Motivational Interviewing

Tim Bingham BA

Introduction to

What is motivational interviewing?“a therapeutic style intended to help

clinicians work with patients to address the patient’s fluctuation between opposing behaviors and thoughts.”

Source: Miller and Rollnick, Motivational Interviewing 1991.

Characteristics of Motivational InterviewingClient directed towards changeFeedback and information offered

selectivelyEmpathic reflection used selectivelyTherapist creates or amplifies client

discrepancies to enhance motivation

Characteristics of Motivational InterviewingDe-emphasis on labelsEmphasis on personal choiceTherapists elicits client’s own concernResistance is normal Client provides goals and change plans

ResistanceWhen we see our freedom to act in a

particular way threatened, the behaviour seems more desirable and we will be more likely to choose that behaviour

“You’re a drug addict”…”No I’m not”“You’ve got to stop”…”No I don’t”

Ambivalence Ambivalence is being in two minds about

something

Ambivalence is normal.

General principles of M.I.1. Express empathy2. Develop Discrepancy3. Roll with resistance4. Support self-effiacy5. Avoid Arguments

Express EmpathyEmpathy is the ability to see the issue from

the other persons point of view

Acceptance facilitates change

Skillful reflective listening is fundamental

Develop DiscrepancyThe client rather than the counselor should

present the arguments for change

A discrepancy between present behavior and important personal goals or values will motivate change

Roll with ResistanceAvoid arguing for change

Resistance is not directly opposed

Roll with the resistance by seeing it from the persons point of view

Support self efficacyThe counselor’s own belief in the person’s

ability to change becomes a self-fulfilling prophecy

A person’s belief in the possibility of change is an important motivator

5. Avoid Argumentation

Arguments are the least effective way of exploring a subject

The 5 skills of M.I.1: Ask open ended questions2: Affirm3: Listen Reflectively4: Summarising5: Eliciting “change talk”

Open ended questions are...Questions that do not invite brief answers.

Affirming is…Recognising the work that the client has

done in relation to their problem

Listening reflectively is...Statements to mirror back the clients

own experiences to themTypes of ReflectionNeutral: Emphasis not changed

Enhanced: Amplifying or minimising in direction of change

Double sided: Reflects both sides of ambivalence

Selective ReinforcementStatements supportive of the therapists

agenda are reinforced through neutral or amplified reflection

Statements inconsistent with the agenda are neither reinforced by words nor actions

Summarising is...Listening to the client and reflecting back

to the client the main points of what they are feeling or thinking every few minutes.

Eliciting changetalkIn MI.. The client…provides the argument

for change”There are 4 types of changetalk1: Problem recognition2: Expression of concern3: Intention to change4: Expression of optimism

Methods for Evoking Change Talk1: Ask open ended questions2: Use the importance ruler (1-10)3: Explore the decisional balance (pros and

cons)4: Elaborating5: Exploring Goals and Values

Do you feel motivated?

Thanks for your time