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A 'Taste' of Motivational Interviewing with Dr. Ellen Glovsky
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A 'Taste' of Motivational Interviewing with Dr. Ellen Glovsky

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This is an informative and exciting one-hour webinar, in which I will provided an overview of the "spirit" and technique of Motivational Interviewing. The webinar included 40 minutes of lecture and …

This is an informative and exciting one-hour webinar, in which I will provided an overview of the "spirit" and technique of Motivational Interviewing. The webinar included 40 minutes of lecture and ample opportunity for questions and answers.

MI is an evidence-based approach to health behavior change counseling. The method has been successfully used in many types of interventions, including the lifestyle changes recommended for weight management, diabetes, heart disease, eating disorders, HIV and cancer, the promotion of breast feeding, and nutrition for wellness and the prevention of chronic disease.

For more on MI and how it works, please sign up for my monthly newsletter http://eepurl.com/tbf81 , The Changing Times.

Please join me on Facebook https://www.facebook.com/TrainingwithDrEllenGlovsky and please join me on Facebook at my new 'book' page http://on.fb.me/1c0Iz73

Feel free to email any questions or comments you may have to Ellen@TrainingWithDrEllen.com

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  • 1. Motivational Interviewing A “Taste” of Motivational Interviewing Ellen R. Glovsky, PhD, RD, LDN Training with Dr. Ellen November 6, 2013 1 Motivational Interviewing Definition: directive, person-centered counseling style for increasing intrinsic motivation by helping clients explore and resolve ambivalence. A (Miller & Rollnick, 2002) MI is a collaborative approach to helping people change their behavior regarding their health. Most applicable in consultations where there is a preferred outcome 2 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 1
  • 2. Motivational Interviewing The Spirit of MI • Collaboration You don’t have to make change happen; you can’t Message to your client is “you have everything you need, and we’ll find it together” • Evocation Calling forth that which the client already has Doesn’t come from a deficit model • Acceptance Not necessarily that you approve of the other’s actions Express Accurate Empathy • Let your client know that you understand how they feel and what their issues with this behavior change are. 3 The Spirit of MI • Affirmation Seek and acknowledge the other’s strengths and efforts • Compassion Actively promote the other’s welfare, give priority to the other’s needs • Affirm Autonomy Counselor is willing to let the patient decide if, when and how they will go about changing. 4 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 2
  • 3. Motivational Interviewing Ambivalence • Not pathology! • A normal part of the process of change • Think of a time when you were asked to change something about yourself. Were you sure you wanted to do it? Were you sure you were able to do it? 5 The Four Processes of MI • Form the flow of MI Overlap, flow into each other, recur Each process builds on the one before it and remains as a foundation Planning Evoking Focusing Engaging 6 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 3
  • 4. Motivational Interviewing The Four Processes of MI Engaging: the process of establishing a helpful working relationship, forming an alliance Focusing: creating the agenda • Agenda of clinician and client may differ Evoking: eliciting the client’s own motivations for change • • Having the client voice the argument for change Help resolve ambivalence in the direction of change Planning: taking action Planning Evoking Focusing Engaging 7 Focusing MI: The Guiding Style GUIDE Instruct Listen ....*….....….…....….......*..............................*…... 8 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 4
  • 5. Motivational Interviewing Engaging, Focusing, Evoking Avoid the Righting Reflex: “Taking Sides” Trap Counselor Client • “You must change” • “I don’t want to change” • “You’ll be better off” • “Things aren’t half bad.” • “You can do it!!” • “No I can’t!!” • “You’ll die…” • “Uncle Fred is 89 and healthy as can be.” 9 Two Broad Sets of Skills in MI • Listening skills What did h/she say? What did h/she mean? Listening for CHANGE TALK • What-do-I-say-in-response skills OARS 10 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 5
  • 6. Motivational Interviewing Listening Skills Reinforce Change Talk Change Talk is any selfexpressed language that is an argument for change. It REALLY Matters Who Said What! 11 Listening Skills Good and Not So Good • Develop a discrepancy • Help the client discover their ambivalence • Discrepancy is the ENGINE of change 12 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 6
  • 7. Motivational Interviewing Build A Foundation of Listening: Get Your “OARS” in the Water • O: Open-ended questions • How you ask questions is critical! • Can not be answered with “yes” or “no” • A: Affirmations • Rapport building • Look for what the other person does right • R: Reflect • Helps to let your listener know you heard and helps to clarify what you heard • S: Summarize • Like offering a bouquet • Link material client has offered; ask if it’s accurate • Allows clinician a chance to build “argument” for change Techniques Used in MI 13 Three Places Communication Can Go Wrong Speaker Listener Words Words 2 3 1 Meaning Meaning 14 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 7
  • 8. Motivational Interviewing The Function of Reflection Speaker Listener Words Words 2 1 Meaning Reflection 3 Meaning 15 Engaging, Focusing, Evoking Reflective Listening Content reflections are short summaries “What did she say” Meaning reflections add the next sentence to the story “What did he mean?” 16 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 8
  • 9. Motivational Interviewing Summaries: 3 Types • Collect material that has been offered So far you’ve expressed concern about your blood pressure, your weight, and not being able to afford healthy food. • Link something just said with something discussed earlier. That sounds a bit like the problems you have with eating too much chocolate. Draw together what has happened and transition to a new task Let’s me summarize what you’ve told me so far, and see if I’ve missed anything important. Roll with Resistance/ Dance with Discord The Flip Side of Change Motivation & Resistance are Ever-Changing States of Readiness 18 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 9
  • 10. Motivational Interviewing Handling Resistance Dancing, Not Wrestling : Content reflection Meaning reflection Double-sided reflection When you meet resistance, try a different approach! 19 Assess Readiness and Set an Agenda •2 Important keys: Be alert for Readiness to Change Shift between Instructing and Listening •Overuse of Instruction gets in the way of “natural change” 20 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 10
  • 11. Motivational Interviewing Importance/Confidence 1. How important is it for you right now to change? On a scale of 0 to 10, what number would you give yourself? 0 ………………………………………………………………….. ………………10 not at all important extremely important A. Why are you there and not at 0? B. What would need to happen for you to raise your score a couple of points? Techniques Used in MI 21 Planning Importance/Confidence 2. If you did decide to change, how confident are you that you could do it? 0 ………………………………………………………….. …………………………..10 not at all extremely confident confident A. Why are you there and not at 0? B. What would need to happen for you to raise your score a couple of points? Techniques Used in MI 22 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 11
  • 12. Motivational Interviewing Planning Instruct & Negotiate Collaboratively “…a respectful, thoughtful, and reciprocal flow of information that champions the client’s own needs and autonomy can be a rich and life-changing experience and an integral part of MI.” Miller and Rollnick, 2012 23 Giving Information and Advice: 3 Kinds of Permission 1. The person asks for advice 2. You ask permission to give advice 3. You qualify your advice to emphasize autonomy Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 12
  • 13. Motivational Interviewing Feedback/Advice Formula… The only “recipe” in MI training 1. Ask permission to give feedback 2. Explain the meaning of the feedback you are about to give 3. Give only one fact and then only reflect the client’s responses. Do not argue, interpret, defend, or advise. 25 Words of Advice • Avoid the “I” and “Y” words • “I think…” • “You should…” • Use Neutral language • “Folks have found…” • “Others have benefited from…” • Use Conditional words • “Might consider” vs. “ought to,” “should” 26 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 13
  • 14. Motivational Interviewing How to Learn MI 1. 2. 3. 4. Attend a workshop Read & learn Practice & listen Get feedback and supervision 27 www.trainingwithdrellen.com http://bit.ly/WellnessNotWeight Like my book on Facebook: http://on.fb.me/1hMPHbz 28 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 14
  • 15. Motivational Interviewing MI Training DVDs Available with or without my book http://bit.ly/GXcUJO And the winner is… 29 Guilford Press www.guilford.com Use Promo Code: MINT Other Guilford titles available on my website, via Amazon.com 30 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 15
  • 16. Motivational Interviewing Ellen Glovsky: ellen@trainingwithdrellen.com www.nutrition-coach.com www.trainingwithdrellen.com Resources for Motivational Interviewing www.motivationalinterviewing.org 31 Ellen R. Glovsky, PhD,RD (c) 2007. Please do not reproduce without permission. 16

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