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Miller june7-plenary

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Miller june7-plenary

  1. 1. Bill Miller and Steve Rollnick ICMI, Stockholm, June 2010
  2. 2. <ul><li>In Behavioural and Cognitive Psychotherapy, 2009, 37 : 129-140 . </li></ul>
  3. 3. <ul><li>A ramble in the forest </li></ul><ul><li>This presentation represents an evolution in our thinking, well past MI-2, anticipating MI-3 </li></ul><ul><li>It presents our thinking, and is meant as what Carl Rogers called a “discussion paper” </li></ul>
  4. 4. <ul><li>1. We propose that these are necessary and defining components of MI </li></ul><ul><li>2. None of them is sufficient to make it MI </li></ul><ul><li>3. Most are not unique to MI. It is their confluence that defines MI. </li></ul>
  5. 5. <ul><li>Usually but not necessarily about behavior change </li></ul><ul><li>Change can be broadly defined </li></ul>
  6. 7. <ul><li>Person-centered partnership </li></ul>
  7. 8. <ul><li>People make their own choices </li></ul>
  8. 9. <ul><li>MI evokes the person’s own motivations for change </li></ul>
  9. 10. <ul><li>MI applies specific helping skills in particular prescribed ways e.g., differential use of OARS </li></ul>
  10. 11. <ul><li>Not merely exploring ambivalence </li></ul><ul><li>MI seeks to resolve ambivalence in the direction of change </li></ul><ul><li>Sometimes MI involves creating ambivalence </li></ul>
  11. 12. <ul><li>Elicits and strengthens client change talk </li></ul><ul><li>This is rather unique to MI </li></ul><ul><li>DARN-CAT and beyond </li></ul>
  12. 14. <ul><li>Nonconfrontational – avoids argument </li></ul><ul><li>Does not resist resistance </li></ul>
  13. 15. <ul><li>Engaging – The Relational Foundation </li></ul><ul><li>Person-centered style </li></ul><ul><li>Listen – understand dilemma and values </li></ul><ul><li>OARS core skills </li></ul><ul><li>Learn this first </li></ul><ul><li>Is it MI yet? </li></ul>
  14. 16. <ul><li>Engaging – The Relational Foundation </li></ul><ul><li>Guiding – The Strategic Focus </li></ul><ul><li>Agenda setting </li></ul><ul><li>Finding a focus </li></ul><ul><li>Information and advice </li></ul><ul><li>Is it MI yet? </li></ul>
  15. 17. <ul><li>Engaging – The Relational Foundation </li></ul><ul><li>Guiding – The Strategic Focus </li></ul><ul><li>Evoking – The Transition to MI </li></ul><ul><li>Selective eliciting </li></ul><ul><li>Selective responding </li></ul><ul><li>Selective summaries </li></ul><ul><li>Is it MI yet? </li></ul>
  16. 18. 1. Engaging – The Relational Foundation 2. Guiding – The Strategic Focus 3. Evoking – The Transition to MI 4. Planning – The Bridge to Change Replacing prior Phase I and Phase II Negotiating a change plan Consolidating commitment
  17. 19. Is it MI Yet?
  18. 20. Engaging ? Guiding ? Evoking ? Planning ? No No No Yes
  19. 21. 1. The communication style and spirit involve person-centered, empathic listening (Engage) AND 2. There is a particular identified target for change that is the topic of conversation (Guide) AND 3. The interviewer is evoking the person’s own motivations for change (Evoke)
  20. 22. <ul><li>MI is a particular kind of conversation about change (counseling, therapy, consultation, method of communication) </li></ul><ul><li>MI is collaborative (person-centered, partnership, honors autonomy, not expert-recipient) </li></ul><ul><li>MI is evocative , seeks to call forth the person’s own motivation and commitment </li></ul>
  21. 23. <ul><li>Three levels of definition (of increasing specificity) </li></ul><ul><li>1. A layperson’s definition </li></ul><ul><li>(What’s it for?) </li></ul><ul><li>2. A pragmatic practitioner’s definition (Why would I use it?) </li></ul><ul><li>3. A technical therapeutic definition </li></ul><ul><li>(How does it work?) </li></ul>
  22. 24. Motivational interviewing is a collaborative conversation to strengthen a person’s own motivation for and commitment to change
  23. 25. Motivational interviewing is a person-centered counseling method for addressing the common problem of ambivalence about behavior change
  24. 26. Motivational interviewing is a collaborative, goal-oriented method of communication with particular attention to the language of change. It is intended to strengthen personal motivation for and commitment to a target behavior change by eliciting and exploring an individual’s own arguments for change