Introduction to Motivational Interviewing Ed Arnoll Facilitator Headway Training Manager

Learning Outcomes Understanding of the theoretical framework Identify the different stages Utilise techniques to improve engagement Identify resources to further learning

Warm up Could you be motivated to... Find someone you don’t know and ask them if they could be motivated to carry out one of the tasks on the list If they can be motivated find out how/why If they can’t or they are unsure try and motivate them

Motivational Interviewing Motivational Interviewing is a person centred counselling style for addressing the common problem of ambivalence about change (Miller and Rollnick 2013)

Transtheoretical model Pre contemplation Contemplation Determination/ preparation Action Maintenance Lifestyle/ behaviour change Lapse

Spirit of Motivational Interviewing Opposite approach Partnership Confrontation Acceptance Absolute worth Accurate empathy Autonomy support Affirmation Non-acceptance Judgement Imposition Authority Looking to ‘fix’ Evocation Education Compassion Self-interest

Stages of Motivational Interviewing Engaging Focussing Evoking Planning

Engagement The quality of the therapeutic alliance has been shown to predict TBI rehabilitation outcome, client self awareness and treatment compliance. (Klonof et al 1998, Fingfeld-Connett 2009, Schoneberger et al 2006, Sherer et al 2007)

OARS Open questions Not leading Affirmation Acknowledgement of strengths Reflective listening Statement not question Simple /complex /double Two reflections for each question Summarising ‘Let me just check I’ve got this right...’ Try to avoid ‘Why...’ questions as they can cause person to become defensive Reflections are less likely to evoke defensiveness and encourage exploration Simple reflections just mirror back what the person has said Complex reflections look to reflect the meaning of what they’ve said back, so involve some interpretation of the statement Double reflections use ‘and’ in the middle to separate the two reflections. Start the reflection with ‘you...’ When reflecting try not to make the tone go up at the end to make it a question When using reflections it can be useful to use “right now” to reduce the permanancy Simple rule of thumb is to use two reflections to every question

Confrontation/denial Engagement traps Question-answer trap Trap of taking sides Expert trap Labelling trap Premature focus trap Blaming trap Confrontation/denial

Focussing Choices in direction-Agenda setting Three scenarios Clear direction Choices in direction Unclear direction Choices in direction-Agenda setting Use flipchart to map out different options to get to the same overall goal. Use sleep as an example..what strategies could be used to enable people to sleep better? Ask permission to make suggestions if you run out of strategies...

Ambivalence Benefits Cost “I need to lose weight but I hate dieting”

Evoking How would you recognise change talk? Recognising change talk Desire, Ability, Reason, Need & Commitment Evoking change talk Scaling Elaboration Imagining extremes Looking back/forward Exploring goals/values Exploring pros and cons Responding to change talk EARS-elaboration, affirmation, reflection, summarising How would you recognise change talk? Think of examples for each type of change talk: Desire to change: I want to Ability: I can Reasons: It would be good to... Need: I have to Commitment: I will How would you evoke change talk? Scaling: on a scale of 0-10 how important is it for you? Why not a zero? What would make it a 10? Elaboration: if they make a change statement reflect and ask them to elaborate “in what ways? How much? When?” Imagining extremes: “if you carry on without changing what could happen?” “Imagine you have made this change, what would be some of the positives?” Looking back: “What were things like before you started drinking everyday?” Looking forward: “How would you like things to look ten years from now?” Exploring goals/values: What things are most important to them? How do their values fit in with their behaviour? Exploring pros and cons: Making the change board on flipchart

Questions?