This document discusses motivational interviewing, a counseling approach used to facilitate health behavior change. It provides an overview of the historical development and theoretical underpinnings of motivational interviewing. Key principles of motivational interviewing include expressing empathy, developing discrepancy, rolling with resistance, and avoiding arguing with clients. Specific techniques discussed include reflective listening, open-ended questions, affirming client strengths, and developing awareness of risks and benefits of behavior change.

1. CHCAOD511B Session six07/04/11

2. Motivational interviewing

3. “Motivational interviewing is a style of patient-centred counselling developed to facilitate change in health-related behaviours. The core principle of the approach is negotiation rather than conflict. In this article I review the historical development of motivational interviewing and give some of the theoretical underpinnings of the approach. I summarise the available evidence on its usefulness and discuss practical details of its implementation, using vignettes to illustrate particular techniques” (Treasure, J. 2004).

4. when a person feels that there is nothing that can be done about a serious health threat their defense mechanisms become active and they go into a state of denial to reduce the associated emotional arousal caused by them being aware of this threat. Protection Motivation Theory

6. Empathy – Understanding the clients situation from their point of view. Develop Discrepancy – Try to uncover inconsistencies in the information the client is giving to you. Support will require you to encourage the client to identify these discrepancies and clarify goal setting towards desired change. Fundamental principles

7. Roll with Resistance – Clients sometimes will only provide you with part of the story, be selective in what they consider relevant, and give you half truths. As a support worker you can rephrase a client’s words to maintain their motivation. It may be appropriate to invite changes in perception and ideas. Don’t impose anything on the client. Examples of resistance may be:

8. Client not showing up at appointment

9. Arriving late

10. Refuses to answer questions

11. Plays word games

12. Arguing

13. Denying

14. InterruptingAvoid Arguing – Fear and resistance will be the outcome of any direct arguing with clients. Self-Efficacy – Clients need confidence in their own ability to make change. Workers can: Elicit hope for change Identify and recognize client strengths Discuss client’s belief that change is possible

15. More about MI

16. Motivational interviewing is a collaborative, person-centered,evidence-based, guiding method of communication for enhancing and strengtheningintrinsic motivation for change.

18. First developed in early 1980’s to work with problematic alcohol useBased on the understanding that signification people in one’s life can form the basis of motivation to changeOrigins

19. CollaborationAutonomySpirit of MIRespectCompassion

20. Was there a change agent (teacher, supervisor, counsellor, relative) who had a major positive influence on your life?What were their characteristics?What are some characteristics you believe a counsellor should have?Consider...

21. creative and imaginative shows awareness by not imposing personal concerns on a client has common sense and social intelligence shows respect for the client action orientated. Jarvis, Tebbutt and Mattick (1995)The ideal counsellor is..

22. Protection Motivation' theory, for example, proposes that people change a health risk behaviour when: (1) they perceive a serious and probable risk to their welfare, and (2) they perceive an available and efficacious course of action by which their risk can be reducedA review of PMT

23. MI Tools and techniques

24. Gorden (1990) listed 12 responses which block or inhibit two way conversations. He has called these roadblocksOrdering, directing or commanding Response: You need to stop drinking now. Warning or threatening Response: If you don't stop using heroin you will be dead within six months.Giving advice, making suggestions, or providing solutions Response: The best thing you can do is tell your mother that...Effective listening

25. Persuading with logic, arguing or lecturing Response: You may think that but experts tell us differently. Moralising or preaching Response: You must realise that you can not be a good mother when you are drinking like this.Disagreeing, judging, criticisingResponse: No matter how strong the cravings are there is no excuse for stealing.Agreeing, approving or praising Response: It is very hard for you, your father had a drink problem so naturally you drink heavily.Roadblocks

26. Shaming, ridiculing or labelling Response: Your children are suffering as a result of your drinking. Why won't you stopInterpreting or analysing. Response: It seems to me that your wife is behaving like that to get a reaction from you. Reassuring, sympathising or consoling Response: Don't worry we will sort everything outInappropriate questioning Response: This may be a question that is not relevant to the intervention and thereby limiting client willingness to respond.Roadblocks cnt

27. Withdrawing, distracting, humoring or changing the subjectResponse: I think most of us drink in excess of the guidelines on occasions. Did you have any luck in finding a job?Roadblocks cnt

28. EmpathyParaphrasingReflectingOpen ended questionsMore tools & techniques

29. The client questions consistency between personal values and current behavior. The counselor uses affirmations of the client's strengths and focuses on constructive efforts to change.Carl Rogers “unconditional positive regard”Client in contemplation stage ready to start developing discrepancy...in pre-contemplation need to continue developing awarenessDeveloping discrepancy

30. Good reflective statements incorporate meaning with elements of the change dilemma. E.g. when the client says, "I do not think I have a drinking problem, but my wife does," the counselor responds with something like, "I understand you are not concerned about your drinking, but your wife is and this concerns you." Reflective statements, therefore, are the mainstay of a positive therapeutic relationship, allowing resistance to be acknowledged and diffused.Reflection

31. Begin with an opening/welcoming statement. Focus on one aspect of ambivalence. Ask about the positive/benefits of the client's substance use - ask the client to be specific, individualise the importance. Ask about the less good things: be specific individualise using reflection and amplified reflection probe to find out how the client feels (just because something is less good does not mean the client sees it as a problem). Checklist for MI interview