Motivational Interviewing workshop for health psychologists.

1. MOTIVATING CHANGE
Health in action. Developing a connection that creates openness to
transformation. Moving from wrestling to dancing…

3. MI Spirit comes from the foundation in humanistic psychology. This foundation
holds that people when supported to continue to be authentically engaged
with their experience will move towards their own best health.
ACE is the Center of MI Spirit
Autonomy
Collaboration
Evocation
Authority
Coercion
Education
VS

4. Motivational Interviewing – Your main goal in MI is to support and engage
with change talk and avoid triggering sustain talk. Change talk is talk that
is motivated towards a new more authentic direction and sustain talk is
focused on reasons why things are the way they are.
More Change Talk = More Change
More Sustain Talk = More of the Same

5. Change
Talk
Sustain
Talk
1. MI is a person centered approach not a
disorder centered approach to health and
change.
2. Motivation has stages that can be moved
through and is not a character trait.
3. Defensiveness/resistance is therapeutic.
4. Therapist style impacts motivation and behavior.
5. Resistance and change talk are both part of the
core challenge of ambivalence.
6. How a can individual resolves ambivalence is
central to changeDo More that
supports…
Do less that
increases…

9. Spirit
Principals
Microskills
Change Talk Commitment
Behavior Change
ACE - A: Autonomy, Collaboration, Evocation Acceptance
Role with Resistance, 2. Express Empathy, 3. Develop
Discrepancy, 4. Support Self-Efficacy
Desire, Ability, Reason, Need
Commitment, Activation,
Taking Steps
OARS - O = Open Ended Questions, A = Affirmation,
R = Reflective Statements, S = Summaries

10. GROUP SKILLS PRACTICE Use the Skills
https://www.youtube.com/watch?v=80XyNE89eCshttps://www.youtube.com/watch?v=80XyNE89eCs

11. REFLECTIVE STATEMENTS 1. Simple Reflection: Simply Repeats or
Paraphrases the patient response.
2. Amplified Reflection: Amplifies a
particular point expressed by the patient.
3. Double-Sided Reflection: Includes both
sides of the ambivalence.
4. Metaphor Reflection: Uses a metaphor to
capture the feeling and experience of the
patient.
5. Meaning Reflection: Captures depth of
meaning and reflects it back to a patient.
6. Reflection of Feeling: Reflects back the
feeling state the patient expressed.
• Reflective statements are statements where you
reflect back to a patient what they have said.
• The ratio of reflective statements (RS) to questions
should be about RS to every questions.
• Start interactions with simple reflective statements
and move to more deep and integrated reflective
statements at the middle of the session.
• Metaphors, stories and emotional reflections are
types of reflective statements used when there has
been a clear establishment of connection.
Types of Reflective Statements

12. EXERCISE – REFLECTIVE STATEMENT SPEED THERAPY
1. Get in two rows of chairs facing one another
2. Count off from 1 to 8
3. All odd number people will be the patient first and ask the question on the next slide.
4. All the even number people will be the clinician first and will respond using a type of
reflective statement. We will start with the simple reflections as 1 and move through
reflection of feelings as number 6.
5. Once you have completed a question. The people in the odd number rows will rotate. All
people will shift one seat down and the person on the end will go to the beginning of the
line.
5. You can use your handout incase you forget the question and the statement.

13. SPEED THERAPY SKILLS PRACTICE Reflective Statements
‘I want my diabetes to be less out of control. But I
love sugar! Treats make me feel better. I live in a
really stressful home. I know they are not good for
me but if they are around I can’t stop myself.”

16. The first PROCESS in a motivational interviewing session
is patient engagement…
Engagement is – The “PROCESS” of establishing a mutually
trusting and respectful helping relationship.

17. 1. Engaging: Building a relationship bases for change.
(Avoid to many questions, Avoid Solutions, Avoid labeling, Avoid Assigning
Blame)
2. Focusing: Collaborative agenda setting. Ongoing process of developing
and focusing along with agenda setting. Identify differences in goals…
3. Evoking: Elicit client responses through use of OARS.
4. Planning: Developing commitment to change.

20. 5 Minute Practice Sessions… Practical Behavior Change
Overview: In this exercise we will divide up into groups with an
observer, a patient and a clinician. The patient can use a real change
they would like to make in their life or the example change. We will use
the SBIRT quick tool to support change. Using the four part series on the
card and rotate. http://www.sbirtoregon.org/video-demonstrations/

21. ROLLING WITH RESISTANCE…
Signs of Resistance
Arguing with your point.
Interrupting the clinician
Negating or denial
Sustain talk/Ignoring facts
------------------------------------------------
These are a cue to: Change strategies,
Normal expression of ambivalence,
related to interpersonal dynamic
How to Roll with Resistance
Reflections – Once you have engaged the
patient using double sided reflections can
help support change while allowing
ambivalence
Shift Focus – Don’t push against the resistance
shift the focus to exploring the ambivalence
Come along side – Join the person and
explore their thoughts, fears and concerns.
Emphasize Choice and Control – Reinforce
that the individual is the one with choice and
power and that they can work on their goals
and visions.

23. Motivational
Interviewing
Hill Metaphor
Pre-Cont. Cont. Prep. Action
Types of Change Talk
D = Desire talk is expressions of desire
to change
A = Ability or expressions that someone
feels able to change.
R = Reasons the patient explores their
responses that they want to change
N = Needs the patient explores needs
for change.
________________________________
C = Commitment at this point the patient
has crossed into action. They are
exploring their commitments for change,
A = Actions change talk is exploring the
actions needed to be successful.
T = Taking Steps is the time when a
patient is discussing active steps they
have taken towards change.

24. An adult patient who uses
methamphetamine receives
a brief intervention.
SBIRT Oregon Training Video
Listening for change talk… While watching
this video count the number of times that you
hear each kind of change talk. Considering
MI Skills after the video is over choose one
moment of change talk and explore how you
would valite or increase exploration of
change talk.
http://www.sbirtoregon.org/video-demonstrations/

25. Self Evaluation Form… Committments for Change.
What are you able to committee to for
exploring and increasing MI Skills in your
patient interactions?