motivational interviewing

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  • 1. Introduction to Motivational Interviewing Tim Bingham BA

2. What is motivational interviewing? a therapeutic style intended to help clinicians work with patients to address the patients fluctuation between opposing behaviors and thoughts. Source: Miller and Rollnick, Motivational Interviewing 1991. 3. Characteristics of Motivational Interviewing Client directed towards change Feedback and information offered selectively Empathic reflection used selectively Therapist creates or amplifies client discrepancies to enhancemotivation 4. Characteristics of Motivational Interviewing De-emphasis on labels Emphasis on personal choice Therapists elicits clients own concern Resistance is normal Client provides goals and change plans 5. Resistance When we see our freedom to act in a particular waythreatened, the behaviour seems more desirable and we will be more likely to choose that behaviour Youre a drug addictNo Im not Youve got to stopNo I dont 6. Ambivalence Ambivalence is being in two minds about something Ambivalence is normal. 7. General principles of M.I. 1. Express empathy 2. Develop Discrepancy 3. Roll with resistance 4. Support self-effiacy 5. Avoid Arguments 8. Express Empathy Empathy is the ability to see the issue from the other personspoint of view Acceptance facilitates change Skillful reflective listening is fundamental 9. Develop Discrepancy The client rather than the counselor should present thearguments for change A discrepancy between present behavior and importantpersonal goals or values will motivate change 10. Roll with Resistance Avoid arguing for change Resistance is not directly opposed Roll with the resistance by seeing it from the persons pointof view 11. Support self efficacy The counselors own belief in the persons ability to changebecomes a self-fulfilling prophecy A persons belief in the possibility of change is an important motivator 12. 5. Avoid Argumentation Arguments are the least effective way of exploring a subject 13. The 5 skills of M.I. 1: Ask open ended questions 2: Affirm 3: Listen Reflectively 4: Summarising 5: Eliciting change talk 14. 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 15. Listening reflectively is... Statements to mirror back the clients own experiencesto them Types of Reflection Neutral: Emphasis not changed Enhanced: Amplifying or minimising in direction ofchange Double sided: Reflects both sides of ambivalence 16. Selective Reinforcement Statements supportive of the therapists agenda are reinforcedthrough neutral or amplified reflection Statements inconsistent with the agenda are neither reinforced by words nor actions 17. Summarising is... Listening to the client and reflecting back to the client themain points of what they are feeling or thinking every few minutes. 18. Eliciting changetalk In MI.. The clientprovides the argument for change There are 4 types of changetalk 1: Problem recognition 2: Expression of concern 3: Intention to change 4: Expression of optimism 19. Methods for Evoking Change Talk 1: Ask open ended questions 2: Use the importance ruler (1-10) 3: Explore the decisional balance (pros and cons) 4: Elaborating 5: Exploring Goals and Values 20. Thanks for your time Do you feel motivated?

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