The objections of this presentation include: to experience and practice motivational interviewing, learn motivational interviewing styles and principles and see how it integrates into everyday practice.

1. Motivational Interviewing:Motivational Interviewing: Working with TheWorking with The
Resistant ClientResistant Client
 Dr Louise A. Stanger Ed. D,Dr Louise A. Stanger Ed. D,
LCSW, BRI II, CIPLCSW, BRI II, CIP
 MINT Trainer of TrainersMINT Trainer of Trainers
 Faculty SDSUFaculty SDSU
 Director All AboutDirector All About
InterventionsInterventions

2. ObjectivesObjectives
 To experience and practice the basics of MI
 To learn MI Style and Principles
 To directly experience the MI approach and
contrast with others
 To see how it integrates into everyday practice

3. Getting To Know YouGetting To Know You
 Hello, Tell us aboutHello, Tell us about
Yourself ?Yourself ?
 What brought you hereWhat brought you here
today ?today ?
 What do you want to getWhat do you want to get
out of training ?out of training ?

4. What is Motivation?What is Motivation?
 Probability ofProbability of
behavior change orbehavior change or
movement toward ormovement toward or
against goalagainst goal
 Extrinsic…….Extrinsic…….
 Intrinsic ……Intrinsic ……

5. Personal Goal :Personal Goal :
 Choose a personal goalChoose a personal goal
 Develop an action PlanDevelop an action Plan
Action
Thinking
Idea

6. SO…………………..SO…………………..
 How realistic is this plan for you & how soon will youHow realistic is this plan for you & how soon will you
start?start?
 How faithful will you be to the plan?.. Be Honest!How faithful will you be to the plan?.. Be Honest!
 Will it be easy or hard?Will it be easy or hard?
 How long will you do this plan for?How long will you do this plan for?
 How will you view yourself if you stop, do it partially ,How will you view yourself if you stop, do it partially ,
stop & start, never start at all?stop & start, never start at all?
 Can others help you and how will you respond toCan others help you and how will you respond to
reminders?reminders?

7. Second ThoughtsSecond Thoughts

8. AfterthoughtsAfterthoughts
 How was this for youHow was this for you
 Is the process of changeIs the process of change
simple or complexsimple or complex
 Is change linearIs change linear
 Is it all or nothing forIs it all or nothing for
you?you?
 Motivation >>>Motivation >>>
 Confidence >>>>Confidence >>>>

9. When do People ChangeWhen do People Change
 Stages of ChangeStages of Change
 Readiness to ChangeReadiness to Change

10. In between the cravingsIn between the cravings
Find the Spaces InbetweenFind the Spaces Inbetween
Omar Manejawa MDOmar Manejawa MD
Cravings – MyopicCravings – Myopic
Spaces- ChangeSpaces- Change
Habits -ActionsHabits -Actions

11. Stages Of ChangeStages Of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance

12. PrecontemplationPrecontemplation
 Person is not seeing need for lifestyle changePerson is not seeing need for lifestyle change
 Client believes there is no problemClient believes there is no problem
 May feel forced into treatment.May feel forced into treatment.
 Response to resisistanceResponse to resisistance
 What does this sound like?What does this sound like?

13. Counselors Task : PrecontemplationCounselors Task : Precontemplation
 Raise DoubtRaise Doubt
 Increase the person’s perception of risks andIncrease the person’s perception of risks and
problems with current behaviorproblems with current behavior

14. 2. Contemplation2. Contemplation
 Person is consideringPerson is considering
making a change and hasmaking a change and has
not decided yetnot decided yet
 Response to resistanceResponse to resistance
 Estimates put 80% ofEstimates put 80% of
people eitherpeople either
precontemplative orprecontemplative or
contemplativecontemplative
 Maybe I willl …………Maybe I willl …………

15. Task : ContemplationTask : Contemplation
 Client is considering changeClient is considering change
 Client not fully convinced he / she will makeClient not fully convinced he / she will make
change- eovke responses to changechange- eovke responses to change
 Tip the Balance –strengthen self efficacyTip the Balance –strengthen self efficacy
 Case example :Lisa visits CVSCase example :Lisa visits CVS

16. PreparationPreparation
 Person has decided toPerson has decided to
change and ischange and is
considering how to Makeconsidering how to Make
changeschanges
 Motivation fluctuates asMotivation fluctuates as
does ambivalencedoes ambivalence
 MI used to elicit changeMI used to elicit change
talktalk

17. ActionAction
 Person is actively doingPerson is actively doing
something to changesomething to change
 May experience setbacksMay experience setbacks
 Encourage action, setEncourage action, set
example, give homeworkexample, give homework

18. MaintenanceMaintenance
 Person is maintaining activity over timePerson is maintaining activity over time
 Some temptation to return to former behaviorSome temptation to return to former behavior
or small lapses ( TRIGGER LANE )or small lapses ( TRIGGER LANE )
 Change has existed over 6 months or moreChange has existed over 6 months or more

19. RELAPSE & RECYCLERELAPSE & RECYCLE
 Restart, reboot the processesRestart, reboot the processes
 Help the person renew the process ofHelp the person renew the process of
contemplation, determination, and action w/ocontemplation, determination, and action w/o
getting stuck in Shameville !getting stuck in Shameville !

20. What is Motivational Interviewing?What is Motivational Interviewing?
 A directive client-centered counseling approachA directive client-centered counseling approach
for eliciting behavior change by helping clientsfor eliciting behavior change by helping clients
to explore and resolve ambivalence.to explore and resolve ambivalence.
 Rollnick and Miller 1995Rollnick and Miller 1995

21. MI StyleMI Style
 Process not TechniqueProcess not Technique
 CollaborativeCollaborative
 Evocation- elicit clientsEvocation- elicit clients
internal viewpointinternal viewpoint
 AutonomyAutonomy
 Roll With ResistanceRoll With Resistance

22. MI SpiritMI Spirit
 Rogerian approachRogerian approach
 Coupled with a directionCoupled with a direction
 EqualitarianEqualitarian
 Warm, Empathetic, Affirming & RespectfulWarm, Empathetic, Affirming & Respectful
 Guiding & eliciting vs. instructing & persuadingGuiding & eliciting vs. instructing & persuading
 Video- Join Up (Horse Whisper)Video- Join Up (Horse Whisper)

23. Characteristics of MICharacteristics of MI
 Counselor is active and directiveCounselor is active and directive
 Counselor helps shape behaviorCounselor helps shape behavior
 MI strategy is specific and systematicMI strategy is specific and systematic
 Consistent with principles of client choice andConsistent with principles of client choice and
empowermentempowerment
 Consistent with cultural sensitivity in that clientConsistent with cultural sensitivity in that client
leads and counselors agenda is not imposedleads and counselors agenda is not imposed

24. Traps to AvoidTraps to Avoid
 Question-AnswerQuestion-Answer
 Labeling Trap – dx codesLabeling Trap – dx codes
 Premature Focus Trap-start withPremature Focus Trap-start with
clients concern not yoursclients concern not yours
 ExpertExpert
 Taking sidesTaking sides
 Blaming Others _ who is toBlaming Others _ who is to
blame is not as important asblame is not as important as
to what your concerns areto what your concerns are

25. MI PrinciplesMI Principles
EE-DD-RR-SSEE-DD-RR-SS
 Express EmpathyExpress Empathy
 Develop Discrepancy- help one get unstuck fromDevelop Discrepancy- help one get unstuck from
ambivalent feelingsambivalent feelings
 Roll with Resistance ( get out of the way )Roll with Resistance ( get out of the way )
 Support Self Efficacy ( Bandura) The capacity of aSupport Self Efficacy ( Bandura) The capacity of a
person to believe they can carryspecific act or behaviorperson to believe they can carryspecific act or behavior

26. Guiding StrategiesGuiding Strategies
 How to Express EmpathyHow to Express Empathy
 How to Develop DiscrepancyHow to Develop Discrepancy
 How to Roll With ResistanceHow to Roll With Resistance
 How to Elicit Self-MotivationHow to Elicit Self-Motivation
 Brief NegotiationBrief Negotiation

27. How to Express EmpathyHow to Express Empathy
Use your OarsUse your Oars
 Open Ended QuestionsOpen Ended Questions
 AffirmationsAffirmations
 ReflectionsReflections
 SummariesSummaries

28. Open and Closed EndedOpen and Closed Ended
 What types of things do youWhat types of things do you
want to talk aboutwant to talk about
 Tell me about…Tell me about…
 How do you think smokingHow do you think smoking
pot is related to the problemspot is related to the problems
you talk about in youryou talk about in your
marriagemarriage
 What brings you hereWhat brings you here
today?/today?/
 Don’t yuu think your wifeDon’t yuu think your wife
and kids are hurt enough byand kids are hurt enough by
your drinking ?your drinking ?
 Isn’t your friends idea thatIsn’t your friends idea that
you quit ?you quit ?
 Are there good things aboutAre there good things about
your drug use?your drug use?
 How long have you beenHow long have you been
concerned about x ?concerned about x ?

29. Mining for AffirmationsMining for Affirmations
Group ExerciseGroup Exercise
 20 Strengths20 Strengths
 Groups of 5-with 5Groups of 5-with 5
strengthsstrengths
 Identify open endedIdentify open ended
question to elicit strengthquestion to elicit strength
and an affirmation youand an affirmation you
might offer in responsemight offer in response
to a strengthto a strength

30. Affirm your clientAffirm your client
 I appreciate your honestyI appreciate your honesty
 I can see that caring forI can see that caring for
your children isyour children is
important to youimportant to you
 It shows courage andIt shows courage and
commitment to comecommitment to come
back to meetingsback to meetings
 You have good ideasYou have good ideas

31. Listening ExerciseListening Exercise
 Break up in dyadsBreak up in dyads
 Practice Listening – 3Practice Listening – 3
minutesminutes
 DebriefDebrief

32. 12 Roadblocks to Listening12 Roadblocks to Listening
 1. Ordering, directing,1. Ordering, directing,
commandingcommanding
 2. Warning or threatening2. Warning or threatening
 3. Giving advice, suggestions,3. Giving advice, suggestions,
solutionssolutions
 4. Persuading with logic,4. Persuading with logic,
arguing,arguing,
 5. Moralizing, preaching5. Moralizing, preaching
 6.Disagreening, judging,6.Disagreening, judging,
criticizing , blamingcriticizing , blaming

33. 12 Roadblocks to Listening12 Roadblocks to Listening
 7.Agreeing, approving,7.Agreeing, approving,
praisingpraising
 8. Shaming, ridiculing or8. Shaming, ridiculing or
labelinglabeling
 9. Interpreting or analyzing9. Interpreting or analyzing
 10. Reassuring, sympathizing10. Reassuring, sympathizing
 11. Questioning or probing11. Questioning or probing
 12.Withdrawing, distracting12.Withdrawing, distracting

34. Assumptions To AvoidAssumptions To Avoid
 Person OUGHT to changePerson OUGHT to change
 Person WANTS to changePerson WANTS to change
 Persons health is primePersons health is prime
motivation factormotivation factor
 If she/he decides not toIf she/he decides not to
change consultation is achange consultation is a
failurefailure
 Individuals are eitherIndividuals are either
motivated to change or theymotivated to change or they
are notare not
 Now is the right time toNow is the right time to
consider changeconsider change
 A tough approach isA tough approach is
always the best approachalways the best approach
 I am the expert andI am the expert and
know bestknow best
 A egotiation approach isA egotiation approach is
always bestalways best

35. Persuasion ExercisePersuasion Exercise
 Grps of 2Grps of 2
 Identify change you are consideringIdentify change you are considering
 Counselors roleCounselors role
 1. Explain why perosn should make this change1. Explain why perosn should make this change
 2. Give three specific benefits that result from change2. Give three specific benefits that result from change
 3. Tell the person how they can change3. Tell the person how they can change
 4. Emphasize its important for them to make change/include4. Emphasize its important for them to make change/include
negative consequencesnegative consequences
 5. Tell persuade the person to do it5. Tell persuade the person to do it
 And if you encounter resitance try harderAnd if you encounter resitance try harder

36. Listen ReflectivelyListen Reflectively
 Being quiet and activelyBeing quiet and actively
listeninglistening
 Responding with aResponding with a
statement that accuratelystatement that accurately
reflects the essence ofreflects the essence of
what the client meantwhat the client meant
 Listen carefully thinkListen carefully think
ReflectionsReflections

37. ReflectionsReflections
 Think in terms of forming anThink in terms of forming an
hypotheses or best guess athypotheses or best guess at
what client is sayingwhat client is saying
 Take a guess –Do youTake a guess –Do you
mean…mean…
 You have to differentiateYou have to differentiate
between a question and abetween a question and a
statementstatement
 Voice goes down at end ofVoice goes down at end of
statement rather then up withstatement rather then up with
a questiona question
 ““You're angry with yourYou're angry with your
mother …mother …
 A statement does not requireA statement does not require
an answer .an answer .
 Used strategically emaphsize,Used strategically emaphsize,
clients view , feelings,clients view , feelings,
ambivalence, emotion changeambivalence, emotion change
talktalk

38. Level of ReflectionLevel of Reflection
 Repeating repeat what someone has just saidRepeating repeat what someone has just said
 Rephrase – substitute a few different wordsRephrase – substitute a few different words
 Paraphrasing-make a fairly major restatementParaphrasing-make a fairly major restatement
inferring what you think a person has saidinferring what you think a person has said
 Reflecting feeling – special kind of paraphraseReflecting feeling – special kind of paraphrase
where you are not necessarily relecting contentwhere you are not necessarily relecting content
rather feelingrather feeling

39. Simple ReflectionSimple Reflection
 Client: She is driving meClient: She is driving me
crazy trying to get me tocrazy trying to get me to
do quitdo quit
 Counselor; Her methodsCounselor; Her methods
are really bothering youare really bothering you
 Client: I don’t haveClient: I don’t have
anything to sayanything to say
 Counselor- You are notCounselor- You are not
feeling talkative todayfeeling talkative today

40. Amplified ReflectionsAmplified Reflections
 Exaggerate what clientExaggerate what client
says be careful not to besays be careful not to be
sarcasticsarcastic
 All my friends smokeAll my friends smoke
weed and I don’t seeweed and I don’t see
giving it upgiving it up
 So you are likely to keepSo you are likely to keep
smoking foreversmoking forever

41. Doubled Sided ReflectionDoubled Sided Reflection
((meant to capture both sides of ambivalencemeant to capture both sides of ambivalence ))
 C- It would stink to lose my job over a dumb policyC- It would stink to lose my job over a dumb policy
because I have been using,because I have been using, butbut do way do I want to quitdo way do I want to quit
partying just because of thatpartying just because of that
 Co-Co- On the one handOn the one hand you value your job because it allowsyou value your job because it allows
you to live comfortably and on the other hand you alsoyou to live comfortably and on the other hand you also
enjoy using drugs with your friendsenjoy using drugs with your friends
 C -It would be hard to stick to a plan (workout)……….C -It would be hard to stick to a plan (workout)……….
 CO--------CO--------

42. Other strategies for HandingOther strategies for Handing
ResistanceResistance
 ClarificationClarification
 Shift focus away fromShift focus away from
stumbling blockstumbling block
 Emphasize PersonalEmphasize Personal
Choice and ControlChoice and Control

43. Provide SummariesProvide Summaries
 Communicate what you have tracked what theCommunicate what you have tracked what the
client has said so that you have understanding ofclient has said so that you have understanding of
what is being saidwhat is being said
 Helps structure session so you do not getHelps structure session so you do not get
sidetrackedsidetracked
 Provide opportunity to emphasize statements aProvide opportunity to emphasize statements a
client has made about change talk gives clientclient has made about change talk gives client
another opportunity to hear what she has saidanother opportunity to hear what she has said
in context provided by the counselorin context provided by the counselor

44. ExampleExample
 So Sally , let me know if I heard you correctly.So Sally , let me know if I heard you correctly.
You care about your children and you areYou care about your children and you are
hoping social services does not intervene. Youhoping social services does not intervene. You
believe you need to change your realtionshipsbelieve you need to change your realtionships
that involve using and aren’t quite sure how tothat involve using and aren’t quite sure how to
do that?do that?
 Or what else would you add ?......Or what else would you add ?......

45. Exploring AmbivalenceExploring Ambivalence
 The Existence ofThe Existence of
conflicting emotions orconflicting emotions or
thoughts about a personthoughts about a person
object or ideaobject or idea
 Protagonist ExerciseProtagonist Exercise

46. Decisional Balance WorksheetDecisional Balance Worksheet
((Fill in what you are considering as change )Fill in what you are considering as change )
Good things aboutGood things about
Changing behaviorChanging behavior
Good things about changingGood things about changing
behaviorbehavior
Not so good things aboutNot so good things about
behaviorbehavior
Not so good things aboutNot so good things about
changing behaviorchanging behavior

47. Protagonists' ExerciseProtagonists' Exercise
 Explore Roles forExplore Roles for
resolving ambivalenceresolving ambivalence
 Break up in groups of 6Break up in groups of 6
 Client is to discuss anClient is to discuss an
issue on which he/she isissue on which he/she is
ambivalentambivalent
 Four counselors areFour counselors are
assigned a role & eachassigned a role & each
has 3 minuteshas 3 minutes
 1 observer1 observer

48. Protagonists' ExerciseProtagonists' Exercise
 #1- argues for one side#1- argues for one side
of ambivalenceof ambivalence
 #2 argues other side of#2 argues other side of
ambivalenceambivalence
 #3 communicates#3 communicates
disinterest- “I really don’tdisinterest- “I really don’t
care what you to”care what you to”
 #4 show interest in how#4 show interest in how
the person is doingthe person is doing

49. Eliciting Change TalkEliciting Change Talk
 Desire StatementsDesire Statements
 I’d like toI’d like to quit drinking ifquit drinking if
I couldI could
 I wish I couldI wish I could make mymake my
life betterlife better
 I want toI want to ……….……….
 Getting in shape wouldGetting in shape would
make me feel…….make me feel…….
 Ability StatementsAbility Statements
 II thinkthink I can do thatI can do that
 ThatThat mightmight be possiblebe possible
 I’m thinkingI’m thinking I might beI might be
able to……..able to……..
 If I had someone to helpIf I had someone to help
me ,me , I probablyI probably couldcould
…..…..

50. Eliciting Change TalkEliciting Change Talk
 REASON StatementsREASON Statements
 I have to quit smokingI have to quit smoking
becausebecause of my asthmaof my asthma
 To keep my truck license ITo keep my truck license I
probably shouldprobably should cut down oncut down on
my meth and drinkingmy meth and drinking
 My kids may be taken fromMy kids may be taken from
me if I keep usingme if I keep using
 I don’t like my kids to see meI don’t like my kids to see me
this waythis way
 NEEDNEED StatementsStatements
 It’s really important to myIt’s really important to my
health to change my diethealth to change my diet
 Something has to change orSomething has to change or
my marriage will breakmy marriage will break
 I will die if I keep using likeI will die if I keep using like
thisthis

51. Do You Swear????Do You Swear????
 Person 1: “I want to”Person 1: “I want to”
 Person 2: “ I could”Person 2: “ I could”
 Person 3: “ I have goodPerson 3: “ I have good
reasons to”reasons to”
 Person 4 : “ I need to”Person 4 : “ I need to”
 Person 5: I willPerson 5: I will

52. DARN (DARN (Desire, Ability , Reason, Need)Desire, Ability , Reason, Need)
 What do you think you willWhat do you think you will
do ?do ?
 What does this mean aboutWhat does this mean about
your habit ?your habit ?
 What are your options?What are your options?
 What's the next step for you?What's the next step for you?
 What are some good thingsWhat are some good things
about making a change ?about making a change ?
 Where does this leave you?Where does this leave you?

54. On A Scale of 1-10On A Scale of 1-10
Not at all ImportantNot at all Important Very ImportantVery Important
Not at all ConfidentNot at all Confident
You picked a 7 , why wasn’tYou picked a 7 , why wasn’t
a lower scorea lower score
Very ConfidentVery Confident
You picked a seven whyYou picked a seven why
wasn’t a higher scorewasn’t a higher score

55. ResistanceResistance
 TraditionalTraditional
 Client not getting itClient not getting it
 MI ViewMI View
 Counselor may not beCounselor may not be
getting itgetting it
 Case Example – LisaCase Example – Lisa

56. Signs of ResistanceSigns of Resistance
 ArguingArguing
ChallengingChallenging
DiscountingDiscounting
HostilityHostility
 IgnoringIgnoring
-Inattention-Inattention
-Non-answer-Non-answer
-No response-No response
-Sidetracking-Sidetracking
 DenyingDenying
 BlamingBlaming
 DisagreeingDisagreeing
 ExcusesExcuses
 Claiming impunityClaiming impunity
 MinimizingMinimizing
 PessimismPessimism
 ReluctanceReluctance
 Unwilling to changeUnwilling to change
•InterruptingInterrupting
Taking OverTaking Over
Cutting OffCutting Off

57. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change
 1.1. Ask Evocative questionsAsk Evocative questions
 Why would you want to make this change? (Desire)Why would you want to make this change? (Desire)
 How might you go about that ? (Ability)How might you go about that ? (Ability)
 What are the three best reasons for doing that ?What are the three best reasons for doing that ?
(Reasons)(Reasons)
 How important is it for you to make this change?How important is it for you to make this change?
(Need)(Need)
 So what do you think you will do? (Commitment)So what do you think you will do? (Commitment)

58. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change
 2.2. Ask for ElaborationAsk for Elaboration
 When change talk emerges ask for more detail. InWhen change talk emerges ask for more detail. In
what ways?what ways?
 3. Ask For Examples3. Ask For Examples
Ask for specific examples, when was the last time thatAsk for specific examples, when was the last time that
happened ? give me an examplehappened ? give me an example
 4. Look Back4. Look Back
Ask about a time before current concern emerged.Ask about a time before current concern emerged.
How were things better? different?How were things better? different?

59. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change
 5. Looking Forward-5. Looking Forward-
What would happen if thingsWhat would happen if things
stay the same/ If you arestay the same/ If you are
100% successful in making100% successful in making
changes you want whatchanges you want what
would life look like ?would life look like ?
 6. Extremes6. Extremes
What is the worst thing thatWhat is the worst thing that
could happen? What is thecould happen? What is the
best thing that could happenbest thing that could happen

60. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change
 7.7. Use Change RulersUse Change Rulers
 On a scale ofOn a scale of
1-------------------101-------------------10
 8.8. Explore Goals andExplore Goals and
ValuesValues
 What are the personsWhat are the persons
values and goalsvalues and goals
 9.9. Join upJoin up –Come along–Come along
sideside

61. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change
 10. Responding to10. Responding to
Change Talk (Change Talk (EARSEARS))
 EXPLOREEXPLORE
 AFFIRMAFFIRM
 SUMMARIZESUMMARIZE

62. Closing Skills –Closing Skills –
55 44 33 22 11
I guaranteeI guarantee
I willI will
I promiseI promise
I vowI vow
I shallI shall
I give myI give my
wordword
I assumeI assume
I dedicateI dedicate
myselfmyself
I knowI know
I am devotedI am devoted
toto
I pledge toI pledge to
I agree toI agree to
I intend toI intend to
I am ready toI am ready to
I look forwardI look forward
toto
I consent toI consent to
I plan toI plan to
I resolve toI resolve to
I expect toI expect to
I concede toI concede to
I declare myI declare my
intention tointention to
I favorI favor
I endorseI endorse
I believeI believe
I acceptI accept
I volunteerI volunteer
I aimI aim
I aspireI aspire
I proposeI propose
I amI am
predisposedpredisposed
I anticipateI anticipate
I predictI predict
I presumeI presume
I mean toI mean to
I forseeI forsee
I envisageI envisage
I assumeI assume
I betI bet
I hop esoI hop eso
I will tryI will try
I think I willI think I will
I suppose II suppose I
willwill
I imagine II imagine I
willwill
I guessI guess

63. Setting a Course of ActionSetting a Course of Action
 Set Specific Short term goalsSet Specific Short term goals
 Consider Your optionsConsider Your options
 Establish a PlanEstablish a Plan
 Establish Monitoring ( CBT)Establish Monitoring ( CBT)

64. 10 Things MI is not10 Things MI is not
 Based on transtheoreticalBased on transtheoretical
modelmodel
 TrickeryTrickery
 A specific techniqueA specific technique
 Decisional balanceDecisional balance
(equally exploring pros(equally exploring pros
and consand cons
 Assessment feedbackAssessment feedback
 CBTCBT
 Just clinet centeredJust clinet centered
 Easy tpo learnEasy tpo learn
 What yu are alreadyWhat yu are already
doingdoing
 Panacea for every clinicalPanacea for every clinical
challengechallenge

65. Traditional Assumptions ofTraditional Assumptions of
Motivation & ChangeMotivation & Change
 Symptoms are weaknesses that need to be fixed.Symptoms are weaknesses that need to be fixed.
 Client is damaged, Counselor fixes clientClient is damaged, Counselor fixes client
 Doctor knows bestDoctor knows best
 Only client has control over motivationOnly client has control over motivation
 Client must hit “Rock Bottom”Client must hit “Rock Bottom”
 Change is linear and static, “on-off switch”Change is linear and static, “on-off switch”
 No motivation=No treatment. ( Ping-Pong for DuallyNo motivation=No treatment. ( Ping-Pong for Dually
Diagnosed clients)Diagnosed clients)
 Double Standard of Efficacy.Double Standard of Efficacy.

66. Non-Directive Counseling vs. MINon-Directive Counseling vs. MI
 Non-Directive CounselingNon-Directive Counseling
 Client determines content 7Client determines content 7
directiondirection
 Counselor avoids adviceCounselor avoids advice
giving 7 feedbackgiving 7 feedback
 High use of empathicHigh use of empathic
reflectionreflection
 Explores clients conflictsExplores clients conflicts
and emotionsand emotions
 Motivational InterviewingMotivational Interviewing
 Systematically directs clientSystematically directs client
towards motivation fortowards motivation for
changechange
 Counselor offers advice &Counselor offers advice &
feedback when appropriatefeedback when appropriate
& solicited& solicited
 Empathic reflection usedEmpathic reflection used
selectively to reinforceselectively to reinforce
processprocess
 Seeks to create & amplifySeeks to create & amplify
clients discrepancy in orderclients discrepancy in order
to enhance motivation.to enhance motivation.

67. Skills Training/ CBT vs. MISkills Training/ CBT vs. MI
 CBT/ Skills TrainingCBT/ Skills Training
 Assumes Client is motivatedAssumes Client is motivated
 Seeks to modify maladaptive cognitionsSeeks to modify maladaptive cognitions
 Treatment provides specific copingTreatment provides specific coping
strategiesstrategies
 Teaches through instruction, modelingTeaches through instruction, modeling
practice & feedbackpractice & feedback
 Specific problem solving strategies areSpecific problem solving strategies are
taught.taught.

68. Role PlaysRole Plays

69. Role PlaysRole Plays