Motivational Interviewing Stages of Change
Learning Objectives • Identify the stages of change. • Identify the core principles of Motivational Interviewing. • Demonstrate active listening skills.
Listening is a Foundational Skill • It is the basis for cultural competency • Remaining open and curious • It is what consumers and family members say is most helpful • For people with co-occurring disorders, listening is a core skill taught in Motivational Interviewing
Motivational Interviewing - Definition Motivational Interviewing is a directive, client centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Rollnick and Miller
Motivational Interviewing • Motivational Interviewing is a way of working with people who are in the process of change. • MI is focused on really understanding where a person is at in the stages of change. • Then, making stage-wise interventions.
Stages of Change Pre-contemplation Relapse Contemplation Maintenance Preparation Action
Exercise • What Stage of Change Are You In?
The Dilemma of Change • Sometimes we are ambivalent – we feel two ways about things. • Motivational Interviewing helps people look more closely at their own pros and cons for change. • Ultimately, this style of working with people builds their motivation to change.
Study of therapist’s behaviors • The more a therapist confronted, the more likely the client would be drinking (more than a year later) • The more the therapist had been supportive and listening, the more the client had changed. • Miller and Sovereign (1989)
Core Strategy of Motivational Interviewing • To elicit from the ambivalent client • the reasons for concern • and the arguments for change.
Five General Principles of MI • Express empathy • Develop discrepancy • Avoid argumentation • Roll with resistance • Support self-efficacy
Empathy • Listen and be supportive in your comments. Show respect and acceptance. • Your goal is to build an alliance with the client.
Develop Discrepancy • Your task is to help the client focus on their current behavior and how it differs from their ideal or desired behavior. The use of reflection can be very valuable here.
Avoid Argumentation • Avoid trying to convince the client of your point of view and avoid power struggles. Your job is to “walk” with the client not to drag them along.
Roll with Resistance • When the person is highly resistant it may be viewed as the client understanding the issue differently than you do. This is a sign to you to change direction and listen more carefully and express empathy.
Support Self Efficacy • Listen for statements that support the person’s strengths and bring those to the fore when possible. Elicit and support hope, optimism and the possibility to make positive changes.
Five Opening Strategies • Asking open-ended questions • Reflective listening • Summarizing • Affirming • Listening for self-motivational statements
Open-ended Questions • Facilitates dialogue and helps you to understand their point of view • Tell me, what brings you here today? • So, what do you think you want to do about your drinking? • Tell me about your family?
Reflective Listening • It is a means to demonstrate that you have heard and understood what the client has said. • Use the three options in reflections: • Use exact words • Paraphrase – use your own words • Reflect emotions
Exercise • Listening Relay
Summarizing • Taking all of the information and condensing it down to its essential meaning. • Summaries reinforce what has been said • They show that you have been listening
Affirming • Sincere affirmation promotes self-efficacy and validation of the clients experiences and feelings. • I think it’s great that you want to do something about this problem. • That must have been very difficult for you. • You’re certainly a resourful person to have been able to live with the problem this long and not fall apart.
Elicit Self-Motivational Statements • Your role is to entice the client to voice their concerns and desires. MI requires the client, not the clinician, to argue for change and persuade themselves to change. • I guess this has been affecting more than I realized. • I feel terrible about how my drinking has affected my family. • I think I could become clean and sober if I wanted to.