Motivational Interviewing Basics of Motivational Interviewing - - PowerPoint PPT Presentation

Motivational Interviewing

Basics of Motivational Interviewing Module # 1

Objectives of Training

• To be able to

demonstrate reflective listening & open ended questions, and understand the importance of these techniques

• To begin to learn the

stages of change

• To have a basic

working knowledge of Motivational Interviewing

• To understand the

principles of Motivational Interviewing

“When given a choice between changing and proving that it is not necessary, most people get busy with the proof”

John Galbraith

What is Motivation & How is it Instilled?

Have the audience list several ideas of their definition of motivation & what motivates people to change

What is Motivational Interviewing? It is an approach designed to help clients build commitment & reach a decision to change It is one approach, not the only approach to work with clients

What is Motivational Interviewing?

1 An approach designed to help members build commitment & reach a decision to change 2 It appears to be member-centered, yet the staff maintains a strong sense of purpose & direction- and chooses the right moments to interject

What is Motivational Interviewing?

A person-centered, directive method of communication for enhancing intrinsic motivation of change by exploring and resolving ambivalence.

What is Motivational Interviewing?

• It is a style:

– Non-Authoritarian – Responsibility for change is ultimately left with the client, but the case manager plays a critical role

It’s a style

• By changing their therapeutic style between

confrontational & client-centered, the therapist can drive client resistance rates up & down. (Miller, Benefield & Tonigan, 1993)

• Client resistance behavior, in turn, is

predictive of failure to change

• Empathy is associated with more favorable

client outcomes

What is Motivational Interviewing?

• It is strategies:

– It is supportive, not argumentative – Timing plays a crucial role – Emphasis is on the reasons to change, rather than on how to change

What is Motivational Interviewing?

• The goals are:

– Resolve ambivalence – Develop discrepancy – Increase intrinsic motivation – Increase the client’s self-perception, regarding the ability to change – Encourage the client to present the argument to change

Which Statements are True?

• Being resistive & unmotivated for change is

an inherent characteristic, especially of addicts

• It is crucial for a person to admit their

problems

• The only way to get through to someone is

to confront them, especially if you want results fast

Ambivalence

• Conflict between two courses of action
• Unsure of the action that one wants to take
• Ambivalence must be resolved to move

forward with change and reduce the probability of relapse

Contributors of Ambivalence

• Attachments
• Fear of Change
• Is the payoff worth the work to change
• Lack of reaching a decision
• Pat predicators
• Unique to the individual
• Pressuring often produces resistance

Principles of Motivational Interviewing

• Express empathy
• Develop discrepancy
• Avoid argumentation
• Roll with resistance
• Support self-efficacy

Principles of Motivational Interviewing

Review of the MI poster

Five Early Strategies

1) Ask Open Ended Questions 2) Listen reflectively 3) Affirm- (to build relationship) 4) Summarize- (to check that on the same track) 5) Elicit change- (try to get them to talk change, and them argue for change)

Reflective Listening as a Process & as an Empathetic Strategy

Reflective Listening

• Characteristic of Motivational Interviewing
• Understand the member’s feelings &

perspectives w/o judging or criticizing

• It’s not only about how you listen or keep

quiet - it is about how you respond

Reflective Listening Goals

• Allow the member to explore ambivalence
• To make a guess as to what the member

means means

• The guess is most often in the form of a

statement- a well-informed reflective statement is less likely to evoke resistance than a well-informed question

Reflective Listening Goals cont.

• Clarify the member’s own experiences
• Elicit self-motivational statements
• Become genuinely interested in the member
• Change is more a process than an outcome

It is important to remember

• Acceptance is not the same thing

as agreement or approval. It is possible to accept and understand a member’s perspective but not agree with it.

5 Types of reflective statements

1) REPEATING: The simplest form of reflection, the listener repeats a portion of what was said.

5 Types of reflective statements

2) REPHRASING: The listener stays close to what the person said but substitutes synonyms or slightly rephrases what was said.

5 Types of reflective statements

3) PARAPHRASING: Major restatement. The listener infers the meaning in what was said and reflects this back in new words. This adds to and extends what was actually stated.

5 Types of reflective statements

4) REFLECTION OF FEELING: The deepest form of reflection, this is a paraphrase that emphasizes the emotional dimension through feeling statements, metaphor, etc.

5 Types of reflective statements

5) SUMMARIZING: Major summaries made to pull together what has taken place to that point. Allows another opportunity for the staff to check the understanding of what the person was saying and to hear their own words again.

The Caseworkers Response

Reflective Listening Exercise # 1

Let the member be the member they are

• Let’s not make

them imitate others. Let them find themselves and be themselves

• Cultivate an

atmosphere of change

Poor reflective listening techniques

(roadblocks)

• Order, direct or command the member what

to do

• Warn & threaten the member of what they

did wrong

• Providing solutions, giving advice
• Persuading with logic, arguing or lecturing
• Moralizing, preaching “should do”
• Disagreeing, judging or blaming

Poor reflective listening techniques

(roadblocks)

• Agreeing, approving or praising
• Shaming, ridiculing, labeling
• Sympathizing, reassuring
• Questioning or probing
• Withdrawing or distracting

Reflective Listening

Exercise #2 Roadblocks: Responses of Poor Reflective Listening Statements

AVOIDING PITFALLS Remain as positive and nonjudgmental as possible and rely on brief open-ended questions to elicit the member’s concerns and exploration of feelings.

Ask open-ended questions

Use questions that will elicit an informative answer. Example: Tell me more about these difficulties versus Have you had any difficulty with this?

The optimal approach is to ask an

• pen-ended question, then to

respond to the member’s response with reflective listening strategy- not another question. Too many questions will lead into a “passive” question/answer trap.

Open Ended Questions goals

• Establish an atmosphere of openness,

acceptance and trust

• The member should do most of the talking
• Let the member explore their thoughts

Open Ended Question Role Play

• Role Play Activity

Stages of Change

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

Stages of Change

Precontemplation

The person has no intention to change behavior in the foreseeable

• future. Individuals in this stage are

unaware or underaware of their problems

Stages of Change

Contemplation

A person is aware that a problem exists and are seriously considering changing, but have not yet made a commitment to take action. Contemplators perform a risk- reward analysis.

Stages of Change

Preparation Individuals are intending to take action and may practice some of the behaviors necessary to change, but have yet to make a full commitment.

Stages of Change

Action

In this stage individuals modify their behavior, experiences or environment in order to overcome their problems.

Stages of Change

Maintenance

Individuals in this stage work to prevent relapse and consolidate gains.

Role Play

• More advanced role plays: reflective

listening/open ended questions

Summary

• Review of the objectives and the main

points of the training