Motivational Interviewing

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Motivational Interviewing

• Basics of Motivational Interviewing
• Module 1

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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

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When given a choice between changing and proving
that it is not necessary, most people get busy
with the proofJohn Galbraith
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What is Motivation How is it Instilled?
Have the audience list several ideas of their
definition of motivation what motivates people
to change
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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

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What is Motivational Interviewing?

• An approach designed to help members build
  commitment reach a decision to change
• It appears to be member-centered, yet the staff
  maintains a strong sense of purpose direction-
  and chooses the right moments to interject

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What is Motivational Interviewing?

• A person-centered, directive method of
  communication for enhancing intrinsic motivation
  of change by exploring and resolving ambivalence.

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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

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Its 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

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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

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What is Motivational Interviewing?

• The goals are
• Resolve ambivalence
• Develop discrepancy
• Increase intrinsic motivation
• Increase the clients self-perception, regarding
  the ability to change
• Encourage the client to present the argument to
  change

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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

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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

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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

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Principles of Motivational Interviewing

• Express empathy
• Develop discrepancy
• Avoid argumentation
• Roll with resistance
• Support self-efficacy

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Principles of Motivational Interviewing

• Review of the MI poster

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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)

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Reflective Listening as a Process as an
Empathetic Strategy
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Reflective Listening

• Characteristic of Motivational Interviewing
• Understand the members feelings perspectives
  w/o judging or criticizing
• Its not only about how you listen or keep quiet
  - it is about how you respond

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Reflective Listening Goals

• Allow the member to explore ambivalence
• To make a guess as to what the member means
• 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

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Reflective Listening Goals cont.

• Clarify the members own experiences
• Elicit self-motivational statements
• Become genuinely interested in the member
• Change is more a process than an outcome

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It is important to remember

• Acceptance is not the same thing as agreement or
  approval. It is possible to accept and
  understand a members perspective but not agree
  with it.

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5 Types of reflective statements

• 1) REPEATING
• The simplest form of reflection, the listener
  repeats a portion of what was said.

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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.

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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.

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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.

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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.

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The Caseworkers Response

• Reflective Listening Exercise 1

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Let the member be the member they are

• Lets not make them imitate others. Let them find
  themselves and be themselves
• Cultivate an atmosphere of change

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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

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Poor reflective listening techniques (roadblocks)

• Agreeing, approving or praising
• Shaming, ridiculing, labeling
• Sympathizing, reassuring
• Questioning or probing
• Withdrawing or distracting

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Reflective Listening

• Exercise 2
• Roadblocks Responses of Poor Reflective
  Listening Statements

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AVOIDING PITFALLSRemain as positive and
nonjudgmental as possible and rely on brief
open-ended questions to elicit the members
concerns and exploration of feelings.
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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?

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The optimal approach is to ask an open-ended
question, then to respond to the members
response with reflective listening strategy- not
another question. Too many questions will lead
into a passive question/answer trap.
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Open Ended Questionsgoals

• Establish an atmosphere of openness, acceptance
  and trust
• The member should do most of the talking
• Let the member explore their thoughts

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Open Ended Question Role Play

• Role Play Activity

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Stages of Change

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

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Stages of ChangePrecontemplation

• The person has no intention to change behavior in
  the foreseeable future. Individuals in this
  stage are unaware or underaware of their problems

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Stages of ChangeContemplation

• 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.

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Stages of ChangePreparation

• Individuals are intending to take action and may
  practice some of the behaviors necessary to
  change, but have yet to make a full commitment.

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Stages of ChangeAction

• In this stage individuals modify their behavior,
  experiences or environment in order to overcome
  their problems.

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Stages of ChangeMaintenance

• Individuals in this stage work to prevent relapse
  and consolidate gains.

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Role Play

• More advanced role plays reflective
  listening/open ended questions

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Summary

• Review of the objectives and the main points of
  the training