1. Psychology Association
Motivational Interviewing: Counseling Tools to Enhance Motivation for Behavior Change in Schools
Terry Molony, Psy.D., NCSP
Minnesota School
Psychology Association
January, 2016

2. What is Motivational Interviewing?
MI is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.
MI is a style, not simply a set of techniques
Takes into consideration why people change?

3. Evolution of MI
Observation that confrontational approach to counseling did not work well with substance abuse clients
Evidenced Based Practice
1980’s expanded from substance abuse to health behavior counseling
Based on work of Carl Rogers

4. What Does Research Say About Why People Change?
Natural Change
Brief Intervention
Dose Effects
Faith and Hope Effects
Counselor Effects
Waiting List Effect
Change Talk Effects

5. Readiness for What?
Instead of asking: “Why isn’t this person motivated?”
Ask:
“What is this person motivated for?”

6. Change Talk MI is a conversation about change
Refers to language when a person states a need, desire, reason, ability, or commitment to make a change
We need to listen carefully because change talk is often hidden

7. Examples of Change Talk
“My class is out of control. I need to teach the standards but it seems like I don’t have any time for instruction this year with all of the students who are off task.”
Reason for change
“I wish I knew how to help Johnny but he’s not going to change no matter what I do.”
Desire
“If I could only connect with Joey, I think I could get control of the class.”
Ability
“I am going crazy! I go home every day from work just feeling exhausted. I don’t think the students are learning very much this year with all of the distractions.”
Need/Problem with the status quo
“If only they would listen, they’d be so much more engaged and make more progress.”
Reason/Benefit of change

8. Examples of Change Talk
“I can’t stand school. I get in so much trouble all the time but I can’t help it. ”
Reason for change
“Ms. Jones hates me. I just wish she would leave me alone.”
Desire
“If I could get my work done if only Joey would stop bothering me.”
Ability
“Every day I get punished when I go home because Ms. Jones is so mean and gets me in trouble.”
Need/Problem with the status quo
“I only get to play video games at home after I do my homework, but it’s too hard to do.”
Reason/benefit of change

9. Why did we decide to be helpers?
A desire to help
Make a difference
To give back
Prevent or alleviate suffering

10. “Righting Reflex” Used with the best of intentions
Fix what is wrong with people
Set them on the right course
Direct them in the right path
Used with the best of intentions
Usually activates an opposing argument against change

11. Resisting the Righting Reflex
Resisting the human tendency to help set people on the right course
Recognizing the we don’t control the situation, we can only influence it
Real change rests within the individual not through external pressure

12. Paradoxical Responses
Ambivalent people may not respond in what looks to us like a logical manner
Psychological reactance predicts an increase in the rate and attractiveness of a problem behavior if the person perceives personal freedom is being infringed upon or challenged.
Sometimes (often) increasing negative consequences does not serve as a deterrent.

13. The Underlying Spirit of MI
Collaboration
Evocation
Acceptance
Autonomy
Partnership, MI is done “for” and “with” a person
Elicits, does not impart info
Seeks to acknowledge the person’s strengths and efforts
Responsibility to change is with client

14. Meaningful Connections and Motivation
The interpersonal context that you create, holds the key for motivation to change.

15. A Motivational Understanding Toward Change
Motivation as an interpersonal process, a product of interaction, not a personal state or trait within a person.
Critical components to change
Ready
Willing
Able

16. Ambivalence
Often ambivalence is interpreted as pathological but feeling 100% sure of something is probably more exceptional than feeling two ways about something.

17. Developing Discrepancy
MI attempts to increase the discrepancy between the current situation and the goal
Takes into consideration the person’s readiness for change

18. Continuum of Communication Styles
What is your most comfortable style?
Directing
Guiding
Following

19. Homework Assignment During the week
Pay attention to how much directing occurs
Pay attention to how much listening occurs
Think about something that you want to change and decide where you fit in the Profiles of Ambivalence

20. Nonverbal Attending What is important in nonverbal communication?
Let’s practice: The speaker will talk to the listener and the listener will not say a word but will use only nonverbal communication to convey attention a and interest.

21. Adopted from Prochaska and Di Clemente's cycle of change model
Stages of Change
Adopted from Prochaska and Di Clemente's cycle of change model

22. Prochaska and DiClementi Stages of Change Model
Pre-contemplation
Feels no need to change
Contemplation
Wants to change but not committed
Preparation
Making plans to change
Action
Begins to change
Maintenance

23. Profiles of Ambivalence
High importance/
Low confidence
High confidence
Low importance /
Low importance/

24. Considerations for Intrinsic Change to Occur
Meet students, teachers, and parents where they are and not where we want them to be
Recognize “resistance” as a part of a process of change
Determine the level of the stage of change the person is in, intervene appropriately

25. Awareness of Different Stages For Appropriate Interventions
Motivational interviewing can be used to help the person move into the action stage from the precontemplation, or contemplation stage, by helping them to develop a discrepancy between what they desire and what is going on.

26. Setting the Tone Traps to avoid Question-Answer trap
Confrontation-Denial trap
Expert trap
Premature Focus trap

27. Four General Principles
Express empathy
Ambivalence is normal
Develop discrepancy
Client presents reasons for change
Roll with resistance
Avoid arguing for change
Support self-efficacy
Belief in the possibility of change

28. Methods of MI (OARS) Open ended questions Affirm Reflective listening
Summarizing
Collecting summaries
Linking summaries
Transitional summaries

29. OARS (Con’t) Open-ended questions (can’t be answered in a single word)
“What are your concerns about…?”
“How have you handled these problems in the past?”
Affirmations (specific and genuine)
“You’re really putting a lot of thought into this.”
“I see how hard you are working on this.”
Reflective statements (paraphrasing with special attention to implied feelings)
“You’re really frustrated by how things are going.”
“You just really want the best for these kids.”
Summaries (draw connections in two to three sentences)
“Let me make sure I’m understanding all of the big ideas so far. You’re feeling pretty worn out from all the chaos in your classroom this year and taking on new classroom strategies just seems like another burden right now. At the same time, part of you is hopeful that spending time on it now could eventually give you more time.”

30. Client Resistance Arguing Interrupting Negating Ignoring
Miller & Rollnick (2002): Box 5.1 Four Process Categories of Client Resistance Behavior, p. 48

31. SP’s Resistance Arguing for change Assuming the expert role
Criticizing, shaming or blaming
Labeling
Miller & Rollnick (2002): Box 5.3 Six Types of Counselor Advocacy Responses, p. 50

32. Gordon’s Roadblocks to Communication
Ordering, directing, commanding
Warning or threatening
Giving advice
Persuading with logic
Moralizing, preaching
Judging, criticizing, disagreeing, blaming
Agreeing, approving, praising
Shaming ridiculing, name-calling
Interpreting, analyzing
Reassuring, sympathizing, consoling

33. Activity
Pair up with the person next to you. One will be the speaker, the other will be the listener. Think of something you feel two ways about.
The speaker goes first and talks about their ambivalence. The listener responds by trying to fit in as many roadblocks as possible.
Then switch roles.

34. Communication/ Miscommunication
Communication can go wrong because:
The speaker does not say exactly what is meant
The listener does not hear the words correctly
The listener gives a different interpretation to what the words mean based on the listeners experiences

35. Thinking Reflectively
Increase awareness of the ongoing process of generating and testing hypotheses during reflective listening
In pairs, take turns completing the sentences “One thing I like about myself is…”
Listener asks “Do you mean…?” and the speaker responds only “yes” or “no”

36. Change Talk vs. Resistance
Disadvantages of status quo
Advantages of change
Intention to change
Optimism about change
Resistance Talk
Advantages of status quo
Disadvantages of change
Intentions not to change
Pessimism about change
Milner and Rollick, p. 49

37. Methods of Evoking Change
Asking Evocative Questions
Using the Importance Ruler
Exploring the Decisional Balance
Elaborating
Querying the Extremes
Looking Back/Forward
Exploring Goals and Values
Miller & Rollnick (2002), Box 6.3 Example Open Questions to Evoke Change Talk, p. 79

38. Evocative Questions to Elicit Change Talk
Desire for Change
Ability/Optimism for Change
Reasons/Benefits of Change
Needs
Disadvantages of the Status Quo
Problem Recognition
Reinke, Herman, & Sprick (2011) Evocative Questions That Evoke Change Talk, p

39. Importance/Confidence Ruler

40. How to Build Motivation Using the Ruler
Building Motivation for Change
Importance, Confidence, Ready rulers
“Tell me how important this is to you right now.”
Why are you at a “_” and not a “0.”
What would it take for you to go from “_” to a higher number.

41. Miller & Rollnick (2002). Decisional Balance, p. 15

42. Decisional Balance Sheet
Current Practice: ___________________________________
Benefits
Good things about ____________________
Barriers
Bad things about ______________________
New Practice: ___________________________________
If you were to try it, what might be some benefits:
If you were to try it, what might be some challenges:

43. Rolling with Resistance
Simple reflection
Amplified reflection
Double-sided reflection
Shifting focus
Reframing
Agreement with a twist
Emphasizing personal choice and control
Coming alongside

44. Rolling with Resistance
Simple Reflection
Acknowledge the client’s disagreement, emotion or perception
Amplified Reflection
Overshoot- Reflect back in an exaggerated form what the client has said
Double Sided Reflection
Acknowledge what the client has said and add the other side of the client’s ambivalence connected with “and”

45. Rolling with Resistance
Shifting Focus
Shift away from a stumbling block
Agreement with a Twist
Offer agreement but with a slight change of direction
Emphasizing personal choice
Assure the client that ultimately the decision to change rests with him or her

46. Rolling with Resistance
Reframing
Acknowledge the validity of the client’s observation but offer a new meaning or interpretation for them
Coming alongside
Siding with the negative/Therapeutic Paradox/Prescribe the Problem
Risky and must be used with caution!

47. Phases of MI Building motivation for change
Building intrinsic motivation
Can be a slow process if client is starting far down the slope of motivation
Strengthen commitment for change
Helps to confirm and justify decision and develop a plan of action

48. Building Confidence Reviewing past successes
Personal strengths and supports
Brainstorming
Giving information and advice
Reframing
Hypothetical change
Responding to confidence talk

49. Confidence Traps “I’ll take over” “There, there. You’ll be fine.”
Sharing the helplessness!

50. Strengthening Commitment to Change
Recognizing Readiness
Decreased resistance
Decreased discussion about the problem
Resolve
Change talk
Questions about change
Envisioning
Experimenting
Miller & Rollnick (2002). Box 10.1 Signs of Readiness for Change, p. 127

51. Hazards of the Action Phase
Underestimating ambivalence
Over prescription
Insufficient direction

52. Negotiating Change Setting goals Consider change options
Arrive at a plan
Elicit commitment

53. Ethical Considerations
Although MI is a directive approach, using your role to coerce or influence the client is not compatible with it’s spirit.
Using MI in the schools can be challenging since school professionals have an interest in changing negative behaviors.

54. References
Miller, W., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change(2nd ed.). New York: Guilford Press. Miller, W., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press. Reinke, W., Herman, K., Sprick, R. (2011). Motivational interviewing for effective Classroom management. New York: Guilford Press.

55. Thanks! Questions? Send an email: Terry Molony, Psy.D., NCSP