MOTIVATIONAL INTERVIEWING

IN CLINICAL PRACTICE

AN OVERVIEW OF THE THEORY

BASIC THEORY & PRICIPLES WHAT TO REMEMBER ESSENTIAL ELEMENTS

M.I. Is a practice that believes in, and PEOPLE CAN CHANGE Empathy
thus supports & promotes, a client’s
ability to personally identify, establish, CHANGE IS NOT LINEAR Avoiding Confrontation & Arguments
motivate & maintain change
behaviours. CHANGE BEHAVIOUR NEEDS TO Addressing Discrepancy
BE NOURISHED, SUPPORTED
M.I. developed from principles of; AND ENCOURAGED – NOT Supporting Self-Efficacy & Optimism
CONTROLLED
Self-Actualization Theory Embracing Resistance
THE CLIENT IS THE EXPERT,
Reactance Theory THE COUNSELLOR IS THE Engaging
SUPPORTER
Social Learning Theory Focusing
AMBIVALENCE AND
Self-Efficacy Planning
RESISTANCE ARE NORMAL, AND
INFORMATIVE Evoking
It is a collaborative style of therapy.

8 IMPORTANT STEPS TO LEARNING THE TECHNIQUE OF MOTIVATIONAL INTERVIEWING

1. Be open to the collaborative approach, which means 5. Minimize resistance, without reinforcing “sustain
understand & respect client autonomy and help elicit talk & behaviours”.
motivation, not give it.
6. Know when & how to progress from ambivalence
2. Express genuine empathy, and client-centered skills. talk into a Change Plan.

3. Recognize change and commitment talk – including: 7. Be able to negotiate a plan and engage client’s
desire, ability, reasons, and need. commitment to said plan.

4. Be able to stimulate, and support change talk to increase 8. Involve other methods of therapy into MI to make
and strengthen it. it more directive and effective.

Ask to Changing Readiness

Elaborate Elicit - Direction Rulers
Provid Pro/Con
e Lists Agenda
D.A.R.N. Mapping
Zooming S.M.A.R.T
C.A.T O.A.R.S Reflective
In Goals
Listening
Look
Forward/
Recognize – Affirmations Open-
Backwar Summaries
Respond d ended
question
s
TOOLS & METHODS FOR SUCCESS 1
 MOTIVATIONAL INTERVIEWING
IN CLINICAL PRACTICE

IN DETAIL

THERAPIST/COUNSELLOR OBJECTIVES

❖ Listen, observe, be curious in exploring the client, their needs, and goals
❖ Help the client investigate and explore their behaviours
❖ Help increase their likelihood to embrace change, by decreasing their resistance levels to change
❖ Help client become comfortable analyzing, thinking, discussing and making efforts towards change
❖ Help the client clarify their goals
❖ Aid and support the client in establishing realistic, achievable plans, and methods to facilitate change
❖ Establish and maintain an environment that is supportive, non-judgemental/threatening, and safe for therapeutic
work

CLIENTS RESISTANT TO CHANGE: EMBRACING & WORKING WITH RESISTANCE AND AMBIVALENCE

Resistance (arguing, interrupting, denying, and ignoring) is part of counselling – a client can be resistant to us, and to change.

We can use tools like the “readiness, importance and confidence rulers” to help establish where our client is in regard to change, and
what it is that is preventing them from moving forward.

MI suggests the following techniques are useful in understanding, working with, and working past resistance from clients;

❖ Reflections; simple, amplified, and double-sided

❖ Shifting Focus
❖ Reframing
❖ Agreeing (with shift)
❖ Siding with the negatives

CLIENTS READY TO CHANGE: EVOKING AND ENCOURAGING CHANGE TALK

Evoking Change Talk: When our client has indicated and identified a problematic, or target behaviour, but has not yet taken the steps
towards change, we can help promote their change behaviour by evoking change talk. Here are techniques to evoke:

- Ask suggestive questions: How might you move towards making this change? What are your top reasons for making change?
What would you need to be successful? How important is this change to your life? How do you feel about making this change?
- Ask client to elaborate: when change talk emerges, seek more detail
- Ask for examples: of the behaviour, of the change issues or successes the client has already faced
- Ask client to look back, and forward: think about time before concern emerged, and what the future would look like with and
without change
- Ask for a best, and worst, case scenario: to make, and to not make change in order to explore the client’s concerns/hopes
- Use Change rulers: where do you see yourself, from 1-10 (how important is this, how ready are you, how confident?)
- Explore goals/values in more depth: What are their guiding motivations towards change, and currently
- Come alongside your client: if client feels negatively, emphasize negativity, and accept it (perhaps X is so important to you that
you will not be able to give it up), and explore client response.

Encouraging Change Talk: when our client has shown some commitment towards change, we can help further this motivation, and
thus – the change behaviours by exploring and supporting the client. To do so, MI suggests the following techniques:

- DARN: use questions related to Desire, Ability, Reasons, and Need to change further motivate and discuss the target
2 behaviour
- OARS: use Open- ended questions in this phase, Affirm the client to encourage, Reflect on the client’s statements to promote a
therapeutic relationship, and Summarize to help outline the client’s perspective of change.
 MOTIVATIONAL INTERVIEWING
IN CLINICAL PRACTICE

SESSION OVERVIEW

A “TYPICAL” SESSION

Making an agenda – first, identify the target behaviour, or target “issue”

Explore what the target is, why it’s important to the client, and why/what – if any – they are experiencing
contradictory feeling (ambivalence) about changing

Explore and summarize the NEGATIVE elements Explore and summarize POSTIVE elements of
of the behaviour the behaviour

For example; what is the downside to X? What makes For example; What are some of the good things
you feel unhappy? about X? How has X helped you?

Explore the client’s present, future, goals, and their current values
These goals & values will establish a base for which the target behaviour (and its respective “pros/cons”) can be
weighed against. We are looking to see the cost and benefits of the target value on the client’s “ideal” person.

Important questions: What is important to you? What type of person would you like to be? What is
your ideal future situation? What are you hoping to accomplish/have accomplished a year from now?

Ask for a decision

Use a summary to restate their current dilemma, mixed feelings, - and ambivalence, then ask questions about
their feelings towards plans & commitment

For example, You were saying you are thinking about X – has this conversation made your feelings, or what you
would like to do, clearer? How committed are you to planning this change?

IF CLIENT IS READY for change plan, set goals using S.M.A.R.T

Here, we aim to explore the client’s ideal way to tackle their behaviour, and what change behaviours they believe
are necessary, realistic, and motivating.
Important Questions: What do you think is your first, or next, step? Who will help you accomplish this step?
Have you tried any strategies before – how were they useful, or not? What is the likelihood you will do your
proposed next step?

IF CLIENT ISNT READY to change, or is continuing behaviour explore, empathize, and reflect

Important Questions: Is there something that would help you make a decision towards change? What has made
you decided to continue your current behaviour? Can we reduce some of the other problems while you are
debating your target behaviour? Can we re-explore your mixed feelings?