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Motivational Interviewing for Student Health and Counselling Practitioners: Queen's University at Kingston

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Mi queen's 2013 pub

  1. 1. Motivational Interviewing Marilyn Herie PhD RSW Health, Counselling and Disability Services Queen’s University September 4, 2013
  2. 2. marilyn.herie@utoronto.ca @MarilynHerie www.educateria.com • Dr. Marilyn Herie is the Academic Chair, Community Services at Centennial College in Toronto, Canada, and Assistant Professor (Status Only), University of Toronto Factor-Inwentash Faculty of Social Work. She is a member of the international Motivational Interviewing Network of Trainers (MINT), and has published numerous books, chapters and journal articles on addiction, professional education and evidence-based practice, including Substance Abuse in Canada with Oxford University Press. Dr. Herie’s areas of interest and focus include e-learning and classroom teaching, motivational interviewing and health behaviour change, education research and evaluation, social media and interprofessional education. She blogs about education and teaching-related topics at www.educateria.com.
  3. 3. First, empty your cup
  4. 4. A scientist went to visit a famous Zen master. While the master quietly served tea, the scientist talked about Zen. The master poured the visitor's cup to the brim, and then kept pouring. The scientist watched the overflowing cup until he could no longer restrain himself. "It's overfull! No more will go in!" the scientist blurted. "You are like this cup," the master replied, "How can I show you Zen unless you first empty your cup?" http://users.rider.edu/~suler/zenstory/emptycup.html
  5. 5. Confidence Ruler 0 1 2 3 4 5 6 7 8 9 10 No Way I am Bill Miller http://www.williamrmiller.net/
  6. 6. Learning Objectives At the end of this session, you will be able to: 1. Frame MI as a way of being with your client – evocation versus installation 2. Review and practice the five key MI strategies 3. Troubleshoot challenging practice issues/cases 4. Identify barriers and enablers to implementing MI skills with clients 5. Set concrete implementation objectives for clinical practice
  7. 7. Motivational Interviewing Three Definitions
  8. 8. 1. What is it for? Motivational interviewing is a collaborative conversation to strengthen a person’s own motivation for, and commitment to, change
  9. 9. Spirit of MI
  10. 10. Who was your favourite teacher? Why?
  11. 11. The “Spirit” of Motivational Interviewing • Partnership • Acceptance • Compassion • Evocation • Absolute worth • Accurate empathy • Autonomy support • Affirmation 12 Miller & Rollnick 2013
  12. 12. Partnership “You are the best judge of what is going to work for you.”
  13. 13. Acceptance “I am here to help whatever you decide to do.”
  14. 14. Compassion Guide me to be a patient companion, to listen with a heart as open as the sky. Grant me vision to see through his eyes, and eager ears to hear his story…Let me honour and respect his choosing of his own path. Adapted from Miller, 2013, “A Meditative Preparation” (p.24)
  15. 15. Evocation “What were you hoping for by coming here today?”
  16. 16. Common Human Reactions to Being Listened to • Understood • Want to talk more • Liking the counselor • Open • Accepted • Respected • Engaged • Able to change • Safe • Empowered • Hopeful • Comfortable • Interested • Want to come back • Cooperative 17Slide from Bill Miller
  17. 17. 2. Why would I use it? Motivational interviewing is a person- centered counseling method for addressing the common problem of ambivalence about change Miller & Rollnick 2013
  18. 18. The “Righting Reflex” http://tinyurl.com/lyk4gqo
  19. 19. http://tinyurl.com/lbcvo76
  20. 20. http://www.usmagazine.com/celebrity-body/news/hollywoods-most-extreme-diets-2010121
  21. 21. http://www.keepcalm-o-matic.co.uk/p/keep-calm-and-have-safe-sex-9/
  22. 22. Practitioner to the rescue!
  23. 23. Yes, but…
  24. 24. “Unsolicited advice is the junk mail of life.” (Bern Williams, in Miller & Rollnick 2013)
  25. 25. Common Reactions to Righting Reflex • Angry, agitated • Oppositional • Discounting • Defensive • Justifying • Not understood • Not heard • Procrastinate • Afraid • Helpless, overwhelmed • Ashamed • Trapped • Disengaged • Not come back – avoid • Uncomfortable 27Slide from Bill Miller
  26. 26. Common Human Reactions to Being Listened to • Understood • Want to talk more • Liking the counselor • Open • Accepted • Respected • Engaged • Able to change • Safe • Empowered • Hopeful • Comfortable • Interested • Want to come back • Cooperative 28Slide from Bill Miller
  27. 27. But what if the person refuses to change?
  28. 28. A 'No' uttered from the deepest conviction is better than a 'Yes' merely uttered to please, or worse, to avoid trouble. Mahatma Gandhi
  29. 29. “He that complies against his will is of the same opinion still.” Samuel Butler 1612-1680 English Poet
  30. 30. Motivational Interviewing in Dental Practice How NOT to do it: Emily’s Oral Piercing http://tinyurl.com/c2kh3z9 The Righting Reflex
  31. 31. Motivational Interviewing in Dental Practice Emily’s Oral Piercing http://tinyurl.com/bojtj92 A Better Way
  32. 32. Quick Reflection: How confident are you feeling? 0 1 2 3 4 5 6 7 8 9 10 “Spirit” of MI – Resist the Righting Reflex 0 1 2 3 4 5 6 7 8 9 10 “Spirit” of MI – Directional (versus directive) 0 1 2 3 4 5 6 7 8 9 10 “Spirit” of MI – Evoke (versus educate)
  33. 33. The Evidence Base for Motivational Interviewing
  34. 34. Research publications evaluating MI effectiveness have been doubling every three years. www.motivationalinterview.org
  35. 35. MI Applications • Public health & workplace • Sexual health • Dietary change • Weight management • Voice therapy • Gambling • Physical activity • Stroke rehab • Chronic pain • Medication adherence • Diabetes • Mental health • Addictions • Fibromyalgia • Chronic leg ulceration • Self-care • Criminal justice • Vascular risk • Domestic violence Anstiss, 2009
  36. 36. A Causal Chain for MI Therapist MI- consistent speech Increased client change talk Improved treatment outcomes Moyers et al., 2009
  37. 37. “What [practitioners] reflect, they will hear more of.” Moyers et al., 2009
  38. 38. 2002 2009 41 2012
  39. 39. 2012 2013
  40. 40. 2008 2011 43
  41. 41. Engaging Focusing Evoking Planning Four Processes in MI Adapted from Miller and Rollnick, 2013, p. 26
  42. 42. Engaging
  43. 43. Focusing
  44. 44. Evoking
  45. 45. Planning
  46. 46. 3. How does it work? Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. Miller & Rollnick 2013
  47. 47. Change Talk
  48. 48. Change Talk and Sustain Talk Opposite Sides of a Coin
  49. 49. Sustain Talk and Resistance • Sustain Talk is about the target behavior • Discord is about your relationship • Both are highly responsive to counsellor style • We respond to both in the same way Miller & Rollnick 2013
  50. 50. DARN CAT • Desire • Ability • Reasons • Need • Commitment • Activation • Taking Steps Miller & Rollnick 2013
  51. 51. Yet another metaphor MI Hill Contemplation Preparation Action(Pre-) Slide from Bill Miller, 2010
  52. 52. DARN CAT • Desire • Ability • Reasons • Need • Commitment • Action • Taking Steps Snap fingers = DARN Clap = CAT Silence = No change talk Motivational Interviewing Network of Trainers (MINT)
  53. 53. Listening for Change Talk “Things are getting totally messed up with my courses.” • Desire • Ability • Reasons • Need • Commitment • Action • Taking Steps
  54. 54. “My parents are the ones who are worried about my grades.” • Desire • Ability • Reasons • Need • Commitment • Action • Taking Steps
  55. 55. “I am not addicted to smoking pot. I can quit anytime I want.” • Desire • Ability • Reasons • Need • Commitment • Action • Taking Steps
  56. 56. “I want to get well again, but this whole situation is totally unfair.” • Desire • Ability • Reasons • Need • Commitment • Action • Taking Steps
  57. 57. “I have started working out, quit smoking and drinking, have joined Varsity basketball and am attending all of my classes.” • Desire • Ability • Reasons • Need • Commitment • Action • Taking Steps
  58. 58. When you are not sure where to go next…
  59. 59. “Tell me more…Tell me more…”
  60. 60. 0 1 2 3 4 5 6 7 8 9 10 Recognizing Change Talk 0 1 2 3 4 5 6 7 8 9 10 Evoking Change Talk Quick Reflection: How confident are you feeling?
  61. 61. Foundation Skills: O A R S
  62. 62. FOUR KEY STRATEGIES – OARS OPEN questions (to elicit client change talk) AFFIRM the client appropriately (support, emphasize personal control) REFLECT (try for complex reflections) SUMMARIZE ambivalence, offer double-sided reflection
  63. 63. Open Questions
  64. 64. Open versus Closed Questions • CLOSED questions invite a “yes/no”, one- word or very limited answer • OPEN questions encourage elaboration – they evoke the client’s ideas, opinions, hopes, concerns, etc.
  65. 65. Affirmations
  66. 66. Affirmations: • Go beyond “giving a good grade” • Are not about the practitioner’s approval of the client • Acknowledge the client’s experience, struggle, expertise, efforts, etc.
  67. 67. Example of Praising: You are such a wonderful group - I have really enjoyed our session.
  68. 68. Example of Affirming The group has worked hard today in exploring some tough issues, and we have come closer as a result of that.
  69. 69. Choose one of your most challenging patients – and come up with an affirmation that you could offer
  70. 70. http://www.gems.tv/
  71. 71. 0 1 2 3 4 5 6 7 8 9 10 Open-ended Questions 0 1 2 3 4 5 6 7 8 9 10 Affirmations (versus praise) Quick Reflection: How confident are you feeling?
  72. 72. Reflections
  73. 73. EAR EYES UNDIVIDED ATTENTION HEART “To Listen” IMPERIAL
  74. 74. Simple Reflection Complex Reflection
  75. 75. Simple Reflection Complex Reflection They are really on your case about your cannabis use. It wasn’t your idea to come, and you’re not sure this is going to be at all helpful to you. “I’m only coming to see you because my parents and my boyfriend are all pressuring me about smoking pot.”
  76. 76. Simple Reflection Complex Reflection They are really on your case about your cannabis use. How you see it is, they are the ones who have a problem with it, and that is frustrating. “I’m only coming to see you because my parents and my boyfriend are all pressuring me about smoking pot.”
  77. 77. Simple Reflection Complex Reflection They are really on your case about your cannabis use. It would feel a lot better if they respected that what you do or not do is your choice and decision. “I’m only coming to see you because my parents and my boyfriend are all pressuring me about smoking pot.”
  78. 78. Simple Reflection Complex Reflection They are really on your case about your cannabis use. Even if you did have any concerns, all this pressure makes it hard to want to change. “I’m only coming to see you because my parents and my boyfriend are all pressuring me about smoking pot.”
  79. 79. Video Demonstration: A tough question… http://tinyurl.com/kxomabp
  80. 80. Practicing Reflective Listening Individually, take a moment to write down an example of a simple and a complex reflection for the following statement (coming up – next slide). Then compare what you wrote with others at your table. As a group, choose the best examples to share with the larger group.
  81. 81. Practicing Reflective Listening (1) “How I live my life is no one else’s business, and certainly not yours!”
  82. 82. Simple Reflection: ___________________________________ ___________________________________ Complex (Enhanced) Reflection: ___________________________________ ___________________________________ “How I live my life is my own business and certainly not yours.”
  83. 83. Simple Reflection: You are the only one to decide how to live your life. Complex (Enhanced) Reflection: You’re being told you have to make all these changes, and that doesn’t feel very respectful of your choice and autonomy. “How I live my life is my own business and certainly not yours.”
  84. 84. Practicing Reflective Listening (2) “I know you mean well, but I don’t need this medication any more.”
  85. 85. Simple Reflection: ___________________________________ ___________________________________ Complex (Enhanced) Reflection: ___________________________________ ___________________________________ “I know you mean well, but I don’t need this medication any more.”
  86. 86. Simple Reflection: You see that I am concerned, but you are ready to stop taking the medication. Complex (Enhanced) Reflection: You feel like I am pushing for you to take this medication, and not really appreciating where you are at. “I know you mean well, but I don’t need this medication any more.”
  87. 87. More Reflections • I am not going to call a crisis line. • I was too busy to do that homework you gave me. • I am a perfectionist – I don’t stop until I get something perfect. • How am I supposed to improve my self- esteem? • I don’t have time to eat. • Anxiety motivates me.
  88. 88. Reflecting Panel Motivational Interviewing Network of Trainers (MINT)
  89. 89. 1. Four volunteers: Counsellors
  90. 90. 2. One volunteer: Client Something you are considering changing/struggling with
  91. 91. 3. One volunteer: Coach A sounding board for the “client”
  92. 92. Reflecting Panel Instructions 1. Client: Share a paragraph with the Reflecting Panel about your struggle/experience 2. Panel: Take turns offering a single reflection 3. Client: After ALL Panel members are done, talk to your coach about which reflection resonates most for you and why 4. Client: Offer this feedback to the panel, and continue the paragraph Motivational Interviewing Network of Trainers (MINT)
  93. 93. 0 1 2 3 4 5 6 7 8 9 10 Simple Reflections 0 1 2 3 4 5 6 7 8 9 10 Complex Reflections Quick Reflection: How confident are you feeling?
  94. 94. Summary Statements
  95. 95. Why use summary statements? • To check your understanding of the person’s situation as a whole • To reflect back key components of what the person has discussed • To signal a transition to another topic or the end of the session/consultation • To highlight change talk
  96. 96. Example of OARS (including Summary Statement) “Angry Bob” http://www.youtube.com/user/teachproject#p/u/5/79YTuZUFRIc
  97. 97. Partner A: Something you are considering changing Partner B: • Start with an open question • Follow up with two reflective statements • Offer an affirmation • End with a summary statement Hands-on Practice: O A R S
  98. 98. The 5th Foundation Skill: Providing Information in a Motivational Way
  99. 99. “Advice is what we ask for when we already know the answer but wish we didn’t.” (Erica Jong, in Miller & Rollnick 2013)
  100. 100. Agenda-Mapping
  101. 101. Agenda Mapping • A brief discussion with the client, where he/she has the most decision-making freedom possible • The client chooses what area toward better health they want to discuss • No topic is off limits – success in one area can lead to success in another Miller & Rollnick 2013
  102. 102. • Start with understanding the patient’s perspectives and preferences • Try not to ‘trap’ the person by suggesting a lifestyle change (or focusing too soon on change) once the person raises a lifestyle area Tips for Agenda Mapping Miller & Rollnick 2013
  103. 103. • Consider providing the patient with a finite list of topics to choose from, and asking them if any of the areas they want to discuss are included in that list • After the patient responds, feel free to mention topics that you want to talk about Tips for Agenda Mapping Miller & Rollnick 2013
  104. 104. Strategies Include… • Asking for elaboration • Reflective listening • Emphasizing personal choice and control • Asking permission before making suggestions • Summary statements Miller & Rollnick 2013
  105. 105. Agenda-Mapping Worksheet Priorities Miller & Rollnick 2013
  106. 106. Priorities Diagnosis Treatment Plan Symptoms $$$ Agenda-Mapping Worksheet
  107. 107. Priorities Diagnosis Treatment Plan Symptoms $$$ Grades Stress Relationship Agenda-Mapping Worksheet Sex
  108. 108. “Given these possible areas to focus, what would you like to talk about in our time together today?” Miller & Rollnick 2013
  109. 109. Priorities Diagnosis Treatment Plan Symptoms $$$ Grades Stress Relationship Agenda-Mapping Worksheet Sex
  110. 110. Agenda Mapping conversation with "Sal“ http://www.youtube.com/watch?v=klnHJ4coG8o Agenda Mapping
  111. 111. “Readiness Ruler” • How important is it to change this behaviour? • How confident are you that you could make this change? 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 People usually have several things they would like to change in their lives – this may be only one of those things. Answer the following two questions with respect to your goal for this week. Miller & Rollnick 2013
  112. 112. 0 1 2 3 4 5 6 7 8 9 10 Agenda-mapping 0 1 2 3 4 5 6 7 8 9 10 Readiness Ruler Quick Reflection: How confident are you feeling?
  113. 113. Putting it all together
  114. 114. “A Psychological Law” I learn what I believe as I hear myself speak. Bill Miller (Based on D. Bem, 1967, “Self-Perception: An alternative interpretation of cognitive dissonance phenomena”)
  115. 115. …or put another way… The word you keep between your lips is your slave. The word you speak is your master. - Arabic proverb
  116. 116. Motivational Interviewing Coding Sheet • Number of closed questions: __________ • Number of open questions: __________ • Number of simple reflections: _________ • Number of complex reflections: _______ • Change statements by client: _______ • Sustain statements by client: __________ • Therapist talk time (approx.): __________ % Targets: Twice as many reflections as questions At least 50% complex reflections No more than 50% therapist talk time MI “Spirit” (low) (high) Partnership 1 2 3 4 5 Acceptance 1 2 3 4 5 Compassion 1 2 3 4 5 Evocation 1 2 3 4 5 Herie & Skinner 2013, adapted from Moyers et al. MITI coding guide
  117. 117. How Not to Do It A conversation with Sal about his asthma http://www.youtube.com/watch?v=kN7T-cmb_l0
  118. 118. Motivational Interviewing Coding Sheet • Number of closed questions: __________ • Number of open questions: __________ • Number of simple reflections: _________ • Number of complex reflections: _______ • Change statements by client: _______ • Sustain statements by client: __________ • Therapist talk time (approx.): __________ % Targets: Twice as many reflections as questions At least 50% complex reflections No more than 50% therapist talk time MI “Spirit” (low) (high) Partnership 1 2 3 4 5 Acceptance 1 2 3 4 5 Compassion 1 2 3 4 5 Evocation 12 3 4 5 Herie & Skinner 2013, adapted from Moyers et al. MITI coding guide
  119. 119. A Better Way A conversation with Sal about his asthma http://www.youtube.com/watch?v=-RXy8Li3ZaE
  120. 120. Motivational Interviewing Coding Sheet • Number of closed questions: __________ • Number of open questions: __________ • Number of simple reflections: _________ • Number of complex reflections: _______ • Change statements by client: _______ • Sustain statements by client: __________ • Therapist talk time (approx.): __________ % Targets: Twice as many reflections as questions At least 50% complex reflections No more than 50% therapist talk time MI “Spirit” (low) (high) Partnership 1 2 3 4 5 Acceptance 1 2 3 4 5 Compassion 1 2 3 4 5 Evocation 1 2 3 4 5 Herie & Skinner 2013, adapted from Moyers et al. MITI coding guide
  121. 121. Ineffective Practitioner Effective Practitioner Closed Questions 2 0 Open Questions 0 3 Simple Reflections 0 1 Complex Reflections 1 6 Change Statements 1 7 Sustain Statements 8 8 Therapist Talk Time 70% 50% Let’s Compare
  122. 122. Hands-on Practice • In groups of three, take three roles: – Person “A” describe a change you are thinking of making in the next 6 months – 1 year – Person “B” respond using motivational strategies – Person “C” observe and give feedback Each “Real Play” will take 5 minutes. After each turn, rotate the roles so that everyone has a chance to practice and receive feedback. Please HOLD your feedback until everyone has had a chance to practice – you will have an opportunity to debrief as a small group at the end of this exercise
  123. 123. In groups of three, take three roles: – Person “A” describe a change you are thinking of making in the next 6 months – 1 year – Person “B” respond using motivational strategies – Person “C” observe and give feedback A B C
  124. 124. Motivational Interviewing Coding Sheet • Number of closed questions: __________ • Number of open questions: __________ • Number of simple reflections: _________ • Number of complex reflections: _______ • Change statements by client: _______ • Sustain statements by client: __________ • Therapist talk time (approx.): __________ % Targets: Twice as many reflections as questions At least 50% complex reflections No more than 50% therapist talk time MI “Spirit” (low) (high) Partnership 1 2 3 4 5 Acceptance 1 2 3 4 5 Compassion 1 2 3 4 5 Evocation 12 3 4 5 Herie & Skinner 2013, adapted from Moyers et al. MITI coding guide
  125. 125. Page 19
  126. 126. Re-write this challenging case: • From the client’s perspective • From the client's parents’ or partner’s perspective • From the faculty’s perspective
  127. 127. Here’s how we see the case from our perspective:
  128. 128. Let’s re-imagine this case in a different way
  129. 129. The goal is to find a way in
  130. 130. Bridging the learning-practice gap
  131. 131. Page 20
  132. 132. What are the MI skills that you will commit to using? • MI Spirit • Identify and evoke change talk • OARS • Using Elicit/Provide/Elicit to provide information • Agenda-mapping • Other?
  133. 133. Engaging Focusing Evoking Planning Motivational Interviewing: Practice Tips MI Spirit: The Essential Foundation Partnership: You and the client are equal experts Acceptance: Absolute worth, accurate empathy, autonomy support, affirmation Compassion: Beneficence, caring, focus on the other Evocation: The client’s wisdom is most important OARS: Key Skills Open Questions: What are your reasons for change? How might you go about it in order to succeed? Affirmation: You have worked hard to make this happen. I can see that you’ve given this a lot of thought. Reflections: You wish that… You would like to… Summary Statements: Let me make sure I understand how this all fits together… Diagnosis Treatment Plan Symptoms Benefits Finances Stress Relationship Agenda-Mapping Can we take a few minutes to talk about the different issues or concerns that you or others have? Just to get a “big picture” view of what you are coping with right now… Given all of these possible areas for change, what are your priorities? Where would be the most helpful place for us to start? 0 1 2 3 4 5 6 7 8 9 10 People usually have multiple or competing priorities. On a scale of zero-to-ten, how important is it to change…? How confident are you that you could make this change? Readiness Ruler Why did you say [lower number] and not [higher number]? What would it take to go from [lower number] to [higher number]? Elicit: What do you already know about…? Provide information: Be brief! Elicit: How does that fit for you? What do you make of that? Listen for Change Talk: DARN CAT Desire, Ability, Reasons, Need Commitment, Activation, Taking Steps Reference: Miller, W. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd Edition). New York: Guilford. © 2013 Marilyn Herie, PhD RSW marilyn.herie@utoronto.ca Four MI Processes
  134. 134. Recommended Resources 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 (MIA STEP). Salem, OR: Northwest Frontier Addiction Technology Transfer Center, Oregon Health and Science University. http://www.motivationalinterview.org/Documents//MIA-STEP.pdf Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (Third Edition). New York: Guilford. Miller, W.R. & Rollnick, S. (2009). Ten things that Motivational Interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129-140. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=531 8416 Rollnick, S., Miller, W.R., & Butler, C.C. (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: The Guildford Press. First chapter and table of contents available at www.motivationalinterview.org Rosengren, D.B. (2009). Building Motivational Interviewing Skills: A Practitioner Workbook. New York: Guilford. Wagner, C.C. & Ingersoll, K.S. (2013). Motivational Interviewing in Groups. New York: Guilford Useful Websites Motivational Interviewing Website http://www.motivationalinterview.net/ Motivational Interviewing Network of Trainers (MINT) Website www.motivationalinterviewing.org Examples of Motivational Interviewing Videos on YouTube http://www.youtube.com/user/teachproject#p/u
  135. 135. Motivational Interviewing Glossary of Acronyms Compiled by Marilyn Herie, PhD, RSW November, 2012 ACE (Spirit of MI from Miller and Rollnick 2002 edition) Autonomy / Collaboration / Evocation versus Authority / Coercion / Education OARS (Fundamental strategies of MI) Open questions / Affirmations / Reflections / Summary statements EARS (Strategies for eliciting change talk) Evocation / Affirmation / Reflective listening / Summary statements RULE (Fundamental strategies in MI v.2) Resist the righting reflex / Understand reasons for change (motivation) / Listen empathically / Empower the client to use own resources DARN CAT (Types of preparatory change talk and commitment language) Desire / Ability / Reasons / Need / Commitment / Action / Taking steps FRAMES (Ingredients of brief, motivational interventions) Feedback / Responsibility / Advice / Menu (of strategies)/ Empathy / Self-efficacy RAISE (How to give advice) Relationship / Advice to change / “I” statements (affirmation) / Support autonomy / Empathy READS (Principles of MI) Roll with resistance / Express empathy / Avoid argumentation / Develop discrepancy / Support self- efficacy PACE (Spirit of MI from Miller and Rollnick 2013 edition) Partnership / Acceptance / Compassion / Evocation MIST (Coding form) Motivational Interviewing Supervision and Training Scale MITI (Coding form) Motivational Interviewing Treatment Integrity Coding Form MET (Manual-based motivational intervention) Motivational Enhancement Therapy MIA (Coding abbreviation, used in the MITI) Motivational Interviewing Adherent MINA (Coding abbreviation, used in the MITI) Motivational Interviewing Non-Adherent MIA-STEP (MI supervision manual and coding resource) Motivational Interviewing Assessment – Supervisory Tools for Enhancing Proficiency AMI Adaptations of Motivational Interviewing
  136. 136. Additional Reflections and Next Steps
  137. 137. Confidence Ruler 0 1 2 3 4 5 6 7 8 9 10 No Way I am Bill Miller http://www.williamrmiller.net/
  138. 138. “When people are ready to, they change. They never do it before then, and sometimes they die before they get around to it. You can't make them change if they don't want to, just like when they do want to, you can't stop them.” ― Andy Warhol, Andy Warhol in His Own Words http://en.wikipedia.org/wiki/File:Warhol-Campbell Soup-1-screenprint-1968.jpg
  139. 139. Thank you marilyn.herie@utoronto.ca www.educateria.com @MarilynHerie
  140. 140. Life can only be understood backwards, but it must be lived forwards. -Kierkegaard

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