Motivational Interviewing

What is it? Motivational Interviewing is a client-centered method of communication which seeks to call forth the client’s own motivation for change

The “Spirit” of MI Collaboration (v. Confrontation) MI is a partnership between the social worker and the client, based on the perspective and the past experiences of the client Collaboration builds rapport between the social worker and client, as it does not emphasize the social worker as the “expert” The social worker may see things differently but the process is focused on mutual understanding, not the social worker being right

The “Spirit” of MI (cont.) Evocation (Drawing Out, Rather than Imposing Ideas) Evocation draws out client’s own thoughts and ideas It does not impose the social worker’s opinions when it comes to change Change most likely occurs when the client discovers their own reasons and motivations for change

The “Spirit” of MI (cont.) Autonomy (v. Authority) MI understands that true power for change rests within the client It gives empowerment as well as responsibility to the client There is no one “right way” to change, so clients are encouraged to develop many ways to achieve desired change

Principles of Motivational Interviewing Express Empathy See the world through the client’s eyes, share their experiences When clients feel understood they are more likely to share in depth

Principles of MI (cont.) Support Self-Efficacy MI believes that clients possess the capabilities to change successfully Self-efficacy is the client’s belief that change is possible This is necessary for difficult changes to occur In MI, social workers focus on previous successes and highlight skills and strengths the client already possess

Principles of MI (cont.) Roll with Resistance Resistance occurs when the client feels conflict between their views of the “problem” or “solution” and the social worker’s view of these things It also occurs when the client feels like their freedom is impinged upon Avoid confronting the client, de-escalate and avoid a negative reaction; “roll with it” instead Having the client define the problem and develop their own solutions allows little for the client to resist

Principles of MI (cont.) Develop Discrepancy MI works to help the client explore the discrepancies between their current circumstances and where they want to be Clients are more likely to experience motivation to change when they realize their goals don’t match up with their current circumstances

MI Skills and Strategies- OARS O: Open-ended questions are not easily answered with “yes/no”. The client is able to answer in many possible ways, moving the conversation forward. A: Affirmations are statements that acknowledge the client’s strengths. They build rapport and when they are genuine they can prove to the client that change is possible despite previous unsuccessful attempts. R: Reflections, or reflective listening, demonstrate that the social worker sees the situation from the client’s viewpoint. Reflection can be used to guide the client toward resolving ambivalence by pointing out the positives of change. S: Summaries are when the social worker recaps everything that has happened in all or part of the sessions. This calls attention to important parts of the discussion. It can also change the direction of the conversation and prepare the client to “move on”.

MI Skills and Strategies- Change Talk Preparatory Change Talk Desire (I want to change) Ability (I can change) Reason (It’s important to change) Need (I should change) Implementing Change Talk Commitment (I will make changes) Activation (I am ready, prepared, and willing to change) Taking Steps (I am taking specific actions to change)

Efficacy of MI MI is more effective than no intervention when treating alcohol use, marijuana dependency, and tobacco use. MI is usually most effective when combined with other forms of treatment. MI has also been shown efficacious in promoting lifestyle changes for older adults with both chronic and acute illness. Another study performed on homeless veterans as they waited to enter into a residential treatment program showed that using MI on the initial intake of the veterans increased program entry.

Sources “A Definition of Motivational Interviewing.” 2009. http://www.motivationalinterview.org/Documents/1%20A%20MI%20Definition% 20Principles%20&%20Approach%20V4%20012911.pdf. From http://www.motivationalinterview.org/quick_links/about_mi.html. Cummings, S. M., Cooper, R. L., & Cassie, K. M. Motivational interviewing to affect behavioral change in older adults. Research on Social Work Practice, 19, 195-204. Lundahl, B., & Burke, B. L. The Effectiveness and Applicability of Motivational Interviewing: A Practice-Friendly Review of Four Meta-Analyses. Journal of Clinical Psychology, 65, 1232-1245. 2009. Retrieved July 24, 2014. Wain, R. M., Wilbourne, P. L., Harris, K. W., Pierson, H., Teleki, J., Burling, T. A., et al. Motivational interview improves treatment entry in homeless veterans. University of Nebraska-Lincoln. Retrieved July 25, 2014.