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Motivational Interviewing

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Christy NW

on 19 September 2016

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Transcript of Motivational Interviewing

Early Majority
"Pragmatists"
Now you have an idea of where they are and what the Stages of Change are, it's time to develop a treatment focus.
Motivational Interviewing
Christy Newell Wyatt, LCSW, LCAS, CSI
Starting Out
What skills do I need in my pack to help my client meet this challenge?
Where are we?
The stages of change
The Chasm
Roll with Resistance
Verbal Tai-Chi
Change Talk
When you hear it, don't wait! Run towards it!
When there's resistance, that's typically a sign that the clinician is moving in a different stage than the client and that the clinician needs to change direction.
“We are generally the better persuaded by the reasons we discover ourselves than by those given to us by others.”
― Blaise Pascal, Pensees (17th Century)
What stage of change are they in?
This will help you as you travel with them on their journey.
How do I help them from one stage to the next?
Curiosity
Being Non-Judgemental in words and tone of voice.
Accepting of where they are
Stages of Change
Prochaska and DiClemente
Pre-contemplation Stage
The client does not see any problems with their behaviors. Therefore they are not thinking that change is needed. "I don't have a problem. I don't need any help."

Contemplation Stage
The client recognizes there is some concern but are ambivalent about changing. They may be experiencing fear or anxiety about change.
Preparation
Stage
There is a clear awareness of a problem. There is now a small commitment to change. They may even make some small changes as their level of determination increases. "I have a problem, and I need to do something about it."
Action Stage
They are now taking steps to change, but if previous stages were rushed, they may not be able to sustain their efforts. "This is what I'm doing about my problem."



Maintenance Stage
They have achieved their initial goals and are setting up and working towards long term goals. They incorporate new behaviors are able to manage challenges. "This is what I'm continuing to doing about my problem."
Collaborative
Empathetic
and
Respectful
Accepting
and
Eliciting
Current Status
Where they may want to be in the future.
Develop
Discrepancy
O
pen Ended Questions
A
ffirm
R
eflective Listening
S
ummarize
Tip the scales
Current Status
Control
and
Choice
People are more likely to change if it is their idea or their choice to do so. Most people react badly if there is an authority figure telling them to do something.
Change
Talk
DARN (preparatory) CAT (Implementing)
Desire (want, wish, like)
Ability (can, could, able)
Reason (why they could...)
Need (need to, have to, must)
Commitment (will, intend, going)
Activation (ready to willing to)
Taking steps (specific actions taken)
Listen,
Don't talk
The idea that less is more. Being subtle can be the one thing that moves the client.
Acceptance
When people feel accepted now matter where they are, they are more likely to make a choice to move as they have the freedom to make that decision on their own. When something is forced on a person, they are more likely to resist it.
Reactance theory: Brehm & Brehm, 1981; Self determination theory: Deci, 1980
Hope
and Possibility
A clinicians' ability to foster and encourage self determination.
Self-efficacy theory: Bandura, 1994; Leake and King, 1977
Making a Commitment
Once a person makes that commitment, they are more likely to act on it. At that point, support, planning and encouragement is needed.
Your Style
Defining your style as this is an intrinsic part of creating motivation and/or resistance to change.
Motivational Interviewing: Miller and Rollnick, 1991, 2002.
Pre-contemplation
Outreach
Practical help
Crisis intervention
Engagement
Contemplation
Psycho-education
Set goals
Build awareness and
develop hope
Persuasion
Preparation
Empower
Trigger control training
Introduce alternative activities and coping skills
Persuasion
and
Planning
Action
Therapy
Skills Training
Self-help groups
Active Treatment
Maintenance
Relapse Prevention Plan
Skills training
Expand Recovery
Be Genuine
Relapse Prevention
Creating a Paradox of Change
If a person feels unequivatibly accepted, healthy or unhealthy, it allows for a freedom to consider change rather than feeling defensive of change.
Ambivalence
Precontemplation
Outreach
Practical help
Crisis intervention
Engagement
Contemplation
Psycho-education
Set goals
Build awareness and
develop hope
Persuasion
Preparation
Empower
Trigger control training
Introduce alternative activities and coping skills
Persuasion
and
Planning
Action
Therapy
Skills Training
Self-help groups
Active Treatment
Maintenance
Relapse Prevention Plan
Skills training
Expand Recovery
Relapse Prevention
Stalled Out
Four Types of Resistance
Arguing
Interrupting
Denying
Ignoring
Challenging the accuracy of the counselors statements
Discounting as in questioning the expertise of the counselor
Hostility directed at the counselor
Talking over, not waiting for the counselor to pause or stop speaking.
Cutting off or breaking in, different than talking over as this takes on a more resistent tone such as "hold on, I don't agree.."
Blaming other people for their problems
Disagreeing with a suggestion the counselor "yes but.."
Excusing their own behavior
Minimizing or suggesting that the counselor is exaggerating things
Pessimism
Reluctance or reservations about the information being given
Unwilling to change
Inattention, looking away, closed off, or responding in such a way that shows their thoughts were somewhere else
Nonanswer, answering but not to the question that was asked.
No response at all
Sidetracking the conversation
Answering in ways that show inattention
No response at all
Changing the topic
Remain non judgemental and respectful.
Encourage the client to continue to talk and stay engaged.
Be genuine.

Help the client see their behaviors as separate from their goals & values. See the contradiction.
Ambivalence is to be considered normal AND an obstacle and it CAN be resolved.
To develop discrepancy the clinician needs to recognize and implement change talk.

The clinician needs understand the clients cultural background as it affects their perception of discrepancy.
Avoid Arguments!
Power struggles negate all the efforts of both the client and clinician.
A Basic Introduction
What is Motivational Interviewing?
It's a Person Centered Therapy that provides an atmosphere of genuine acceptance and caring. It's a form of strength-based conversation to strengthen a person's own motivation to change.
This type of therapy is frequently used not only with substance abuse and behavioral health issues, but also in the medical field to help motivate patients to make healthier lifestyle changes.
The effectiveness of Change Talk is rooted in the overall collaboration of the clinician and the client. Using and asking open ended questions based on the client's Desire, Ability, Reason, Need, and Commitment are ways of eliciting change talk in the client.
D: Why do you want to change _____?
A: How would you change____?
R: What are three reasons you want to change ____?
N: How important is this? Why?
C: What do you think you might do to change___?

See the disadvantages of the status quo.
See the advantages of making a change.
Verbalize optimism for change.
Verbalizing an intent to change.
4 Goals in change talk are getting the client to:
Be subtle.. add- uncover client strengths and utilize those strengths to motivate. Be Genuine - Clients can sense the spirit/intent behind our words
Affirmation


Simple Reflection: Be Neutral and reflect what they say.

Client: My parents are on my back. I'm just having a normal college experience.
Clinician: So your doing what everyone does in college.
SUMMARIZATION
Evoke Change Talk
Express Empathy
Support Self-Efficacy
You want the client to do the work and change. You are their guide, their coach, their encourager. Be collaborative.
O
pen Ended Questions
A
ffirm
R
eflective Listening
S
ummarize
Open vs. Closed questions
Open ended questions are less leading and allow for relationship and trust building.

Ex: Tell me how your exercises went this week.
This is a declaration of something that is true or positive.

Ex. Wonderful! You were able to get 2 days of exercise in!
REFLECTIVE LISTENING
Periodically, take a moment to summarize what the client is saying. This expresses to them that you are paying attention to their thoughts and concerns.
Ask evocative questions (open ended)
Why would you want to ...
How might you go about...
How important is it to you...
What are the 3 best reasons for you to....
Evoke Change Talk
Ask evocative questions
Ask for Elaboration
Ask for Examples
Look Back
Look Forward
Look for Extremes
Use a Change Ruler
Explore their goals and Values
Come Alongside them.
Develop discrepancy
OARS
Full transcript