Motivational Interviewing

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Motivational Interviewing

  1. 1. Motivational Interviewing Scott Peters, M.A., LPC-S
  2. 2. Background of Motivational Interviewing <ul><li>Developed by William Miller in 1983 </li></ul><ul><li>Later refined by Miller and Stephen Rollnick in 1991 </li></ul><ul><li>Used to address and intervene with problem drinkers </li></ul><ul><li>MI can be defined as follows: </li></ul><ul><li>“ Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.” (Rollnick & Miller, 1995). </li></ul>
  3. 3. Miller based Motivational Interviewing on the “Change Model” * <ul><li>Developed by Prochaska & DiClemente (1982) </li></ul><ul><li>Made up of Five Stages: </li></ul><ul><li>Precontemplation </li></ul><ul><li>Contemplation </li></ul><ul><li>Determination </li></ul><ul><li>Action </li></ul><ul><li>Maintenance </li></ul><ul><li>Relapse </li></ul><ul><li>* This model was a radical departure from past approaches to addictions </li></ul>
  4. 4. Change Model- Stages <ul><li>Precontemplation - One is told there may be a problem. Needs information on the problem behavior. Not really considering change. </li></ul><ul><li>Contemplation - One begins to consider that there may be a problem. Sitting on the fence. </li></ul><ul><li>Determination - One now concludes that they need to do something. This is a dynamic stage. </li></ul><ul><li>(Sometimes called the “ Preparation ” stage) </li></ul>
  5. 5. Change Model- Stages <ul><li>Action- One makes steps to address the problem behavior. One is practicing new behaviors. </li></ul><ul><li>Maintenance - One continues to implement what one has learned in order to maintain healthy behaviors. They begin to find more intrinsic rewards. </li></ul><ul><li>Relapse - Resumption of old behaviors/patterns. </li></ul><ul><li>(Some research suggests that this is a normal and expected stage) </li></ul>
  6. 6. Key Concepts of Motivational Interviewing <ul><li>To understand how the client sees the problem </li></ul><ul><li>Counselor uses active listening and reflection to facilitate this process </li></ul><ul><li>Counselor asks questions to elicit information </li></ul><ul><li>Central focus is to examine and resolve ambivalence </li></ul><ul><li>Counselor points out discrepancies </li></ul><ul><li>Client-Counselor relationship is a partnership </li></ul>
  7. 7. Key Concepts of Motivational Interviewing <ul><li>Motivation to change is elicited from the client, not imposed by the counselor </li></ul><ul><li>It is the client’s task, not the counselor’s to state and resolve the ambivalence </li></ul><ul><li>Direct persuasion is not effective </li></ul><ul><li>Counselor’s approach is generally quiet and eliciting one </li></ul><ul><li>The counselor is directive in assisting the client </li></ul><ul><li>Readiness to change is not static, but fluctuating </li></ul>
  8. 8. Key Concepts of Motivational Interviewing <ul><li>Resistance and denial are seen as a product of environmental factors, not a character trait </li></ul><ul><li>Motivational level over the course of treatment is more important that initial motivation (or lack thereof) </li></ul><ul><li>Priority is given to resolving ambivalence </li></ul><ul><li>The MI counselor is persuasive, but not coercive; at times challenging, but never argumentative </li></ul>
  9. 9. Motivational Interviewing is … <ul><li>An interpersonal style </li></ul><ul><li>A subtle balance of directive and client-centered components </li></ul><ul><li>Affirming the client’s freedom of choice and self-direction </li></ul><ul><li>Self-empowering </li></ul>
  10. 10. Strategies of Motivational Interviewing <ul><li>Express empathy </li></ul><ul><li>Promote self-efficacy because the belief that one can change is a powerful motivator </li></ul><ul><li>Encourage the client to develop their own solutions to the problems that they themselves have identified </li></ul><ul><li>Assist the client is seeing how some of their current ways to doing things may lead them away from their eventual goals </li></ul>
  11. 11. Caveats to Consider in Motivational Interviewing <ul><li>Avoid arguing with the client </li></ul><ul><li>Ensure that any resistance to change is not generated by “jumping ahead” of the client </li></ul><ul><li>Stay away from labeling, blaming, being the expert, confrontation </li></ul><ul><li>Pressing client to change may increase resistance </li></ul>
  12. 12. Caveats to Consider in Motivational Interviewing <ul><li>Don’t use an authoritarian stance, leaving the client in a passive role </li></ul><ul><li>Don’t offer direct advice without direct permission to do so </li></ul><ul><li>Avoid the question-answer-question (leads to a hierarchical relationship) </li></ul>
  13. 13. A final thought… <ul><li>The basic approach to interactions in motivational interviewing is captured by the acronym OARS: </li></ul><ul><li>(1) Open-ended questions </li></ul><ul><li>(2) Affirmations </li></ul><ul><li>(3) Reflective listening </li></ul><ul><li>(4) Summaries </li></ul><ul><ul><ul><ul><ul><li>(Miller & Rollnick, 1991) </li></ul></ul></ul></ul></ul>

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