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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

Assumes that responsibility and


capability for change lies
within the client
Therapists task is to create a
set of conditions that will
enhance the clients own
motivation for and
commitment to change
Mobilize the clients inner
resources, helping relationships,
support intrinsic motivation
for change

FIVE BASIC PRINCIPLES


Express Empathy
Develop Discrepancy
Avoid Argumentation
Roll with Resistance
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
ARGUMENTATION
counterproductive
makes clients
defensive
resistance may
indicate a need to
change strategies

ROLL WITH
RESISTANCE
use resistance to
help build
motivation
reframe statements
acknowledge
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-bystep through recovery

It employs motivational
strategies to mobilize the
clients 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

FR AM E S

FEEDBACK
very persuasive
use information from an
objective intake
evaluation as a basis for
feedback to build
motivation
should be personal, not
about general dangers
of substance abuse

RESPONSIBILITY
emphasis on clients
personal
responsibility and
freedom of choice

FR AM E S

ADVICE
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

MENU
to facilitate choice
there must be
alternatives from
among which to
choose
theres more than
one right way to
change

FR AM E S

EMPATHY
maintain a clientcentered approach,
listening to and
reflecting feelings.
the opposite of
confrontation

SELF - EFFICACY
communicating
optimism that
change can be
achieved.
Helping clients
develop necessary
skills to change
encourage client to
feel s/he can change.

PHASE I
BUILDING MOTIVATION FOR
CHANGE

ASSESS CLIENTS 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
Youre certainly a resourceful person, to have
Thats 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 clients 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.)
Dont 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 SELFMOTIVATIONAL STATEMENTS

How client sees the problem

What the clients concerns are about


the problem

Intention to change

Belief in their ability to change


(optimism)

STRATEGIES AND TECHNIQUES FOR


EVOKING SELF-MOTIVATIONAL
STATEMENTS

EVOCATIVE
QUESTIONS
using open-ended
questions to ask for
statements
DECISIONAL
BALANCE
discussing pros and
cons

ELABORATION
asking for examples
or clarifications

USING EXTREMES
imagining the worst
consequences

LOOKING BACK
remembering times
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 clients most important values and/or
goals

PARADOX
agreeing with clients 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
dont insist the client accept everything youre 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
summarize the
clients current
situation based on
your interaction in
order to evaluate
what to do next

KEY QUESTIONS
ask clients what
they want to do
use open-ended
questions
encourages client to
reflect and talk
about change

PHASE II
STEPS TO STRENGTHENING
COMMITMENT TO CHANGE

INFORMATION AND
ADVICE
in response to client
questions, provide the
information or ideas
wait for invitation from
client to provide advice
do not fall prey to the
yes, but pattern

NEGOTIATING A
PLAN
set goals
consider change options
arrive at a plan

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