This slide show explores motivational interviewing skills, concepts and techniques for health psychologists. Behavior is the main driver of of health. CDC estimates that 50% of health is behaviorally driven while only 10% is having access to a physicians. The ability to integrate skills for behavioral change into health discussions can be a driver for health change at both the individual and systemic level.

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
Authorit
y
Coercion
Educatio
n
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. Chang
e 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.
Do More
that
supports…
Do less that
increases…

9. Spirit
Principa
lsMicrosk
ills Change
Talk
Commitm
ent
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=80XyNE89https://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

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. Prep. Actio
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

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?