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Motivational Interviewing. What Is It? Why Use It? How To Learn It?. Agenda. What it is and isn’t (briefly, more later) Dynamics of change Why use it How it works Applying it in clinical practice How to learn it . Motivational Interviewing What Is It?. Motivational Interviewing.

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Motivational Interviewing


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motivational interviewing

Motivational Interviewing

What Is It?

Why Use It?

How To Learn It?

agenda
Agenda
  • What it is and isn’t (briefly, more later)
  • Dynamics of change
  • Why use it
  • How it works
  • Applying it in clinical practice
  • How to learn it
motivational interviewing4
Motivational Interviewing

A person-centered,

goal-oriented

method of communication

for enhancing intrinsic motivation to change

by exploring and resolving ambivalence.

phases of motivational interviewing
Phases of Motivational Interviewing

Phase I: Snow Shoeing

  • Resolve ambivalence and build motivation
  • Snowshoeing up the mountain
phases of motivational interviewing6
Phases of Motivational Interviewing

Phase I: Snow Shoeing

  • Resolve ambivalence and build motivation
  • Snowshoeing up the mountain

Phase II: Skiing

  • Strengthen commitment and create a plan
  • Skiing down the mountain
what it is not
What It Is Not
  • Skills training
  • Confrontive denial breaker
  • Simply sitting there listening and reflecting
  • The solution to all client issues and clinician headaches
dynamics of change

Dynamics of Change

You would think that…….

the problem with them is
The Problem With Them Is….
  • They don’t see (insight, denial)
  • They don’t know
  • They don’t know how
  • They don’t care
so the answer is
So The Answer is…..
  • Give them Insight……if they just seethey will change.
  • Give them Knowledge….. if they just knowthey will change.
  • Give them Skills….. if you can just teach them howto change, then they will change.
  • Give them Hell….. if you can make them feel bad or afraid enough they will change.
and yet sometimes insight knowledge skills and feeling bad or fearful is still not enough
And Yet….. Sometimes Insight, Knowledge, Skills, And Feeling Bad Or Fearful Is Still Not Enough
what is happening
What Is Happening?
  • Ambivalence
  • Motivation
  • Readiness
  • Confidence

Issues of……

stages of change
Stages of Change
  • Precontemplation
  • Contemplation
  • Determination/Preparation
  • Action
  • Maintenance

Prochaska, Norcross, DiClemente

Relapse

stages of change14
Stages of Change
  • 80% of substance abusers are in precontemplation or contemplation
  • Define success by the movement from one stage to the next
miller hester 1995 alcohol
Top

Brief intervention

Social skills training

Motivational enhancement

Community reinforcement approach

Behavior contracting

Bottom

Relaxation training

Confrontation

Psychotherapy

General alcoholism counseling

Education

Miller & Hester 1995: Alcohol
miller hester 2003 alcohol adapted post combine
Top

Brief intervention

Motivational enhancement

Community reinforcement approach

Self-change manual

Opiate Antagonists (Naltrexone)

BSCT

Bottom

Relaxation training

Confrontation

Psychotherapy

General alcoholism counseling

Education

Miller & Hester 2003: Alcohol (adapted post COMBINE)
miller zweben johnson 2006
Miller, Zweben & Johnson 2006
  • Cognitive-behavioral treatment
  • Community reinforcement approach
  • Motivational interviewing
  • Relapse prevention
  • Social skills training
overview of treatment methods
Overview of Treatment Methods
  • Build client motivation, readiness and engagement
  • Cognitive and behavior skills
  • Increasing positive rewards for non-use
  • Involve family and social networks
    • Think outside the skin
  • Appropriate medications
some benefits of motivational interviewing
Some Benefits of Motivational Interviewing
  • A good preparation for more action-oriented treatments
  • Gains rapport and reduces resistance
  • Increases retention and engagement in treatment
  • Resolves ambivalence (prepares for change)
  • Increases client motivation and change talk
some benefits of motivational interviewing23
Some Benefits of Motivational Interviewing
  • Can help increase client confidence
  • Reductions in use
  • Particularly useful with angry clients and those in the early stages of change
  • Prevents counselor burnout?
benefits for using with methamphetamine users
Benefits For Using With Methamphetamine Users
  • Helps deal with paranoia and suspicion
  • Effective in dealing with cognitive deficits
key assumptions
Key Assumptions
  • Motivation is interpersonal
  • Resistance is interpersonal
  • Clinician approach and behaviors matter
  • Persuasion is usually not an effective method to increase motivation and change
mi how it works
MI: How it Works

Clinician manages important in-session behaviors of client using MI spirit, principles and skills

Interaction of

clinician and client

Increase Change talk

and

Decrease Resistance

Leads to

change talk
Change Talk

Desire

Ability

Reasons

Need

Taking Steps

Commitment

Strength

Behavior

Change

resistance
Resistance
  • Arguing
  • Interrupting
  • Denying
  • Ignoring
slide30

MI

Pyramid

Strategies

Principles

Spirit

components of mi spirit
Components of MI Spirit

A= Autonomy (vs. authority)

C = Collaboration (vs. confrontation)

E= Evocation (vs. education)

basic mi principles
Basic MI Principles
  • D= Develop Discrepancy
  • R = Roll with Resistance
  • E= Express Empathy
  • S= Support Self-efficacy
develop discrepancy
Develop Discrepancy
  • Change is motivated by a perceived discrepancy between present behavior and important personal goals or values
  • The person rather than the counselor should present the arguments for change
roll with resistance
Roll with Resistance
  • Avoid arguing for change
  • Resistance is not directly opposed
  • Resistance is a signal to respond differently
  • The person is a primary resource in finding answers and solutions
express empathy
Express Empathy
  • Acceptance facilitates change
  • Skillful reflective listening is fundamental
  • Ambivalence is normal
support self efficacy
Support Self-Efficacy
  • A person’s belief in the possibility of change is an important motivator
  • The person, not the counselor, is responsible for choosing and carrying out change
  • The counselor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy (HARP)
strategies
Strategies
  • Open Questions
  • Affirming
  • Listen Reflectively
  • Summarizing

Dunn/MINT

OARS

change talk38
Change Talk

Original idea from Bem’s theory

“I learn what I believe from what I hear myself say.”

assessing importance
Assessing Importance
  • How important on a scale of 1-10?

1---x--------------y-------------10

  • Why X and not 1?
  • What would have to happen for you to go from X to Y?
mi what it looks like
MI: What It Looks Like

Generally quiet and eliciting

Is anything going on here?

The Data Says Yes!

into practice
Into Practice
  • As a preparation for more action-oriented forms of treatment such as:
    • CBT
    • 12 Step
    • Matrix Model
  • In individual and group sessions
    • More data about using in individual sessions
  • Reducing resistance and anger upon entry to treatment (and throughout)
  • When ambivalence crops up at any point

MI plays well with others

a time not to use mi
A Time Not To Use MI
  • When the client is clearly ready and committed to action
how to learn it
How To Learn It
  • Workshops: typically equivalent of 2-3 days
    • (preferably with follow-up and feedback)
  • Reading MI material
  • Viewing training videos
  • Watching or listening to your own taped sessions
  • Supervision and consultation
  • Peer encouragement
stuck points in learning
Stuck Points in Learning
  • Openness to change behavior and maintaining old behaviors
  • Proficiency in reflective listening
  • Eliciting and recognizing change talk
  • Summarizing
  • Transitioning to other therapeutic methods
mi resources
MI Resources
  • Motivational Interviewing (2002) 2nd Edition, Miller & Rollnick, Guilford Press
    • Complete description of MI and individual chapters on various populations, i.e. adolescents, corrections clients, clients with COD, etc.
  • www.motivationalinterview.org
    • Information, training announcements, videos, bibliography
contact information
Contact Information

Steve Brazill

316 304-5272

sbrazill@earthlink.net