MOTIVATIONAL INTERVIEWING

MOTIVATIONAL 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
PRINCIPLES
 Motivational Interviewing FIVE BASIC PRINCIPLES
• Assumes that responsibility and
capability for change lies
• Express Empathy
within the client

• Therapist’s task is to create a • Develop Discrepancy

set of conditions that will
enhance the client’s own
motivation for and • Avoid Argumentation
commitment to change

• Mobilize the clients inner • Roll with Resistance

resources, helping
relationships, support intrinsic
motivation for change • Support Self-efficacy
 FIVE GENERAL PRINCIPLES OF
MOTIVATIONAL INTERVIEWING
 EXPRESS 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 INTERVIEWING

 AVOID  ROLL WITH

ARGUMENTATION RESISTANCE
 counterproductive  use resistance to
 makes clients help build
defensive motivation
 resistance may  reframe statements
indicate a need to  acknowledge
change strategies ambivalence as
natural
 FIVE GENERAL PRINCIPLES OF
MOTIVATIONAL INTERVIEWING

 SUPPORT 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 RESEARCH
 This treatment strategy does
not guide a client step-by-
step through recovery
 It employs motivational
strategies to mobilize the
client’s own change
resources
 It looks at motivating
clients through short/brief
encounters
 There is evidence that the
therapeutic “style” forms
the core of Motivational
Interviewing
• Accurate 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
 FRAMES

 FEEDBACK  RESPONSIBILITY
 very persuasive
 emphasis on client’s
 use information from an
personal
objective intake
evaluation as a basis for responsibility and
feedback to build freedom of choice
motivation
 should be personal, not
about general dangers of
substance abuse
 FRAMES
 ADVICE  MENU
 giving client clear and
direct advice as to the
need for change and
how it might be
accomplished
 should be given in a
supportive, not
authoritarian
(domineering) way
 to facilitate choice
there must be
alternatives from
among which to
choose
 there’s more than
one “right way” to
change
 FRAMES

 EMPATHY  SELF - EFFICACY

 maintain a client-  communicating
centered approach, optimism that
listening to and change can be
reflecting feelings. achieved.
 Helping clients
 the opposite of develop necessary
confrontation skills to change
 encourage client to
feel s/he can change.
 PHASE I
BUILDING MOTIVATION FOR
CHANGE

 ASSESS CLIENT’S CURRENT

SITUATION

 IDENTIFY PROBLEMS OR ISSUES

 EVOKE SELF-MOTIVATIONAL
STATEMENTS
 PHASE I
BUILDING MOTIVATION FOR
CHANGE

 FIVE EARLY STRATEGIES IN MI:

 OPEN-ENDED QUESTIONS
 REFLECTIVE LISTENING
 AFFIRMING
 SUMMARIZING
 ELICITING SELF-MOTIVATIONAL
STATEMENTS
 AFFIRMING
 Compliments and statements of appreciation and
understanding

 Shows respect for client and their efforts

 “I appreciate how hard it must have been for you to …”

 “I think it is great that you…”

 “That must have been difficult for you”

 “You’re certainly a resourceful person, to have…”

 “That’s 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 STATEMENT

 Restates client’s statements regarding problem recognition,

concern, reasons for change, and optimism about the change
 If 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.)
 Don’t ramble - be concise
 End 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 problem

 What the client’s concerns are about
the problem
 Intention to change
 Belief in their ability to change
(optimism)
 STRATEGIES AND TECHNIQUES FOR
EVOKING SELF-MOTIVATIONAL
STATEMENTS

 EVOCATIVE  ELABORATION
QUESTIONS  asking for examples
 using open-ended or clarifications
questions to ask for
statements  USING EXTREMES
 imagining the worst
 DECISIONAL consequences
BALANCE  LOOKING BACK
 discussing pros and  remembering times
cons before the problem, and
comparing to present
situation
 STRATEGIES AND TECHNIQUES FOR
EVOKING SELF-MOTIVATIONAL
STATEMENTS

 LOOKING FORWARD
 envisioning a changed future

 EXPLORING GOALS
 discussing client’s most important values and/or
goals

 PARADOX
 agreeing with client’s perception of “no
problem” in order to evoke the opposite
behavior
 USING ASSESSMENT / FEEDBACK
TO BOOST MOTIVATION

 WHAT ASSESSMENT RESULTS TO COVER IN

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

 Results of any medical tests

 Results of diagnostic interview / checklist
 Any 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 /
FEEDBACK

 WITH 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 Resistance

 don’t insist the client accept everything you’re saying

 Self-Efficacy
 encourage client; be optimistic about change
 PHASE II
STRENGTHENING COMMITMENT
TO CHANGE

SIGNS OF READINESS FOR CHANGE

 Decreased resistance
 Decreased questions about the problem
 Resolve
 Self-motivational statements
 Increased questions about change
 Envisioning
 Experimenting
 PHASE II
STRENGTHENING COMMITMENT
TO CHANGE

 Client is ready to change

 Client has not made a firm

commitment to change

 Contemplation / Preparation
 PHASE II
STEPS TO STRENGTHENING
COMMITMENT TO CHANGE

 RECAPITULATION  KEY QUESTIONS

 ask clients what
 summarize the
they want to do
client’s current
situation based on  use open-ended
your interaction in questions
order to evaluate
what to do next  encourages client to
reflect and talk
about change
 PHASE II
STEPS TO STRENGTHENING
COMMITMENT TO CHANGE

 INFORMATION AND  NEGOTIATING A

ADVICE PLAN
 in response to client
questions, provide the  set goals
information or ideas
 consider change options
 wait for invitation from
client to provide advice
 arrive at a plan
 do not fall prey to the
“yes, but” pattern
 PHASE II
STRENGTHENING COMMITMENT
TO CHANGE

HAZARDS
 Understanding Ambivalence
 does not disappear quickly

 Overprescription
 developing a plan that is unacceptable to the
client

 Insufficient direction
 providing too little guidance / direction
 NON-VERBAL ROLES

 What it was like growing up in my home

 Ways in which I have changed as a person over the years

 The good things and not so good things about my high school years

 What I hope and plan to do over the next ten years

 Describe one of your parents, or someone else close to you

 How I came to do the kind of work I am doing