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.
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.
Say more in change talk and tx planning stage.
Motivational Interviewing lecture
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?
Start with the bad news
Minimum of two days
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
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
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
Different types of music
Science of counseling
Art of counseling
Phase I – Explore
Phase II – Change
Talk, Planning, Strengthening
APPROACH OF MI
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
The counseling style is generally a quiet and eliciting
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.
Avoid Argument (Amplify Ambivalence)
Roll with Resistance
R – Resist the righting reflex
U – Understand your client’s motivation
L – Listen to your client
E – Empower your client
―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
Client-centered: Understanding the client’s
internal frame of reference and present
Understanding vs condoning
Why don’t you change?
How can you tell me that you don’t have a
What makes you think that you’re not at risk?
Why don’t you just…?
Why can’t you…?
Normalize is not approval.
It is common experience.
Permission to truly be known and know
Vs Compartmentalization and shame
Their behavior may be a seemingly senseless
problem, help them dig deeper to invalidated
Based on a human need and
desire…maladaptive ways to get them.
―Every problem was a solution to a previous
Boyfriend: Phobia caused woman's 2-year
"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
"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."
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
Freedom from the pressure of success
Giving up secondary gains
Not Grace or Truth, Grace vs Truth
Grace with Truth
Rogers: ―The curious paradox is that when I
accept myself just as I am, then I can change.‖
Key strength of MI: You don’t have to be an
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)
MI isn’t about finding the missing piece of
It isn’t necessarily problem-solving or ―figuring
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.
Even if you may not agree with their
choice, they are choosing with their eyes wide
With this ―informed consent‖ they are being
responsible for their life, they are choosing
their path, choosing their consequences.
Develop flexibility in shifting modes
―Good leading is gentle, responsive
and imaginative.‖ MI 2nd ed. P. 22
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)
Your best option is to take these tablets.
Changing your diet would make sense
medically, but how does that feel to you?
Yes, it’s a common experience; many patients
also feel quite shocked and unsettled about
simple things like going to the toilet.
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
This has been a huge shock. (following)
Group A: Low importance, low confidence
Group B: Low importance, high confidence
Group C: High importance, low confidence
Group D: High importance, high confidence
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.
Where Good Ideas Come From: The Natural
History of Innovation
Statements of appreciation and understanding
You’re clearly a (character quality/value)
If I were in your position…
I’ve enjoyed talking with you today…
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.
Parroting – repeating, using same words
Simple – basic paraphrase, acknowledge
feeling, perception or disagreement, small shift
Amplified – amplified or exaggerated form
Double-sided – one way to develop
summary, interpretation, metaphor/simile, con
tinuing the paragraph
I just don’t like the way she comments on how
I raise my children.
Shift the person’s attention away from what
seems to be a stumbling block in the way of
Go around barriers rather than climbing over
Agreeing with a twist
Emphasizing personal choice and control
A part of you…
When you tried that in the past…
I’m guessing, you might…(tentative)…
Some people…when modeling or giving advice
"You feel stuck." sometimes brings the session
to an awkward pause or even a grinding halt.
Therapist: "So, you feel stuck."
Another variation is reflecting "You feel
helpless." or "You feel hopeless." or "You feel
―As I hear myself talk, I learn what I believe.‖
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).
Continue to drink as before Abstain from alcohol
Helps me relax
Enjoy drinking with
Could lose my family
Bad example for my
Damaging my health
Spending too much
Impairing my mental
Might lose my job
Losing my time/life
Less family conflict
More time for my
Feel better physically
Helps with money
I enjoy getting high
What to do about my
How to deal with
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?‖
"What was/is going on?"
"What is happening/happens? when
"How is pattern continuing? What fuels
"What did you do? What didn't you do?"
"Where did this happen?"
"When did you start believing that [core
belief or cognitive distortion]?"
"Where did you start doing that
"Who taught you that
[behavior/coping]? Who modeled that in
"How did you get here? To this place?"
"What did they do/say?"
"How did you respond?" (vs. "They made
me...[feeling or behavior]")
"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."
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?
What are you feeling?
How can you reframe this?
What is the alternative?
What/How can you
What are the obstacles?
Awareness of consequences is important
A discrepancy between present behavior and
important goals will motivate change
The client should present the arguments for
A ―holy discontent‖
―Food for thought‖ vs judgment/criticism
―Columbo‖ technique. ―Help me understand.‖
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
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
Defense mechanisms: Freud's original set.
Self-harm mechanisms: That hurt our selves.
Values and priorities
Values are positive.
Preferred experiences (for example a valued
Values Card sort at
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
How does (behavior) fit with the importance of
How does (behavior) fit with your desire to
Clarification: in what ways? How much? How
Description of the last time?
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
Dissonance and incongruence vs shame or feeling
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
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
4. Ignoring – The client shows evidence of
ignoring or not following the counselor.
Challenging- challenges the accuracy of
what is said
Discounting – counselor’s personal
Hostility – Client expresses direct
Rich Young Ruler – Luke 18
Paralytic at Bethesda – John 5
Not just logically weigh pros and cons, Change
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
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
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
Trust me, ―It’s good for you‖ isn’t good enough.
If they feel disrespected or
More importantly, we’ve stolen growth/process
from them, we’ve stolen their opportunity to
overcome their fear and to make their own free
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.
Judge or Attorney
In client’s life who is the judge? Who has the
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.
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
This where you ―don’t work harder than your
You don’t care more, you don’t have all the
insights/interpretations of meaning, aha
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.
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.
Ask for what they want/need.
Find what they want and need. Or ask for help.
Authentically know their limits vs pretense and
Not driven to do too much, free to do much.
Passion vs pressure
Normalize it takes practice.
Trainer and Spotter
Model, teach, coach, come alongside, spot.
Start here by casting vision for self-efficacy.
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)
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
5. Blame yourself and put yourself down
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
10. Keep relating to the same unhelpful people
11. Put more importance on being right than
Recognize and elicit
Desire: I want, I’d like to, I wish I could, I can’t
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…
Recognizing the disadvantages of the status
Recognizing the advantages of change
Expressing optimism about change
Expressing intention to change
―What is your client’s change language‖
Desire: "What do you want to do about this
Ability: "What makes you believe you can do
Reason/Need: "Why would you want to make
Commitment: "So what are you willing to do
Desire: Why would you want to make this
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?
―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?‖
Summary of client’s perception, change
talk, importance talk
Summary of ambivalence, positives of status
Objective evidence, if any
Restatement of DARN-C, confidence talk
Your own assessment of client’s situation
Positive and Negatives from the
Positive and Negatives in the
Positive and Negatives in the
―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-
―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
What is the worst case scenario?
What is the best case scenario?
How? Or What? Would you do…if…
Desire: "What do you want to do about I this
Ability: "What makes you believe you can do
Reason/Need: "Why would you want to make this
Commitment: "So what are you willing to do
Paradoxical, ―therapeutic paradox‖ ―reverse
Permission to not change
―Not the right time‖
―In the meantime…‖
Actually ―firing‖ your client or suggesting
referral to another counselor, other solutions.
Reinforce and consolidate change talk
Elaborating: In what way… ?; Tell me more…;
Affirming: That took a lot of courage; You’re a
person who can make changes when you need
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
Scientist Stuart Kauffman quoted by Steven
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
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
There is no one ―right way‖ to change – menu
"The goal of treatment is to RISE above your
problems rather than be controlled and
dominated by them." Stephen Arterburn
Healing is A Choice
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
Reduce the substances you use to help cope with
the pain in your life.
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.
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.
Substitute positive emotions for negative ones.
Substitute the willingness to risk for fear.
Substitute humility for arrogance.
Substitute acceptance for anger.
Substitute peace for anxiety.
Substitute surrender for control.
Eliminate addictive behaviors
Eliminate a critical and judgemental spirit.
Eliminate certain repetitive sins in your life.
Sometimes change talk can sound like
ambivalence or resistance.
Client may be articulating what they will be
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.
Motivational Interviewing: Preparing People
for Change, 2nd Edition Miller, William
R., Rollnick, Stephen (2002)
Building Motivational Interviewing Skills: a
practioner workbook Rosengren, David B.
Motivational Interviewing in Health Care:
Helping Patients Change Behavior Rollnick, S.,
Miller, WR & Butler, CC (2008)
Motivational Interviewing in the Treatment of
Psychological Problems Arkowitz, H., Westra,
HA, Miller, WR., Rollnick, S editors
Emotional Intelligence 2.0 Bradberry, T.,
Greaves, J (2009)
Emotional Intelligence Quick Book Bradberry,
T., Greaves, J (2003)
Change 101: A Practical Guide to Creating
Change in Life or Therapy O’Hanlon, B. (2006)