building skills in motivational...
TRANSCRIPT
BuildingSkillsinMotivationalInterviewing
HelpingPeopleChange
AllHomeSeattle,WA
October17,2017
KenKraybillCenterforSocialInnovation/t3
www.thinkt3.com
1
BuildingSkillsinMotivationalInterviewing
TrainingObjectivesParticipantswillbeableto:
• Describethefourelementsofthemindsetandheart-setofMI• ExplainthefourprocessesthatguideMIconversations• ProvideexamplesofthecoreinterviewingskillsofMI• Namethreestrategiestoelicitchangetalk
9:00 OverviewofMIBasics
Whatwouldyousaynext?RelevancyofMIforyourworkEmbodyingthemindsetandheart-setofMIFourprocessesthatguidetheflowofMI
10:40 BREAK
10:50Respondingwithreflectivestatementsandsummaries
Formingreflectivestatements Usingreflectivestatementsstrategically
Offeringthreetypesofsummaries12:10 LUNCH 12:40Usingevocativequestionsandaffirmations
Formingthoughtful,compellingopenquestionsUsingopenquestionstodeepentheconversation
Combiningreflectivestatementswithquestions Offeringaffirmationstohighlightstrengths
1:50 BREAK
2:00 Recognizing,eliciting,andrespondingtochangetalk Recognizingchangetalk Strategiestoelicitchangetalk Respondingtochangetalktostrengthenit Providinginformationandsuggestions
3:30 ADJOURN
2
ABriefHistoryofMotivationalInterviewingMotivationalInterviewing(MI)isawayoftalkingwithpeopleaboutchangerelatedtothingsweoftenhavemixedfeelingsabout–exercise,diet,alcoholandotherdruguse,relationshipissues,riskysexualbehaviors,schoolandjobrelatedconcerns,spiritualpractices,certainattitudes,andotherissueswefaceinourlives.TheMIapproachgrewoutWilliamR.Miller’sworkwithproblemdrinkers.Inthepast,itwasbelievedthatpeoplewhodranktoomuchwereunabletoseehowtheirusewasharmingthemselvesandothers.Theyweresaidtobeindenial.Counselorsandotherswhowantedtohelpwouldtrytobreakthroughthisdenialbyusing“in-your-face”tacticssuchasconfrontationandshametotrytoconvincepeopleoftheirneedtochange.Asyoucanimagine,thisapproachdidn’tworkverywell.Noneofuslikeitwhenotherpeoplethinktheyknowwhat’sbestforusortrytogetustochange.Wewanttodecideforourselveshowtoliveourlives.In1991,WilliamR.MillerandStephenRollnickwroteabooktitledMotivationalInterviewing:PreparingPeopletoChangeAddictiveBehavior.Itexplainedhowtotalkwithpeopleabouttheiralcoholanddruguseinwaysthatrespectedtheirabilitytodecideforthemselveswhethertheywantedtochange.Inthebook,theauthorsdescribedthespirit(coreattitudesandbeliefs)ofthisapproachandthespecificskillsandstrategiesofMI.Asecondedition,MotivationalInterviewing:PreparingPeopleforChange,waspublishedin2002.ItfurtherexplainedhowMIworks,theresearchbehindit,andhowtogetbetteratusingMI.ItalsodescribedthespreadofMItootherareasbeyondsubstanceusedisordersincludinghealthcare,mentalhealth,corrections,andschoolsettings.Athirdedition,MotivationalInterviewing:HelpingPeopleChange,2013,expandedontheMIapproachandincludedsomenewideassuchasthefourprocessesofMIconversations:engaging,focusing,evoking,andplanning.MIisdefinedas“acollaborativeconversationstyleforstrengtheningaperson’sownmotivationandcommitmenttochange.”MIcanalsobedescribedas“awayofhelpingpeopletalkthemselvesintochanging.”Thisapproachembodies“amind-setandaheart-set”thatincludespartnership,acceptance,compassion,andevocation.MotivationalInterviewingisaguidingstylethatinvitespeopletoexaminetheirownvaluesandbehaviorsandcomeupwiththeirownreasonstochange.Itdoesn’ttrytoconvincepeopleorarguewiththem.Instead,itdrawsoutpeople’sownhopes,experience,andwisdomaboutthemselvesincludingwhetherornottochange.AsWilliamR.Millersays,“Youalreadyhavewhatyouneed,andtogetherlet’sfindit.”Peoplewhoareusedtoconfrontingandgivingadvicewilloftenfeellikethey’renot“doinganything.”But,asMillerandRollnickpointout,theproofisintheoutcome.Moreaggressivestrategiesoftenpushpeopleaway.MI,ontheotherhand,increasestheoddsthatpeoplewillgivechangeachance
3
TheSpiritofMI:Partnership,Acceptance,Compassion,andEvocation
“MIisdonefororwithsomeone,notonortothem.”
MotivationalInterviewing,3rdedition
Imaginetakingadrinkofacarbonatedbeveragethathasgoneflat.Itstilltastesvaguelylikeitself,butthefizzhasgoneoutofit.It’snolongerworthdrinking,andyou’llprobablypouritdownthedrain.ThespiritofMIisthefizzofahelpingconversation.It’swhatshowsyouthatapersontrulycaresaboutyouandisn’tjustpretendingtocare.IndescribingMIspirit,MillerandRollnicknote:“WhenwebeganteachingMIinthe1980swetendedtofocusontechnique,onhowtodoit.Overtimewefound,however,thatsomethingimportantwasmissing.AswewatchedtraineespracticingMI,itwasasthoughwehadtaughtthemthewordsbutnotthemusic…ThisiswhenwebeganwritingabouttheunderlyingspiritofMI,itsmind-setandheart-set.”(MotivationalInterviewing,3rdedition)ThespiritofMIiscommunicatedinourbodylanguage,facialexpressions,toneofvoice,andattitudes.Itcomesfrominsideusandcan’tbefaked.Ithastobereal.Spiritisaboutthewaywearewithpeople,notjustwhatwesay.MillerandRollnickidentifyfourpartsofthespiritofMI:partnership,acceptance,compassion,andevocation.Eachoftheseisrelatedbutalsounique.PARTNERSHIP–showingrealrespectfortheotherperson;assumingbothofyouhaveimportantinput;dancingratherthanwrestlingACCEPTANCE–meetingpeople“wherethey’reat”withoutjudgingthem;believinginthem;tryingtounderstandwherethey’recomingfrom;shiningalightonthegoodstuffyouseeintheminsteadofpointingoutwhat’swrongwiththemCOMPASSION–hangingintherewithpeoplewhenthey’rehurtingorstrugglingwithanissue;doingwhateverisintheperson’sbestinterestsEVOCATION–“callingforth”oraskingpeopleaboutthingssuchaswhatmakesthemtick,whattheyalreadyknow,what’simportanttothem,howwouldtheyliketheirlivestobedifferent
AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013
4
FourProcessesofMI:Engaging,Focusing,Evoking,Planning
MIconversationshaveapurposeanddirection.Theyseektohelppeopleidentifyandexploretheirhopes,values,andchangegoalsusinganempathic,guidingapproach.Theguidingapproachusedinmotivationalconversationsgenerallymovesthroughfourprocesses.Theseprocesses–engaging,focusing,evoking,andplanning–tendtofollowalogicalorderbeginningwithengagingandendingwithplanning.However,itdoesn’tmeanthattheyalwaysfollowastraightlineorthateveryconversationwillincludeallfour.UsingMIissimilartoimprovtheatre;youdon’thaveascript,butthereisabasicstorylinethatyou’retryingtofollow.Engaging–gettingtoknowsomeoneandbuildingtrust
• “It’sreallygoodtomeetyou.”• “Whatdoyoudoforfun?”• “Tellmeabitaboutyourself.”
Focusing–figuringouttogetherwhattotalkabout
• “Whatwouldyouliketotalkabouttoday?”• “Youmentionedsomeproblemsatschool,someissueswithyourgirlfriend,and
wantingtofindawaytomakesomemoney.Wheredoyouwanttostart?”• “Woulditbeallrightifwetookacloserlookatyourrelationshipwithalcohol?”
Evoking–drawingouttheperson’sowndesire,reasonsandabilitytochange
• “Howwouldyoudescribetheroleofalcoholinyourlife?”• “Ifyoudiddecidetohaveahealthierlifestyle,wherewouldyoustart?”• “Howconfidentareyouthatyoucouldmakethischangeifyouwantedto?”
Planning–developingaspecificchangeplanthatthepersoniswillingtoputinaction
• “Whatdoyouthinkyou’lldonext?”• “Whatmightgetinthewayofyourplan?”• “HowcanIandotherssupportyouincarryingoutyourplan?”
AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013
5
OARS:OpenQuestions
Openquestionsinvitepeopletosayasmuchoraslittleastheywantaboutatopic.Theyallowpeopletodecideforthemselveswhatideas,thoughtsorfeelingstheywanttoshare.Answeringopenquestionstendstohelppeopleunderstandthemselvesbetterandthinkinnewwaysabouttheirsituation.Herearesomeexamplesofopenquestions:
What’sgoingwellinyourlife?What’snotgoingsowell?Whatwouldyouliketotalkabouttoday?Howdoesalcoholfitinyourlife,ifatall?Whenyoudodrink,whatdoesitdoforyou?Whatdoyouvaluemostinafriend?Ifyoucouldchangeanythinginyourlife,whatwoulditbe?Whatspecificchangesareyouthinkingaboutmaking?
Closedquestions,incontrast,limittheconversation.Theyaremostoftenusedtogatherspecificinformationoraskyesornoquestions.Forexample:
Whatisyourdateofbirth?Howmuchdoyoudrink?Whenisthelasttimeyougotaphysicalexam?Whichdaywouldyouliketomeetnextweek?
OpenquestionsareusedthroughoutthefourprocessesofMIandhelptoengagewiththeperson,increaseunderstanding,strengthencollaboration,findafocus,drawoutmotivation,anddevelopaplanforchange.Asageneralguideline,openquestionsshouldbeusedmorethanclosedones.
OARS:Affirmations
Affirmationsarestatementsthatshinealightonwhatisgoodaboutaperson.Theyputemphasisonpeople’sstrengthsratherthantheirweaknesses.Strengthscanincludeaperson’stalents,qualities,knowledge,skills,efforts,andmuchmore.Affirmationsoftenhelppeopleseestrengthstheypossessthattheymayhaveahardtimeseeingforthemselves.Affirmationscanalsobuildaperson’sconfidenceinbeingabletomakechanges.Anaffirmationmustberealandfromtheheart.Peoplewillknowifitseemsfalseandmightbelesslikelytotrustyou.Affirmingsomeone’sstrengthsisdifferentthancheerleadingorpraising.Praisestatementsputyouina“one-up”positionandareusuallybasedonjudgingsomeone’sperformance.Furthermore,praisecanbebothgivenandwithdrawn.Whenformingaffirmations,it’susuallybesttoavoidstartingwith“I”andinsteadcenterthecommenton“you.”It’salsohelpfultobespecific.Hereareafewexamplesofaffirmation.
Youwereverycourageoustospeakupforwhatyouthoughtwasright.Youknowwhat’sbestforyouandyouaren’tgoingtobeeasilyswayed.Youshowedalotofpatienceinthewayyouwaiteduntilhefinishedspeaking.Itwashard,yetyoureffortstonotdrinkontheweekendpaidoff.Thankyoufortakingthetimetotalkwithmetoday.
AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013
6
OARS:ReflectiveListening
“Whatpeoplereallyneedisagoodlisteningto."–MaryLouCasey
“GoodlisteningisfundamentaltoMI.TheparticularskillofreflectivelisteningisonetolearnfirstbecauseitissobasictoallfourprocessesofMI.Ittakesafairamountofpracticetobecomeskillfulinthiswayoflisteningsothatreflectionscomemorenaturallyandeasily.”[p.48]Reflectivelisteningistheskillof“bendingback”topeoplewhatwehearthemsayinginanefforttounderstand“wherethey’recomingfrom.”Inotherwords,toseetheworldthroughtheotherperson’seyes.Thiskindoflisteningmeansgivingapersonyourfullattention.Wedothiswithourwords,actions,andbodylanguage.Reflectivelisteningisaspecialgiftwecanoffertoothersinbothourworkandpersonallives.Reflectivelisteningtakestheconversationtoadeeperlevel.Thisisespeciallytrueofreflectivestatementsthatgobeyondrepeatingwhatwassaidbymakingareasonableguessabouttheperson’smeaning.Suchstatements“havetheimportantfunctionofdeepeningunderstandingbyclarifyingwhetherone’sguessisaccurate.Reflectivestatementsalsoallowpeopletohearagainthethoughtsandfeelingstheyareexpressing,perhapsindifferentwords,andponderthem.Goodreflectivelisteningtendstokeepthepersontalking,exploring,andconsidering.Itisalsonecessarilyselective,inthatonechooseswhichaspectstoreflectfromallthatthepersonhassaid.”[p.34]Formingreflectionsrequirestheabilitytothinkreflectively.Sincewordscanhavemultiplemeanings,andpeopledon’talwayssayexactlywhattheymean,itisusefultoregardpeople’sstatementsasa“firstdraft.”Inotherwords,ratherthanassumingwhatsomeonemeans,checkitout.Becausereflectionsarestatements,notquestions,theinflectionusuallyturnsdownattheend.Forexample,noticethedifferencebetween: “Youdon’tthinkyourdrinkingisaproblem?” “Youdon’tthinkyourdrinkingisaproblem.”Somereflectivestatementsbasicallyrepeatorslightlyrephrasewhatapersonhassaid.Thesesimplereflectionscanconveybasicunderstandingandhelptheflowoftheconversation.However,theyaddlittleornomeaningtowhatthepersonsaid,andcanstoptheconversationfromgoingtoadeeperlevel.Forexample:
Statement:I’mfeelingprettydepressedtoday.Response:You’refeelingdepressed./You’refeelingkindofdown./Prettydepressed…
Complexreflectionsaddmeaningoremphasistowhatsomeonehassaidbymakingaguessaboutwhatisunspoken.Complexreflectionstendtohelppeoplethinkmoreabouttheirsituation.Whenfirstlearningtousecomplexreflections,itcanfeelabitstrange.However,whenyougetusedtoit,suchreflectionscommunicaterealunderstanding.Forexample:
Statement:I’mfeelingprettydepressedtoday.Response:You’renotfeelinglikeyourusualself./Youwishyouhadmoreenergyand
interestindoingthings./Itsoundslikesomethinghashappenedsincewelasttalked.
AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013
7
OARS:Summaries
Asummaryisastatementthatdrawstogethertwoormorethingsthatsomeonehassaidpreviously.Itisbasicallyaparagraphofselectedreflectivestatements.Decidingwhattochoosetoincludeinasummarydependsonthesituation.However,usuallyyouwanttopickthethingsthatmoveinthedirectionofchange–kindoflikepickingthetastiestchocolatesfromaboxofcandy.Summariescanbeofferedatvarioustimesinaconversationtodrawideastogetherandguidetheconversation.Summaries,liketheotherOARSskills,areusedthroughoutthefourprocessesofMI.Particularlyintheengagingandfocusingprocesses,summariesshowthatyouhavebeenlisteningcarefullyandthatyouvaluewhatthepersonhassaid.Theyalsoprovideanopportunityforaskingthepersontofillinwhatyouhavemissed.Intheevokingprocess,summariesareoftenusedtoemphasizethingsthatsupportaperson’schangegoal.Summariescanhavedifferentpurposes.Collectingsummariespulltogether“inonebasket”variousstatementsthepersonhasmade.Linkingsummariesconnectwhattheindividualhassaidwithsomethingtheysaidinapriorconversation.Transitionalsummariesareusedasawrap-upattheendofaconversation,ortocreateabridgeforshiftingtheconversation.Inallthreecases,emphasisisplacedonshiningalightonthepersonschangetalk(seemoreonpage9).DuringtheplanningprocessofMI,summariesaregenerallyusedtorecaptheperson’sreasonsforwantingtochangeandwhattheyintendtodo.Thiscanhelpstrengthencommitmenttomakethechange.Belowaresomeguidelinesfordevelopingandofferingsummaries.Remembertokeepsummariesbriefandtothepoint.1.Beginwithastatementindicatingyouaremakingasummary.Forexample:
LetmeseeifIunderstandsofar… HereiswhatI’veheard.TellmeifI’vemissedanything.
2.Ifthepersonis“feelingtwoways”aboutchanging,namebothsidesoftheuncertaintyinthesummary.Forexample: Ontheonehandyou...ontheotherhand...”3.Highlightchangetalkyouheard–statementsindicatingtheperson’sdesire,ability,reasons,need,andcommitmenttochange.Forexample: Youmentionedseveralreasonswhyyouwouldwanttomakethischange,including...4.Endwithaninvitation.Forexample:
Whatwouldyouadd?AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013andhandoutscreated
byDavidB.Rosengren,Ph.D.
8
InformingandAdvisingWhileMIisaninherentlyperson-centeredapproach,thisdoesnotmeanthatinformationandsuggestionsareneveroffered.InMI,bothpartiesareviewedashavingexpertise;thus,theremaybeoccasionswhenthiskindofinputisappropriate,suchaswhenapersonrequestsit.However,informationandsuggestionsareprovidedsparinglyandnotasafirstlineofresponse.TherearetwomaindifferencesastohowinformationandsuggestionsareofferedinMI,ascomparedtobeingdispensedinanunsolicited,authoritativemanner.Thefirstisthatitisofferedonlywithpermissionfromtheperson.Secondly,itisprovidednotasthe“finalword”butratherinthecontextofhelpingpeoplecometotheirownconclusionsaboutitsrelevanceandvalue.Itisoftenhelpfultoverballyacknowledgethiswithpeople.IntentofprovidinginformationandsuggestionsinMI
• Notanattempttoconvincepeopleofthefollyoftheirways• Providesanopportunitytoexpressconcernsandhelptheindividualmovefurther
alongintheprocessofchange• Canhelpapersoncometoadecision
Afewconsiderations
• It'sallrighttoexpressyourconcerns• Therearemanypathwaystochange;yourwaymaynotbethewayofanother• Focusonhelpingthepersonevaluateoptions• Offerinformationandadvice,don'timposeit
Suggestedmethod:Evoke-Provide-Elicit(E-P-E)Elicit
• Askwhattheindividualalreadyknowsaboutthetopic/issue• Inquirewhatsheorhewouldliketoknow• Askpermissiontoprovideinput–e.g.,“WoulditbeallrightifIsharesome
ideas/impressions/possibleoptionswithyou?”Provide
• Offersmalldoseofinformationoradviceinakind,nonjudgmentalmannerElicit
• Askfortheperson’sresponse–e.g.,“Iwonderwhatyouthinkofthat”• Emphasizechangetalk,provideaffirmations,andinstillhope.• Recognizeandaffirmitistheindividual'sdecisiontomake–e.g.,“Ofcourse,you’re
theonlyonewhocanmakethisdecision.”
AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013andhandoutscreatedbyDavidB.Rosengren,Ph.D.
9
EvokingChangeTalk
Changetalkreferstoanythingsomeonesaysthat“favorsmovementtowardaparticularchangegoal.”Evoking,or“callingforth,”changetalkhelpspeoplecomeupwiththeirownreasonstochange.Thisisfarbetterthansomeoneelsetryingtoconvincethemtochange,whichoftenmakespeopledefensiveandargueagainstchanging.AsaworkeryoucanusetheOARSskills(Openquestions,Affirmations,Reflectivelistening,andSummaries)to“askfor”andrespondtochangetalk.NoticethatchangetalkcomesindifferentflavorsthatformthephraseDARN-CAT.PreparatoryChangeTalk–“thinkingaboutchanging”
Desire–Iwantto,Iwouldliketo,Iwish,IhopeAbility–Ican,Icould,IamabletoReasons–Itwouldhelpme,I’dbebetteroffifNeed–Ineedto,Ihaveto,somethinghastochange
MobilizingChangeTalk–“takingaction”
Commitment–Iwill,Ipromise,IgiveyoumywordActivation–I’mwillingto,Iamreadyto,IampreparedtoTakingsteps–Icutbackonmyweekenddrinking
MethodsforEvokingChangeTalkAskingevocativequestions Whatworriesyouaboutyourcurrentsituation? Whywouldyouwanttomakethischange? Howmightyougoaboutit,inordertosucceed?Usingtheimportanceruler(alsouseregardingperson’sconfidencetochange) Onascaleof0to10,howimportantisitforyoutomakethischange?Tellmeabout beingat___comparedto(severalnumberslower)?Whatwouldittaketomovefrom ___to(nexthighestnumber)?AndhowImightIhelpyouwiththat?
Exploringextremes–Whatconcernsyouabsolutelymostabout____?Whataretheverybest resultsyoucouldimagineifyoumadeachange?
Lookingback–Whatwerethingslikebeforeyoubegandrinkingmorefrequently?
Lookingforward–Howwouldyoulikethingstobedifferentinthefutureregarding____?
Exploringgoalsandvalues–What’smostimportanttoyouinlife?Whataretherulesyou’d sayyouliveby?Howdoesdrinkingfitwithyourpersonalgoals?
AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013
0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely important important
10
RespondingtoDiscord
Whatdoyoudowhensomeone“pushesback”atyouinawaythatfeelslikeit’spersonal?Maybethepersonsays,“Whoareyoutotellmewhattodo!”or“Youdon’treallycareaboutme!”Or,theindividualrefusestotalk.Or,perhapsagreestodosomething,butthendoesn’tdoit.Whenthesethingshappen,youcanbeprettysurethatsomething’sgonewrongintherelationship.InMI,wecallthisdiscord.Thisriftcanoccurforvariousreasonsasnotedbelow.Ratherthanplacingblameontheindividual,itisimportantforworkerstolookattheirownbehaviortoconsiderwhatmightbepromptingthepersontoreact.Thepresenceofdiscordintherelationshipisasignaltotryadifferentapproach.Commoncausesofdiscordintherelationship
• Thetwoofyouhavedifferentgoals• You’retryingtogetthepersontochange• Wheneitherofyoubringsangerandfrustrationintothesituation• You’renottrulylistening,oryou’remakingassumptionsorinterrupting• There’salackofagreementaboutrolesintherelationship
Practitionerbehaviorsthattendtoincreasediscord• Pushingtoohardonthepersontochange• Assumingyou’retheexpert;notworkingcollaboratively• Criticizing,shaming,blaming;usingnegativeemotionstogetthepersontochange• Labeling;“that’sbecauseyou’reanalcoholic/addict”• Beinghurried• Givingtheimpressionthatyou“knowwhat’sbestfortheindividual”
Practitionerbehaviorsthattendtodecreasediscord
• Usingsimpleandcomplexreflectivestatementso “You’rewonderingifIcanhelpyou”o “You’renotsureyoucantrustme”
• Otherresponseso Apologizing–“Sorry,Ididn’tmeantolectureyou.”o Affirming–“You’vebeendoingthisforalongtimeandknowhowtokeep
yourselfsafe.”o Shiftingfocus–“Maybethere’ssomethingelsethatwouldbemoreusefulto
talkaboutfornow.”o Emphasizingpersonalchoiceandcontrol–“Itisentirelyuptoyou.Thisis
yourdecision.Nooneelsecanmakeitforyou.”
AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013
11
MotivationalInterviewing:AGuidedConversationHereisanoutlineofhowamodelMIconversationmightflow.Inthiscase,drinkingisthefocus.Ofcourse,reallifeconversationsrarelyplayoutinsuchastraightforwardmanner.NotethatthespiritandcoreskillsofMIareappliedthroughoutthefourprocessesofMI.Asageneralguideline,itisusefultofollowabasicrhythmofaskinganopenquestionfollowedbyoneormorereflections,beforeaskinganotherquestion.ENGAGINGProvideawarmwelcome;offerabeverage;exchangesmalltalk;makesurethepersonfeelssafe;showthatyoucare;gettoknowthepersonasaperson;behopeful
§ “Hi.It’sreallygoodtoseeyou.Wouldyoulikesomejuiceortea?”“Howhavethingsbeengoinglately?”(Respondwithreflectivestatements)
FOCUSINGAgreeonwhattotalkabout
§ “What’sonyourmind?”“Youmentionedseveralthings.Whereshallwestart?”“Woulditbeallrightifwetookacloserlookatyouanddrinking?”(Reflect)
EVOKINGExploreambivalence
§ “Whatdoesdrinkingdoforyou?Whatconcerns,ifany,doyouhaveaboutit?”(Reflect)
Elicitchangetalk§ DESIRE(want,wish,like)
“Howwouldyoulikethingstobedifferentthantheyarenow?”(Reflect)
§ REASONS(specificreasonsforchange) “Ifyouweretocutbackorstopdrinking,whataresomereasonsyoumightdothat?” (Reflect)
§ ABILITY(can,could,able)
“Howmightyougoaboutitinordertosucceed?”(Reflect)
§ NEED(havetoorimportantto-withoutstatingspecificreason)“Howimportantisittoyoutomakethischange?”(use0-10scalingquestion)(Reflect)
PLANNING
§ TESTINGTHEWATER(readinessandconfidence)“Howreadyareyoutomakethischange?”“Howconfidentareyoutomakethischange?”(oruse0-10scalingquestion)(Reflect)
§ COMMITMENT(will,planto,intendto,goingto,willing,ready,etc.)
“Whatdoyouthinkyouwilldonext?”“Whatisyourplan?”“HowcanIhelpyouwiththat?”(Reflect)
12
MISelf-Appraisal
Astheinterviewer,I…
0-not5-extremelyatallwell
1.Providedasafe,welcomingpresencewithmywordsandactions.Example:
012345
2.Engagedwithandshowedgenuineinterestintheperson,e.g.,whatsheorheenjoys,needs,values.Example:
012345
3.Foundoutandclarifiedwhatthepersonwantedtofocusoncurrently.Example:
012345
4.Helpedexplorebothsidesoftheperson’sdilemma,e.g.,what’sworkingandwhat’snot;upsidesanddownsides.Example:
012345
5.Avoidedtryingto“fix”theproblemorgetthepersontochangebyadvising,confronting,warning,orteaching.Example:
012345
6.Elicitedwhatmightbesomepossiblereasonstochange,ifthepersonweretodecidetochange.Example:
012345
7.Learnedaboutpossiblewaysthatheorshemightgoaboutmakingthischange.Example:
012345
8.Askedhowimportantitisatthistimeforthepersontomakethischange.Example:
012345
9.Askedhowconfidentsheorhefeelstobeabletomakethischange.Example:
012345
10.Inquiredaboutwhatsteps,ifany,thepersonmighttakenext.Example:
012345
11.Askedpermissionbeforeprovidinginformationorsuggestions.Example:
012345
12.UsedthecoreskillsofMI(openquestions,affirmations,reflectivelistening,summaries)throughouttheconversation.
012345
13.ConsistentlydemonstratedthespiritofMI:>Partnership
>Acceptance
>Compassion
>Evocation
012345012345
012345
012345
DevelopedbyKenKraybillbasedonMiller,W.R.&Rollnick,S.,MotivationalInterviewing:HelpingPeopleChange,2013
13
MISelfCheckforPractitioners
IndividualsImeetwithwouldsaythatI…
o Believethattheyknowwhat’sbestforthemselves
o Helpthemtorecognizetheirownstrengths
o Aminterestedinhelpingthemsolvetheirproblemsintheirownway
o Amcuriousabouttheirthoughtsandfeelings
o Helpguidethemtomakegooddecisionsforthemselves
o Helpthemlookatbothsidesofaproblem
o Helpthemfeelempoweredbymyinteractionswiththem
AdaptedfromHohman.&Matulich.MotivationalInterviewingMeasureofStaffInteraction,2008
SelectedResources
Arkowitz,H,Westra,H.A.,&MillerWR,RollnickS.(Eds.).(2015).MotivationalInterviewinginTheTreatmentofPsychologicalProblems(2ndedition).NewYork,NY:GuilfordPress.CenterforSubstanceAbuseTreatment.(1999).EnhancingMotivationforChangeinSubstanceAbuseTreatment:TreatmentImprovementProtocol(TIP)Series35.Rockville,MD:DHHSPublicationNo.(SMA)99-3354. Hohman,M.(2011).MotivationalInterviewinginSocialWorkPractice.NewYork,NY:GuilfordPress.Miller,W.R.,&Rollnick,S.(2013).MotivationalInterviewing:HelpingPeopleChange(3rdEd.).NewYork,NY:GuilfordPress.Miller,W.R.,&Rose,G.(2009).TowardaTheoryofMotivationalInterviewing.AmericanPsychologist,64(6),527-537.Naar-King,S.,&Suarez,M.(2011).MotivationalInterviewingwithAdolescentsandYoungAdults.NewYork,NY:GuilfordPress.Rollnick,S.,Miller,W.R.,&Butler,C.(2008).MotivationalInterviewinginHealthCare.NewYork,NY:GuilfordPress.Rosengren,D.B.(2009).BuildingMotivationalInterviewingSkills:APractitionerWorkbook.NewYork,NY:GuilfordPress.WagnerCC,IngersollKS.(2012).MotivationalInterviewinginGroups.NewYork,NY:GuilfordPress.Website:www.motivationalinterviewing.orgZuckoff,AllanwithGorscak,B.(2015).FindingyourWaytoChange.NewYork,NY:GuilfordPress.