Professional Documents
Culture Documents
Reference
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.
behaviors
Research base is broadening into the areas of
healthcare, corrections, and working with
youth
therapeutic responses
therapeutic responses
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
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.
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Preparation
PreContemplation
Contemplation
Ambivalence is
Ambivalence is
or
wanting both of two incompatible things
Ambivalence is
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
Client feeling
ambivalent, who
says/thinks in response:
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
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
MI Spirit
Partnership
Compassion
Acceptance
Evocation
Partnership
Acceptance
Compassion
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
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
Focusing
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
to each consultation.
This may be the communication style used in initial encounters,
particularly when building engagement
Sustain Talk
Any speech that can be uttered on behalf of
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.
DARNs:
(CATs are likely too premature)
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?
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.
Planning
Encompasses both developing commitment
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
Transitioning Methods
Recapitulation: A transitional collecting summary of
final step.
Implementation intentions involve both a
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
Affirming
Happens through the MI spirit in a general
Reflective Listening
Making a guess about the clients meaning
Functionally, it deepens the understanding of
Summarizing
Reflection statements that collect what the
task
Exchanging Information
Practitioners often overestimate the amount
would be helpful
Advice that meets clients needs is helpful
Elicit
Provid
e
Elicit
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?
ignore
Present what you know without interpreting
the meaning for the client
Elicit (again)
Check back in with the client to see what they
Offering Advice
A special form of information giving as it
!! IMPORTANT TO REMEMBER !!
Motivational
Interviewing
Motivational
Interviewing
Motivational
Interviewing
Motivational
Interviewing
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. 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.)
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
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
(p. 323)
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.
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
Listen for Change Talk and Sustain Talk: count each and determine the
ratio.
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
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:
Modes of Delivery
Family consultations:
Doing so may increase social support for change.
Implementing MI
Organizational
Considerations
change
Life inside a clinical consultation is often an expression
of forces outside of it ( p. 358)
Information Exchange
Information exchange can be viewed as a process rather than
an event, one that requires thoughtfulness on both sides
Wrap-Up