The document provides an overview of motivational interviewing. It discusses the efficacy of MI, which has been shown to be effective in treating addiction and other health behaviors in as little as 1-4 sessions. It outlines the stages of change model and describes strategies and principles of MI, including expressing empathy, developing discrepancy, avoiding argumentation, and supporting self-efficacy. The document emphasizes that the spirit of MI is collaborative and aims to evoke motivation for change from clients in a warm, respectful manner.

1. Motivational Interviewing
By
Gaylord INENA
Supervisor : Dr. KIRABIRA Joseph
M I

2. OUTLINE
-INTRODUCTION
-EFFICACY OF MI
-STAGES OF CHANGE
-BASIC PRINCIPAL OF MI
-SKILLS OF A GOOD MOTIVATIONAL THERAPIST
-MOTIVATIONAL SKILLS OPENING STRATEGIES
-PRINCIPLES OF MOTIVATIONAL INTERVIEWING
-SPIRIT OF MI
-RESISTANCE” OR “SUSTAIN-TALK”
-METHODS
-STAGES OF CHANGE AND WISE INTERVENTIONS
-CONCLUSION
-REFERENCIES

3. Introduction
Motivational interviewing is a treatment
intervention based on principles from humanistic
psychology.
Motivational Interviewing is
“ a client-centered, goal-oriented
method for enhancing intrinsic
motivation to change by exploring and
resolving ambivalence”
Miller & Rollnick, 2002
Or…
Helping people talk
themselves into
changing

4. Resolve ambivalence by increasing internal motivation
& increasing self-efficacy

 MI : seeks to increase the perceived
importance of making a change
and increase the client’s belief that
change is possible.
Readiness to change:
Is a high degree of both importance
and confidence.
(Stephen Rollnick)
(2)
Low _ Confidence _high
H
i
g
h_
importance
_l
o
w (1)
(3) (4)
(1) unwilling & unable
(2) unwilling & able
(3) willing & unable
(4) willing & able

5. Efficacy of MI
-MI is evidenced based,
-1200 publications or more supports it’s effectiveness
-200 of which are Random Control Trials
-Primary focus has been on addictive behaviors
-Research base is broadening into the areas of
healthcare, corrections, and working with youth

6. Efficacy of MI…
 Effective in the treatment of a wide range of
behavioral and health related problems.
 Successfully in addiction treatment in inpatient,
outpatient, crisis services and long-term residential
settings.
 increase compliance with psychiatric, diabetes, and
cardiac medical treatment effectively.
 also been used :
-successfully to improve diet,
-increase level of exercise and
-there is mixed evidence of it’s effectiveness in
smoking cessation.

7. Summary of Outcome in Clinical Trials
 Outcome effectiveness has been shown
(in as little as 1 to 4 sessions) with:
 Substance abuse and dependence with substances including:
alcohol, cocaine, amphetamines, opiates, marijuana, and tobacco.
 Medical issues that have proven outcome evidence include diet and
physical activity, medication adherence, HIV prevention, cardiovascular and
diabetes management, hypertension, asthma,TBI, SCI, and bulimia.
 The variables used to measure outcome include: abstinence, reduction
in symptoms, increase in insight, goal-setting, attendance, participation,
adherence, successful transition from inpatient to outpatient services and
retention of clients in treatment.
 Settings where motivational interviewing has been successful
include residential, inpatient, outpatient, outreach, and colleges.

8. :
James Prochaska, and Carlo DiClemente identified
stages that people progress through as they make a
behavioral change.

9. Stages of Change
Pre-contemplation: The person has no intention to change/ Not
Ready for Change
Contemplation: The person is ambivalent about change and
sees both pros and cons to the behavior / Thinking About
Change.
Decision-making: This is typically a brief stage as the person
resolves ambivalence and decides to make a change.
Action: The person takes some action toward resolution of the
problem behavior.
Maintenance: For a year after the change has been successfully
made, the client is at risk for relapse.

10. PRECONTEMPLATION
Offer factual information
Explore the meaning of events
that brought the person to
treatment
Explore results of previous
efforts
Explore pros and cons of
targeted behaviors
CONTEMPLATION
Explore the person’s sense
of self efficacy
Explore expectations
regarding what the change
will entail
Summarize self‐motivational
statements
Continue exploration of pros
and cons
DETERMINATION
Offer a menu of options for
change
Help identify pros and cons of
various change options
Identify and lower barriers to
change
Help person enlist social
support
Encourage person to publicly
ACTION
Support a realistic view of
change through small steps
Help identify high‐risk
situations and develop
coping strategies
Assist in finding new
reinforcers of positive change
Help access family and social
support
MAITAINENCE
Help identify and try
alternative
behaviors (drug‐free sources
of pleasure)
Maintain supportive contact
Help develop escape plan
Work to set new short and
long term goals
RELAPSE
Frame recurrence as a learning
Opportunity. Explore possible
behavioral, psychological, and
social antecedents
Help to develop alternative
coping strategies
Explain Stages of Change &
encourage person to stay in the
process
Maintain supportive contact

11. Stages of Change Model
Processes of Change
STAGES
CHANGE
STRATEGIES
Pre-contemplation Contemplation Preparation Action Maintenance
Consciousness raising
Catharsis
Self re-evaluation
Self liberation
Helping relationship
Reinforcement management
Conter-conditioning
Stimulus control
EMOTIONAL/COGNITIVE BEHAVIOURAL ACTIVITIES

12. Curent

13. Rogerian/Client centered Therapy
Characteristics of Effective Change
Agents (Helpers)
 Accurate empathy
 Non-possessive warmth
 Genuineness
According to Carl Rogers & empirically
supported

14.  1.Empathy - is the ability to put oneself in another’s situation and
accurately convey an understanding of their emotional experience without
making a judgment about it.
sympathy which connotes “feeling sorry” for another person.
Eempathy is a more egalitarian sharing of a feeling state. It encompasses
a wide range of affect where sympathy is generally a reaction to another’s
sadness or loss.
2.Warmth - Someone who is warm uses the self to convey acceptance
and positive regard through their own positive affect and body language.

Rogerian* Constructs on which
Motivational Interviewing is based

15. Rogerian* Constructs on which
Motivational Interviewing is based
 3.Genuineness -is the ability to be oneself and feel comfortable in
the context of a professional relationship with a client. It does not
imply a high degree of self-disclosure, but a genuine presence in the
relationship. It may involve an ability to use the skill of immediacy.
 4.Immediacy -means that the counselor conveys thoughts, feelings and
reactions “in the moment”. An example is the counselor’s sharing of
their own feelings of sadness in response to a client story of a loss.
It is different from empathy in that empathy will convey an accurate
understanding of the client’s feeling of sadness..
 * Based on the work of Carl Rogers a humanistic psychologist, theorist, researcher and clinician.

16. 


A PATHY - no response
to other’s distress
ANTI PATHY -
minimizing other’s
distress
SYM PATHY - sharing
other’s distress
 EM PATHY -
understanding without
sharing other’s distress

17. LISTENING JUDGING HELPING
APATHY NO NO NO NO
ANTSIPATHY YES NO YES NO
SYMPATHY YES YES YES NO
EMPATHY YES YES NO YES
UNDER
-STANDING

18. How your brain handles love and pain:
Scanners reveal mechanisms behind empathy and placebo
effect
Tania Singer / University College London
Functional brain imaging shows that some of the same regions of the brain are
activated by personal pain, at left, and by empathy over the pain of a loved one,
at right. But other areas are not activated by empathy.

19. The skills of a good motivational
therapist
 Understand the other person’s frame of reference
 Filter the patient’s thoughts so that statements encouraging change are
amplified and statements that reflect the status quo are dampened
down
 Elicit from the patient statements that encourage change
(expressions of problem recognition, concern, desire, intention to change and
ability to change)
 Match the processes used in the theory to the stage of change; ensure that
they do not jump ahead of the patient
 Express acceptance and affirmation
 Affirm the patient’s freedom of choice and self-direction

20. Principles of Motivational
Interviewing
DARES
 EE - Express Empathy
 RR - Roll with Resistance
 DD - Develop Discrepancy
 SS - Support Self-efficacy
 AA - Avoid Argumentation

21. Principle #1 Express Empathy
 Accurate empathy conveys understanding of the
client through the skill of reflective listening.
It clarifies and mirrors back the meaning of client
communication without distorting the message.
 Empathy can be measured through objective scoring,
and high levels of empathy are correlated with
increased client perception of therapeutic alliance.
*HCP empathy is highly correlated with successful
treatment outcome.
* HCP = Health Care Provider

22. Principle #2 Roll with Resistance
In MI,
 “Resistance” is defined as a misalliance in
the HCP-client relationship and not an
inherent “symptom” of addiction.
 Client ambivalence is accepted as a natural
part of the change process.
 Client “resistance” is decreased through
the use of non-confrontational methods.
 MI advocates “rolling with” and accepting
client statements of resistance rather than
confronting them directly.

23. Principle #3 Develop Discrepancy
 Arguments clients themselves make for change are
more effective than arguments offered by others.
 It is the HCP’s role to elicit these arguments by
exploring client values and goals. Discrepancies
identified between the client goals, values and current
behavior are reflected and explored.
 The HCP focuses on the pros and cons of the
problem behavior and differentially responds to
emphasize discrepancies identified by the client.

24. Principle #4 Support Self-efficacy
 • Key to behavior change is the expectation
that one can succeed.
 Motivational Interviewing seeks to increase
client perception about their skills, resources
and abilities that they may access to achieve
their desired goal.

25. Principle #5 Avoid Argumentation
 • It is easy to fall into an argument trap when
a client makes a statement that the HCP
believes to be inaccurate or wrong.
 MI takes a supportive and strength-based
approach. Client opinions, thoughts and
beliefs are explored, reflected and clarified,
but not directly contradicted.

26. Spirit of Motivational Interviewing
 • Motivational Interviewing, like client -centered
counseling has been described as a “way of being”
with a client.
 The “spirit” in which it is delivered is as important as
the techniques that are used.
 The spirit of MI is characterized by a warm, genuine,
respectful and egalitarian stance that is supportive of
client self-determination and autonomy.

27. Spirit of MET: “ACE”
 (Miller and Rollnick) (2002)
 1. Autonomy
Self-determination theory
Clients present arguments for change
 2. Collaboration:
Partner vs. authority
Exploration vs. exhortation
Support vs. persuasion
 3. Evocation :
Eliciting vs. imparting

28. Curent Spirit of MI
(Miller and Rollnick) (2013)
 Refined and expanded the dimensions of the spirit of MI
 include :
-Partnership
-Acceptance
-Compassion
-Evocation

29. Partnership
 Similar to collaboration
 the patient should be approached as a partner in a
consultative manner.
 The emphasis is on working together with the patient
to arrive at decisions VS. authoritative, prescriptive
stance often characteristic of clinicians.
 The authors liken MI to “dancing rather than
wrestling” with the patient.

30. Partnership…
---------This also involves recognizing that the clinician
have his agenda for the patient (to stop using drugs or
alcohol typically),
---------But the patient’s agenda must be respected as
well, and
**** it is ultimately the patient who must decide to
implement change

31. Acceptance
 founded in the work of Carl Rogers
 Divided into four concepts:
-Absolute worth : valuing and accepting the patient for
who they are VS. to passing judgment
-Accurate empathy: the effort to deeply understand the
patient’s point of view VS allowing the clinician’s
perspective to interfere;

32. Acceptance…
-Autonomy support: respecting that the patient is in
charge and needs to decide for himself or herself the
course of action VS. impose on or coerce the patient
toward particular goals;
-Affirmation : identifying and recognizing a patient’s
strengths, abilities, and efforts VS focusing on
weaknesses or failures.

33. Compassion
-Means a fundamental commitment to understand and
pursue the best interests of the patient.
-Emphasized to ensure that MI is intended to support
the goals and values of the patient VS those of the
clinician or anyone else.

34. Evocation
Reflects a fundamental assumption of MI:
‘’’the patient has strengths and capabilities and that
the goal is to draw these out.”””
This is in contrast to a deficit model that pervades much
of medicine and other

35. Self-Perception Theory:
“I know what I think when I hear myself speak”
Daryl Bem (Self-Perception theory)

36. Client Counselor Relationship
 The quality of the therapeutic relationship accounts
for up to 30% of client improvement in outcome
studies. (Hubble, Duncan & Miller,2004)
 The emphasis on client-HCP relationship may be
related to the positive outcomes achieved by MI in a
wide-range of settings and with broad range of
behavioral health problems.

37. working alliance
-or “collaboration to change”
-Common into all models of therapy, and to supervisory
relationship.
-Composed of 3 elements:
1.The bond between therapist and client.
2.The extent to which they agree on goals.
3.The extent to which they agree on tasks to obtain the
goals.
-The real change in therapy occurs during the process of
weakening of the relationship and then repair of the
relationship

38. Motivational Skills Opening Strategies
 Open-ended Questions
 Affirmations
 Reflections
 Summaries

39. Opening Strategies (OARS)
 Open-ended Questions
Open-ended questions are questions that you
cannot comfortably answer with a yes/no/maybe
answer.
An example of a close-ended question (one that
can be answered yes/no/maybe) is, “Have you had
anything to drink today?”
An example of an open-ended question is,
“What is a typical drinking day like for you?”

40. Opening Strategies (OARS continued)
Affirmations
 identifies something positive about the client and gives credit or
acknowledgement. It may be a trait, behavior, feeling or past or
present accomplishment.
Eexamples of an affirmation, “I really like the way you are
approaching this problem, I can see that you are very
organized and logical and I am sure this will help you to
succeed in our program.”
 An affirmation must always be genuine and never condescending.
 An affirmation can be used to reframe what may at first seem like
a negative.
“I can see that you are very angry about being here, but I’d
like to tell you that I am impressed that you chose to come
here anyway, and right on time!”

41. Opening Strategies (OARS continued)

 Reflections
Statements made to the client reflecting or mirroring back to them the
content, process or emotion in their communication.


When using MI the counselor wants the majority of their communication to
be in the form of reflections and not questions.

An example of a reflection is “You have been really trying to stay sober and
are upset by this set-back.”

42. Opening Strategies (OARS continued)
 Summaries
 Summaries are simply long reflections.
They can be used to make a transition in a session, to
end a session, to bring together content in a single
theme, or just to review what the client has said.
 An example is: “Let’s take a look at what we have talked about
so far. You are not at all sure that you have a ‘problem’ with
alcohol but you do feel badly about your( Driving While
intoxicated) and it’s effect on your family. You said that your
family is the most important thing to you and you would consider
totally quitting drinking if you believed it was hurting them.”

43. “Resistance” or “Sustain-talk”
 •Client “resistance” is seen as a normal part of the
change process.
•Clients are assumed to be ambivalent about
change and statements can be seen as arguing
either for change or for the status quo.
 Clients arguing for the status quo have been
historically identified as “unmotivated” or
“resistant” to change.
 MI currently uses the term “sustain-talk” to describe
client communication that indicates a desire, plan or
commitment to staying the same.

44. Types of “Sustain-talk”
Clients may not want to make the changes required by the program
and many argue strongly against making these changes.
They may:
 Argue
 Deny a problem
 Accuse
 Interrupt
 Disagree
 Passively resist though minimal answers
 Overtly comply due to mandate with little investment
 Become angry

45. Examples of Client Statements
 “I don’t have a problem, it is all a mistake.”
 “I don’t drink anymore alcohol than the Judge
does.”
 “You people are just out to make money on this.”
 “My wife thinks everyone has a problem because her
father is an alcoholic.”
 “I know I need to cut down, but I can do it on my own.”
 “Coming to this program makes me feel worse, when do
I get discharged?”

46. Responding to “Sustain-talk”
 One of the goals of motivational interviewing is to increase the
amount of time the client engages in “change-talk” and minimize
the amount of “sustain-talk.”
 Specific techniques have been shown to decrease “resistance” or
“sustain-talk.”

47. Techniques for Responding to “Sustain-talk”
Reflective Techniques
Simple Reflection:
 A simple reflection, mirrors or reflects back to the client the content, feeling or
meaning of his/her communication.
 An example of a simple reflection to respond to “sustain-talk” is:
Client: “I know I made a mistake but the
hoops they are making me jump through
are getting ridiculous.”
Counselor: “You are pretty upset about all this. It seems
like everyone is overreacting to a mistake.”

48. Amplified Reflection
An amplified reflection takes what the client said and increases the intensity of the
“sustain-talk. ”When hearing an amplification of what was communicated, a client will
often reconsider what he/she said and clarify.
An example is:
 Client: “I know I made a mistake, but the hoops they
are making me jump through are ridiculous.”
 Counselor: “You don’t agree with any of what they
are making you do.”
 A client may respond to this, “No, I know I need to do
some things to make this right but I am frustrated
with all these meetings.”

49. Double-sided Reflection
 A double-sided reflection attempts to reflect back both sides of the ambivalence the
client experiences so that the client hears back both the “sustain-talk” in his/her
communication and the “change-talk.”
 An example of a double-sided reflection is:


Client: “I know that I made a mistake, but the hoops they are making me
jump through are ridiculous.”
Counselor: “You made a mistake and it sounds like you feel badly about
that, but you also think that people are asking you to do too much

50. Eliciting Change Talk
Evocative Questions:
 How do you want your life to be different?
 How confident are you that you could stop
using?
 What consequences have you had because
of this problem?
 How important is it for you to change?
 What do you think you might do about your
job?

51. DARN-C
 Desire
 Ability
 Reason
 Need
 Commitment

52. Methods of MI
4 process in MI
Engaging : both parties establish a helpful connection
and a working relationship
Focusing : process of engaging leads to a focus on a
particular agenda: what the person came to talk about.
The provider may also have an agenda, some of which
may or not overlap with the client .
One or more change goals may emerge.
The focusing process helps clarify direction

53. Methods…
Evoking : involves eliciting the client’s own motivation
for change.
Most simply put, evolving is having the person voice
the arguments for change.
Planning : encompasses both the commitment to
change and formulating a specific plan of action.

54. Method of MI – Questions to Ask Yourself
54
● Engaging
1. How comfortable is this person in talking to me?
2. How supportive and helpful am I being?
3. Do I understand this person’s perspective and concerns?
4. How comfortable do I feel in this conversation?
5. Does this feel like a collaborative partnership?

55. Method of MI – Questions to Ask Yourself
55
● Focusing
1. What goals for change does this person really have?
2. Do I have different aspirations for change for this person?
3. Are we working together with a common purpose?
4. Does it feel like we are moving together, not in different directions?
5. Do I have a clear sense of where we are going?
6. Does this feel more like dance or wrestling?

56. Method of MI – Questions to Ask
Yourself

57. Method of MI – Questions to Ask
Yourself
Planning
1.What would be a reasonable next step towards change?
2.What would help this person to move forward?
3.Am I remembering to evoke rather than prescribe a
plan?
4.Am I offering needed information or advice with
permission?
5. Am I retaining a sense of quiet curiosity about what
will work best for this person?

58. Stages of Change Stage-Wise
Interventions
Precontemplation :
-The client is not ready to change and
- identification with the “problem” is marked with
positive associations.
Goal : to get client to form some ambivalence
regarding problem.
Contemplation:
-Ambivalence exists with the client regarding problem
-the association with the identified problem are now
good and bad.
Goal : to move the client into preparation stage.

59. Stages of Change Stage-Wise
Interventions
Preparation :
-Client has substantially resolved ambivalence and
-prepares to commit to a change in the problem behavior.
Goal is to move the client into the action stage.
Action :
-Client has committed to specific actions intended to bring
about change,
-but needs help in maintaining this level of change.
Goal : to provide client with help in this area and work
client towards next stage

60. Stages of Change Stage-Wise
Interventions
Maintenance :
-The client enters the point of being able to sustain the
changes accomplished previously.
-Replacing problem behaviors with new, healthy life-
style.
Termination :
-Person exits in the cycle of change without fear of
relapsing to previous behavior.
-Much debate over whether certain problems can
be terminated.

61. Stages of Change Stage-Wise
Interventions
Relapse/Recycling :
-Relapse to one of the first three stages of change.
-Expectable setbacks and hopefully learn from relapse
before committing to a new cycle of action
-Multidimensional assessment to explore relapse
reasons

62. Stages of Change Stage-Wise Interventions
Engagement
Building a relationship with the individual
Reflective listening
Meeting basic needs
Persuasion Reflective
listening Instilling hope
Success stories
Develop discrepancies Plans to
change
Active Interventions
Education/information
Relapse Prevention Strategies to
prevent relapse Maintaining Supports
Multidimensional assessment to
explore relapse reasons
Pre-contemplative
Unaware there is a problem
Lack of Insight
Denial
Contemplation Admitting/wanting to change
but not able/willing to change
Preparation Pros and cons list
Unsuccessful efforts to change
Action
Motivated Taking steps to change Building
supports
Maintenance and Termination
Met goal Prevention of falling back to old
behaviors
Relaps

63. Conclusion
MI
-A Humanistic psychotherapy
-Client Centered
-Use the stages of the Change
-Has Methods, Principles, spirit,…
-Effective for addiction and others

64. REFERENCES
1.Petros L., Bachaar A .,Carla M., Motivational interviewing for Clinical
Practice. Arlington, Virginia : American Psychiatric Association
Publishing, 2017
2. Jacqueline Corcoran, Motivational Interviewing A workbook for social
workers. Oxford University Press, 2016
3. Richardson, L. (2012). Motivational interviewing: Helping patients
move toward change. Journal of Christian Nursing, 29(1), 18-24
4. Miller, W. R. & Rollnick, S. (2013). Motivational Interviewing, 3rd
Edition.Guilford Press. New York, NY.
5. Ravindranath Kolli, MD Director of Psychiatric services SPHS,
Monessen, PA .Presentation .2010.
6. Cari Guthrie Cho, LCSWC Chief Operating OfficerThreshold Services,
Inc. Presentation .2014.

65. MANY THANKS
Patrick Archange and Theonor Michael ange