The document provides information about motivational interviewing (MI), including its key principles and techniques. Some main points:
- MI is a client-centered, directive method used to resolve ambivalence and increase intrinsic motivation for behavior change.
- It follows four main processes: engaging the client, focusing on changing talk, evoking and strengthening commitment to change, and transitioning to action planning.
- Key MI techniques include expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. The counselor aims to be a partner rather than expert.
- MI utilizes open-ended questions, affirmations, reflections, and summaries to honor client autonomy and elicit the client's own arguments
A discussion of motivational interviewing: what is it, how does it work, and how can we start to use it with students face forced behavior change in academics?
Josué Guadarrama MA Presentation at 2016 Science of HOPE
Motivational Interviewing (MI) is a directive, client-centered counseling and/or communication style for eliciting behavior change by helping individuals to explore and resolve ambivalence, while minimizing resistance and maximizing intrinsic motivation. Compared with nondirective counseling, MI is more focused and goal-directed. Based on the physics of behavior change, participants will learn assessment and communication skills that foster sustained behavior change by tapping into intrinsic motivation. Aside from a didactic approach, there will be video examples and skill practice. Audience participation is highly encouraged.
A discussion of motivational interviewing: what is it, how does it work, and how can we start to use it with students face forced behavior change in academics?
Josué Guadarrama MA Presentation at 2016 Science of HOPE
Motivational Interviewing (MI) is a directive, client-centered counseling and/or communication style for eliciting behavior change by helping individuals to explore and resolve ambivalence, while minimizing resistance and maximizing intrinsic motivation. Compared with nondirective counseling, MI is more focused and goal-directed. Based on the physics of behavior change, participants will learn assessment and communication skills that foster sustained behavior change by tapping into intrinsic motivation. Aside from a didactic approach, there will be video examples and skill practice. Audience participation is highly encouraged.
Josue Guadarrama, MA Presentation at 2016 Science of HOPE
Description
Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique, empirically based psychological intervention that uses acceptance and mindfulness strategies, together with value driven commitment and behavior change strategies, to increase psychological flexibility. ACT uses three broad categories of techniques: mindfulness, including being present in the moment and defusion techniques; acceptance; and commitment to values-based living. Participants in this seminar will learn mindfulness as a way of observing ones experience, in the present moment, without judgment and “defuse,” or distancing oneself from unhelpful thoughts, reactions and sensations. Aside from a didactic approach, there will be video examples, and skill practice. Audience participation is highly encouraged.
Learn how mindfulness-based stress reduction (MBSR) can help relax your body, calm your mind and spirit, and reduce overall stress. Our meditation techniques are ideal for women and men coping with chronic anxiety, illness, and pain.
When faced with a problem you can stay miserable, tolerate the distress, change how you think and feel about the problem or change the situation. Distress Tolerance Skills help you tolerate unpleasant feelings until you can think clearly and make the best choice to keep you moving toward your goals.
As research into the applications of mindfulness progresses, both in the medical field for problems like pain and chronic illness management, and in the mental health field through therapies such as Dialectical Behavior Therapy, Acceptance & Commitment Therapy, and Mindfulness-Based Cognitive Therapy continue to increase the empirical support for the efficacy of this approach in a variety of conditions, it behooves us to learn more about this and apply it in our own lives and practices.
Kevin Drab
Listen to this presentation on Counselor Toolbox Podcast, available on any podcast app. Earn CEUs for this at https://www.allceus.com/member/cart/index/product/id/923/c/
Attendees will gain insight into the stigma that is attached to individuals who have dual diagnosis and criminal justice involvement, as well as, the importance of instilling power and hope to the individual. They will increase knowledge of the stages of change and utilizing motivational interviewing techniques to assist the individual through their path of recovery from mental illness, substance abuse, and criminal justice involvement.
Josue Guadarrama, MA Presentation at 2016 Science of HOPE
Description
Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique, empirically based psychological intervention that uses acceptance and mindfulness strategies, together with value driven commitment and behavior change strategies, to increase psychological flexibility. ACT uses three broad categories of techniques: mindfulness, including being present in the moment and defusion techniques; acceptance; and commitment to values-based living. Participants in this seminar will learn mindfulness as a way of observing ones experience, in the present moment, without judgment and “defuse,” or distancing oneself from unhelpful thoughts, reactions and sensations. Aside from a didactic approach, there will be video examples, and skill practice. Audience participation is highly encouraged.
Learn how mindfulness-based stress reduction (MBSR) can help relax your body, calm your mind and spirit, and reduce overall stress. Our meditation techniques are ideal for women and men coping with chronic anxiety, illness, and pain.
When faced with a problem you can stay miserable, tolerate the distress, change how you think and feel about the problem or change the situation. Distress Tolerance Skills help you tolerate unpleasant feelings until you can think clearly and make the best choice to keep you moving toward your goals.
As research into the applications of mindfulness progresses, both in the medical field for problems like pain and chronic illness management, and in the mental health field through therapies such as Dialectical Behavior Therapy, Acceptance & Commitment Therapy, and Mindfulness-Based Cognitive Therapy continue to increase the empirical support for the efficacy of this approach in a variety of conditions, it behooves us to learn more about this and apply it in our own lives and practices.
Kevin Drab
Listen to this presentation on Counselor Toolbox Podcast, available on any podcast app. Earn CEUs for this at https://www.allceus.com/member/cart/index/product/id/923/c/
Attendees will gain insight into the stigma that is attached to individuals who have dual diagnosis and criminal justice involvement, as well as, the importance of instilling power and hope to the individual. They will increase knowledge of the stages of change and utilizing motivational interviewing techniques to assist the individual through their path of recovery from mental illness, substance abuse, and criminal justice involvement.
Any individuals who are in the business of leading, motivating and inspiring others should
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Now take a look at what you had wrote in the paper, I want you to embrace your strengths
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Any individuals who are in the business of leading, motivating and inspiring others should
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Motivational Interviewing - Dr Igor Koutsenok MD, MSjames_harvey_phd
Session 1 "Motivational Interviewing Course: Assisting Patients in Making Sustainable Positive Lifestyle Changes"
Presented by Dr Igor Koutsenok MD, MS (University of California San Diego, Department of Psychiatry) on 05/06/2020 during the first session of an ISSUP virtual training on MI.
**PLEASE NOTE that video slides have been removed to reduce file size**
Presentation content and learning outcomes:
After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.
Learning outcomes:
Introduction: Motivation and behavioral change in addiction medicine
Review of the concepts of Ambivalence, Stages of change, the righting reflex, limits of persuasion.
Spirit of MI
Expressing empathy
Roadblocks to communication
Four Processes in MI
Full details: https://www.issup.net/about-issup/news/2020-05/motivational-interviewing-course
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2. Ability to work with resistant clients?
How much do you agree: I am a good listener?
I am confident working with ―stuck‖ clients?
I know how to help a client change?
4. Start with the bad news
Recommendation
Minimum of two days
5. 1. The SPIRIT of MI
2. OARS – client-centered counseling skills
3. Recognizing and reinforcing change talk
4. Eliciting and strengthening change talk
5. Rolling with Resistance
6. Developing a Change Plan
7. Consolidating client commitment
8. Shifting flexibly between MI and other
methods
8. I do not understand what I do. For what I want to do I do not
do, but what I hate I do. 16 And if I do what I do not want to
do, I agree that the law is good. 17 As it is, it is no longer I
myself who does it, but it is sin living in me. 18 For I know that
good itself does not dwell in me, that is, in my sinful
nature. For I have the desire to do what is good, but I cannot
carry it out. 19 For I do not do the good I want to do, but the
evil I do not want to do—this I keep on doing. 20 Now if I do
what I do not want to do, it is no longer I who do it, but it is
sin living in me that does it.
21 So I find this law at work: Although I want to do good, evil
is right there with me. 22 For in my inner being I delight in
God’s law; 23 but I see another law at work in me, waging war
against the law of my mind and making me a prisoner of the
law of sin at work within me. 24 What a wretched man I am
9.
10.
11.
12. It is a client-centered, directive method of
engaging intrinsic motivation to change
behavior by exploring and resolving
ambivalence within the client.
William Miller and Stephen Rollnick
13. Basic
Like scales
Different types of music
Science of counseling
Art of counseling
14. Phase I – Explore
ambivalence/Build Motivation
Phase II – Change
Talk, Planning, Strengthening
Commitment
17. Motivation to change is elicited from the client, and not
imposed from without.
It is the client's task, not the counselor's, to articulate
and resolve his or her ambivalence
Direct persuasion is not an effective method for
resolving ambivalence.
The counseling style is generally a quiet and eliciting
one.
The counselor is directive in helping the client to
examine and resolve ambivalence.
Readiness to change is not a client trait, but a
fluctuating product of interpersonal interaction.
The therapeutic relationship is more like a partnership
or companionship than expert/recipient roles.
18. Develop Discrepancy
Express Empathy
Avoid Argument (Amplify Ambivalence)
Roll with Resistance
Support Self-Efficacy
19. R – Resist the righting reflex
U – Understand your client’s motivation
L – Listen to your client
E – Empower your client
20.
21.
22. ―We tend to believe what we hear ourselves
say. The more patients verbalize the
disadvantages of change, the more committed
they become to sustaining the status quo.‖
―If you are arguing for change and your patient
is resisting and arguing against it, you’re in the
wrong role. You are taking all the good lines.‖
MI in Health Care p. 8
23. Personal Competence
Self-Awareness
Self-Management
Delaying gratification
Social Competence
Social Awareness
Relationship management
24. Client-centered: Understanding the client’s
internal frame of reference and present
concerns.
Non-judgmental attitude.
Understanding vs condoning
25. Why don’t you change?
How can you tell me that you don’t have a
problem?
What makes you think that you’re not at risk?
Why don’t you just…?
Why can’t you…?
28. Normalize is not approval.
It is common experience.
Permission to truly be known and know
themselves
Vs Compartmentalization and shame
29. Their behavior may be a seemingly senseless
problem, help them dig deeper to invalidated
parts.
Based on a human need and
desire…maladaptive ways to get them.
Trauma, codependency
―Every problem was a solution to a previous
problem…‖
30.
31.
32. From CNN:
Boyfriend: Phobia caused woman's 2-year
bathroom stay
"The case drew nationwide attention after Ness
County Sheriff Bryan Whipple said it appeared
the Ness City woman's skin had grown around
the seat in the two years she apparently was in
the bathroom.
"We pried the toilet seat off with a pry bar and
the seat went with her to the hospital,"
Whipple said. "The hospital removed it."
33. There is a ―value‖ in staying the same.
Freedom from the ―cost‖ of change
Freedom of the risk of failure.
Safety of low expectations, not taking
responsibility.
Freedom from the pressure of success
Giving up secondary gains
34.
35. Not Grace or Truth, Grace vs Truth
Grace with Truth
Scalpel
Anesthesia
Rogers: ―The curious paradox is that when I
accept myself just as I am, then I can change.‖
36. Key strength of MI: You don’t have to be an
expert
Insight doesn’t guarantee change.
Information doesn’t guarantee change.
Diet book, self-help book, formula, plan
―If reasons/change talk were enough they
would have made the change already…‖ (MI in
tx of Psych. Problems. P.30)
37. MI isn’t about finding the missing piece of
information.
It isn’t necessarily problem-solving or ―figuring
things out‖.
It isn’t ―Making People Change‖ it’s
―Preparing People Change‖
By helping them fully be aware of their
choices, competence and challenges and
helping them CHOOSE.
38. Even if you may not agree with their
choice, they are choosing with their eyes wide
open.
With this ―informed consent‖ they are being
responsible for their life, they are choosing
their path, choosing their consequences.
39. Following
Guiding
Directing
Develop flexibility in shifting modes
―Good leading is gentle, responsive
and imaginative.‖ MI 2nd ed. P. 22
40. Asking
How many times has that happened? (directing)
What kind of change makes sense to you? (guiding)
How have you been since your son died? (following)
41. Your best option is to take these tablets.
(directing)
Changing your diet would make sense
medically, but how does that feel to you?
(guiding)
Yes, it’s a common experience; many patients
also feel quite shocked and unsettled about
simple things like going to the toilet.
(following)
42. So you understand what’s going to happen this
morning, but you want me to tell you more
about what will happen later on. (directing)
You’re feeling concerned about your
weight, and you are not sure where to go from
here. (guiding)
This has been a huge shock. (following)
43. Group A: Low importance, low confidence
Group B: Low importance, high confidence
Group C: High importance, low confidence
Group D: High importance, high confidence
45. 14And we urge you, brothers, admonish the
idle, encourage the fainthearted, help the
weak, be patient with them all. See that no one
repays anyone evil for evil, but always seek to
do good to one another and to
everyone. Rejoice always, pray without
ceasing, give thanks in all circumstances; for
this is the will of God in Christ Jesus for you.
53. Compliments
Statements of appreciation and understanding
Thanks…
I appreciate…
You’re clearly a (character quality/value)
person…
If I were in your position…
You enjoy…
I’ve enjoyed talking with you today…
54. It is a hypothesis of what may be going on.
―Do you mean?‖
It is a statement to understand meaning.
MI: 2-3 reflections per question asked vs 10
questions: 1 reflections in other counseling
sessions. About half responses are reflections.
55. Parroting – repeating, using same words
Simple – basic paraphrase, acknowledge
feeling, perception or disagreement, small shift
in emphasis
Amplified – amplified or exaggerated form
Double-sided – one way to develop
discrepancy
Complex –
summary, interpretation, metaphor/simile, con
tinuing the paragraph
56. I just don’t like the way she comments on how
I raise my children.
57. Shifting Focus
Shift the person’s attention away from what
seems to be a stumbling block in the way of
progress.
Go around barriers rather than climbing over
them
Reframing
Agreeing with a twist
Emphasizing personal choice and control
Coming alongside
58. Sometimes…
A part of you…
When you tried that in the past…
I’m guessing, you might…(tentative)…
Some people…when modeling or giving advice
vs self-disclosure.
59. "You feel stuck." sometimes brings the session
to an awkward pause or even a grinding halt.
Therapist: "So, you feel stuck."
Client: "Yep."
[BONK!]
[Crickets]
Another variation is reflecting "You feel
helpless." or "You feel hopeless." or "You feel
trapped."
62. ―As I hear myself talk, I learn what I believe.‖
Decisional Balance
The person experiences competing motivations
because there are benefits and costs associated
with both sides of the conflict. There are two
kinds of weights on each side of a the balance:
one has to do with the perceived benefits of a
particular course of action; the other has to do
with the perceived costs or disadvantages of
the course of action (such as taking medication
to lower blood pressure).
63.
64. Continue to drink as before Abstain from alcohol
Benefits
Helps me relax
Enjoy drinking with
friends
Costs
Could lose my family
Bad example for my
children
Damaging my health
Spending too much
money
Impairing my mental
ability
Might lose my job
Losing my time/life
Benefits
Less family conflict
More time for my
children
Feel better physically
Helps with money
problems
Costs
I enjoy getting high
What to do about my
friends
How to deal with
stress
65. Why, besides being an invitation for a fight, is
victim language, past focused, it distracts from
moving forward and facing change. On one
hand, the past is one the best predictors of
future behaviors; on the other, we're told
Insight doesn't necessarily lead to change.
Search for meaning
―Why do I?‖ ―I know/believe…why do I still?‖
66. "What was/is going on?"
"What is happening/happens? when
you..."
"How is pattern continuing? What fuels
it?"
"What did you do? What didn't you do?"
"Where did this happen?"
"When did you start believing that [core
belief or cognitive distortion]?"
67. "Where did you start doing that
[behavior]?"
"Who taught you that
[behavior/coping]? Who modeled that in
your life?"
"How did you get here? To this place?"
"What if?"
"What did they do/say?"
"How did you respond?" (vs. "They made
me...[feeling or behavior]")
68. "What did that look like? What did you feel?
What did you experience?"
"When that happened - What did that mean to
you? What did you start telling yourself?
About God, others, family, yourself?"
"What was your role?―
"What would you do if you knew "Why?‖
How would knowing why? help you."
69. How does this affect you?
What are you experiencing?
What will you do with this?
What do you want/need?
Who will you share this with?
70. What are you feeling?
How can you reframe this?
What is the alternative?
What/How can you
change/control?
What are the obstacles?
71. Awareness of consequences is important
A discrepancy between present behavior and
important goals will motivate change
The client should present the arguments for
change.
A ―holy discontent‖
―Food for thought‖ vs judgment/criticism
―Columbo‖ technique. ―Help me understand.‖
72. Minimization: where it all begins
Rationalization: the plot thickens
Denial: a preferred way to live
Re-labeling: telling it like it isn’t
Justification: I couldn’t help it
Entitlement: you deserve a break today
73. http://changingminds.org/explanations/behaviors/c
oping/coping.htm
Adaptive mechanisms: That offer positive help.
Attack mechanisms: That push discomfort onto others.
Avoidance mechanisms: That avoid the issue.
Behavioral mechanisms: That change what we do.
Cognitive mechanisms: That change what we think.
Conversion mechanisms: That change one thing into
another.
Defense mechanisms: Freud's original set.
Self-harm mechanisms: That hurt our selves.
74. Values and priorities
Values are positive.
Preferred experiences (for example a valued
career/job)
Behavioral ideals
Values Card sort at
www.motivationalinterviewing.org
75. Self-oriented behaviors that neglect loved ones
Short-sighted behaviors that reap short-term
rewards while ignoring long-term costs
Inefficient behaviors that fulfill certain needs at
the expense of others
76. Alignment?
How does (behavior) fit with the importance of
(value)?
How does (behavior) fit with your desire to
do/be (value)?
77. Specific examples
Clarification: in what ways? How much? How
often?
Description of the last time?
What else?
78. Your client can’t ―lose‖ their way to change.
Don’t use your clients words against them.
Or at least if you do, don’t do a happy dance.
Don’t back them into a corner, force them to
swallow their words down.
Yeah, yeah, yeah, you’re right. I said that but
you’re a bastard for pointing it out!
―A man convinced against his will is of the same
opinion still.‖
Dissonance and incongruence vs shame or feeling
tricked
79. Avoiding arguing for change
Resistance is not directly opposed
New Perspectives are invited but not imposed
The client is a primary resource in finding
answers and solutions
Resistance is a signal to respond differently, to
change strategies
81. 1. Arguing – The client contests the
accuracy, expertise, or integrity of the counselor.
2. Interrupting – The client breaks in and
interrupts the counselor in defensive manner.
3. Negating – The client expresses an
unwillingness to recognize
problem, cooperate, accept responsibility or take
advice.
4. Ignoring – The client shows evidence of
ignoring or not following the counselor.
82. Challenging- challenges the accuracy of
what is said
Discounting – counselor’s personal
authority
Hostility – Client expresses direct
hostility
87. Rich Young Ruler – Luke 18
Paralytic at Bethesda – John 5
88. Not just logically weigh pros and cons, Change
Balance Sheet.
Doesn’t fully account for, or address sin.
How does our new nature interact with our
flesh, this body of sin?
How does the reality of the Holy Spirit interact
with us being sinful?
How does the gospel apply?
Trying on new clothes. Feels very
uncomfortable, intolerable.
89. http://youtu.be/rdWEgu7c3i0
I wish I had what I need
To be on my own
'Cause I feel so defeated
And I'm feeling alone
And it all seems so helpless
And I have no plans
I'm a plane in the sunset
With nowhere to land
And all I see
It could never make me happy
And all my sand castles
Spend their time collapsing
90. Let me know that You hear me
Let me know Your touch
Let me know that You love me
Let that be enough
It's my birthday tomorrow
No one here could now
I was born this Thursday
22 years ago
And I feel stuck
Watching history repeating
Yeah, who am I?
Just a kid who knows he's needy
91.
92.
93.
94. Trust me, ―It’s good for you‖ isn’t good enough.
If they feel disrespected or
worse, traumatized/abused.
More importantly, we’ve stolen growth/process
from them, we’ve stolen their opportunity to
overcome their fear and to make their own free
choice.
It may be good for them but it risks
mistrust, anger, resentment.
Innoculate them to other risks/changes.
Find ways to make change fun, not traumatic.
95. Judge or Attorney
In client’s life who is the judge? Who has the
final authority?
Who is hardest critic?
You don’t want to be put in the position of
being the judge.
You advocate for your client.
Eventually advocate for themselves. Ultimately
they stand and give an account for themselves.
96. Directive
Belief in the possibility of change: client’s and
counselors. Self-Fulfilling prophecy.
Direct your client to direct themselves
Direct your client to ―grow up‖ – not in a
pejorative sense, they are
adult, responsible, heroic, significant, God’s
workmanship.
This where you ―don’t work harder than your
client‖
97. You don’t care more, you don’t have all the
insights/interpretations of meaning, aha
moments.
You are winning when your client is
winning, when they come up with the cool
meaning and understanding about themselves.
When they seem themselves for what they are.
98. Shifting from an external locus of
control, where they are constantly seeking
approval or answers outside of themselves to
an internal locus of control. (Of course God is
sovereign and involved. They do business
directly with God. They don’t need an
intermediary to discern God’s will for them.)
Bear their weight, carry their own load.
Interdependence.
Ask for what they want/need.
Find what they want and need. Or ask for help.
99. Humble courage.
Authentically know their limits vs pretense and
defensiveness.
Not driven to do too much, free to do much.
Passion vs pressure
Normalize it takes practice.
100. Trainer and Spotter
Model, teach, coach, come alongside, spot.
Start here by casting vision for self-efficacy.
Empower client.
Affirmations
You can do it.
You have done it.
You might do it.
People have done it. (normalize)
How did you do it? (talk about successful changes
in the past)
101. 1. Don't listen to anybody
2. Listen to everybody
3. Endlessly analyze and don't make changes.
On the other hand, perhaps: "Don't just do
something, stand there."
4. Blame others for your actions or problems.
"We have only one person to blame and that's
each other."
5. Blame yourself and put yourself down
regularly
102. 6. Keep doing the same things that don't work
7. Keep focusing on the same things when that
focus doesn't help
8. Keep thinking the same thoughts when those
thoughts don't help
9. Keep putting yourself in the same unhelpful
environment
10. Keep relating to the same unhelpful people
11. Put more importance on being right than
changing
103. Recognize and elicit
Desire: I want, I’d like to, I wish I could, I can’t
wait…
Ability: I could, I can, I might be able to
Reason: I would probably feel better if I…, It
would be good if I…
Need: I ought, I have to, I really should…
104. Recognizing the disadvantages of the status
quo
Recognizing the advantages of change
Expressing optimism about change
Expressing intention to change
―What is your client’s change language‖
105. Desire: "What do you want to do about this
behavior?"
Ability: "What makes you believe you can do
this?"
Reason/Need: "Why would you want to make
this change?"
Commitment: "So what are you willing to do
now?"
106. Desire: Why would you want to make this
change?
Ability: How would you do it if you decided?
Reason: What are the three best reasons?
Need: How important is it? and why?
Commitment: What do you think you’ll do?
107. ―What do you think you will do?‖
―What does this mean about your (habit)?’
―What do you think has to change?‖
―What are your options?’
―What’s the next step for you?‖
―What would be some of the good things about
making a change?‖
―Where does this leave you?‖
110. Summary of client’s perception, change
talk, importance talk
Summary of ambivalence, positives of status
quo
Objective evidence, if any
Restatement of DARN-C, confidence talk
Your own assessment of client’s situation
111. Positive and Negatives from the
Past
Positive and Negatives in the
Present
Positive and Negatives in the
Future
114. ―If on a scale of 1 to 10, 1 is not at all important to give up
smoking and 10 is extremely important to give up, what
number would you give yourself at the moment?‖
―If you were to decide to give up smoking now, how
confident are you that you would succeed? On a scale of 1 to
10, 1 means that you are not at all confident and 10 means you
are 100% confident you could give up and remain a non-
smoker.‖
―Why are you at (chosen number) and not at 1?‖
―What would need to happen for you to go from (chosen
number) to (a higher number)?‖
―How can I help you go from (chosen number) to (a higher
number)?‖
115. What is the worst case scenario?
What is the best case scenario?
117. Hypothetical
How? Or What? Would you do…if…
Desire: "What do you want to do about I this
behavior?"
Ability: "What makes you believe you can do
this?"
Reason/Need: "Why would you want to make this
change?"
Commitment: "So what are you willing to do
now?"
118.
119.
120.
121. Paradoxical, ―therapeutic paradox‖ ―reverse
psychology‖
Permission to not change
Postpone change
―Not ready‖
―Not the right time‖
―In the meantime…‖
Actually ―firing‖ your client or suggesting
referral to another counselor, other solutions.
122. Reinforce and consolidate change talk
Elaborating: In what way… ?; Tell me more…;
What else?
Affirming: That took a lot of courage; You’re a
person who can make changes when you need
to…
Reflecting: That’s really important to you …; You
realize it’s become a problem…
Summarizing: There are a number of things I’m
hearing about your situation . First, you’re
concerned about….. Also, you feel…, and you are
thinking…
127. Scientist Stuart Kauffman quoted by Steven
Johnson
The phrase captures both the limits and the
creative potential of change and innovation.
What is possible?
What is probable?
What are the small, next steps?
Being faithful with a little first
128. Building emotional, mental, relational muscles
that they haven’t built yet.
What would that look like?
What might happen?
There is hope in the range of alternative
approaches available.
There is no one ―right way‖ to change – menu
of changes
131. "The goal of treatment is to RISE above your
problems rather than be controlled and
dominated by them." Stephen Arterburn
Healing is A Choice
132. Reduce the stress in your life by learning some
new management skills
Reduce conflicts that cause inner turmoil and
difficulties in your relationships.
Reduce the negative patterns that have set in over
your lifetime.
Reduce the substances you use to help cope with
the pain in your life.
133. Increase your self-awareness and how you
affect people who interact with you.
Increase your awareness of your feelings.
Increase your understanding of yourself and
why you do the things you do.
134. Increase your connection with others.
Increase your assertiveness in a way that draws
people to you rather than repels them.
Increase the healthy influences in your life.
Increase your time alone with God in the Bible
and in prayer.
135. Substitute positive emotions for negative ones.
Substitute the willingness to risk for fear.
Substitute humility for arrogance.
136. Substitute acceptance for anger.
Substitute peace for anxiety.
Substitute surrender for control.
137. Eliminate addictive behaviors
Eliminate a critical and judgemental spirit.
Eliminate certain repetitive sins in your life.
138. Sometimes change talk can sound like
ambivalence or resistance.
Client may be articulating what they will be
giving up.
Even dysfunctional
relationships, beliefs, behaviors can be hard to
let go of.
For some weight can be a defense, being more
attractive can be risky, it opens up opportunity
for relationship which in term means more risk
at being known and being hurt.
Orientation, way of being, a tool, a way of communicating more than a technique.
Scales vs. Jazz and improv.The more dialed, the beat, the bass, the groove, the key signature, the more freedom you have to move away from it for a bit. You have the notes. Now we are going to refine.You have some science, no we are going to look at being more artistic and intuitive.Not just playing notes, “Here just say this”, hand you a script. “When they say this, you say this…” Like a Choose Your Own Adventure book.Energy, volume, intensity, pitch, tension, dynamics, use of silence, timing. Knowing the script of a joke, doesn’t guarantee you will be funny. Timing and delivery are key.
1st half Spirit and Principles, 2nd half on OARS, Change talk, Specific tools. Practice if we have time.
www.stephenrollnick,com
Why doesn’t this work?
One cool thing about MI is you don’t have to be an expert. You don’t have to be an expert at ADD, Anxiety, Axis II, Parenting, Career, Marriage, Addiction, etc. You don’t have to be wise beyond your years or super experienced (even though sometimes those things can help).Evoke/Ellicitvs DirectAlso not role to confront, argue, persuade, pressure or coerce your client.Intrinsic vs Extrinsic motivation – Goals, Values, Drive, PassionA lot of this is review.Tendency is yeah, goals, treatment plans, technique, tools, resources, etc. NOW we’re getting to the good stuff.
When you get frustrated, impatient, sarcastic with your client, when a husband and wife have Gottman’s Four Horsemen(Criticism, Defensiveness, Contempt, Stonewalling), when you have an angry resistant client. Empathy is the good stuff.Must fundamentally get the sense, you are for them. You cannot have trust without this, the glue for your alliance.
What happens in marriage? In workplace? In families? In community, spiritual?
Brain or heart surgery
If truth (info, advice, plans for change) are the scapel, then grace (empathy, love, patience) is the anesthesia. It is the space, the safety for the digging, the cutting out of stuff, the exploration to happen. Why dig around in the past? Why change? Why risk, try, grow? When the going gets tough in therapy your client needs the safety to continue pressing into new behavior, new ideas, new relationships – to face the pain of their past, present and maybe future.Grace and Truth, not Grace or Truth. Grace with Truth. Grace is True, is a truth. Don’t “switch”, don’t compartmentalize. You will shift words, but even as you work on change, advice, problem-solving don’t leave empathy behind. You will be more effective if you constantly ask yourself am I understanding my client? Are will still on the same side of the table, looking at the problem together?Social intelligence. Personality type affect on being/presence as a therapist.
They may choose to stay the same.They may realize they don’t want to change their job, they may realize they want to stay single.They may realize they want to stay married.
Different approaches needed but be patient with all.Paul says elsewhere restore those who are in sin gently, lest you fall. Gal.6:1
QA: yes, no, interrogated. Passive. Tempting to work harder.Focus: counselor’s agenda, moving on without permission, move too fastConfrontation: defensiveness if counselor takes “problem-change” side of conflict.Blaming: whose fault is problem? Waste of time. Defensive if feel blamed. Expert: having all the answers. Be curious. Be confident but not arrogant. Work with.Labeling: diagnostic label. Focus on client’s inner world.
One mirror vs two or more mirrors – you see different angles of yourself.“Who are you to give me advice…you probably never drink.”“My parents always nag me. I haven’t been doing that bad.”
Playing chess, outwitting client. Client playing chess with themselves like Pixar.