MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING IS A STYLE FOR:

Avoiding Resistance

Resolving Ambivalence

Inducing Change

MI is not primarily a nondirective approach. Although client-centered strategies are employed, the process of eliciting self-motivational statements is intentional and directive

RATIONALE AND BASIC PRINCIPLESMotivational InterviewingAssumes that responsibility and capability for change lies within the client

Therapists task is to create a set of conditions that will enhance the clients own motivation for and commitment to change

Mobilize the clients inner resources, helping relationships, support intrinsic motivation for changeFIVE BASIC PRINCIPLESExpress EmpathyDevelop DiscrepancyAvoid ArgumentationRoll with ResistanceSupport Self-efficacy

FIVE GENERAL PRINCIPLES OF MOTIVATIONAL INTERVIEWINGEXPRESS EMPATHY

by communicating acceptance of clients as they are, they are freed to change.

Seek to compliment not denigrate (build up)

More listening, not telling

Gentle persuasion

DEVELOP DISCREPANCY

to help clients see and feel how their current behavior threatens important personal goals or is inconsistent with more central personal values.

FIVE GENERAL PRINCIPLES OF MOTIVATIONAL INTERVIEWINGAVOID ARGUMENTATION

counterproductivemakes clients defensiveresistance may indicate a need to change strategiesROLL WITH RESISTANCE

use resistance to help build motivationreframe statementsacknowledge ambivalence as natural

FIVE GENERAL PRINCIPLES OF MOTIVATIONAL INTERVIEWINGSUPPORT SELF - EFFICACY

explore past successes in other problem areas and apply to present situation.

Client is responsible for choosing and carrying out personal change.

THOUGHTS FROM RESEARCHThis treatment strategy does not guide a client step-by-step through recovery

It employs motivational strategies to mobilize the clients own change resources

It looks at motivating clients through short/brief encountersThere is evidence that the therapeutic style forms the core of Motivational InterviewingAccurate empathy (Rogers)There are six elements that have been described as active ingredients of the relatively brief interventions that have been shown to induce change in problem behaviors: F.R.A.M.E.S

F R A M E S

FEEDBACK

very persuasive

use information from an objective intake evaluation as a basis for feedback to build motivationshould be personal, not about general dangers of substance abuse

RESPONSIBILITY

emphasis on clients personal responsibility and freedom of choice

F R A M E S

ADVICE

giving client clear and direct advice as to the need for change and how it might be accomplishedshould be given in a supportive, not authoritarian (domineering) way

MENUto facilitate choice there must be alternatives from among which to choosetheres more than one right way to change

F R A M E S

EMPATHYmaintain a client-centered approach, listening to and reflecting feelings.

the opposite of confrontation

SELF - EFFICACYcommunicating optimism that change can be achieved.Helping clients develop necessary skills to changeencourage client to feel s/he can change.

PHASE IBUILDING MOTIVATION FOR CHANGE

ASSESS CLIENTS CURRENT SITUATION

IDENTIFY PROBLEMS OR ISSUES

EVOKE SELF-MOTIVATIONAL STATEMENTS

PHASE IBUILDING MOTIVATION FOR CHANGEFIVE EARLY STRATEGIES IN MI:OPEN-ENDED QUESTIONSREFLECTIVE LISTENINGAFFIRMINGSUMMARIZINGELICITING SELF-MOTIVATIONAL STATEMENTS

AFFIRMINGCompliments and statements of appreciation and understanding

Shows respect for client and their effortsI appreciate how hard it must have been for you to I think it is great that youThat must have been difficult for youYoure certainly a resourceful person, to haveThats a real good question

SUMMARIZING

Used to link together material that has been discussed.

Should be done periodically.

Reinforces what has been said.

Shows that you have been listening carefully.

Prepares the client to move on.

One of the more directive applications of MI

COMPONENTS OF A GOOD SUMMARY STATEMENTRestates clients statements regarding problem recognition, concern, reasons for change, and optimism about the changeIf client is ambivalent, it is useful to capture both sides (double-sided reflections)It is legal to include information from other sources (I.e., family, courts, other counselors, etc.)Dont ramble - be conciseEnd with an invitation for client to respond:How did I do?If this is a fair summary, are there other points?Is there anything you want to correct or add?

GOALS FOR EVOKING SELF-MOTIVATIONAL STATEMENTS

How client sees the problemWhat the clients concerns are about the problemIntention to changeBelief in their ability to change (optimism)

STRATEGIES AND TECHNIQUES FOR EVOKING SELF-MOTIVATIONAL STATEMENTSEVOCATIVE QUESTIONSusing open-ended questions to ask for statements

DECISIONAL BALANCEdiscussing pros and consELABORATIONasking for examples or clarifications

USING EXTREMESimagining the worst consequences

LOOKING BACKremembering times before the problem, and comparing to present situation

STRATEGIES AND TECHNIQUES FOR EVOKING SELF-MOTIVATIONAL STATEMENTSLOOKING FORWARDenvisioning a changed future

EXPLORING GOALSdiscussing clients most important values and/or goals

PARADOXagreeing with clients perception of no problem in order to evoke the opposite behavior

USING ASSESSMENT / FEEDBACK TO BOOST MOTIVATIONWHAT ASSESSMENT RESULTS TO COVER IN FEEDBACK?

Choose parts of the assessment / evaluation package already used, e.g.

Results of any medical testsResults of diagnostic interview / checklistAny test scores / results that compare clients to others (the general population / norms)Problem areas that are related to substance use (e.g. Employment, family problems)

USING ASSESSMENT RESULTS / FEEDBACKWITH WHAT STYLE TO GIVE FEEDBACK?

Empathy - check in with client to see their reaction to feedback. Try to keep resistance down to they can take in feedback and use it

Developing Discrepancy

Avoid Argumentation

Roll With Resistancedont insist the client accept everything youre saying

Self-Efficacyencourage client; be optimistic about change

PHASE IISTRENGTHENING COMMITMENT TO CHANGESIGNS OF READINESS FOR CHANGEDecreased resistanceDecreased questions about the problemResolveSelf-motivational statementsIncreased questions about changeEnvisioningExperimenting

PHASE IISTRENGTHENING COMMITMENT TO CHANGE

Client is ready to change

Client has not made a firm commitment to change

Contemplation / Preparation

PHASE IISTEPS TO STRENGTHENING COMMITMENT TO CHANGERECAPITULATION

summarize the clients current situation based on your interaction in order to evaluate what to do nextKEY QUESTIONS

ask clients what they want to do

use open-ended questions

encourages client to reflect and talk about change

PHASE IISTEPS TO STRENGTHENING COMMITMENT TO CHANGEINFORMATION AND ADVICE

in response to client questions, provide the information or ideas

wait for invitation from client to provide advice

do not fall prey to the yes, but patternNEGOTIATING A PLAN

set goals

consider change options

arrive at a plan

PHASE IISTRENGTHENING COMMITMENT TO CHANGEHAZARDSUnderstanding Ambivalencedoes not disappear quickly

Overprescriptiondeveloping a plan that is unacceptable to the client

Insufficient directionproviding too little guidance / direction

NON-VERBAL ROLESWhat it was like growing up in my homeWays in which I have changed as a person over the yearsThe good things and not so good things about my high school yearsWhat I hope and plan to do over the next ten yearsDescribe one of your parents, or someone else close to youHow I came to do the kind of work I am doing

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