1.
Greg Merrill, LCSW
MOTIVATIONAL
INTERVIEWING:
TRAUMA INFORMED
APPLICATIONS TO YOUTH
What people
really need is
a good
listening to.
Mary Lou Casey
When we
listen, they
talk. When
they talk, they
discover.
Unknown

2.
Motivational interviewing is a
person-centered and focused
communication style plus methods that
strategically responds to language about
change, often accelerating resolution of
ambivalence and increasing motivation
and commitment to change.
WHAT IT IS

3.
COW AMBIVALENCE
I’m not
stuck. I’m
thinking..

4.
THE TRANSTHEORETICAL MODEL
STAGES OF CHANGE
( P R O C H A S K A & D I C L E M E N T E )

5.
THE CHANGE TRIFECTA
Readiness
(the right time, the right way)
Importance Confidence
(willing) (able)

6.
WHEN IT COMES TO LISTENIN’
STYLE MATTERS
75% of MI is NOT saying
what everyone else does:
NO FIXIN’

7.
Listener Anxiety
can lead to:
Talking too much
Offering advice or
resources prematurely
Rescuing
Lecturing
Pressuring
Invalidating
Fixin’ vs. Listenin’
“After all, when you
seek advice from
someone it’s certainly
not because you
want them to give it.
You just want them to
be there while you talk
to yourself.”
--Terry Pratchett
FIXIN’ AIN’T LISTENIN’

8.
DECIDING/
PLANNING
EVOKING
(EXPLORING)
FOCUSING
ENGAGING
THE FOUR PROCESSES OF MI

9.
LISTENER’S GOAL:
TO GENERATE NATURAL SPEECH

10.
When we listen,
they talk.
When they talk,
they discover.

11.
OPENING STRATEGIES (OARS)
Open Ended Questions (>50%)
Affirm (at least 1x)
Reflective Listening (2:1)
Summarize (1-3x)
Pause. Punctuation.

12.
(WIDE) OPEN ENDED QUESTIONS
Ask brief questions that do not invite brief
answers, and more important, invite the
person to tell their story.
Common constructions:
What . . .?
How. . .?
Tell me about . . .
Followed by punctuation (?) and PAUSE.

13.
Encouragers are short follow-up questions or
prompts that help the person to answer the
original, open-ended question more
completely.
What else?
What example of that comes to mind?
Say more.
Wow! That’s really interesting!
Go on.
Mmm-hmmm.
Really?
ENCOURAGERS EXTEND

14.
EXERCISE 1: Open Ended Question Formation
The talker says:
About a month ago, everything was blowing up, for real. I was
getting a bunch of run around, everyone telling me: go here, do this,
go there, do that. I’m doing cool now. I’m still alive. I’m going to
school. A month ago, it was me and a hard time and no one helping
me.
Form 3 open questions using “what,” “how,” or “tell me about” that
the talker is likely to answer:
1.
2.
3.

15.
 Recognize effort (over success)
 “The important part was that you tried so hard.”
 Recognize strengths (reframe resistance)
 “You are very persistent and strong-minded.”
 Emphasize the talker’s personal choice, control, freedom,
autonomy
 “You are absolutely right. No one can make you do this.”
 Express support
 “Quitting smoking can be one of the hardest things to do in life.”
 Express confidence
 “If you decide to change this, I believe you can eventually succeed.”
AFFIRMATION

16.
 http://www.npr.org/2014/03/07/286921391/a-homeless-
teen-finds-solace-in-a-teacher-and-a-recording
STORYCORPS: AARON, A HOMELESS TEEN
FINDS SOLACE IN AN (AFFIRMING) TEACHER
Celeste Davis-Carr, a high school
English teacher in Chicago,
learned her student Aaron was
homeless from a recording for
the StoryCorpsU program.

17.
“Every
block of
stone has a
statue
inside it
and it is
the task of
the
sculptor to
discover
it.”
-Michelangelo

18.
 A hypothesis as to what the talker is getting at said
as a statement, not a question. Voice tone turns
down at the end of the reflection, not up.
 Integrate underlying feelings, values, and unsaid
portions.
 Brief: 10 words or less (variance here).
 Period. Pause. Wait, Watch.
REFLECTIVE LISTENING

19.
 Simple Reflections: stays close to the person’s
original speech
 Repeating – simply repeats an element
 Rephrase – substitutes synonyms
 Complex Reflections: adds or enhances what the
person said
 Affective – emphasizes the emotional dimension
 Values – emphasizes beliefs and principles
 Understated/Overstated – minimizes or increases intensity
 Continuing the paragraph – completes next sentence
 Double-sided – states both sides
 Uses images or metaphors – to increase perspective
LEVELS OF REFLECTION

20.
LEVELS OF REFLECTION
SIMPLE
COMPLEX

21.
WHAT DID THE WRITER MEAN?

22.
ALL SPEECH IS POETRY

23.
EXERCISE 2: Reflection Formation
2.1 The talker says:
I’m not going to school. The principal and the teachers already hate
me so I don’t see how that’s going to benefit me.
Form 3 reflections
1. Simple:
2. Complex:
3. Use the word “you”:
2.2 The talker says:
I don’t want to live with my grandmother anymore. She was a good
grandmother but not a great parent. She does her best. There’s dust
everywhere in her house. It’s gross and I have asthma. As soon as I
turn 18, I’m just going to go live with my father.
Form 3 reflections
1. Simple:
2. Complex:
3. Use the word “you”:

24.
2.3 The talker says:
My dog is the only living thing I care about, and she loves me, too.
People think that’s weird but I don’t care. She’s better than any
human as far as I can tell.
Form 3 reflections
1. Simple:
2. Complex:
3. Use the word “you:”
2.4 The talker says:
I take my medications when I feel like it. I don’t need them every day.
I don’t feel like myself on them. All everyone cares about is whether I
take my medications.
Form 3 reflections
1. Simple:
2. Complex:
3. Use the word “you”:

25.
2.5 The talker says:
I’m not trying to get disappointed. I don’t want to hear about any
disappointment or rejection. If I feel like I’m going to get a no, I’m
just going to shut myself down. I’m not even going down that route.
O-A-R All Together Now!
1. Open Question:
2. Affirmation:
3. Reflection:

26.
Preface: “Let me try to summarize what you’ve
been expressing . . .”
Pearls of Wisdom: One, Two, or Three “Pearls”
Ask for feedback: “What would you add or
subtract?” “What did I miss?” “How accurate was
that?”
SUMMARIZING

27.
EXERCISE 3: Summarize This
Adolescent girl in an internship program she was excited about
She says:
Somebody told me the break was 30 minutes so I was like, all right
cool. The supervisor dude was like, no way, you’ve got to finish
before you go on break. I was like, “no, I can’t. I’m not doing it.” The
other students all think the supervisor has anger issues with girls.
One time I noticed he talked to me all crazy. He said something
smart, just no need. I was like, OK, I’m going to let that slide. I’m
going to let that pass. He just got at me wrong.
I don’t have an issue with him even though he gets mad at me and
raises his voice. I have no issue with him. I am still going to be there
for him and give him a helping hand with the project. I have a right
to be in this shop as a female.
When he has an issue with somebody, he doesn’t tell them straight
up. He talks about them to other people. That’s not right. That’s not
professional.

28.
I don’t like the way he deals with people. I want him to be direct but I
don’t want to talk to him any kind of way. He can get mad easily and
what he says can be seen as disrespectful. I don’t play that. I’m not
taking that. If he talks to me crazy, I’m going to let him know that
you can’t talk to me like that.
It's nothing. He’s my co-worker. He just has issues. I don’t have an
issue with him. I want to keep it in the past. It was an incident, just a
misunderstanding. It’s nothing. I’m a professional.
1. What are the 2-3 of the talker’s most important points?
2. If you had to give the talker one piece of advice, what would it
be?
3. If this talker had difficulties interacting with authority, which
speech would you consider “sustain talk” and which speech
would you consider “change talk”?

29.
After all, when you seek advice
from someone it’s certainly not because you
want them to give it. You just want them to
be there while you talk to yourself.
--Terry Pratchett

30.
GIVING ADVICE: MI WAY
ASK
•Permission
•What they
already
know
OFFER
•Information
•Advice
•Resources
•Your
concern
•Your
Perspective
ASK
•What they
think
•What they
agree or
disagree
with
SUPPORT AUTONOMY WHENEVER POSSIBLE

31.
The concerns, the ideas, and/or the inspiration
come directly from the talker whenever possible.
Evocation is the opposite of “installing” or
“instilling” from the outside in (i.e. the righting
reflex).
Evocation emphasizes “inviting out” the values,
knowledge, skills, and hopes that are just inside
waiting. . .
EVOCATION (EXPLORATION)

32.
CHANGE TALK
 Any speech that favors
the possibility for change
related to a specific
target
 Examples:
 Discomfort with the status
quo
 Confidence
 Optimism or hopes for the
future
 Need to avoid negative
consequences
SUSTAIN TALK
 Any speech that favors
the status quo or no
change position
 Examples
 Minimizing problems
 Blaming others
 Expressing pessimism about
ability to change
successfully
CHANGE TALK
AND
SUSTAIN TALK

33.
Preparatory
Desire
Ability
Reason
Need
Commitment
Commitment
Action
Taking Steps
TYPES OF CHANGE TALK

34.
Use Your:
Elaboration or Example (Ask for)
Affirm
Reflect
Summarize
RECOGNIZING AND RESPONDING
TO CHANGE TALK

35.
Given what we’ve talked about
today, what’s next?
What else?
NEXT STEP QUESTION

36.
THEORY OF MI CHANGE MECHANISMS
(Commitment
Talk)

37.
 EXPRESS EMPATHY: When people feel cared about and accurately
understood, they open themselves up to questions of change and
become more contemplative
 DEVELOP DISCREPANCY: People who may be acting in a way that
is against their own values or goals can benefit from realizing of their
own accord that there is an internal (vs. external) conflict (trick:
without triggering defensiveness or shame)
 SUPPORT SELF-EFFICACY: When people feel that they – or
people like them -- have a chance at success, they are more likely to
try.
 PROMOTE AUTONOMY: When people feel in charge of and
responsible for making their own decisions and that their autonomy is
respected, they are more likely to actively make decisions.
FOUR META-METHODS

38.
 When human beings feel accurately understood and
unconditionally positively regarded, they can physiologically
relax which, paradoxically, opens them up to challenge,
growth, and self-reflection
ACCURATE EMPATHY

39.
 The mental stress or discomfort experienced by an individual
who holds two or more contradictory beliefs, ideas, or values
at the same time, or is confronted by new information that
conflicts with existing beliefs, ideas, or values.[1][2] When
inconsistency (dissonance) is experienced, individuals tend to
become psychologically uncomfortable and are motivated to
attempt to either resolve the contradiction or avoid situations
and information which are likely to increase it.
COGNITIVE DISSONANCE (FESTINGER)

40.
People with a strong sense
of self-efficacy:
 View challenging problems
as tasks to be mastered
 Develop deeper interest in
the activities in which they
participate
 Form a stronger sense of
commitment to their
interests and activities
 Recover quickly from
setbacks and
disappointments
People with a weaker sense
of self-efficacy:
 Avoid challenging tasks
 Believe that difficult
tasks and situations are
beyond their capabilities
 Focus on personal
failings and negative
outcomes
 Quickly lose confidence
in personal abilities
SELF EFFICACY: “THE BELIEF IN ONE’S CAPABILITIES TO
ORGANIZE AND EXECUTE THE COURSES OF ACTION REQUIRED TO
MANAGE PROSPECTIVE SITUATIONS” –BANDURA, 1977

41.
PROMOTING AUTONOMY
(SELF-DETERMINATION)
Clinicians who
promote autonomy:
 Explicitly honors the person’s
right not to change
 Help the person recognize the
choices or decisions in front
of them
 Express confidence about the
person’s abilities particularly
if they decide to change
 markedly expand the person’s
experience of his or her own
sense of control and choice