motivational interviewing workshop
TRANSCRIPT
Motivational Interviewing
Presented by: Derek Zike & Heather Morrow
Rinella Learning Center: CRLA Workshop Series
How to Use Motivational Interviewing to Encourage Behavior Change
Motivational Interviewing
● A client-centered tool for making changes, increasing helpful behaviors and decreasing unhelpful behaviors.
● Began as a counseling technique in addiction recovery
● Relies on individuals’ intrinsic motivation and interest in change
● Uses a non-confrontational approach to frame goals in a practical, attainable fashion
● Used to enhance listening and problem solving skills to become better communicators and establish better rapport
Why Use Motivational Interviewing in Academia?
MI may be particularly helpful to use with a student when they:
● Are working through workload stress or burnout● Have a discrepancy between academic behaviors and academic goals● Display ambivalence about educational ability● Are reluctant about accessing campus services and accommodations● Are ambivalent about disclosing a disability● Other fluctuations in motivation
Motivational Interviewing
Student Development - “the ways that a student grows, progresses, or increases his or her developmental capabilities as a result of enrollment in an institution of higher education.”
● What student development looks like and how to foster it must be reinforced with tutors/SI leaders
● You as RLC employees have the opportunity to help your clients develop, foster independence and increase student retention at the university
4 Parts of Motivational Interviewing
Partnership: The willingness to suspend the reflex to dispense expert advice is a key element in establishing
collaboration -- RAPPORT, and not “talking down” to the client
Acceptance: Honors each person’s absolute worth and potential; Recognizes and supports the person’s
independence to choose his or her own way; Seeks to understand the other’s perspective; and, Affirms the
person’s strengths and efforts
Compassion: To actively promote the other’s welfare by giving priority to their individual needs
Evocation: People already have within themselves much of what is needed and your task is to evoke it. A
client’s own arguments for change are more persuasive than whatever arguments you might be able to
provide -- focus on the client strengths and help them make the desire to change THEIR idea, not yours
Motivational Interviewing
● Draws from Carl Rogers’s (1951, 1957) person-centered therapy○ Importance of therapeutic alliance to help facilitate client change
including: ■ Counselor’s expression of empathy■ Genuineness■ And having unconditional positive regard for the client
MI Acronyms
OARS ● Open-ended questions:
○ Allows them to tell their story -- “Tell me what you’re struggling with in the class…”
● Affirmations: ○ Useful for strengthening tutor/SI - student relationship. Sincerity and careful judgement show
your interest and concern -- “That’s awesome that you haven’t missed any of your classes; I’m
sure your professor appreciates that.”
● Reflective listening: ○ Allows students to hear their comments aloud through another person’s voice. “It sounds like
you’re frustrated with the teaching style of your professor and you wish you could more easily
understand it.”
● Summary statements: ○ Brings the conversation to a conclusion
MI Acronyms
FRAMES● Feedback: delivered in clear non-judgemental way
● Responsibility: links the problematic behavior with the action of the individual
● Advice: provide alternatives to the undesirable behavior
● Menu: offer more than one solution to a problem
● Empathy: build rapport by acknowledging that change can take effort and work
● Self-efficacy: increase likelihood of individual feeling empowered
Righting ReflexTend to try and actively fix problems for our clients but in doing so we reduce the likelihood of change
If we fix their problems, they are not empowered and do not learn how to solve their own problems.
Use M.I. to help empower individuals to change, resolve issues, etc. Don’t tell them what they need to do or how to do it.
Avoid these behaviors
● Trying to convince clients they have a problem
● Arguing for the benefits of change
● Telling clients how to change
● Warning them of the consequences of not changing
Examples
ASKING PERMISSION:
● “Can we talk a bit about your skipping classes?”
ELICITING/EVOKING CHANGE TALK
● “What would you like to see different about your current situation?”
● “What makes you think you need to change?”
● “What will happen if you don't change/continue skipping class?”
OPENED-ENDED QUESTIONS
● “What makes you think it might be time for a change?”
● “What brought you here today?”
● “What happens when you behave that way?”
Reflective Listening
Rationale: Reflective listening involves listening carefully to clients and then making a reasonable guess about what they are saying; in other words, it is like forming a hypothesis.
Examples (generic):● “What I hear you saying…”
● “So on the one hand it sounds like …. And, yet on the other hand….”
Examples (specific):● “It sounds like you recently became concerned about your [insert risky/problem behavior].”
● “It sounds like your [insert risky/problem behavior] has been one way for you to [insert whatever
advantage they receive].”
Normalizing
Rationale: Normalizing is intended to communicate to clients that having difficulties while changing is not uncommon, that they are not alone in their experience, or in their ambivalence about changing.
Examples
● “A lot of people are concerned about changing their [insert risky/problem behavior].”
● “Most people report both good and less good things about their [insert risky/problem behavior].”
● “Many people report feeling like you do. They want to change their [insert risky/problem
behavior], but find it difficult.”
Decisional Balancing
Rationale: The goal for clients is two fold: To realize that (a) they get some benefits from their risky/problem behavior, and (b) there will be some costs if they decide to change their behavior.
Examples● “What are some of the good things about your [insert risky/problem behavior]? [Client answers] Okay,
on the flipside, what are some of the less good things about your [insert risky/problem behavior].”
The Columbo Approach-- “Touche”
Rationale : While the following responses might sound a bit unsympathetic, the idea is to get clients who present with discrepancies to recognize them rather than being told by their therapists that what they are saying does not make sense.
Example● “On the one hand you’re coughing and are out breath, and on the other hand you are saying cigarettes
are not causing you any problems. What do you think is causing your breathing difficulties?”
Statements Supporting Self-Efficacy
Rationale: Eliciting statements that support self-efficacy (self-confidence) is done by having clients give voice to changes they have made.
Examples● “It seems you’ve been working hard to quit smoking. That is different than before. How have you been
able to do that?”
● “Last week you were not sure you could go one day without using cocaine, how were you able to avoid
using the entire past week?”
● “So even though you have not been abstinent every day this past week, you have managed to cut your
drinking down significantly. How were you able to do that?”
Affirmations
Rationale: Affirmative responses or supportive statements by therapists verify and acknowledge clients’ behavior changes and attempts to change.
Examples● “Your commitment really shows by [insert a reflection about what the client is doing].”
● “You showed a lot of [insert what best describes the client’s behavior—strength, courage,
determination] by doing that.”
● “It’s clear that you’re really trying to change your [insert risky/problem behavior].”
Advice/Feedback
Rationale: This is a valuable technique because clients often have either little information or have misinformation about their behaviors.
Examples● “Do you mind if we spending a few minutes talking about….? [Followed by] “What do you know
about….?” [Followed still by] “Are you interested in learning more about…..?” [After this clients can be
provided with relevant materials relating to changing their risky/problem behavior or what affects it
has on other aspects of their life.]
● “What do you know about how your drinking affects your [insert health problem]?”
● “What do you know about the laws and what will happen if you get a second drunk driving arrest?”
Summaries
Rationale: Summaries are used judiciously to relate or link what clients have already expressed, especially in terms of reflecting ambivalence, and to move them on to another topic or have them expand the current discussion further.
Example
● “It sounds like you are concerned about your cocaine use because it is costing you a lot of money and there is a chance you could end up in jail. You also said quitting will probably mean not associating with
your friends any more. That doesn’t sound like an easy choice.”
The Therapeutic Paradox
Rationale: Paradoxical statements are used with clients in an effort to get them to argue for the importance of changing.
Examples● “Maybe now is not the right time for you to make changes.”
● “You have been continuing to engage in [insert risky/problem behavior] and yet you say that you want
to [insert the behavior you want change—e.g., get your children back; get your driver’s license
returned; not have your spouse leave]. Maybe this is not a good time to try and make those changes.”
● “So it sounds like you have a lot going on with trying to balance a career and family, and these priorities
are completing with your treatment at this time.”
Activity