A 'Taste' of Motivational Interviewing with Dr. Ellen Glovsky

Motivational Interviewing

A “Taste” of
Ellen R. Glovsky, PhD, RD, LDN
Training with Dr. Ellen
November 6, 2013

1

Definition:

directive, person-centered
counseling style for increasing intrinsic
motivation by helping clients explore and resolve
ambivalence.
A

(Miller & Rollnick, 2002)

MI is a collaborative approach to helping people change
their behavior regarding their health.
Most applicable in consultations where
there is a preferred outcome
2

Ellen R. Glovsky, PhD,RD (c) 2007. Please do not
reproduce without permission.

1


The Spirit of MI
• Collaboration
You don’t have to make change happen; you can’t
Message to your client is “you have everything you need, and
we’ll find it together”

• Evocation
Calling forth that which the client already has
Doesn’t come from a deficit model

• Acceptance
Not necessarily that you approve of the other’s actions
Express Accurate Empathy
• Let your client know that you understand how they feel and what their
issues with this behavior change are.

3

The Spirit of MI
• Affirmation
Seek and acknowledge the other’s strengths and efforts

• Compassion
Actively promote the other’s welfare, give priority to the
other’s needs

• Affirm Autonomy
Counselor is willing to let the patient decide if, when and
how they will go about changing.

4


2


Ambivalence
• Not pathology!
• A normal part of the process of
change
• Think of a time when you were asked
to change something about yourself.
Were you sure you wanted to do it?
Were you sure you were able to do it?

5

The Four Processes of MI
• Form the flow of MI
Overlap, flow into each other, recur
Each process builds on the one before it
and remains as a foundation
Planning
Evoking
Focusing
Engaging

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3


The Four Processes of MI
Engaging: the process of establishing a helpful working
relationship, forming an alliance
Focusing: creating the agenda
•

Agenda of clinician and client may differ

Evoking: eliciting the client’s own motivations for change
•
•

Having the client voice the argument for change
Help resolve ambivalence in the direction of change

Planning: taking action

Planning
Evoking

Focusing
Engaging

7

Focusing

MI: The Guiding Style

GUIDE
Instruct

Listen

....*….....….…....….......*..............................*…...

8


4


Engaging, Focusing, Evoking

Avoid the Righting Reflex:
“Taking Sides” Trap
Counselor

Client

• “You must change”

• “I don’t want to change”

• “You’ll be better off”

• “Things aren’t half bad.”

• “You can do it!!”

• “No I can’t!!”

• “You’ll die…”

• “Uncle Fred is 89 and
healthy as can be.”

9

Two Broad Sets of
Skills in MI
• Listening skills
What did h/she say?
What did h/she mean?
Listening for CHANGE TALK

• What-do-I-say-in-response skills
OARS

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5


Listening Skills

Reinforce Change Talk

Change Talk is any selfexpressed language that is
an argument for change.
It REALLY Matters
Who Said What!
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Listening Skills

Good and Not So Good
• Develop a discrepancy
• Help the client discover their
ambivalence
• Discrepancy is the ENGINE of change

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6


Build A Foundation of Listening:
Get Your “OARS” in the Water
• O: Open-ended questions
• How you ask questions is critical!
• Can not be answered with “yes” or “no”

• A: Affirmations
• Rapport building
• Look for what the other person does right

• R: Reflect
• Helps to let your listener know you heard and helps to
clarify what you heard

• S: Summarize
• Like offering a bouquet
• Link material client has offered; ask if it’s accurate
• Allows clinician a chance to build “argument” for change

Techniques Used in MI
13

Three Places Communication Can Go
Wrong
Speaker

Listener

Words

Words

2
3
1
Meaning

Meaning

14


7


The Function of Reflection
Speaker

Listener

Words

Words

2
1
Meaning

Reflection

3
Meaning

15

Engaging, Focusing, Evoking

Reflective Listening
Content reflections are short summaries

“What did she say”
Meaning reflections add the next sentence
to the story

“What did he mean?”

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8


Summaries: 3 Types
• Collect material that has been offered
So far you’ve expressed concern about your blood pressure,
your weight, and not being able to afford healthy food.

• Link something just said with something
discussed earlier.
That sounds a bit like the problems you have with eating too
much chocolate.

Draw together what has happened and transition
to a new task
Let’s me summarize what you’ve told me so far, and see if
I’ve missed anything important.

Roll with Resistance/
Dance with Discord
The Flip Side of Change
Motivation &
Resistance are

Ever-Changing
States of
Readiness

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9


Handling Resistance
Dancing, Not Wrestling

:

Content reflection
Meaning reflection
Double-sided reflection
When you meet resistance, try a
different approach!

19

Assess Readiness and Set an
Agenda
•2 Important keys:
Be alert for Readiness

to Change
Shift between

Instructing and Listening
•Overuse of Instruction gets
in the way of “natural change”
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10


Importance/Confidence
1. How

important is it for you right now to change?

On a scale of 0 to 10, what number would you give yourself?

0 ………………………………………………………………….. ………………10
not at all
important

extremely
important

A. Why are you there and not at 0?
B. What would need to happen for you to raise your
score a couple of points?

Techniques Used in
MI

21

Planning

Importance/Confidence
2. If you did decide to change, how confident are you that
you could do it?
0 ………………………………………………………….. …………………………..10
not at all
extremely
confident
confident
A. Why are you there and not at 0?
B. What would need to happen for you to raise your score a
couple of points?

Techniques Used in
MI
22


11


Planning

Instruct & Negotiate
Collaboratively

“…a respectful, thoughtful, and reciprocal
flow of information that champions the
client’s own needs and autonomy can be a
rich and life-changing experience and an
integral part of MI.” Miller and Rollnick, 2012
23

Giving Information and Advice:

3 Kinds of Permission
1. The person asks for advice
2. You ask permission to give advice
3. You qualify your advice to emphasize
autonomy


12


Feedback/Advice Formula…
The only “recipe” in MI training
1. Ask permission to give feedback
2. Explain the meaning of the feedback you
are about to give
3. Give only one fact and then only reflect
the client’s responses. Do not argue,
interpret, defend, or advise.

25

Words of Advice
• Avoid the “I” and “Y” words
• “I think…”
• “You should…”

• Use Neutral language
• “Folks have found…”
• “Others have benefited from…”

• Use Conditional words
• “Might consider” vs. “ought to,” “should”

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13


How to Learn MI
1.
2.
3.
4.

Attend a workshop
Read & learn
Practice & listen
Get feedback and supervision

27

www.trainingwithdrellen.com
http://bit.ly/WellnessNotWeight
Like my book on Facebook:
http://on.fb.me/1hMPHbz

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MI Training DVDs
Available with or without my book
http://bit.ly/GXcUJO
And the winner is…
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Guilford Press www.guilford.com
Use Promo Code: MINT
Other Guilford titles available on my
website, via Amazon.com
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Ellen Glovsky:
ellen@trainingwithdrellen.com
www.nutrition-coach.com
www.trainingwithdrellen.com
Resources for Motivational Interviewing
www.motivationalinterviewing.org

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A 'Taste' of Motivational Interviewing with Dr. Ellen Glovsky

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