1. Motivational Interviewing
Presented by:
Dale House
Julie Williams
Connie Kent

2. Assumptions about Behavior Change What are your assumptions
Assumptions about Behavior Change What are your assumptions? Activity 5-10 minutes
MI Adherent
Assumptions
MI Non-Adherent
Assumptions
Assumption quiz… 5 minutes for them to work on the quiz, minutes to review

3. Behavior Change Assumptions Is each assumption MI adherent or Non-Adherent??
MI Non-Adherent
When faced with change we feel ambivalent about it
Resolving this discrepancy builds internal motivation to change
Threatening people with consequences forces them to change
When people do not change, it is because they have not suffered enough
Answers about behavior change come from the client
Agents are responsible for making clients change
What we say out loud about change influences whether or not we change
Motivation is a client trait—some are motivated and some are not, and there is nothing anyone can do about it
People do not change

4. Motivation quote

5. Definition of Motivational Interviewing
Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
Break down of definition minutes

6. Continuum of Styles Tell Order Steer Administer Rule Lead Govern Allow
Permit
Shadow
Stay with
Go along with
Observe
Assist
Collaborate
Inspire
Motivate
Support
Elicit
Point
Accompany
It is possible to think about helping conversations lying along a continuum. At one end directing. At this end the helper provides information, instruction, and advice. The implicit communication in directing is “I know what you should do and here’s how to do it”. The complementary role for the recipient is to obey, adhere, and comply.
At the other end of the continuum is the Following style – this is being a good listener, taking interest in what the person is saying, and respectfully refrain from inserting their own material. The implicit communication of the helper is “I trust your own wisdom, will stay with you, and will let you work this out in your own way”. The complementary recipient roles are taking the lead, going ahead, and exploring. In the middle is the guiding style- imagine going to another country and hiring a guide to help you. It’s not the guide’s job to order you when to arrive, where to go, what to see or do. Neither does a good guide just follow you around. A skillful guide is a good listener and offers expertise where needed. Examples of the 3 styles: directing– a doctor explaining to a patient how to take a medication properly or PO explaining conditions of a court order. Following style- hospice worker communicating with a dying patient or working with strong emotions.
Following
Directing
Guiding

7. Less Dr. Phil, More Oprah
More evoking, active listening, empathy and compassion
Less blaming, shaming, sarcasm, and lecturing

8. Two Primary Success Factors
The level of the client’s motivation
The style and approach of the helping professional
The goal is to get to intrinsic motivation by increasing their own desire for change. First extrinsic to lead to intrinsic motivation. Our style of communication has an impact on outcomes!! Relationship matters.

9. The quality of your professional relationship with clients IS important!!
“PUTTING IT ALL INTO PERSPECTIVE, THE AMOUNT OF CHANGE ATTRIBUTABLE TO THE RELATIONSHIP IS ABOUT SEVEN TIMES THAT OF THE AMOUNT ATTRIBUTABLE TO A SPECIFIC MODEL OR TECHNIQUE”
-Hubble, Duncan, and Miller 1999

11. Focus on Intrinsic Motivation
*Find long term and short term goals-this will help identify their intrinsic motivators
(i.e. family, friends, perceived work ethic, respect of others, feeling of control..etc.)
Remember: For most people, change is an INSIDE job!!

12. MI Global Concepts-The Heart of MI
Evocation
Helping professional works proactively to evoke client’s own reasons for change and ideas about how change should happen.
Collaboration
Helping professional actively fosters and encourages power sharing in the interaction in such a way that client’s ideas substantially influence the nature of the interview.
Autonomy
Helping professional adds significantly to the feeling and meaning of client’s expression of autonomy, in such a way as to markedly expand client’s experience of own control and choice.
Direction
Helping professional exerts influence on the session and generally does not miss opportunities to direct client toward the target behavior or referral questions.
Empathy
Helping professional shows evidence of deep understanding of client’s point of view, not just for what has been explicitly stated but what the client means but has not yet said.

13. s.o.a.r. The basic skills of MI
S = Summaries O = Open Ended Questions A= Affirmations R= Reflections

14. Defensive/ Resistant
FIVE Chairs Exercise
Ambivalent
Motivated

15. Client Language Sustain Talk Change Talk
Snippets of both change talk and sustain talk
“”You don’t know how annoying my wife can be..she makes me do it”
I want to change to make a better home for my kids”

16. Evoking change talk -where the magic begins

17. Asking evocative questions Importance/confidence rulers
Evoking Change Talk
Asking evocative questions
Importance/confidence rulers
Querying extremes
Looking back/Looking forward
Exploring goals/values
snippets

18. Motivational Interviewing resources

19. MI in groups

20. Some helpful websites http://motivationalinterviewing.org
casaa.unm.edu/download/miti3_1.pdf