Motivational interviewing is a collaborative counseling method used to strengthen a person's own motivation for change. It aims to resolve ambivalence about change in a spirit of partnership, acceptance, compassion, and evocation rather than confrontation. Research shows MI is effective for addressing many health behaviors and conditions, with studies doubling every three years. MI works by having the therapist use MI-consistent speech to increase the client's change talk, which improves outcomes.
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12. Learning Objectives
1. Identify practical strategies to motivate
change
2. Reflect on how you can adapt these
strategies with your clients
3. Set concrete objectives for clinical
practice
13.
14. Persuasion Exercise
• Choose one person near you to have a
conversation with, and work together
• One will be the speaker, the other will be
a counsellor
Miller & Rollnick, 2013
14
15. Speaker’s Topic
• Something about yourself that you
want to change
need to change
should change
have been thinking about changing
but you haven’t changed yet
…in other words – something you’re
ambivalent about
Miller & Rollnick, 2013
15
16. Counsellor: Find out what change the
person is considering making, and then:
• Explain why the person should make this
change
• Give at least three specific benefits that
would result from making the change
• Tell the person how they could make the change
• Emphasize how important it is to change
• If you meet resistance, repeat the above.
P.S. This is NOT motivational interviewing
Miller & Rollnick, 2013
16
17. Listeners:
What were you thinking
or feeling during this
conversation?
Miller & Rollnick, 2013
18. Common Reactions to Righting Reflex
• Angry, agitated • Afraid
• Oppositional • Helpless, overwhelmed
• Discounting • Ashamed
• Defensive • Trapped
• Justifying • Disengaged
• Not understood • Not come back – avoid
• Not heard • Uncomfortable
• Procrastinate
Miller & Rollnick, 2013
18
23. Listener
• Listen carefully with a goal of understanding the dilemma
• Give no advice.
• Ask these four open questions and listen with interest:
1. Why would you want to make this change?
2. How might you go about it, in order to succeed?
3. What are the three best reasons to do it?
4. On a scale from 0 to 10, how important would you
say it is for you to make this change?
Follow-up: And why are you at __ and not zero?
• Give a short summary/reflection of the speaker’s
motivations for change
• Then ask: “So what do you think you’ll do?” and
just listen
Miller & Rollnick, 2013
23
24. Speakers:
What were you thinking
or feeling during this
conversation?
Miller & Rollnick, 2013
25. Common Human Reactions to
Being Listened to
• Understood • Safe
• Want to talk more • Empowered
• Liking the counselor • Hopeful
• Open • Comfortable
• Accepted • Interested
• Respected • Want to come back
• Engaged • Cooperative
• Able to change
Would you rather work with these people…
Miller & Rollnick, 2013 25
26. …or these?
Common Reactions to Righting Reflex
• Angry, agitated • Afraid
• Oppositional • Helpless, overwhelmed
• Discounting • Ashamed
• Defensive • Trapped
• Justifying • Disengaged
• Not understood • Not come back – avoid
• Not heard • Uncomfortable
• Procrastinate
Miller & Rollnick, 2013
26
27. What is it for?
Motivational interviewing is a
collaborative conversation to
strengthen a person’s own
motivation for and commitment to
change
Miller & Rollnick, 2013
35. It is your choice But giving your kids
whether to make healthy food is very
this change… important in preventing
future problems
36. You are the one But if you keep
who has to injecting, your veins
decide… aren’t the only serious
thing to worry about
37. Regardless of what But even people we
you do, I will be trust make mistakes
here to support sometimes, and that
you… includes your
boyfriend
38. It is your choice But giving your kids
whether to make healthy food is very
this change… important in preventing
future problems
You are the one But if you keep
who has to injecting, your veins
decide… aren’t the only serious
thing to worry about
Regardless of what
you do, I will be But even people we
here to support trust make mistakes
you… sometimes, and that
includes your
boyfriend
39. • “It is your choice whether to make this
change.”
• “You are the one who has to decide.”
• “Regardless of what you do, I will be
here to support you.”
40. “People are most able to
change when they feel
free not to.”
- Carl Rogers
41. The “Spirit” of Motivational
Interviewing
• Partnership • Absolute worth
• Accurate empathy
• Acceptance
• Autonomy support
• Compassion • Affirmation
• Evocation
Miller & Rollnick, 2013
41
44. 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)
47. 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
59. “Miller and Mount, 2001 have
suggested that learning MI involves
at least two processes, one of
adding preferred behaviors, and
another of suppression of non-
preferred behaviors.”
(Baer, 2004)
60. “There is some evidence that
eliminating those responses such as
confrontations, advice without
permission, directing, threatening,
and raising concern without
permission is more important than
just adding MI-consistent responses.”
(Moyers and Ernst, 2001)
68. Four Processes in MI
1. Engaging: The relational foundation
2. Focusing: Clarify directions: What is the
horizon?
3. Evoking: The person’s own arguments for
change
4. Planning: Developing commitment to
change + formulating a plan of action
“Planning is the clutch that engages
the engine of change talk” (p.30)
Miller and Rollnick, 2013
69. Four Processes in MI
Planning
Evoking
Focusing
Engaging
Adapted from Miller and Rollnick, 2013, p. 26
75. Video Demonstration
Agenda Mapping conversation with "Sal"
http://www.youtube.com/watch?v=klnHJ4coG8o
76. “Readiness Ruler”
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.
• How important is it to change this
behaviour?
0 1 2 3 4 5 6 7 8 9 10
• How confident are you that you could
make this change?
0 1 2 3 4 5 6 7 8 9 10
83. Sustain Talk and Resistance
• Sustain Talk is about the target behavior
• Resistance is about your relationship
• Both are highly responsive to counsellor
style
• We respond to both in the same way
84. Change Talk: Sustain Talk:
I should But beer is
really cut good!
back on the
drinking…
85. Change Talk: Sustain Talk:
Smoking is But it is part
unhealthy… of who we are
86. Change Talk: Sustain Talk:
I should But I am
practice this booked back-
motivational to-back with
interviewing clients and
stuff… there is no
time!
87. DARN CAT
• Desire • Commitment
• Ability • Action
• Reasons • Taking Steps
• Need
88. Yet another metaphor
MI Hill
k M
al ob
Nange
T ili C
R Ch
zin
g A
Aory Ch
an
T
D rat ge
Ta
e pa lk
Pr
(Pre-) Contemplation Preparation Action
Slide from Bill Miller, 2010
89. DARN CAT
• Desire • Commitment
• Ability • Action
• Reasons • Taking Steps
• Need Snap fingers = DARN
Clap = CAT
Silence = No change talk
90. Listening for Change Talk
“I am getting too old for this
lifestyle.”
• Desire • Commitment
• Ability • Action
• Reasons • Taking Steps
• Need
91. “My probation order is the only
reason I am coming here.”
• Desire • Commitment
• Ability • Action
• Reasons • Taking Steps
• Need
92. “I am not addicted. I can quit
anytime I want.”
• Desire • Commitment
• Ability • Action
• Reasons • Taking Steps
• Need
93. “I want to get well again, but my
pain is still really bad.”
• Desire • Commitment
• Ability • Action
• Reasons • Taking Steps
• Need
94. “I have started a modified exercise
program, quit smoking and drinking,
am practicing mindfulness meditation
for one hour daily and will do whatever
else I need to return to work.”
• Desire • Commitment
• Ability • Action
• Reasons • Taking Steps
• Need
109. 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.
111. “How I live my life is my own business and
certainly not yours.”
Simple Reflection:
___________________________________
___________________________________
Complex (Enhanced) Reflection:
___________________________________
___________________________________
112. “How I live my life is my own business and
certainly not yours.”
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.
114. “I know you mean well, but I don’t need this
medication any more.”
Simple Reflection:
___________________________________
___________________________________
Complex (Enhanced) Reflection:
___________________________________
___________________________________
115. “I know you mean well, but I don’t need this
medication any more.”
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.
120. 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
121. “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”)
122. …or put another way…
The word you keep between
your lips is your slave. The
word you speak is your
master.
- Arabic proverb
123. Where am I in MI?
Simple Reflections
0 1 2 3 4 5 6 7 8 9 10
Complex Reflections
0 1 2 3 4 5 6 7 8 9 10
126. Confidence Ruler
No Way I am
0 1 2 3 4 5 6 7 8 9 10 Bill Miller
http://www.williamrmiller.net/
127. Castles in the air?
If you have built castles in the air, your
work need not be lost. That is where
they should be. Now put the
foundation under them.
Henry David Thoreau
130. 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=5318416
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
131. 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
132. Thank
you
marilyn.herie@utoronto.ca
www.educateria.com
@MarilynHerie