Introduction to Motivational Interviewing in the Behavioral Health Setting

3. MOTIVATIONAL INTERVIEWING (MI):
• AN EFFECTIVE WAY OF TALKING WITH PEOPLE ABOUT CHANGE.
• A FORM OF COLLABORATIVE CONVERSATION FOR STRENGTHENING A PERSON’S OWN MOTIVATION AND
COMMITMENT TO CHANGE.
• DESIGNED TO STRENGTHEN AN INDIVIDUAL’S MOTIVATION FOR AND PROGRESS TOWARDS A SPECIFIC
GOAL.

5. SO WHY DON’T PEOPLE CHANGE?
• DOESN’T SEEM ALL THAT IMPORTANT
• HASSLE
• ENJOY CURRENT WAYS
• TAKES TIME TO DEVELOP NEW HABITS
• REACTANCE
• DEMORALIZED
• AMBIVALENCE

6. AMBIVALENCE
• WHEN CHANGE IS HARD IT IS OFTEN DUE TO AMBIVALENCE. AMBIVALENCEIS UNCOMFORTABLE AND
LEADS TO PROCRASTINATION. MOST MISTAKE THIS FOR RESISTANCE. AMBIVALENCE IS NOT
RESISTANCE.

7. AMBIVALENCE

8. AMBIVALENCE
COGNITIVE:
KEEP THINGS THE SAME………….TRY SOMETHING NEW
EMOTIONAL:
DREAD/ANGER/GRIEF/SHAME………..EXCITEMENT/CONFIDENCE
BEHAVIORAL:
HALTING OR RUSHING……………………CAREFULLY CONSIDERED AND STEADY

9. STAGES OF CHANGE

10. MISTAKES PROFESSIONALS MAKE
• “THE PROBLEM IS, IF YOU DON’T CHANGE, YOU MAY END UP LOSING YOURTOES. AND IF THAT DOESN’T DO
IT AND YOU KEEP GOING, WE MAY HAVE TO AMPUTATE AT THE ANKLE. THEN…”
• “YOUR KID IS NEVER GOING TO CHANGE IF YOU KEEP LETTING HIM GET AWAY WITH EVERYTHING”
• “I DON’T THINK YOU’RE REALLY READY TO DO ANYTHING DIFFERENTLY YET. COME BACK WHEN YOU’RE
READY TO TAKE THIS SERIOUSLY ANDI’LL BE HAPPY TO WORK WITH YOU.”

11. SKILLS

12. CORE SKILLS – “OARS”
• OPEN ENDED QUESTIONS
• AFFIRMATIONS
• REFLECTIONS
• SUMMARIES
• *YOU WILL NOTE THESE ARE BASIC COUNSELING SKILLS

13. OPEN ENDED QUESTIONS
• WHAT WAS THAT LIKE FOR YOU?
• WHAT DO THINK ABOUT THAT?
• WHAT WOULD YOU LIKE TO DO?
• HOW DO YOU SEE THAT?
• HOW COULD YOU GO ABOUT ACCOMPLISHING THAT?
• HOW MIGHT YOU MAKE THINGS DIFFERENT?
• WHAT MIGHT CAUSE YOU SOME SETBACKS?
• HOW CAN YOU GET PAST ANY OBSTACLES?

14. CLOSED ENDED QUESTIONS
• SHORT YES/NO QUESTIONS
• WERE YOU UNHAPPY ABOUT THAT?
• DO YOU THINK HE UNDERSTANDS?
• DON’T YOU THINK YOU SHOULD APOLOGIZE?
• AREN’T YOU JUST AVOIDING DOING IT?
• HOW MANY TIMES A WEEK DO YOU….?

15. REFLECTIONS
• REFLECTIONS- UNDERSTANDING WHAT THE CLIENT IS THINKING AND FEELING THEN SAYING IT BACK TO
CLIENT. NO QUESTIONS HERE!
CLIENT: I DON’T THINK I HAVE PTSD!
COUNSELOR: YOU’RE NOT SURE ABOUT THE DIAGNOSIS OF PTSD?

16. REFLECTIONS
SIMPLE
SLIGHTLY REPHRASE OR CHOOSE ONE WORD THAT SUMMARIZES MEANING
COMPLEX
MAKE A GUESS ABOUT DEEPER MEANING THAT THE CLIENT HASN’T DIRECTLY STATED…UNDERLYING
FEELINGS, VALUES, METAPHORS, ETC.

17. FOUR PROCESSES OF MI

18. ENGAGE
• TO ESTABLISH A HELPFUL CONNECTION
• TO BUILD RAPPORT
• TO OFFER A RELATIONSHIP

19. FOCUS
• TO DEVELOP A SPECIFIC AGENDA
• TO DEVELOP CHANGE GOALS
• TO ADD DIRECTION

20. EVOKE
• FIND THE PERSON’S MOTIVATION FOR SPECIFIC CHANGE
• RESPOND TO CHANGE TALK
• ELICIT THE PERSON’S RATIONALE FOR AND STRATEGIES FOR CHANGING

21. PLAN
• OPTIMAL! NOT ALWAYS PART OF MI.
• HELP DEVELOP A PLAN
• FOR SELF CHANGE
• FOR SUPPORTED CHANGE

22. MI ALWAYS INCLUDES
• EMPATHY
• ACCEPTANCE
• OPTIMISM
• COMPASSION

23. MI INVOLVES A CHANGE OF ROLE
• YOU DON’T HAVE TO MAKE CHANGE HAPPEN
• YOU CAN’T ANYWAY
• YOU DON’T HAVE TO COME UP WITH ALL THE ANSWERS
• YOU PROBABLY DON’T HAVE THE BEST ONES
• YOU’RE NOT WRESTLING
• YOU’RE DANCING

24. CHANGE TALK (DARN-CAT)
• DESIRE (I MIGHT LIKE TO…)
• ABILITY (I COULD…)
• REASONS (IT WOULD BE SMART TO…)
• NEED (I HAVE TO…)
• COMMITMENT (I WILL…)
• ACTIVATION (I AM BEGINNING TO…)
• TAKING STEPS(I AM…)