Easy to make assumption that people want to change
Where does MI ‘fit’ into this diagram?
Pre-contemplation-seeds of change Contemplation-possibility of change
People who are ready for change do not need MI. It is designed for the resolution of ambivalence with a tip in one direction
Stripped back Motivational Interviewing
What are they?
How can they be measured?
Make a list…….
Willingness to change
Wanting to help
Knowing ‘what is best’
‘Movere’ Latin for ‘to move’
Energy and direction.
Sources of motivation?
Think of a behaviour of yours that you have
thought about changing;
Where has the motivation to change
originated from? External or internal?
Easy to assume.
Sometimes people are unaware.
Pleasure vs pain.
Informed by 7 distinct theories:
1) Conflict and ambivalence (Orford, 1985)
2) *Decisional balance (Janis and Mann, 1977)
3) Health beliefs (Rogers, 1975)
4) Reactance (Brehm and Brehm, 1981)
5) Self-perception (Bem, 1967)
6) Self-regulation theory (Kanfer, 1987)
7) Rokeach’s value theory (Rokeach, 1973)
Happy to maintain status-quo
Question the present situation
Strategy implemented, steps taken
Changed behaviour adopted and maintained
Learning from ‘failure’
One step forward, two steps back…..
Most people need more than one attempt.
Rooted in work of Carl Rogers.
‘A collaborative, person-centred form of
guiding to elicit and strengthen motivation
(Miller and Rollnick, 2009)
More than a set of techniques.
Based on 3 key elements: ACE
Autonomy (vs Authority)
Collaboration (vs Confrontation)
Evocation (vs Imposition)
Express Empathy (vs sympathy)
Empathy because you have ‘been there’ vs
sympathy when you have not.
Supporting the belief that change is possible.
Focus on previous successes.
Mismatch between ‘where they are’ and ‘where
they want to be’. Conflict between current
behaviour and future goal. ‘Throw away’
Roll with Resistance
Comes from conflict between view of ‘problem’
and ‘solution’. Non-confrontation using de-
escalation techniques. ‘Yes, but….’ MI focus on
client define problem results in more ‘dancing and
Being in two minds…
Exploration and resolution of ambivalence.
Ambivalence is preferred to resistance in
order to explore the dynamic
interrelationship (Arkowitz et al, 2008)
Approach-Avoidance-moving betwixt and
between e.g. just one more drink, play on
the gaming machine, slab of chocolate……..
What mistakes do you think were made in this
Open ended questions:
Affirmations-support self-efficacy. Must be
congruent and genuine.
Reflections. Has 2 purposes; help to express
empathy and resolution of ambivalence by
focusing on negatives of maintenance and
positives of change.
Ww example of reflective listening
Summaries-communicate interest and
understanding. Shift attention/direction-
‘move on.’ Highlight both sides (but focus
more on positives) of ambivalence therefore
Seek to guide client to expressions of change
Correlation between statements of change
and change behaviour.
DARN CAT-types of change talk.
Desire (I want to change)
Ability (I can change)
Reason (Its important to change)
Need (I should change)
Commitment (I will change)
Activation (I am ready, prepared and willing
Taking steps (I am taking specific action to
Ask evocative questions
Explore decisional balance (pros/cons-more
Good/not so good about behaviour
Ask for examples
Use change rulers
Less emphasis on the problem.
Change talk; person gives off increasing
S/he is posing her own questions about her
own change process.
Envisioning-how the future might look, could
Resisting the ‘righting reflex’.
Forgetting the answers lie within the
MI not based on the TTM. What is the
MI not a way of tricking people into change
behaviour. ALWAYS in the persons best
interests. You do not ‘MI’ someone. You
cannot do MI ‘on’ or ‘to’ someone.
MI is not a technique. Not simple with steps
to follow. More complex.
MI is not a decisional balance. Exploring pros
AND cons can sometimes avoid influencing
direction of choice.
MI is not CBT. MI is a brief intervention-new
skills are not learned. NOT ‘I have what you
need’ rather ‘you have it already.’
MI is not just client centred counselling. Goal
MI is not what you were already doing.
Communication style rather then problem
MI is not a panacea. Not suitable for all health
related problems. Short term sessions
Bem, D. (1967) Self-Perception. An Alternative
Interpretation of Cognitive Dissonance Phenomena.
Psychological Review 74 (3), p.183-200.
Brehm, S. S. and Brehm, J. W. (1981) Psychological
Reactance: A Theory of Feedom and Control. New
York: Academic Press.
Janis, I. L. and Mann, L. (1977) Decision- Making. A
Psychological Analysis of Conflict, Choice and
Commitment. New York: Free Press.
Kanfer, F. H. (1987) Self Regulation and Behaviour.
Jenseits des Rubikon. Heidelberg: Springer-Verlag.
Miller, W. R. and Rollnick, S. (2009) Ten Things that
MI is Not. Behavioural and Cognitive Psychotherapy
Orford, J. (1985) Excessive Appetites. A
Psychological View of Addictions. New York: Wiley.
Prochaska, J. O. and DiClemente, C. C. (1984) The
Transtheoretical Approach. Crossing Traditional
Boundaries of Therapy. Homewood, Illinois:
Rokeach, M. (1973) The Nature of Human Values.
New York: Free Press.
Rogers, R. W. (1975) A Protection Motivation
Theory of Fear Appeals and Attitude Change.
Journal of Psychology 91 (1), p.93-114.