1. Motivational Interviewing
Stages of Change

2. Learning Objectives Identify the stages of change.
Identify the core principles of Motivational Interviewing.
Demonstrate active listening skills.

3. Listening is a Foundational Skill
It is the basis for cultural competency
Remaining open and curious
It is what consumers and family members say is most helpful
For people with co-occurring disorders, listening is a core skill taught in Motivational Interviewing

4. Motivational Interviewing - Definition
Motivational Interviewing is a directive, client centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.
Rollnick and Miller

5. Motivational Interviewing
Motivational Interviewing is a way of working with people who are in the process of change.
MI is focused on really understanding where a person is at in the stages of change.
Then, making stage-wise interventions.

6. Stages of Change Pre-contemplation Relapse Contemplation Maintenance
Preparation
Action

7. Exercise
What Stage of Change Are You In?

8. The Dilemma of Change
Sometimes we are ambivalent – we feel two ways about things.
Motivational Interviewing helps people look more closely at their own pros and cons for change.
Ultimately, this style of working with people builds their motivation to change.

9. Study of therapist’s behaviors
The more a therapist confronted, the more likely the client would be drinking (more than a year later)
The more the therapist had been supportive and listening, the more the client had changed.
Miller and Sovereign (1989)

10. Core Strategy of Motivational Interviewing
To elicit from the ambivalent client
the reasons for concern
and the arguments for change.

11. Five General Principles of MI
Express empathy
Develop discrepancy
Avoid argumentation
Roll with resistance
Support self-efficacy

12. Empathy
Listen and be supportive in your comments. Show respect and acceptance.
Your goal is to build an alliance with the client.

13. Develop Discrepancy
Your task is to help the client focus on their current behavior and how it differs from their ideal or desired behavior. The use of reflection can be very valuable here.

14. Avoid Argumentation
Avoid trying to convince the client of your point of view and avoid power struggles. Your job is to “walk” with the client not to drag them along.

15. Roll with Resistance
When the person is highly resistant it may be viewed as the client understanding the issue differently than you do. This is a sign to you to change direction and listen more carefully and express empathy.

16. Support Self Efficacy
Listen for statements that support the person’s strengths and bring those to the fore when possible. Elicit and support hope, optimism and the possibility to make positive changes.

17. Five Opening Strategies
Asking open-ended questions
Reflective listening
Summarizing
Affirming
Listening for self-motivational statements

18. Open-ended Questions
Facilitates dialogue and helps you to understand their point of view
Tell me, what brings you here today?
So, what do you think you want to do about your drinking?
Tell me about your family?

19. Reflective Listening
It is a means to demonstrate that you have heard and understood what the client has said.
Use the three options in reflections:
Use exact words
Paraphrase – use your own words
Reflect emotions

20. Exercise
Listening Relay

21. Summarizing
Taking all of the information and condensing it down to its essential meaning.
Summaries reinforce what has been said
They show that you have been listening

22. Affirming
Sincere affirmation promotes self-efficacy and validation of the clients experiences and feelings.
I think it’s great that you want to do something about this problem.
That must have been very difficult for you.
You’re certainly a resourful person to have been able to live with the problem this long and not fall apart.

23. Elicit Self-Motivational Statements
Your role is to entice the client to voice their concerns and desires. MI requires the client, not the clinician, to argue for change and persuade themselves to change.
I guess this has been affecting more than I realized.
I feel terrible about how my drinking has affected my family.
I think I could become clean and sober if I wanted to.