Motivational Interviewing Basics of Motivational Interviewing Module # 1
Objectives of Training • To have a basic • To be able to working knowledge of demonstrate reflective Motivational listening & open Interviewing ended questions, and understand the • To understand the importance of these principles of techniques Motivational Interviewing • To begin to learn the stages of change
“When given a choice between changing and proving that it is not necessary, most people get busy with the proof” John Galbraith
What is Motivation & How is it Instilled? Have the audience list several ideas of their definition of motivation & what motivates people to change
What is Motivational Interviewing? It is an approach designed to help clients build commitment & reach a decision to change It is one approach, not the only approach to work with clients
What is Motivational Interviewing? 1 An approach designed to help members build commitment & reach a decision to change 2 It appears to be member-centered, yet the staff maintains a strong sense of purpose & direction- and chooses the right moments to interject
What is Motivational Interviewing? A person-centered, directive method of communication for enhancing intrinsic motivation of change by exploring and resolving ambivalence .
What is Motivational Interviewing? • It is a style: – Non-Authoritarian – Responsibility for change is ultimately left with the client, but the case manager plays a critical role
It’s a style • By changing their therapeutic style between confrontational & client-centered, the therapist can drive client resistance rates up & down. (Miller, Benefield & Tonigan, 1993) • Client resistance behavior, in turn, is predictive of failure to change • Empathy is associated with more favorable client outcomes
What is Motivational Interviewing? • It is strategies: – It is supportive, not argumentative – Timing plays a crucial role – Emphasis is on the reasons to change, rather than on how to change
What is Motivational Interviewing? • The goals are: – Resolve ambivalence – Develop discrepancy – Increase intrinsic motivation – Increase the client’s self-perception, regarding the ability to change – Encourage the client to present the argument to change
Which Statements are True? • Being resistive & unmotivated for change is an inherent characteristic, especially of addicts • It is crucial for a person to admit their problems • The only way to get through to someone is to confront them, especially if you want results fast
Ambivalence • Conflict between two courses of action • Unsure of the action that one wants to take • Ambivalence must be resolved to move forward with change and reduce the probability of relapse
Contributors of Ambivalence • Attachments • Fear of Change • Is the payoff worth the work to change • Lack of reaching a decision • Pat predicators • Unique to the individual • Pressuring often produces resistance
Principles of Motivational Interviewing • Express empathy • Develop discrepancy • Avoid argumentation • Roll with resistance • Support self-efficacy
Principles of Motivational Interviewing Review of the MI poster
Five Early Strategies 1) Ask Open Ended 4) Summarize- (to check Questions that on the same track) 2) Listen reflectively 5) Elicit change- (try to get them to talk change, and them 3) Affirm- (to build argue for change) relationship)
Reflective Listening as a Process & as an Empathetic Strategy
Reflective Listening • Characteristic of Motivational Interviewing • Understand the member’s feelings & perspectives w/o judging or criticizing • It’s not only about how you listen or keep quiet - it is about how you respond
Reflective Listening Goals • Allow the member to explore ambivalence • To make a guess as to what the member means means • The guess is most often in the form of a statement- a well-informed reflective statement is less likely to evoke resistance than a well-informed question
Reflective Listening Goals cont. • Clarify the member’s own experiences • Elicit self-motivational statements • Become genuinely interested in the member • Change is more a process than an outcome
It is important to remember • Acceptance is not the same thing as agreement or approval. It is possible to accept and understand a member’s perspective but not agree with it.
5 Types of reflective statements 1) REPEATING: The simplest form of reflection, the listener repeats a portion of what was said .
5 Types of reflective statements 2) REPHRASING: The listener stays close to what the person said but substitutes synonyms or slightly rephrases what was said.
5 Types of reflective statements 3) PARAPHRASING: Major restatement. The listener infers the meaning in what was said and reflects this back in new words. This adds to and extends what was actually stated.
5 Types of reflective statements 4) REFLECTION OF FEELING: The deepest form of reflection, this is a paraphrase that emphasizes the emotional dimension through feeling statements, metaphor, etc.
5 Types of reflective statements 5) SUMMARIZING: Major summaries made to pull together what has taken place to that point. Allows another opportunity for the staff to check the understanding of what the person was saying and to hear their own words again.
The Caseworkers Response Reflective Listening Exercise # 1
Let the member be the member they are • Let’s not make them imitate others. Let them find themselves and be themselves • Cultivate an atmosphere of change
Poor reflective listening techniques (roadblocks) • Order, direct or command the member what to do • Warn & threaten the member of what they did wrong • Providing solutions, giving advice • Persuading with logic, arguing or lecturing • Moralizing, preaching “should do” • Disagreeing, judging or blaming
Poor reflective listening techniques (roadblocks) • Agreeing, approving or praising • Shaming, ridiculing, labeling • Sympathizing, reassuring • Questioning or probing • Withdrawing or distracting
Reflective Listening Exercise #2 Roadblocks: Responses of Poor Reflective Listening Statements
AVOIDING PITFALLS Remain as positive and nonjudgmental as possible and rely on brief open-ended questions to elicit the member’s concerns and exploration of feelings.
Ask open-ended questions Use questions that will elicit an informative answer. Example: Tell me more about these difficulties versus Have you had any difficulty with this?
The optimal approach is to ask an open-ended question, then to respond to the member’s response with reflective listening strategy- not another question. Too many questions will lead into a “passive” question/answer trap.
Open Ended Questions goals • Establish an atmosphere of openness, acceptance and trust • The member should do most of the talking • Let the member explore their thoughts
Open Ended Question Role Play • Role Play Activity
Stages of Change • Precontemplation • Contemplation • Preparation • Action • Maintenance
Stages of Change Precontemplation The person has no intention to change behavior in the foreseeable future. Individuals in this stage are unaware or underaware of their problems
Stages of Change C ontemplation A person is aware that a problem exists and are seriously considering changing, but have not yet made a commitment to take action. Contemplators perform a risk- reward analysis.
Stages of Change Preparation Individuals are intending to take action and may practice some of the behaviors necessary to change, but have yet to make a full commitment.
Stages of Change Action In this stage individuals modify their behavior, experiences or environment in order to overcome their problems.
Stages of Change Maintenance Individuals in this stage work to prevent relapse and consolidate gains.
Role Play • More advanced role plays: reflective listening/open ended questions
Summary • Review of the objectives and the main points of the training
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