Copyright and property of Scotty Silva, Director of Pulmonary Services, UNM Hospital

1.  What is MOTIVATIONAL INTERVIEWING?
 Motivational interviewing is a directive, client-
centered counseling style for eliciting behavior
change by helping clients to explore and resolve
ambivalence.
 What is AMBIVALENCE?
 Webster’s defines ambivalence as;
“Simultaneous conflicting feelings”
 “I want to quit smoking and I don’t want to quit
smoking”
 You can’t have motivational interviewing without
ambivalence.

2.  Collaboration (Not Confrontation)
 Working in partnership and consultation with the
patients.
 Evocation (Not Education)
 Listening more than talking
 Autonomy (Not Authority)
 Being respectful of the patient’s own ability to make
decisions.
 Honoring the patients autonomy, resourcefulness,
and the ability to choose.

3.  Motivation is essential to change.
 Change is not an event, change is a process!
 Ambivalence is NORMAL.
 Motivation;
 Ready – A matter of priorities.
 Willing – Understanding the importance of change.
 Able – Confidence in the ability to change.

4.  Precontemplation
 Reluctant – Inertia or lack of information prevents
the person from being fully aware of a problem.
 Rebellious – A heavy investment in the problem
behavior or in controlling a situation makes the
person actively resistant and often hostile.
 Resigned – A belief in the inability to change the
behavior keeps the person “stuck”, lacks energy for
and investment in change as a result.
 Rationalizing – The patient determines that there is
no problem, the odds of personal risk are in their
favor, or the problem is really someone else’s.

5.  Contemplation
 The patient is aware a problem may exist and
seriously considers action, but is not ready to make a
commitment to action.
 Preparation
 The person is intent upon taking action soon.
 This stage is a combination of behavioral actions and
intentions.
 Most patient’s will make a serious quit attempt soon.

6.  Action
 The person is aware that a problem exists and
actively modifies their behavior, experiences, and
environment in order to overcome the problem.
 Commitment is clear and a great deal of effort is
expended towards making changes.
 Maintenance
 The person has made a sustained change wherein a
new pattern of behavior has replaced the old.
 Behavior is firmly established and threat of relapse
becomes less intense.

7.  Change Talk = Self-motivating speech.
 DARN
 Desire to Change
 Ability to Change
 Reason to Change
 Need to Change
 DARN is the patient’s own expression to change!
 In order to move beyond reflective listening, you need
to recognize reflective listening.

8.  Develop Discrepancy – The difference between the
patient’s present state and their desired goals.
 Without discrepancy there is no ambivalence and if
there is no ambivalence, there is no potential for
change!
 First intensify and resolve ambivalence by developing
discrepancy between the actual present and the desired
future.

9.  Communication Model (Thomas Gordon);
The words the The words the
speaker says listener hears
What the speaker What the listener
means thinks the speaker
means

10. “I don’t think that we should
have a foreign exchange
student at our house
because than I will have to
take all my clothes off”

11. “I will have to take all the
clothes off my bunk bed, so
they can have a place to
sleep!”

12.  Thomas Gordon’s 12 Roadblocks
- Ordering, directing, or - Disagreeing, judging,
commanding criticizing or blaming
- Warning, cautioning, or - Agreeing, approving, or
threatening praising
- Giving advice, making - Shaming, ridiculing, or
suggestions, or providing labeling
solutions - Interpreting or analyzing
- Persuading with logic, - Reassuring, sympathizing,
arguing, or lecturing or consoling
- Telling people what - questioning or probing
they should do, moralizing - withdrawing, distracting,
humoring, or changing the
subject

13.  Question – Answer Trap
 Taking Sides Trap
 Expert Trap
 Labeling Trap
 Premature – Focus Trap
 Blaming Trap

14.  Express Empathy
 Develop Discrepancy
 Avoid Argumentation
 Support Self Efficacy

15.  Give information and advice about the concern
with the patient’s permission;
 “Would it be alright if I told you about a concern that
I have about what you are proposing”
 “I don’t know if this would work for you or not, but
can I give you an idea of what some people have
done in your situation”

16.  O-A-R-S
 Ask Open Questions
 Affirm – Statements of support, compliments,
appreciation, and understanding.
 Listen Reflectively – Offers a hypothesis about what
the speaker means, but is done in the form of a
statement rather than a question.
 Summarize – Captures both sides of ambivalence
and ends with an invitation for the patient to
respond.

17.  “The goal of Motivational Interviewing is to
enhance the patient’s confidence in his/her
ability to cope with obstacles and to succeed in
change”

18.  Listening statements
 Readiness Ladders
 Accomplishment Story
 Sidestepping