlapping Processes


Engaging
Focusing
Evoking
Planning

The confluence of these four processes describe


MI

Engaging: The relational foundation


Engaging is establishing a helpful connection

and a working relationship

Engagement is a prerequisite for


everything that follows
Engagement is an open-ended period that

moves toward a clear focus

Engagement
Is paramount
The quality of the therapeutic alliance between client
and counselor directly predicts both retention and
outcome
The clients perspective more strongly predicts
outcome than does the therapists perspective
Therapist style directly impacts development of
engagement

Traps that Promote Disengagement


The Assessment Trap
The Expert Trap
The Premature Focus Trap
The Labeling Trap
The Blaming Trap
The Chat Trap

Factors Influencing Engagement


Desires or goals
Importance
Positivity
Expectations
Hope

Each of these factors should be attended to in


the first visit when engagement is the goal

Engaging: Reflective Listening


Takes a fair amount of practice to become

skillful, in spite of seeming easy to do


The crucial element of good listening is what
the counselor says in response to what the
speaker offers. The choice in what content the
counselor reflects and how is where MI
becomes directional.
Avoid Communication Roadblocks

Focusing

(Miller & Rollnick, 2012, p. 27)

The process by which you develop and


maintain a specific direction in the
conversation about change

Both client and counselor have agendas which


may or may not align

Focusing
Answers the question:
What changes are hoped to arise from this
consultation?
How often are the answers consistent
between your staff and the people they serve?

Styles of Communication
Directing: the focus is provider determined
As a default approach for promoting personal change this
approach has serious limitations

Following: entirely from what the client brings

to each consultation.
This may be the communication style used in initial encounters,
particularly when building engagement

Guiding: promotes a collaborative search for

direction, the focus is negotiated between


experts (the client and counselor)
Focusing calls for this is the style of communication
(wherein MI falls)

Evoking: preparing people to change


The heart of MI: It is in the process of evoking
that counseling becomes distinctly MI
Evoking involves eliciting the clients own
motivations for change
The expert/ directing approach does not
facilitate personal change
Personal change requires the individuals
active participation and is a long term process

Component skills in Evoking

Recognizing change talk when you hear it

And, knowing how to evoke and respond to it when it


occurs

Recognizing sustain talk when you hear it

And, understanding what it signifies and how to respond


to it

Sustain Talk is the hallmark of ambivalence

If someone else voices an argument


for change, people are likely to
respond by expressing a counterchange argument from the other side
of their ambivalence.
People literally talk themselves out of
changing.
Similarly, people talk themselves into
changing by continuing to voice prochange arguments.

Preparatory Change Talk (The DARNs)


Desire, Ability, Reasons, and Need
Each reflect the pro-change side of
ambivalence.
They are considered preparatory change talk
because none of them, alone or together,
indicate that change is going to happen.

Mobilizing Change Talk (The CATS)


The CATS signal movement toward resolution
of the ambivalence in the favor of change.

Commitment: signals the likelihood of action


I will; I promise; I guarantee; I intend to (decision
with a little doubt)

Activation: movement toward but not quite a


commitment
Im willing to try; I am ready to; I am prepared to

Mobilizing Change Talk


Taking Steps: the client has already done
something in the direction of change:
I bought nicotine patches; I didnt snack any evening
this past week; I quit smoking inside my house & car

The DARN CATS: Language that


signals movement toward change

Sustain Talk
Any speech that can be uttered on behalf of

change can also be spoken as an equal and


opposite reaction on behalf of the status quo
(p. 164)
In MI, sustain talk is not ignored, in the spirit of
acceptance, it is reflected, respected and
included in the larger picture

Evoking Motivation
Counselors can substantially influence the amount of
change talk spoken.
Strength and frequency of change talk increase over
the course of a MI session.

Amount of change talk predicts


behavior change
So, how do you increase the amount of change talk
spoken by clients?

Ask evoking questions


Ask open-ended questions surrounding the

DARNs:
(CATs are likely too premature)

DESIRE: How would you like for things to

change?
ABILITY: Of these various options youve
considered, what seems most possible?
REASONS: Why would you want to get more
exercise?
NEED: How serious is this to you?

Ask evoking questions (cont)


Querying Extremes: What concerns you the

most about?
Looking back: Do you remember a time when
things were going well for you?
Looking forward: If you did decide to make
this change, what do you hope would be
different in the future? OR: Suppose you
dont make any change, what do you think the
future would hold?
Explore broader goals and values

Wrong Questions?
Questions that would be ill-advised from an MI

perspective.

Why havent you changed?


What keeps you doing this?
Why do you smoke?
Why arent you trying harder?
Why cant you?

Responding to Change Talk

When you hear it, respond to it!

Open-ended questions: Ask for more detail or


examples

Affirmation: Comment positively about what you heard


Reflections: simple or complex, continuing the
paragraph

Summaries: include change talk content in summaries

Responding to Sustain Talk

It is not desirable in MI to evoke and explore all


of the clients possible reasons for maintaining
the status quo
The intent of reflecting sustain talk is to
acknowledge what the person is saying
without pushing against it as this is likely to
entrench sustain talk.

Reflective responses to Sustain Talk


Straight Reflection
Amplified Reflection
Double-sided Reflection
Emphasizing Autonomy
Reframing
Agreement with a twist
Running head start
Coming alongside

Planning
Encompasses both developing commitment

to change and formulating a specific plan of


action
Is a conversation about action that:

is conducted with a sharp ear for eliciting clients own


solutions;
promotes their autonomy of decision making; and,
continues to elicit and strengthen change talk as a
plan emerges

Planning
There is a negotiation of change goals and
plans, an exchange of information, and
usually a specification of next steps that may
or may not involve further treatment
It is common for progress and motivation to
fluctuate, inviting renewal of planning,
evoking, refocusing, or even re-engagement

Signs Clients are ready to transition to planning


There is an increase in change talk with

noticeable strength in commitment language


(The CATS)
The client has begun taking steps toward
change- testing the water
There is a noticeable reduction in the amount
of Sustain Talk
The Client demonstrates resolve
The client asks questions about change

Transitioning Methods
Recapitulation: A transitional collecting summary of

Change Talk, like adding flowers to a bouquet


Ive heard you say you want to feel better, live a longer life, be
able to do more things with your grandkids and set a better
example for them by not smoking. What do you think you need to
do to get there?
Key question: from the bouquet, ask a short and simple

question about doing


What do you think will make that happen?

Pregnant Pause: waiting for the client to hear themselves

or feel the affect associated with their statement, allows


them to sit with the discomfort without rescuing them.

Key Points to planning


Developing the plan is the beginning, not the

final step.
Implementation intentions involve both a

specific plan and the intention or commitment


to carry it out.
Public commitment, social support, and self-

monitoring can reinforce the best of


intentions.

Supporting Change
Support persistence
Provide flexible revisiting

Re-planning
Reminding
Refocusing
Reengaging

Core Skills
Asking

Open-ended questions

Affirming
Reflective Listening
Summarizing
&
Informing and Advising

Asking

Open Questions

Gathering information is not the function of the


question in MI
Responses help you understand the persons

internal frame of reference which strengthens


the collaborative nature of the relationship
Responses aid in finding a clear direction

Affirming
Happens through the MI spirit in a general

sense and specifically through direct


recognition of particular strengths, abilities,
good intentions and efforts
Opposite stance to supporting and providing
affirmations is the idea that people will change
if you can just make them feel bad enough.
You keep drinking when you know its ruining your relationship

Reflective Listening
Making a guess about the clients meaning
Functionally, it deepens the understanding of

both the counselor and client by clarifying


Allows people to hear again the thoughts and
feelings they are expressing and ponder them
Keeps the person talking, exploring, and
considering
The listener chooses which aspects of the
clients statements to reflect

Summarizing
Reflection statements that collect what the

person has been saying and offers it back, as


if in a basket.
Summaries:

Pull together information at the end of a session


Suggest links between present material and past
Function to transition from one task to another
Provide a what else? opportunity
Have different functions

Different functions of Summaries


Functions are based on which MI process is at

task

Engaging: communicate what youve heard, provide


lead for further development of collaborative
relationship
Focusing: the what else? opportunity: what have we
missed
Evoking: there are particular guidelines regarding
eliciting change talk and moving along
Planning: draw together the persons motivation,
intentions, and specific plans for change

Informing and Advising


In MI, providing information and advising is

appropriate, with two considerations:


1.
2.

Information and advice are offered with permission


The goal for the counselor is to understand the
clients perspective of the topic, their needs, and to
facilitate the client drawing their own conclusion
about the relevance of any information provided

Exchanging Information
Practitioners often overestimate the amount

of information clients need


It is unhelpful to give clients information they
already have (e.g., smoking is bad for your
health)
It is more useful to learn what they know,

what theyve already done or tried

Information Exchange: Principles of Good Practice


Clients are the experts on themselves
(using affirmations and reflections elicits a wealth of
information)

Find out what they know and need to know


Match information to clients needs
Clients can tell you what kind of information

would be helpful
Advice that meets clients needs is helpful

Simple Strategy for Information Exchange

Elicit

Provid
e

Elicit

Elicit Information Needs


Ask permission and clarify information gaps and

needs:
May I?
Would you like to know about?
What would you like to know about?
Is there any information I can help you with?
What might be the biggest benefit to you if you were
to quit smoking?
What might you be most interested in knowing about
treatment options that help people quit smoking?

Provide the needed information


Prioritize, be clear and concise, avoid jargon
Support autonomy
Offer small amounts with time to reflect
Acknowledge the freedom to disagree or

ignore
Present what you know without interpreting
the meaning for the client

Elicit (again)
Check back in with the client to see what they

understand the information to mean, their


interpretation, or response
So, what do you make of that?
Have I been clear so far?
You look puzzled?
How does this apply to you?
I wonder what all this means to you?
Tell me in your own words what Ive said.

Offering Advice
A special form of information giving as it

implies a do component: a recommendation


about making personal change
Follow steps to providing information: EPE
Advice carries a strong potential for reactance
Emphasize personal choice and
offer a menu of options

!! IMPORTANT TO REMEMBER !!

The vast majority of people


do not like receiving unsolicited
advice.
Even more people dont think twice
about giving it.

MI: Is NOT/ Does NOT:


Idea/ concept

Motivational
Interviewing

1. Identical to Rogers non-directive


counseling
2. A technique or gimmick to make people
change

1. MIs focusing, evoking, and


planning have clear directionality to
them.
2. MI was specifically developed to
help clients resolve ambivalence and
strengthen their own commitment to
change

MI: Is NOT/ Does NOT:


Idea/ concept

Motivational
Interviewing

3. MI is a panacea, the solution to all


clinical problems

3. MI blends well with other


approaches and does not negate the
value of other techniques. MI is a style
of being with people, an integration of
clinical skills to foster movement for
change.

MI: Is NOT/ Does NOT:


Idea/ concept
4. The Transtheoretical Model (TTM),
although they are compatible and
complementary.
5. The Decisional Balance technique
exploring the pros and cons of change

Motivational
Interviewing

4. TTM defines stages of change while


MI provides a means of moving
through the stages
5. Decisional balance is more
associated with counseling with
neutrality as the counselor explores
cons of change. MI is more
directional, with the intent being to
strengthen the arguments for change

MI: Is NOT/ Does NOT:


Idea/ concept

Motivational
Interviewing

6. Require the use of assessment feedback

7. A way of manipulating people into doing


what you want them to do

6. While personal feedback may be


particularly useful for persons who
arent considering change, it is not a
necessary nor a sufficient component
of MI.
7. MI cannot be used to manufacture
motivation that isnt already there. It
is a collaborative partnership that
honors and respects the others
autonomy, seeking to understand the
persons internal frame of reference.

Part II
Goals:
1 . Yo u w i l l u n d e r s ta n d w h a t i s k n o w n f ro m
th e re s e a rc h a b o u t l e a rn i n g a n d d e v e l o p i n g
p ro fi c i e n c y i n M I ;
2 . Yo u w i l l b e ex p o se d t o so m e o f t h e t yp e s
o f s e r v i c e s i n w h i ch M I h a s b e e n u s e d ( a n d
evaluated); and,
3 . Yo u w i l l b e a b l e to i d e n ti fy
c h a r a c te r i s ti c s o f p r a c t i ti o n e r s / p r a c t i c e
s e t ti n g s w h i c h m a y i n fl u e n c e
o rg a n i z a ti o n a l a d o p t i o n o f M I .

4 Broad Components of Skill in MI

4. Planning
and Spirit
1. 3.
MIFocusing
Knowledge
2. Engaging
andand
Evoking
Integration

Training Guidelines
A single workshop is unlikely to improve competence
In our first evaluation of our own 2-day training
workshop1, participants showed very little
improvement in skills, certainly not enough to make
any difference in how their clients responded, but we
did manage to significantly decrease their interest in
learning more about MI (p. 329)
1

Miller, W.R., & Mount, K.A. (2001) A small study of training in motivational interviewing: Does one
workshop change clinician and client behavior? Behavioural and Cognitive Psychotherapy, 29, 457471.)

However, there are some who may attend one


workshop and get it (p. 329)

Typically such protgs re reasonably skillful in reflective listening


prior to the training

MI Learning Menu
12 Learning Tasks identified by Miller and Rollnick
(2012)
Understanding the underlying MI Spirit (PACE
variables)
Developing skill and comfort with reflective listening
Identifying change goals (Focusing)
Exchanging information and providing advice within
an MI style (EPE)
Being able to recognize Change Talk and Sustain Talk
Evoking Change Talk

MI Learning Menu (cont)


Responding to Change Talk in a manner that

strengthens it
Responding to Sustain Talk and Discord in a
way that does not amplify it
Developing hope and confidence
Timing and negotiating a change plan
Strengthening commitment
Flexibly integrating MI with other clinical
skills and practices

How can the 12 learning tasks be


accomplished?
More than obtaining knowledge is involved
Feedback is fundamental and the more
immediate the better
its hard to learn archery in the dark

(p. 323)

Clients provide immediate feedback


through their responses to the counselor

Developing Proficiency: Whats


needed?
Knowledge development and the opportunity for
continued learning over time through feedback
and coaching based on direct observation
Coaching need not be extensive
One study found that 6 individual expert coaching sessions of
hour each conducted by telephone were sufficient to bring trainees
on average up to a level of proficiency that would be satisfactory
for delivering MI in clinical trial (p. 330)

It is a matter of learning to criterion, not a fixed


dose of training hours completed
Martino, S., Canning-Ball, M., Carroll, K.M., & Rounsaville, B.J. (2011). A criterionbased stepwise approach for training counselors in motivational interviewing.
Journal of Substance Abuse Treatment, 40, 357-365.

MI Coaching and Feedback

While still valuable, a coaches feedback may


be subjective
Coding systems are available and provide
objective feedback

Types of Coding Systems


Coding interviewer responses
MITI: Motivational Interviewing Treatment Integrity

Moyers, T.B., Martin, T., Manuel, J.K., Hendrickson, S.M., and Miller, W.R. (2005)
Assessing competence in the use of motivational interviewing. Journal of
Substance Abuse Treatment, 28(1), 19-26.

Coding client responses


Glynn, L.H., & Moyers, T.B. (2010). Chasing change talk; The clinicians
role in evoking client language about change. Journal of Substance Abuse
Treatment, 39, 65-70.
Quantify interviewer and client responses:

MISC: Motivational Interviewing Skills Code

Moyers, T.B., Martin, T., Catley, D., Harris, K., & Ahluwalia, J.S. (2003). Assessing
the integrity of motivational interventions: Reliability of the Motivational
Interviewing Skills Code. Behavioral and Cognitive Psychotherapy, 31, 177-184.

Visit: mi-campus.com

Additional Learning Methods


Learning Communities:
Groups of interested MI professionals working together
to monitor and build personal skills.
Self-assessment:

Not an ideal practice.

This option requires the individual to take an unbiased


look at their own performance. If doing so, record and
listen to your sessions.

Listening to your own sessions


Record (with permission) your session and:
Count your reflections: were they simple or complex?

Count your questions: were they open or closed?

Aim for 2 reflections for every question

Listen for Change Talk and Sustain Talk: count each and determine the
ratio.

Ask more open than closed questions

Count both reflections and questions: what is your ratio?

Offer more complex than simple reflections

Equal frequency = ambivalence (no change)


When Change Talk occurred, what was the next thing you said?
Count your OARS responses

Listen for MI inconsistent responses (giving advice without permission,


confronting or arguing with the client, other righting reflex responses

How did the client respond to these?

Final Comments on Learning MI


Workshop training is a good start but it is just

the beginning.
Feedback and coaching are important in
learning MI and need to be based on observed
practice and continue over time, even for the
experts.
Skills tend to drift over time
Skill development in MI is not a one-shot
event but an ongoing process.

Applying Motivational
Interviewing
Modes of Delivery and
Service Settings
Problem areas that have
been researched

Modes of Delivery
Consultations with individuals
Telephone and Televideo

Dozens of studies have been done using these


methods for/to: promote physical exercise, colorectal
cancer screening, medication persistence, dietary
change; tobacco cessation; and, blood donation (See
Miller and Rollnick, 2012, p. 337 for comprehensive list
of citations)

Group Counseling
Strongly recommended practitioners hone their skills in
individual first

Modes of Delivery
Text formats:
Early stage of research; shows promising results
Examples include:

Computer based delivery of the drinkers check-up (Walters,


Hester, Chiauzzi, & Miller (2005)
Smoking cessation: (Hollis, et al., 2005)
Depression and marijuana use: (Kay-Lambkin, Baker, Lewin,
& Carr, 2009)
Drug use during pregnancy: (Ondersma, Chase, Svikis, &
Schuster, 2005)

Each of the formats involved providing personalized


feedback regarding substance use, which in itself may
enhance motivation to change (Juarez et al., 2005)

Modes of Delivery
Family consultations:
Doing so may increase social support for change.

The significant other (SO) may need coaching prior to


involvement to reduce potential for their interactions to
reinforce sustain talk (ie., they may blame, etc)

Using MI with personalized feedback (Motivational


Enhancement Therapy) has been used within family
treatment contexts

(Connell & Dishion, 2008; Slavet, et al., 2005; Van Ryzin,


Stormshak, & Dishion, 2012)

Differing Roles and Contexts


Coaching
Education
Opportunistic Interventions
Corrections
Organizations
Cross-culture applications

Implementing MI
Organizational
Considerations

Considerations for scope of


implementation
Limited implementation with few staff vs.

training for all staff


The role of workshops
Workshop training is a good start, but only a beginning
(p. 354)
Ongoing Coaching and Peer Support

Improving service-wide conversations about

change
Life inside a clinical consultation is often an expression
of forces outside of it ( p. 358)

Organizations: Common areas for


improvement
Communication style
Avoid overuse of directing style
Have two feet planted firmly in the Guiding Style
Engagement
Client engagement is a thermometer of a well-functioning
therapeutic relationship or service

Information Exchange
Information exchange can be viewed as a process rather than
an event, one that requires thoughtfulness on both sides

Wrap-Up

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