Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Motivational Interviewing: An Introduction

Motivational Interviewing for Social Services Staff
by

Danielle McCluskey

on 4 May 2016

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Motivational Interviewing: An Introduction


A
collaborative
, goal-oriented
style of communication

with particular attention to the language of change.
It is designed to
strengthen personal motivation

for and commitment to a specific goal
by
eliciting and exploring
the person’s
own reasons for change
within an
atmosphere of acceptance and compassion.
Motivational Interviewing & Stages of Change
MidPen Housing Corporation
Family Services
May 2016
Stages of Change
Stages of
Change
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Non-Linear and Relapse is Common
Maintenance
Action
Preparation
Relapse
Make a plan
1, 2, 3, 4
Identify barriers
Recycle through
1 check, 2 check, 3...
Carry out the plan
Strengthening Commitment
Motivational Interviewing
Ask evocative questions
Strategies for Evoking Change Talk
Change Plan Worksheet
Signs of Readiness to Change
Decreased resistance
The client stops arguing, interrupting, denying, or objecting
6. The things that could interfere with my plan are:
5. I will know that my plan is working if:
4. The ways people can help me are:

Person Possible ways to help
2. The most important reasons I want to make these changes are:
1. The changes I want to make are:
3. The steps I plan to make in changing are:
Self-motivational statements
Statements reflect recognition, concern, openness to change, or optimism
Decreased questions about the problem
The client seems to have enough information
Envisioning
Talks about how life could be after a change, or discusses advantages of change
Ask for elaboration
Come alongside
Explore goals and values
Use change rulers
Query extremes
Look forward
Look back
Ask for examples
Explore decisional balance
Establish Rapport
Assess importance and confidence
Ask Permission
Explore and Build Confidence
Open Questions
Affirmation
Reflective Listening
Summarizing
Encourage Change Talk
Reduce Resistance
Enhance Motivation to Change
Create a Change Plan
Support, Support, Support
Desire:
Reasons:
Need:
Commitment:
What is one MI skill you are committed to developing in the
next week?

What are some of the barriers you see to using MI?

How ready are you to start using some MI strategies and techniques?

What specific plans do you have to continue learning MI?
Going Forward
Resources
Motivational Interviewing
Motivational Interviewing is a
conversational approach
designed
to help people discover their
own interest in considering and/or making change(s) in their own lives
.
Pre-contemplation:
The person is unaware that there is a problem or under-aware of the consequences of the problem.

“I am here because THEY made me come, it’s their problem, not mine.”


Contemplation:
Beginning awareness and early understanding that there may be a problem, yet uncertain of what to do.

“I know I lost control again and did things I regret, but only went overboard with the drinking because she makes me angry.”
Contemplation and Ambivalence

Ambivalence is
NORMAL
The most common place to get stuck on the road to change
Simultaneously wanting and not wanting something
Wanting two incompatible things


Common to hear two types of talk mixed together



Change talk
: the person’s own statements that favor change (self-motivating statements)


Sustain talk
: the person’s own arguments for not changing and maintaining the status quo
“I guess smoking has been affecting me more than I realized."
“I know it’s bad for myself but I can’t imagine not smoking.”
Stages of Change
The Righting Reflex
"A natural and instinctive response of trained care providers is to
fix the problem
, make things right, to use knowledge acquired from training and experience to help the individual seeking care to overcome their problems."
Miller & Rollnick, 2012
Service Provider vs. Ambivalent Client
Professional operating from righting reflex says...
Ambivalent client says/thinks...
"You need to stop..."
"You haven't been compliant with the treatment plan"
"You need to do this to get better"
"Tell me something I don't already know"
"I've tried numerous times and can't seem to stick with it"
"You sound like my wife/husband/mother"
Preparation
:
The person is has an appreciable understanding of the nature of the problem; can express desires, reasons, abilities, and needs; discusses making or considering plans to change
but sustain talk remains
.

“I know I need to manage what I eat and exercise to control my diabetes, but every time I go right back to the same old thing. I just don't know if I have what it takes to change long-term."
Action:
The person is actively taking steps to change but has not yet reached a stable state.

"I've been testing my glucose levels and am keeping track of what I've been eating."
"Yea! I quit smoking!"
"I joined a gym last week!"
Maintenance:
The client has achieved initial goals and is no working to maintain gains.

"I have so much more energy now and am thinking about joining another class at the YMCA"
Contemplation
Tip the balance....
Pre-contemplation
Doubt
More control over my life
Support from family and friends
Less legal trouble & Better health
More relaxed
Will not have to think about my problems
More comfortable with drinking friends
More stress or anxiety
Feel more depressed
Increased boredom
Disapproval from family and friends
Increased chance of legal and job trouble
Costs too much money
Changing
Not Changing
Advantages
Disadvantages
Decisional Balance
Readiness Ruler
1 2 3 4 5 6 7 8 9 10

"You picked a 4, why? What would it take to get you to 7 or 8?"
Motivational Interviewing is an
evidenced-based practice
Contemporary definition:  "the integration of the best research evidence with clinical expertise and patient values"
Empirically-supported

(Sackett, et al. 2000)
Applications of Motivational Interviewing

Efficacy
: strong evidence that Motivational Interviewing triggers change in high-risk lifestyle behaviors

Effectiveness
: meta-analysis of problem behaviors/problems in real-life clinical settings

Low cost
: designed to be a brief intervention

Compatibility with social services/healthcare delivery system
: short term intervention, even a single session has been found to invoke behavior change
The Case for Motivational Interviewing

Enhanced adherence
: improves treatment outcomes

Synergistic effect with other treatment models/ methods

Integrated Dual Disorder Treatment (IDDT)
Supported Employment (SE)
Assertive Community Treatment (ACT)
Integrated Primary & Behavioral Healthcare (IPBH)

What is Motivational Interviewing?
Best Research
Evidence
EBP
Patient
Values
Clinical
Expertise
More than 200 clinical trials conducted & over 1200 articles published
Grounded in psychological theory
Spirit and Core Principles
Spirit of Motivational Interviewing
Partnership
Evocation
Acceptance
Compassion
Why is this important?

aka Proschaska and DiClemente's Transtheoretical Model of Change
Substance abuse (addiction services)
Mental health
Psychiatry
Primary healthcare
Nursing
Supported employment
Tobacco cessation and recovery
Vocational rehabilitation
Residential
Housing
Criminal justice

Motivational Interviewing provides a means of how to help clients move through the stages of change.
Consistent with Social Work Principles
Build on
clients'
strengths
Maximize
client
empowerment
Treat clients with dignity and respect
Consider
clients
experts on
their own
lives
Maximize client self-determination
Increase
clients'
self-efficacy
Individualize
the client
Partnership
Collaborate with
the client
Compassion
Promote the client's welfare by giving priority to their needs
Acceptance
Ground your collaboration in the point of view and experiences of the client
Resist the urge to dispense expert advice- the "Righting Reflex"

Show care and concern for your client
Honor the client's worth as a human being
Recognize
autonomy
Express empathy
Affirm the client's strengths and efforts
Evocation
Focus on the client's strengths
"Draw out" the client's own motivation and skills for change
A Closer Look at Ambivalence...
Relapse:

Possible (and even probable) between any stage, even after prolonged periods of abstinence


Motivational Interviewing
Core Principles
Express
Empathy
Develop
Discrepancy
Support
Self-efficacy
Roll with
Resistance
Ethnic and cultural differences
Verbal vs. nonverbal communication
Physical contact

Considerations..
.
Ordering or directing
Warning or threatening
Giving advice or making suggestions prematurely or when unsolicited
Persuading with logic, arguing, or lecturing
Moralizing, preaching, or telling clients their duty
Judging, criticizing, disagreeing, or blaming

Motivation for change is enhanced when clients perceive discrepancies between their current situation and their hopes for the future
Help clients get “
unstuck
” from their ambivalent feelings

What Does This Mean?
How Do We Do This?
Juxtapose media or image messages
Examine discrepancy on different levels/domains
Physical to spiritual
Attitudinal to behavioral
Decisional Balance
Examining pros and cons


How Do We Roll With Resistance?
Avoid arguments
Argument = power struggle= increased resistance

Walk
” with clients, don’t “drag” them along
Don’t fight with or push a client while trying to motivate them- roll with it

What is Self-efficacy?

Self-efficacy
: person’s belief in his ability to carry out a specific act or behavior
“Can do” attitude

Remember...

Most clients do not have a well-developed sense of self-efficacy
The provider needs to recognize the client's strengths and bring them to the forefront whenever possible
The provider must also believe in the client's capacity to reach their goals
How Do We Encourage Self-efficacy?
Discuss options
Role models
Educate the client
1. Belief in the possibility of change is an important motivator.

2. The client is responsible for choosing and carrying out personal change.

3. There is hope in the range of alternative approaches available.
Enhancing Motivation for Change in Substance Abuse, SAMHSA, 1999
Putting Motivational Interviewing Into Practice
Engaging
Focusing
Evoking
Planning
Motivational Interviewing Processes
Engaging: Building the Relational Foundation
What is Engagement?

Engagement
: "the process of establishing a mutually trusting and respectful helping relationship"

Engagement is important!
Internal Checklist...
Before the Session...
Prepare Your Mind...
Remember the Spirit of Motivational Interviewing
Respect for the client
Partnership with the client
Get rid of distractions
“A practitioner who is listening, even if it is for just a minute,
has no other immediate agenda than to understand the other person’s perspective and experience
.”
(Rollnick, Miller, and Butler, 2008)
Prepare Your Space...
De-clutter your space (if possible)
Minimize distractions
Anticipate and plan for interruptions
Getting Started
How comfortable is the client talking to me?

How supportive and helpful am I being?

Do I understand the client's perspective and concerns?


How comfortable am I with this conversation?

Does this feel like a collaborative partnership?
Engaging
Focusing
Evoking
Planning
Motivational Interviewing Processes
Engaging
Focusing
Evoking
Planning
Motivational Interviewing Processes
Focusing: Setting a Collaborative Agenda
(Miller and Rollnick, 2013)
The quality of the alliance with between the provider and client directly predicts retention and outcome
What is Focusing?

Focusing
: the "ongoing process of seeking and maintaining direction"

Generally allow the client to set the agenda
(Miller and Rollnick, 2013)
Invite the client to talk...
Inviting open questions:
“What brings you in today?”
“What’s on your mind?”
“What would you like to talk about today?”
“How can I be of service to you?”
“How would you like to begin?”
Motivational Interviewing Toolkit
OARS
O
A
R
S
pen-ended questions
ffirmations
eflective listening
ummarizing
Open-ended Questions
Cannot be answered with a simple "yes" or "no"
Invite the client to talk about his/her life and/or concerns
Intended to create momentum and encourage the client to explore his/her situation and motivation for change
Examples...
"Help me understand..."
"What are some of the most important reasons why you want to quit smoking?"
" What would be the benefits of going back to school?"
"Describe a time when..."
"What steps do you think you need to take to make this happen?"
"Give me an example of when..."
Affirmations
Reflections of a client's abilities, strengths, efforts, and/or supportive statements
Affirmations have been associated with an
increase
in change talk
Affirmations should be genuine and demonstrate understanding
Examples...
"It seems like you have identified a lot of resources that can help you with this- you are very resourceful"
"That was a difficult situation...but you handled yourself really well"
"I know it can be difficult to share this kind of confidential information, but I appreciate your honesty"
"You have good ideas"
Reflective Listening
Attentive listening and response,
NOT
in the form of a question
Reflective listening enhances a client's understanding of elements that are implicit but less clearly articulated in conversation
Impact of Attentive Listening
Clients feel...
understood
valued
safe
respected
comfortable
interested
want to talk more
cooperative
empowered
heard
Levels of Reflective Listening
Repeating or rephrasing

Paraphrasing

Reflection of feeling
Listener repeats or substitutes synonyms or phrases, and stays close to what the speaker has said
Listener makes a restatement in which the speaker’s meaning is inferred
Listener emphasizes emotional aspects of communication through feeling statements
Summarizing
Short and concise
Highlight the main points of the conversation and encourage clients to move on
Invite feedback
"Did I miss anything?"
"Anything you want to add or correct?"

Examples...
"Let me see if I understand so far..."
"Here is what I've heard. Tell me if I'm missing anything."
Assessing Motivation
Gauge level of client's motivation for change
Two important questions:
“On a scale of 0 to 10, where “0” is not important at all and “10” is crucially important,
how important
it is for you to make this change?”
“On a scale of 0 to 10 where “0” is no confidence at all and “10” is completely confident,
how confident
are you that you can make the change?”
Gaining Momentum
Evoking: Encouraging Change
Drawing out the client's own reasons for change
Exploring ambivalence
Engaging
Focusing
Evoking
Planning
Motivational Interviewing Processes
Motivational Interviewing Toolkit
Recognizing Change Talk
Engaging
Focusing
Evoking
Planning
Motivational Interviewing Processes
Change Talk
Sustain Talk
Desire
Ability
Reason
Need
D
A
R
N
-
C
Commitment
A
T
Activation
Taking
Steps
Ability:
Activation:
Taking Steps:
I want to change
I can change
Its important to change
I should change
I will make changes
I am ready, willing, and prepared to change
I am taking specific actions to change
PREPARATORY CHANGE
IMPLEMENTING
CHANGE TALK
Avoid the "Righting Reflex"
Be careful with giving advice
Offer information, don't impose it
Elicit, provide, elicit
Planning: The Bridge to Change
Planning encompasses both developing commitment to change and formulating a specific plan of action
Motivational Interviewing Toolkit
S
M
A
R
T
pecific
easurable
ttainable
ealistic
imely
Examining Pros and Cons
PROs
CONs
+ things
- things
More About Planning...
Planning is a negotiation of change goals and plans, an exchange of information, and specification of next steps
Progress and motivation can fluctuate...
Goals Should Be...
Wrap Up
Motivational Interviewing is a
conversational approach
designed to help people discover their
own interest in considering and/or making change(s) in their own lives
.
Malutich, How to do Motivational Interviewing: A Guidebook, 2nd ed. (2013)

Miller & Rose, Toward a Theory of Motivational Interviewing American Psychologist, Vol 64(6), (Sept. 2009)

Enhancing Motivation for Change in Substance Abuse, Treatment Improvement Protocol No.35, SAMHSA (1999)

MIA: STEP, Department of Public Health and Preventive Medicine, Oregon Health and Science University, 2006.

www.motivationalinterview.com

www.motivationalinterviewingonline.com
Test it out...


The Origins of Motivational Interviewing
Empathy is not...
Ambivalence is normal
Empathy elicits emotion
Acceptance facilitates change
Empathy
Form 2 lines:
Line 1: Residents
Line 2: Service Coordinators

Residents: describe your situation to the Service Coordinator in 1 minute or less

Service Coordinators: practice a minimum of 1 MI technique with the resident
Develop engagement
Use OARS
Assess motivation to change
Express empathy
Support self-efficacy

Switch!
Full transcript