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Motivational Interviewing with Latino Populations. Presenter : James (Diego) Rogers, PsyD, CPRP VP of Clinical Services Community Research Foundation San Diego, CA MINT Member 2004. What is Motivational Interviewing?.

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Motivational interviewing with latino populations

Motivational Interviewingwith Latino Populations


James (Diego) Rogers, PsyD, CPRP

VP of Clinical Services

Community Research Foundation

San Diego, CA

MINT Member 2004

What is motivational interviewing
What is Motivational Interviewing?

  • A person-centered directive method for enhancing internal motivation for change by exploring and resolving ambivalence.

    (Miller & Rollnick, 1991; 2002)

What is motivational interviewing1
What is Motivational Interviewing?

  • A way of being with a person, not just a set of techniques for doing counseling.

    (Miller & Rollnick, 1991; 2002)

Broader than behavior change
Broader than Behavior Change

  • Decision- to make a choice

    • Forgiveness, leaving or staying

  • Attitude- to become a different person

    • To be more compassionate, assertive etc.

  • Resolution- acceptance

    • Complicated grief

    • Finding peace regarding a decision

    • Tolerance for anxiety, uncertainty etc.

Mi spirit
MI Spirit

  • Autonomy (Person-centered)

  • Collaboration

  • Compassion

  • Evocation (Guiding/eliciting style)

Normal human reactions to the righting reflex teach direct
Normal Human Reactions to the Righting Reflex (Teach/Direct)

Invalidated Resist Withdraw

Not respected Arguing Disengaged

Not understood Discounting Disliking

Not heard Defensive Inattentive

Angry Oppositional Passive

Ashamed Denying Avoid/leave

Uncomfortable Delaying Not return

Unable to change Justifying

Normal human responses to a listen evoke empathic style
Normal Human Responses to a (Teach/Direct)Listen/Evoke/Empathic Style

Affirmed Accept Approach

Understood Open Talk more

Accepted Undefensive Liking

Respected Interested Engaged

Heard Cooperative Activated

Comfortable/safe Listening Come back


Hopeful/Able to change

Change talk
“Change Talk” (Teach/Direct)

The goal of MI is for the provider to guide the client to discuss/argue for his/her own reasons for change in a compassionate way that respects the client’s autonomy.

4 principles of mi 2 nd edition
4 Principles of MI (Teach/Direct)(2nd Edition)

  • Express Empathy

  • Develop Discrepancy

  • Roll with Resistance

  • Support Self-efficacy/Elicit Change Talk

    (Miller & Rollnick, 1991; 2002)

Express empathy use your oars
Express Empathy (Teach/Direct)(Use your OARS)

  • Open-ended questions

  • Affirmations

  • Reflections

  • Summaries

Develop discrepancy
Develop Discrepancy (Teach/Direct)

  • Empathize with the ambivalence

  • Explore gains/losses of all options

  • Imagine extreme outcomes

  • Look forward & backward

  • Amplify ambivalence with reflections & affirmations

  • Values sorting

What is resistance
What is Resistance? (Teach/Direct)

  • Therapy Interfering Behaviors

  • Interpersonal (It takes two to resist)

  • A signal of dissonance (empathic failure)

  • Predictive of (non)change

What is sustain talk
What is Sustain Talk? (Teach/Direct)

  • Desire for status quo

  • Inability to change

  • Reasons for sustaining status quo

  • Need for status quo

  • Commitment to status quo

Sustain talk and resistance
Sustain Talk and Resistance (Teach/Direct)

  • Sustain Talkis about the target behavior

    • I really don’t want to stop smoking

    • I have to have my pills to make it through the day

  • Resistanceis about your relationship

    • You can’t make me quit

    • You don’t understand how hard it is for me

  • Both are highly responsive to counselor style

How to roll w resistance sustain talk
How to Roll w/ Resistance (Teach/Direct)(Sustain Talk)

  • Simple/Double-sided Reflections

  • Shifting Focus

  • Agreement with a Twist

  • Emphasizing Personal Choice

  • Reframing

Change talk sustain talk

Change Talk & (Teach/Direct)Sustain Talk

Opposite sides of the same coin

Preparatory change talk
Preparatory (Teach/Direct) Change Talk

  • DESIRE to change (want, like, wish . . )

  • ABILITY to change (can, could . . )

  • REASONS to change (if . . then)

  • NEED to change (need, have to, got to . .)

Mobilizing change talk reflects resolution of ambivalence
Mobilizing (Teach/Direct) Change TalkReflects resolution of ambivalence

  • COMMITMENT (intention, decision, promise)

  • ACTIVATION (willing, ready, preparing)


Responding to change talk all ears
Responding to Change Talk (Teach/Direct)(All EARS)

  • Elaboration- Asking for elaboration, more detail, in what ways, an example, etc.

  • Affirming- commenting positively on the person’s statement

  • Reflecting- continuing the paragraph, etc.

  • Summarizing- collecting bouquets of change talk

Culturally competent adaptations
Culturally Competent Adaptations (Teach/Direct)

  • Balancing act between maintaining fidelity to an evidence-based practice…

  • While adapting and tailoring the practice to increase engagement, receptivity, efficacy, and value to the recipent(s) (Cultural Responsiveness).

    • Linguistic Translations

    • Incorporating Social Contexts

    • Incorporating Cultural Values

Linguistic translations
Linguistic Translations (Teach/Direct)

  • Motivational Interviewing (MI) = La Entrevista Motivacional (EM)

  • MI Spirit = Espíritu de EM


Incorporating social contexts
Incorporating Social Contexts (Teach/Direct)

  • Immigration/migration experiences/status (including political/historical contexts)

  • Contexts of Migration (Falicov, 1998)

  • Receptivity of the host community/dominant culture

  • Language barriers

  • Experiences of Group Antagonism

  • Acculturation process/Level of Acculturation

  • Ethnic Identity

  • Socio-economic Status

Social context
Social Context (Teach/Direct)

  • A Cultural Adaptation of MI to Address Heavy Drinking Among Hispanics (Lee, Lopez, Colby, Caetano, Borrelli, & Rohsenow, 2011).

    • Social Context of Immigration (OARS)

    • Changing Family Dynamics (immigration & drinking)

    • Social Support (familismo y amistades/compadres_

    • Alcohol Health Literacy (E-P-E)

Incorporating latino cultural variables
Incorporating Latino Cultural Variables (Teach/Direct)

Assess for value adherence (using OARS/PARS):

  • Familismo (family orientation)

  • Personalismo (relationships with people not agencies)

  • Respeto (mutual respect and deference)

  • Confianza (trust and intimacy in the relationship)

  • Controlarse (self-containment or control)

  • Agüantarse/Luchar (ability to withstand stress & difficult times)

  • Poner de su parte (doing one’s part)

  • Religión

Latino cultural variables
Latino Cultural Variables (Teach/Direct)

  • Engaging Latinos Through the Integration of Cultural Values and MI Principles (Añez, Silva, Paris Jr., Bedregal, 2008).

  • Mental Health treatments were four times more effective when culturally modified for a specific group and when attentive to cultural context and values (Griner and Smith, 2006).

General research findings on mi and latinos
General Research Findings on MI and Latinos (Teach/Direct)

  • Still generally limited in number of studies, sample sizes, and populations.

  • Studies that do exist show that adopting the MI Spirit and incorporating social contexts and cultural values yielded favorable results in the therapeutic relationship:

    • Personalismo

    • Respeto

    • Confianza (buena gente, simpatico)

General research findings on mi and latinos1
General Research Findings on MI and Latinos (Teach/Direct)

  • Studies also show that incorporating social contexts and cultural values with the MI principles/techniques yielded favorable results (High Engagement & Client Satisfaction):

    • Clients enjoyed talking about their cultural values and striving for change toward those values (OARS).

    • Clients enjoyed talking about the change plan goals and action plans (Agenda Setting and Change Talk).

    • Clients enjoyed have an ability to demonstrate “poniendo de mi parte” (Change Talk)

    • Clients enjoyed having their opinion “respected” even when given advice (E-P-E)

Motivational interviewing web site
Motivational Interviewing (Teach/Direct)Web Site

Thanks for your (Teach/Direct)