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Motivational Interviewing
The document discusses motivational interviewing as a method to engage individuals in behavior change by addressing their ambivalence and minimizing resistance. It outlines the stages of change model, emphasizing the importance of empathy, understanding, and strategic reflections throughout the change process. It also highlights common roadblocks in communication that can hinder progress and suggests appropriate interventions for each stage of change.
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An overview of Motivational Interviewing concepts, focusing on effective engagement in behavioral change.
Invitation to discuss personal changes the audience is contemplating and their ambivalence.
Identifies 12 roadblocks in communication that hinder effective motivational interviewing and connection.
Primary goals are to minimize resistance and explore discrepancies between behavior and personal values.
Addressing common challenges that individuals face when undergoing change.
Acknowledges the gradual nature of change, with potential for getting stuck and the holistic context of the individual.
Introduction to the framework that outlines stages of behavior change.
Describes stages such as Pre-Contemplation, Contemplation, Preparation, Action, Maintenance, and Relapse.
Signs that individuals may be unaware of their problems or unwilling to change.
Indicators that a person is starting to recognize their issues and considering change.
Detailed signs of readiness to change, characterized by planning and goal setting.
Focus on modifying behaviors and developing coping strategies during the Action stage.
Discusses maintaining achievements after change and preventing relapse over a significant period.
Understanding that relapses are common, noting that progress isn't linear and stages may shift.
Emphasizes that behaviors are the focus, not the person, and the need for specificity in interventions.
Various scenarios illustrating individuals' stages of change and how they relate to the model.
Importance of matching interventions to clients' stages to reduce resistance and foster change.
Explains how acceptance facilitates change, contrasting it with expectations that lead to resistance.
Highlights active listening techniques and the significance of strategic reflections in MI.
Outlines the initial step of engaging clients in understanding their feelings and directions.
Distinguishes between resistance talk and sustain talk, illustrating how clients express ambivalence.
Emphasizes the significance of identifying change talk vs. sustain talk and reflective practice.
Encouragement for discussion and provides resources for further reading on Motivational Interviewing.
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Motivational Interviewing
- 1. MOTIVATIONAL INTERVIEWING Effectively Engaging inChange Josue Guadarrama Washington State University [email protected]
- 2. FIND A PARTNER DISCUSSIONTOPIC Something about yourself that you: Want to change Need to change Should change Have been thinking about changing …but haven’t changed yet Something you have ambivalence about
- 3. 12 ROADBLOCKS IN12ROADBLOCKS IN COMMUNICATIONCOMMUNICATION 1. Ordering, directing 2. Warning, threatening 3. Giving advice, making suggestions, providing solutions 4. Persuading with logic, arguing, lecturing 5. Moralizing, preaching 6. Judging, criticizing, blaming
- 4. 12 ROADBLOCKS IN12ROADBLOCKS IN COMMUNICATIONCOMMUNICATION 7.7. Agreeing, approving, praisingAgreeing, approving, praising 8.8. Shaming, ridiculing, name callingShaming, ridiculing, name calling 7.7. Interpreting, analyzingInterpreting, analyzing 8.8. Reasoning, sympathizingReasoning, sympathizing 9.9. Questioning, probingQuestioning, probing 10.10. Withdrawing, distracting, humoring,Withdrawing, distracting, humoring, changing the subjectchanging the subject
- 5. MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING PRIMARYGOALSPRIMARY GOALS Reduce or Minimize resistance Explore discrepancy between behavior & values/goals… resolve ambivalence
- 7. WHAT’S YOUR CHALLENGE?WHAT’SYOUR CHALLENGE?
- 8.
- 9. REALITIES OF CHANGEREALITIESOF CHANGE Most change does not occur overnight People can get stuck in the early stages Individuals who are hesitant or reluctant resist being pushed to action/change Contextual: all elements of the person are affected (H.A.L.T.) “He who would learn to fly one day must first learn to stand and walk and run and climb and dance; one cannot fly into flying.” Friedrich Nietzsche
- 10. STAGE OF CHANGEMODELSTAGE OF CHANGE MODEL Offers framework for understanding resistance and behavior change Series of stages through which people progressively pass as they change behavior
- 11.
- 12. Precontemplation Empathy/Understanding Contemplation Explore& Amplify Ambivalence Preparation Clarify Focus, Plan & Set Goals Action Support Self-Efficacy Maintenance Monitor Relapse Triggers Relapse Roll with it - Reassess and Revise Stage Intervention
- 13. CUES FOR PRE-CONTEMPLATION Unawarethat a problem exists Not considering change/does not intend to change Unwilling or too discouraged to change Ignores/resists evidence
- 14. PRE-CONTEMPLATIONPRE-CONTEMPLATION CHARACTERISTICS Appear to behesitant, argumentative, hopeless or in "denial.” TRAP Natural tendency is to try to "convince" them or push into action
- 15. CUES FOR CONTEMPLATIONCUESFOR CONTEMPLATION • Becomes aware that a problem exists • Considering the possibility of change • Acknowledges concern and reason to change • Ambivalent – reasons to change & reasons not to change • “Chronic Contemplation:” substitute thinking for action
- 16. CUES FOR PREPARATIONCUESFOR PREPARATION • Specific planning for change relatively soonSpecific planning for change relatively soon (aiming within a month)(aiming within a month) • Examining strengths & capabilitiesExamining strengths & capabilities • Setting goals and making commitmentsSetting goals and making commitments • Commitment is strengthenedCommitment is strengthened
- 17. • Actively modifying… •Behaviors • Emotions • Surroundings …in specific ways • Behavior change is the main focus • Reevaluating of self-image • Grief Issues ACTIONACTION
- 18. • Maintaining focus& pursuing the goal • Improving problem solving skills & functional strategies • Staying Focused (preventing relapse/backslide) learn to detect and guard against triggers • Identifying & changing destructive thought processes and emotional responses • Develop new coping skills to handle relapse prone situations. ACTIONACTION
- 19. • Takes minimum6 mo. to 2 yrs. of Action • Achieved the goal and sustaining the gainsAchieved the goal and sustaining the gains • Continuing healthy strategiesContinuing healthy strategies • Maintaining focusMaintaining focus • Pursuing new/complementary goalsPursuing new/complementary goals • and activitiesand activities “We are what we repeatedly do. Excellence, therefore, is not an act, but a habit.” Aristotle MAINTENANCEMAINTENANCE
- 20. A STEP BACKASTEP BACK NOTNOT NECESSARILY A FAILURENECESSARILY A FAILURE “You can’t fall off a mountain” Jared Brandon RELAPSES/RECYCLERELAPSES/RECYCLE
- 21. • Total behaviorchange in the beginning is rare • People backslide, even those serious about behavior change • Triggers exist for all of us (HALT) • Intensity of this stage is MAJOR indicator of investment in the goal RELAPSE/RECYCLERELAPSE/RECYCLE
- 22. STAGE OF CHANGEMODELSTAGE OF CHANGE MODEL • A person in any later stage can move to any former stage… is often a normal part of change • Time in any stage may be transient (lasting for moments, minutes, days, weeks)
- 23. STAGE OF CHANGESTAGEOF CHANGE • Target behavior/goal specific… not person specific “This person is pre-contemplative about his/her target behavior” NOT “This person is in the precontemplative stage” NOT “He/she is a precontemplator”
- 24. “I want togo to work. I don’t like being on disability because of my mental health, but I’m still not sure how this process could get me a job.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 25. “I’m fine, Idon’t care what the diagnosis or reports say. I do not need medication.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 26. “I know Istarted out with a pretty bad attitude, but this retraining program has really given me some hope. Once I got into it, the months flew by. Actually, I’ve been enjoying this past year so much I hardly even think of it as training.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 27. “All I hearabout are those horrible side effects. I will quit taking that medication if I have those crazy things happen to me. Do you really think it will help?” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 28. “I took thatclass to help me with my resume and cover letters, I tracked down a nice interview outfit, and I’ve had a few practice interviews and received some helpful feedback. I feel like I’m actually ready to go.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 29. “There is noway I am taking that medication. I know what kind of crap that does to your head. There is nothing they can do to help me or fix me.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 30. “I hate it,but I'm not talking with my old friends. I don't like those AA meetings either. I haven't smoked weed or drank in almost two months. At least some of my memory is coming back.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 31. “That’s easy foryou to say, you don’t live with her. No medication helps and counseling has been a joke.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 32. “Now that mydepression is better managed, I am ready to go to work. I have checked into some training programs at the community college, applied for financial aid, and today I am taking some career interest tests.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 33. “It wasn’t easytalking in group when I first started. It is getting easier and I actually think about what people share in there when I’m riding the bus home. I’m glad I’m in the group and plan to keep coming.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 34. “Marijuana is legalnow anyway. Everybody smokes it and I just sell enough to make a little spending money. It's not like I'm some addict or some major drug dealer.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 35. “I just thoughtI’d always live on disability checks. I’m still nervous that I could lose everything if I go to work. But, I do like this idea of exploring jobs and having somewhere to go every day.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 36. “I feel solidin my recovery. Looking back over this past year: I juggled a day job, being a mom, and night classes. It’s amazing to me I have a job that I love and make a good living to support my kids.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 37. “I understand thatthis program can help, and there are some parts of it I am interested in, but I just want to make sure that this is really going to be worth my time.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 38. “I didn’t doanything wrong at that apartment, I don’t care what anyone says – my landlord lied about why he kicked me out and made stuff up. Not that I care, there was so much drama there and half the people that live there are crazy.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 39. “Well, I wasdischarged 10 days ago. I have been taking my meds ever since, and I have made it to both of my counseling appointments.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 40. “That psychologist doesn’tknow what she’s talking about. I don’t know how she came up with half that crap in the report. You need to get me an evaluation with somebody else.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 41. “I guess thoseare some things I haven't thought about before. I'm not saying I agree with you, or that I am going to pursue that option, but I'll think about what you said.” A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance
- 42. Precontemplation Empathy/Understanding Contemplation Explore& Amplify Ambivalence Preparation Clarify Focus, Plan & Set Goals Action Support Self-Efficacy Maintenance Monitor Relapse Triggers Relapse Roll with it - Reassess and Revise Stage Intervention STAGE MATCHINGSTAGE MATCHING INTERVENTIONSINTERVENTIONS
- 43. WARNING!!! Mismatching your interventionto the client’s stage of change fosters resistance When you get attached to an outcome OR YOU push a quicker pace, you facilitate “resistance”
- 44. …reduces resistance & allowsfor exploration of ambivalence… ‘Equally supported in a steady position’ ‘Internal state of equilibrium or balance’
- 45. …corrects the orientation ofthe body when it is taken out of its normal position… Reaction people have to correct someone/somethin g that is ‘wrong’
- 46. “The force thatopposes motion” Not individual - relationship oriented Focusing outside the self Message that someone or something else is the problem Context of a relationship or system Lightning rod
- 47.
- 48. ““ACCEPTANCEACCEPTANCE FACILITATESFACILITATES CHANGE, WHILECHANGE,WHILE PERCEIVEDPERCEIVED EXPECTATIONEXPECTATION OF CHANGEOF CHANGE GENERATES RESISTANCE”GENERATES RESISTANCE” CARL ROGER’S PARADOXCARL ROGER’S PARADOX
- 51.
- 52. PEOPLE ARE OFTENMORE PERSUADED BY WHAT THEY HEAR THEMSELVES SAY THAN BY WHAT OTHER PEOPLE TELL THEM. CARL ROGER’S PARADOXCARL ROGER’S PARADOX
- 53. “Listening looks easy, butit’s not simple. Every head is a world.” Cuban proverb STRATEGIC REFLECTIONSSTRATEGIC REFLECTIONS
- 54. • Verbalizing whothey are and what they are about “You…” “It’s…” • Inferences and implications regarding what he/she feels, wants, and seeks for goals • Learning the ‘role’/’unzipping the skin’ • “Work… Disability… Depression…” DOG STRATEGIC REFLECTIONSSTRATEGIC REFLECTIONS
- 55. SELECTIVE reflections… Rogers:Rogers: Non-directionalNon-directional MI:MI:DirectionalDirectional STRATEGIC REFLECTIONSSTRATEGIC REFLECTIONS
- 56. Reduces RESISTANCE… • Seekingto understand their ideas • Target line of thinking of the one seeking change • Gets thoughts out of his/her head & more ‘real’… less single-minded • Helps clarify unspoken feelings • NOT a matter if we are right or wrong STRATEGIC REFLECTIONSSTRATEGIC REFLECTIONS
- 57.
- 58. Empathy How he/she feels DirectionDirection Whathe/she wantsWhat he/she wants STRATEGIC REFLECTIONSSTRATEGIC REFLECTIONS
- 59. “With being hospitalizedand losing my apartment, I’ve been feeling more depressed lately. I don’t think I need any counseling, I just need help to find a new apartment.” EmpathyEmpathy (How he/she feels) “This situation has been way harder on you emotionally than you expected it to be.” DirectionDirection (What he/she wants) Finding a safe place to live is a top priority for you, and you are willing to work together to find a place and a way to keep it.” STRATEGIC REFLECTIONS
- 60. 4 TYPES OFTALK4 TYPES OF TALK
- 61. • Focusing attentionoutside of self • Making it personal towards you • ‘Fight’ or ‘Blame’ talk • Any message that someone or something else is the problem RESISTANCE TALKRESISTANCE TALK
- 62. Change Talk Sustain Talk • Anyrationale for why behavior is not going to change • Any message of being stuck or planning on staying the same • One side of the coin of ambivalence SUSTAIN TALKSUSTAIN TALK
- 63. D esire forStatus Quo I nability to Change R eason for Status Quo N eed for Status Quo C ommitment to Status Quo No Behavior Change SUSTAIN TALKSUSTAIN TALK
- 64. SUSTAIN Talk Focusinginternally Staying the same Stuck talk Status quo About his/her behavior Natural w/ ambivalence RESISTANCE Talk Focusing outside self Relationally oriented Fight Talk Lightning Rod language Making it personal between you two RESISTANCE VS. SUSTAINRESISTANCE VS. SUSTAIN
- 65. “Smoking weed justrelaxes me” A. Resistance Talk B. Sustain Talk
- 66. “You people arejust here for the money” A. Resistance Talk B. Sustain Talk
- 67. “Who are youto tell me what to do” A. Resistance Talk B. Sustain Talk
- 68. “It’s easier tojust collect my benefits instead of trying to find a job” A. Resistance Talk B. Sustain Talk
- 69. “If you’re sosmart, you raise my daughter and I’ll do your job.” A. Resistance Talk B. Sustain Talk
- 70. “I’m sure YOUhave your opinion of what you think I should do” A. Resistance Talk B. Sustain Talk
- 71. “I’m not sureif I’m ready for real school.” A. Resistance Talk B. Sustain Talk
- 72. “That landlord isa total ass, he just looks for reasons to harass me” A. Resistance Talk B. Sustain Talk
- 73. “If I don’tpass my classes it’s because you wouldn’t help me with my work.” A. Resistance Talk B. Sustain Talk
- 74. “He never listens,I told my doctor that medication is killing me.” A. Resistance Talk B. Sustain Talk
- 75. “I’m afraid tolose my housing assistance and childcare assistance if I get a job” A. Resistance Talk B. Sustain Talk
- 76. “She wouldn’t giveme a bus token, it’s her fault I didn’t make it.” A. Resistance Talk B. Sustain Talk
- 77. “I’m not smartenough to get a job like that” A. Resistance Talk B. Sustain Talk
- 78. “I don’t thinkyou even try to help people. How long have I been coming here and nothing is any better.” A. Resistance Talk B. Sustain Talk
- 79. SUSTAIN TalkSUSTAIN Talk Focusing internally Staying the same Stuck talk Status quo About his/her behavior Natural w/ ambivalence RESISTANCE TalkRESISTANCE Talk Focusing outside self Relationally oriented Fight Talk Lightning Rod language Making it personal between you two RESPONSE:RESPONSE: Empathic ReflectionEmpathic Reflection ““You feel…”You feel…” RESPONSE:RESPONSE: Rescue change talkRescue change talk ““You want…”You want…” RESISTANCE VS. SUSTAINRESISTANCE VS. SUSTAIN
- 80. If resistance (re)surfaces,you are moving too far ahead of the client in the change process (mismatching stages). With resistance, “more” intensity is not better. More intensity increases defensiveness, producing negative outcomes. CONTINUED RESISTANCECONTINUED RESISTANCE
- 81. Whatever it isthat you are doing – pushing, confronting, educating, explaining, etc. Your agenda Your righting reflex …with resistance by reflecting viewpoint of the individual from a place of equipoise
- 82. • Change talkis client speech that favors movement in the direction of the change • Natural with ambivalence – opposite side of Sustain Talk • What the client really wants, “Top of the Mountain”, aligned with underlying goals &/or values CHANGE TALKCHANGE TALK
- 83. DESIRE: want, wish,like ABILITY: how could, might, can REASONS: should, because NEED: have to, need, important LISTENING TO CHANGE TALKLISTENING TO CHANGE TALK
- 84. D esire forChange A bility to Change R eason to Change N eed for Change C ommitment Behavior Change A ctivation T aking steps CHANGE TALKCHANGE TALK
- 85. • Your senseof his/her “Top of the Mountain” • Vision of happier and/or healthier • Hypothetical statements about change • Problem recognition • Virtues of changing – “stating the case” • Identity (I’m not THAT person) • Envisioning – “should” statements LISTENING TO CHANGE TALKLISTENING TO CHANGE TALK
- 86. Reflections practice S S S S R R R R R=Reflection S= Statement NOT: Questions A conversation Intended to fix the problem
- 90. SAME Discussion Topic Ambivalence Usethese open questions, and then… Actively listen w/ genuine interest to understand his/her dilemma… Practice Reflections: critical elements, change talk, empathy, direction Ask “Anything else?” “What else?” “Tell me more about that”
- 91. Motivational Interviewing in Health Care:Helping Patients Change Behavior by William Miller, Stephen Rollnick, & Christopher Butler Motivational Interviewing in the Treatment of Psychological Problems by William Miller, Stephen Rollnick, Hal Arkowitz, & Henny Westra Motivational Interviewing, Third Edition: Helping People for Change by William Miller & Stephen Rollnick MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING
- 92. How To DoMotivational Interviewing: A Guidebook for Beginners by Bill Matulich Building Motivational Interviewing Skills by David Rosengren www.samhsa.govwww.samhsa.gov TIP 35TIP 35 MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING
Editor's Notes
- #45 Motivational Interviewing: Preparing People for Change (second ed) by William R. Miller and Stephen Rollnick, New York: Guilford Press, 2002 pg 39.
- #49 Motivational Interviewing: Preparing People for Change (second ed) by William R. Miller and Stephen Rollnick, New York: Guilford Press, 2002 pg 39.
- #53 Motivational Interviewing: Preparing People for Change (second ed) by William R. Miller and Stephen Rollnick, New York: Guilford Press, 2002 pg 39.