1. Introduction to Motivational Interviewing
Ed Arnoll
Facilitator
Headway Training Manager

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

3. 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

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

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

6. 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

7. Stages of Motivational Interviewing
Engaging
Focussing
Evoking
Planning

8. 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)

9. 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

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

11. 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...

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

13. 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

14. Questions?