This presentation was used to train juvenile detention center staff in engaging resistant youth in discussing change. About Mark Loewen, LPC: Mark Loewen was born in Asuncion, Paraguay. He completed his BA in Marketing but decided to follow his passion and moved to the United States to complete his master’s degree in counseling. His love for children and teenagers brought him to Richmond, and specialize in play therapy. Mark has years of experience ranging from work with teens in residential facilities to joining children and families in reaching their goals in private practice. He currently also serves as a supervisor to residents pursuing their counseling license. As a Registered Play Therapist, Mark uses research validated interventions that include games, sand tray and art to facilitate expression and growth. Mark provides play therapy to children ages three and up. He uses neuroscience-informed techniques to help children and adults process traumatic events they experienced. Clients enjoy meeting with Mark. Children and teens often report not realizing that they are doing hard work because they are having fun. At his counseling practice in Richmond VA, Mark also works closely with parents, providing parenting feedback that strengthens the relationship with their children. When working with adults, Mark uses mindfulness and art to help his clients gain a deeper understanding of themselves and move forward. Mark is a member of the Association for Play Therapy, The Theraplay Association, and the American Counseling Association. He is fluent in German and Spanish. CONTENT Intro to MI MI style and traps Basic tools Dealing with ambivalence Developing discrepancies Eliciting change talk Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal. Motivation is elicited from the client, not imposed Resolving the ambivalence is the client’s task Direct persuasion is not effective for resolving ambivalence Readiness to change is not a trait, but a fluctuating product of interpersonal interaction The therapeutic relationship is more like a partnership than expert/recipient roles Motivational Interviewing Style Traps Tools - OARS Exploring Ambivalence Developing Discrepancies Change Talk

1. 1
Motivational Interviewing
Mark Loewen, LPC
10/26/11
Merrimac Detention Center

2. 2
Content
• Intro to MI
• MI style and traps
• Basic tools
• Dealing with ambivalence
• Developing discrepancies
• Eliciting change talk

3. 3
What are we talking about
• Motivational interviewing is
• a directive,
• client-centered counseling style
• for eliciting behavior change
• by helping clients to explore and resolve
ambivalence.
• The examination and resolution of ambivalence is
its central purpose, and the counselor is
intentionally directive in pursuing this goal.

4. 4
Motivational Interviewing Style
• Motivation is elicited from the client, not imposed
• Resolving the ambivalence is the client’s task
• Direct persuasion is not effective for resolving
ambivalence
• Readiness to change is not a trait, but a fluctuating
product of interpersonal interaction
• The therapeutic relationship is more like a
partnership than expert/recipient roles

5. 5
Motivational Interviewing Style
• Collaboration
• Evocation
• Autonomy
• Rolling with resistance

6. 6
Traps
• Question-Answer
• Labeling
• Premature Focus
• Taking Sides /Arguing
• Expert

7. 7
MI Tools - OARS
• Reflections
• Reflect words and behaviors
• Communicate that you are listening
• Foster commitment (you took them
seriously)
• Put attention on client’s thoughts
and behaviors instead of your
reaction to them
• Help clients help themselves
*Practice: Interview about a life lesson learned.

8. 8
MI Tools – OARS (cont’d)
• Open-ended questions
• Require more thought on behalf of the client
• Start with “What”, “How”, “How come”, “Tell
me about”, “Help me understand”.
• Affirmations
• Strengthen behavior change
• Highlight the positive
• Build rapport
• Summaries
• Bring everything together

9. 9
Practicing the skills
• 1) In dyads, interview your partner using only
Reflections and Open-Ended Questions on:
• What it was like growing up in my home
• How I came to do the work I’m doing
2) In dyads, interview your partner including
Affirmations and a Summary on:
• What I would like to accomplish in the future
• Ways in which I have changed as a person

10. 10
Exploring Ambivalence
• Everyone experiences ambivalence
• We want things to change but also stay the same
• Reasons for change need to be stronger to “tip the
balance” for change

11. 11
Exploring Ambivalence
• What is likely to happen when you push or
argue with the part of the client that wants to
change, pointing out the reasons for change?
•The client needs to be
have freedom to talk
about the side that
doesn’t want to change.
Decisional BalancePros and Cons
Confidence vs. Importance

12. 12
Developing discrepancies
• Heightens the internal conflict to enhance
motivation to change
• Increases awareness between where the client
is and where he/she wants to be
• Highlights contradictions/inconsistencies
• Increases client’s awareness of irrational
thoughts/behavior
Remember to roll with resistance!

13. 13
Fishing for Change Talk
• Change talk:
• Statements by the client that indicate the
possibility of change.
• DARN C: Desire, Ability, Reasons, Need that
lead to Commitment.

14. 14
Evoking Change Talk
• Ask evocative questions
• Explore decisional balance
• Ask first for good things about status quo, then
for “not so good” things.
• Ask for elaboration
• After a hint of change talk, ask for more detail.
(How come? How so? Tell me about that)
• Examples
• Ask for examples. When was the last time that
happened?

15. 15
Evoking Change Talk
• Look back
• Ask about a time before the current concern
emerged. How were things better?
• Look forward
• What may happen if things continue as they
are? Miracle question: If you were 100%
successful in making the changes you want,
what would be different?
• Explore extremes
• What are the worst things that might happen if
you don’t make a change? What are the best if
you do make the change?

16. 16
Evoking Change Talk
• Change rulers
• Importance of change vs. confidence
• Come alongside
• Explicitly side with the negative (status quo)
side of ambivalence. Perhaps _______ is so
important to you that you won’t give it up, no
matter what the cost.

17. 17
Bibliography
• Martino, S., Ball, S.A., Gallon, S.L., Hall, D., Garcia, M., Ceperich, S.,
Farentinos, C., Hamilton, J., and Hausotter, W. (2006) Motivational
Interviewing Assessment: Supervisory Tools for Enhancing Proficiency.
Salem, OR: Northwest Frontier Addiction Technology Transfer Center,
Oregon Health and Science University
• Miller, W.R. and Rollnick, S. (2002) Motivational Interviewing: Preparing
People to Change. NY: Guilford Press, 2002.
• Moyers, T.B., Miller, W.R., & Hendrickson, S.M.L. (2005). How Does
Motivational Interviewing Work? Therapist Interpersonal Skill Predicts Client
Involvement Within Motivational Interviewing Sessions. Journal of Consulting
and Clinical Psychology, Vol 73(4), Aug 2005. pp. 590-598.
• Hettema, J. E., Miller, W. R., & Steele, J. M. (2004). A Meta-Analysis of
Motivational Interviewing Techniques in the Treatment of Alcohol Use
Disorders. Alcoholism-Clinical and Experimental Research, 28, 74A.

18. 18
This presentation was used to train juvenile detention
center staff in engaging resistant youth in discussing
change.
About Mark Loewen, LPC:
Mark Loewen was born in Asuncion, Paraguay. He completed his BA in Marketing but decided to follow his
passion and moved to the United States to complete his master’s degree in counseling. His love for children
and teenagers brought him to Richmond, and specialize in play therapy.
Mark has years of experience ranging from work with teens in residential facilities to joining children and
families in reaching their goals in private practice. He currently also serves as a supervisor to residents
pursuing their counseling license.
As a Registered Play Therapist, Mark uses research validated interventions that include games, sand tray and
art to facilitate expression and growth. Mark provides play therapy to children ages three and up. He uses
neuroscience-informed techniques to help children and adults process traumatic events they experienced.
Clients enjoy meeting with Mark. Children and teens often report not realizing that they are doing hard work
because they are having fun. At his counseling practice in Richmond VA, Mark also works closely with
parents, providing parenting feedback that strengthens the relationship with their children. When working
with adults, Mark uses mindfulness and art to help his clients gain a deeper understanding of themselves and
move forward.
Mark is a member of the Association for Play Therapy, The Theraplay Association, and the American
Counseling Association.
He is fluent in German and Spanish.

19. 1919
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