1. Motivational Interviewing (MI)
Module 4
Motivational Interviewing (MI)

2. How Does Behavior Change?
Behavior A Behavior B

3. ASSUMPTIONS Behavioral issues are common
Change often takes a long time
The pace of change is variable
Knowledge is usually not sufficient to motivate change
Relapse is the norm

4. Transtheoretical ModelNn
Transtheoretical Model
Pre-contemplation
Relapse
Contemplation
Maintenance
Determination
Action
Synonyms Determination = Preparation Termination = Exit
Termination
4-4 18

5. Prochaska & DiClemente: Stages of Readiness to Change
Stage Description Objectives
Pre-contemplation Not considering change
Contemplation Ambivalent about change
Identify patient’s goals
Provide information
Bolster self-efficacy
Develop discrepancy
between goal & behavior
Elicit self-motivational
statements

6. Prochaska & DiClemente: Stages of Readiness to Change (continued)
Stage Description Objectives
Determination Committed to change
Action Involved in change
Strengthen commitment
to change
Plan strategies for
change
Identify and manage
new barriers
Recognize relapse
or impending relapse

7. Prochaska & DiClemente: Stages of Readiness to Change (continued)
Stage Description Objectives
Maintenance Behavior change
Relapse Undesired behaviors
Termination Change is very stable
Assure stability of change
Foster personal development
Identify relapse when it occurs
Reestablish self-efficacy
and commitment
Behavioral strategies
Assure stability of change

8. Principles of MI 1. Advice
Give advice only when individuals will be receptive
Target advice to stage of change 40

9. Principles of MI (continued)
2. Reduce Barriers
Bolster self-efficacy
Address logistical barriers 41

10. Principles of MI (continued)
3. Provide Choices
It’s the individual’s choice:
Whether to change
How to change 42

11. Principles of MI (continued)
4. Decrease Desirability
Help individuals:
Decrease their perceptions of the desirability of the behavior
Identify other behaviors to replace the positive aspects of alcohol use 43

12. Principles of MI (continued)
5. Empathy
Develop and communicate an understanding of the individual’s situation and feelings around the behavior
Explore pain around the behavior 44

13. Principles of MI (continued)
6. Feedback
Help the individual identify and understand relevant:
Risks of the behavior
Negative consequences of the behavior 45

14. Interview Techniques Open-ended questions Reflective listening
Affirmation
Summarization
Elicit self-motivational statements

15. Open-ended Questions Avoid closed and leading questions like:
“Would you like to quit?”
“Do you know that alcohol is bad for you?”
Instead ask:
“What do you think about your alcohol use?”
“What do you know about the risks of drinking?”

16. Reflective Listening Mirrors what the patient says
Creates a sense of safety for the patient
Deepens the conversation
Helps patients understand themselves
Says:
“I hear you”
“This is important”
“Please tell me more”
“I’m not judging you”

17. Reflective Listening (continued)
Patient: “To tell you the truth, I really enjoy drinking.”
Response: “You like drinking alcohol?”
Patient: “Yes. I like the taste, and it really relaxes me.”

18. Reflective Listening (continued)
Example 1:
“My girlfriend gets really angry when I get drunk and pass out.”
“She gets mad when you do that.” 63

19. “You’ve tried very hard to quit.”
Affirmation
Conveys support, respect, and encouragement
Helps patients reveal less positive aspects about themselves
“You’ve tried very hard to quit.”

20. Affirmation (continued)
“You are very courageous to be so revealing about this.”
“You’ve accomplished a lot in a short time.”
“I can understand why drinking feels so good to you.” 70

21. Summarization “What you’ve said is important.” “I value what you say.”
“Here are the salient points.”
“Did I hear you correctly?”
“We covered that well. Now let's talk about ...” 71

22. Elicit Self-Motivational Statements
Problem recognition
“Has alcohol caused you any problems?”
Concern
“Do you ever worry about your alcohol use?”

23. Elicit Self-Motivational Statements (continued)
Intention to change
“What might be some advantages of quitting or cutting down?”
“On a scale of 0 to 10, how important do you think it is for you to quit? Why didn’t you say
(1 or 2 points lower)?”

24. Elicit Self-Motivational Statements (continued)
Intention to Change
“On a scale of 0 to 10, how important is it for you to change your (behavior)? ”
“Why didn't you say (1 or 2 points lower)?”

25. Elicit Self-Motivational Statements (continued)
Optimism
“What difficult goals have you achieved in the past?”
“What might work for you if you did decide to change?” 80

26. For Ambivalence - DEARS
Develop discrepancy
Compare positives and negatives of behavior
Positives and negatives of changing in light of goals
Elicit self-motivational statements
Empathize
Ambivalence and pain of engaging in behavior that hinders goals

27. For Ambivalence - DEARS (continued)
Avoid Arguments
Don’t push for change, avoid labeling
Roll with resistance
Change strategies in response to resistance
Acknowledge reluctance and ambivalence as understandable
Reframe statements to create new momentum
Engage patient/client in problem-solving

28. For Ambivalence - DEARS (continued)
Support self-efficacy
Bolster responsibility and ability to succeed
Foster hope with menus of options