This document provides an overview of motivational interviewing (MI) as an approach to increasing motivation for change. It defines MI and outlines its key principles of expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. The document also describes the 8 stages of learning MI and the FRAMES approach, which involves providing feedback, emphasizing personal responsibility, advising on change options, providing menus of options, expressing empathy, and supporting self-efficacy. The goal of MI is to elicit a person's own intrinsic motivation for change through a collaborative conversation.

1. People are better persuaded by
the reasons they themselves
discovered than those that come
into the minds of others
Blaise Pascal
1623-1662
French mathematician, physicist, inventor,
writer and Christian philosopher

2. Carl Rogers
1902-1987
American Psychologist
Among the Founders of the Humanistic Approach to Psychology

3. William R. Miller
1947 (age 71 years)
American Clinical Psychologist
Professor of Psychology and Psychiatry at the University
of New Mexico in Albuquerque
Motivational Interviewing Pioneer

4. Stephen Rollnick
1952 (age 66 years)
Professor of Clinical Psychology at
Cardiff University
Motivational
Interviewing
Pioneer

5. 5
What are we talking about?
What does
“Increasing Motivation”
mean to you?

6. • Change is motivated by discomfort.
• If you can make people feel bad enough, they will
change.
• People have to “hit bottom” to be ready for change
• People don’t change if they haven’t suffered enough
The Stick
Traditional Approach (1)

7. • Someone who continues to use is “in denial.”
• The best way to “break through” the denial is
direct confrontation
Traditional Approach (2)
The Stick

8. • People are ambivalent about change
• People continue their drug use because of their
ambivalence
Another Approach: Motivation (1)
The carrot

9. • Motivation for change can be fostered by an
accepting, empowering, and safe atmosphere
The carrot
Another Approach: Motivation (2)

10. This Lecture: Motivational Interviewing
(MI)
• MI Definitions
• MI Principles
• 8 Stages to learn MI
• FRAMES Approach

11. Sources:
• Motivational Interviewing : Preparing People for Change
William R. Miller, Stephen Rollnick. 2nd ed. 2002
• Treatment Improvement Protocol (TIP 35) Enhancing Motivation for Change in Substance Abuse Treatment
• Quick Guide for Clinicians based on TIP 35
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services Administration (SAMHSA)
Center for Substance Abuse Treatment (CSAT) 2008
• Motivating Clients for Treatment and Addressing Resistance
International Network of Drug Dependence, Treatment and Rehabilitation Resource Centers (TREATNET)
United Nations Office on Drugs and Crime (UNODC)
Treatnet Training Volume B (Psychosocial elements of treatment) - Module 2 – 2008
• Eight Stages in learning Motivational Interviewing
Miller, W.R. & Moyers, T.B. Journal of Teaching in the Addictions. 2007
• Motivational Interviewing Training New Trainers (TNT) Manual, 2014
Motivational Interviewing Network of Trainers (MINT) 2014

12. Definition of
Motivational Interviewing

13. Lay person’s Definition:
A Collaborative conversation to strengthen a person’s own motivation
for and commitment to change
William R. Miller and Theresa B. Moyers 2006 Definition:
A clinical method for helping a person to resolve ambivalence about
change by evoking intrinsic motivation and commitment
Treatnet Definition 2008:
A directive, client-centred style of interaction aimed at helping people
explore and resolve their ambivalence about their substance use and
begin to make positive changes

14. A pragmatic practitioner’s definition (Why would I use it?):
A person‐centered counseling method for addressing the common
problem of ambivalence about change
A technical therapeutic definition (How does It work?):
A collaborative, goal‐oriented method of communication with particular
attention to the language of change. It is designed to strengthen an
individual’s motivation for and movement toward a specific goal by
eliciting and exploring the person’s own arguments for change
Most recent definition (2009):
A collaborative, person‐centered form of guiding to elicit and strengthen
motivation for change

15. Principles of
Motivational Interviewing

16. • Express Empathy
Acceptance – Listening – Understanding client’s Perspective – No Labelling
• Develop Discrepancy
Clarify Goals – Explore Behaviours Consequences – Create & Amplify
Discrepancy
• Roll with Resistance
Avoid Arguing – Find Another Way – Avoid Confrontation – Shift Perceptions
• Support Self Efficacy
Belief in Client’s Ability to Change – Ensure the Client is Responsible for
Change – Provide Hope

17. 8 Stages to Learn
Motivational Interviewing

18. 1. The spirit of MI
• Assuming that “health is waiting inside” each person, and your role is to help it
emerge (Humanistic Psychology)
• Spirit of MI is necessary for expert use, but not to begin learning MI
• Contrasted with the model that the patient is flawed
• Components:
• Collaboration
• Evocation
• Respect for person’s Autonomy
8 Stages to Learn
Motivational Interviewing

19. 2. Using client-centered skills (OARS)
•Open ended questions
•Affirmation
•Reflective listening
•Summarizing
8 Stages to Learn
Motivational Interviewing

20. 3. Recognizing change talk (DARN-CAT)
• DESIREto change (want, like, wish . . )
• ABILITYto change (can, could . . )
• REASONSto change (if . . then)
• NEEDto change (need, have to, got to . .)
• COMMITMENT(intention, decision, promise . .)
• ACTIVATION(willing, ready, preparing . .)
• TAKING STEPS (i did, i changed . .)
8 Stages to Learn
Motivational Interviewing

21. 4. Eliciting and reinforcing change talk
• D: Why do you want to make this change?
• A: How might you be able to do it?
• R: What is one good reason for making the change?
• N: How important is it, and why? (0-10)
• C: What do you intend to do?
• A: What are you ready or willing to do?
• T: What have you already done?
8 Stages to Learn
Motivational Interviewing

22. 5. Rolling with resistance
Responding to resistance in a manner that reflects the
resistance and respects the client without reinforcing
the resistance
• Avoid arguing
• Find another way
• Avoid confrontation
• Shift perceptions
8 Stages to Learn
Motivational Interviewing

23. 6. Developing a change plan
The ability to:
• Recognize client readiness
• Negotiate a specific change plan that is acceptable and
appropriate to the client
• Involve timing as well as negotiation
8 Stages to Learn
Motivational Interviewing

24. 7. Consolidating client commitment
The ability to elicit and increase the strength of
client’s commitment to change, and to specific
implementation intentions
8 Stages to Learn
Motivational Interviewing

25. 8. Integrating MI with other intervention
methods
The ability to:
• Blend MI style with the other intervention methods
• Switch flexibly between MI and other approaches
8 Stages to Learn
Motivational Interviewing

26. People often say that motivation
doesn’t last
Neither does bathing
That’s why we recommend it daily
Zig Ziglar
1926-2012
American author, salesman, and motivational speaker

27. F R A M E S
approach to
Motivational Interviewing

28. •Feedback regarding personal risk
or impairment is given to the client
following assessment of substance
use patterns and associated
behaviors or problems
F R A M E S

29. •Responsibility for change is
placed squarely and explicitly on
the client (with respect for the
client's right to make choices for
himself).
F R A M E S

30. •Advice about change, either in
substance use patterns or associated
behaviors is clearly given to the
client in a nonjudgmental manner
F R A M E S

31. •Menus of self-directed
change options and treatment
alternatives are offered to the
client
F R A M E S

32. •Empathetic counseling
showing warmth, respect, and
understanding
F R A M E S

33. •Support self-efficacy and
empower the client to
encourage change
F R A M E S

34. There is no such thing as
teaching; only learning
Monty Roberts
1935 (age 81 years)
American Horse Trainer
Thank you for your time
Hatem Abd Al-Rahman