Bettina O’Brien, MA Patrick Barresi, MPH April 4, 2003 …but the light bulb has to WANT to change... Motivational Interviewing: Principles and Skills Bettina O’Brien, MA Patrick Barresi, MPH April 4, 2003

How many counselors does it take to change a light bulb?

Just one, but the light bulb has to WANT to change!

Goals 1. Participants establish and build their knowledge of Motivational Interviewing 2. Increase knowledge of how MI could be used with their populations of interest. 3. People set personal goals for what they want to do next with MI.

Objectives 1. Promote reflection on how to apply MI to current work. 2. Obtain a first understanding (felt-sense, intuitive, body-based) of what the MI spirit is.

Origins William R. Miller and Stephen Rollnick Univ of New Mexico and Univ of Wales Motivational Interviewing: Preparing People for Change. 1st Ed (1993); 2nd Ed. (2002). Then: Problem Drinkers Now: Broad Applications

MI Defined Inter-Viewing; “looking together” Client-centered method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

The Spirit of Motivational Interviewing Collaboration Evocation Autonomy

Critical Conditions of Change Carl Rogers Accurate Understanding (Empathy) Unconditional Positive Regard (Warmth) Genuineness (Congruence)

Ready, Willing, and Able Willing: How important is change? Able: How confident in ability to change? Ready: Where does change fit in priorities?

The Righting Reflex (overcoming it…)

Ambivalence: the dilemma of change

Who Argues for Change? Client is ‘ambivalent’ about change If counselor argues FOR change, s/he elicits further resistance to change from client. If counselor intentionally sides with status quo, client will side with change as evidenced by change talk.

Confrontation: A goal, not a style

Four General Principles Express Empathy Develop Discrepancy Roll with Resistance Support Self-Efficacy

PHASE ONE: BUILDING MOTIVATION FOR CHANGE

CHANGE TALK Self-Motivating Speech Disadvantages of Status Quo Advantages of Change Optimism for Change Intention to Change

Change Talk vs. Resistance Talk disadvantages of status quo advantages of change intention to change optimism about change Resistance Talk advantages of status quo disadvantages of change intention not to change pessimism about change

FIVE EARLY METHODS O Ask Open-Ended Questions A Affirm R Listen Reflectively Summarize Elicit Change Talk

PHASE TWO: STRENGTHENING COMMITMENT FOR CHANGE

Signs of Readiness for Change: Decreased resistance Decreased discussion about problem Resolve Change talk Questions about change Envisioning Experimenting

Phase II: Traps to Avoid Underestimating Ambivalence Over-prescription Insufficient Direction

Goal of Phase II: 1. Channel intrinsic motivation into a negotiated, workable plan for change 2. Strengthen the person’s commitment for carrying out that plan.

Negotiating a Plan: 1. Setting goals 2. Considering change options 2. Arriving at a plan

Unity’s Problem-Solving Steps 1. Identify the factor/stressor/barrier 2. Determine the goal 3. Brainstorm alternative solutions 4. Evaluate those solutions 5. Choose most appropriate and best solution 6. Develop and action plan 7. Act

Goal Card “My goal for the next session is:…” Realistic Clear Not too easy Not too hard Have a clear end point

So What? What are your next steps -- learning more about MI? What are ways MI can be integrated into your work and the work of your organization?