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Motivational Interviewing

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Motivational Interviewing

  1. 1. Introduction to Motivational Interviewing Tim Bingham BA
  2. 2. What is motivational interviewing? “a therapeutic style intended to help clinicians work with patients to address the patient’s fluctuation between opposing behaviors and thoughts.” Source: Miller and Rollnick, Motivational Interviewing 1991.
  3. 3. Characteristics of Motivational Interviewing Client directed towards change Feedback and information offered selectively Empathic reflection used selectively Therapist creates or amplifies client discrepancies to enhance motivation
  4. 4. Characteristics of Motivational Interviewing De-emphasis on labels Emphasis on personal choice Therapists elicits client’s own concern Resistance is normal Client provides goals and change plans
  5. 5. Resistance When we see our freedom to act in a particular way threatened, the behaviour seems more desirable and we will be more likely to choose that behaviour “You’re a drug addict”…”No I’m not” “You’ve got to stop”…”No I don’t”
  6. 6. Ambivalence Ambivalence is being in two minds about something Ambivalence is normal.
  7. 7. General principles of M.I. 1. Express empathy 2. Develop Discrepancy 3. Roll with resistance 4. Support self-effiacy 5. Avoid Arguments
  8. 8. Express Empathy Empathy is the ability to see the issue from the other persons point of view Acceptance facilitates change Skillful reflective listening is fundamental
  9. 9. Develop Discrepancy The client rather than the counselor should present the arguments for change A discrepancy between present behavior and important personal goals or values will motivate change
  10. 10. Roll with Resistance Avoid arguing for change Resistance is not directly opposed Roll with the resistance by seeing it from the persons point of view
  11. 11. Support self efficacy The counselor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy A person’s belief in the possibility of change is an important motivator
  12. 12. 5. Avoid Argumentation Arguments are the least effective way of exploring a subject
  13. 13. The 5 skills of M.I. 1: Ask open ended questions 2: Affirm 3: Listen Reflectively 4: Summarising 5: Eliciting “change talk”
  14. 14. Open ended questions are... Questions that do not invite brief answers. Affirming is… Recognising the work that the client has done in relation to their problem
  15. 15. Listening reflectively is... Statements to mirror back the clients own experiences to them Types of Reflection Neutral: Emphasis not changed Enhanced: Amplifying or minimising in direction of change Double sided: Reflects both sides of ambivalence
  16. 16. Selective Reinforcement Statements supportive of the therapists agenda are reinforced through neutral or amplified reflection Statements inconsistent with the agenda are neither reinforced by words nor actions
  17. 17. Summarising is... Listening to the client and reflecting back to the client the main points of what they are feeling or thinking every few minutes.
  18. 18. Eliciting changetalk In MI.. The client…provides the argument for change” There are 4 types of changetalk 1: Problem recognition 2: Expression of concern 3: Intention to change 4: Expression of optimism
  19. 19. Methods for Evoking Change Talk 1: Ask open ended questions 2: Use the importance ruler (1-10) 3: Explore the decisional balance (pros and cons) 4: Elaborating 5: Exploring Goals and Values
  20. 20. Thanks for your time Do you feel motivated?