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Overview of Motivational Interviewing (MI)
Jessica D. Hanson, PhDSanford Research
Sioux Falls, SD
Funding from NIH grant #1P20GM121341-01
What is MI?
A goal-oriented, client-centered counseling style Enhances motivation for change Specific communication skills that increase a
client’s motivation to change
Goals of MI
Prepare people to consider changing
Maintain motivation to change
Not “push” people to change
Four Processes of MI
Engage Focus Evoke Plan
Four Processes of MI
Engage Focus Evoke Plan
Why How
Why MI? Evidence-based
Theory-based
Can address a variety of health behaviors
Relatively brief
Complementary to other methods
Verifiable
Appropriate for those not presenting for treatment
First Core of MI
Relational Empathy MI Spirit Absence of negative interaction
#1 predictor of success
#2 predictor of success
Counselor Empathy and Client Outcomes(#1 predictor)
The Spirit of MI
Partnership
Compassion
Evocation
Acceptance
Or how to show empathy…
MI Spirit in Practice
Partnership Counselor avoids an authoritarian role
Counselor creates a positive atmosphere that is conducive to change
Session is a meeting of two experts collaborating
Evocation Counselor does not provide wisdom or insight
Counselor finds things within the client and draws them out through skilled listening and responding
Client presents the arguments for change
MI Spirit in Practice (cont.)
Acceptance and Compassion
Responsibility for change is the client’s
Respect her autonomy
Support her freedom to make the final decision about change
Support her choices
Promote her confidence
Communication Styles to Avoid(#2 predictor)
Not done in MI: Following with no direction Commanding Confronting Arguing Debating Warning Threatening
Done infrequently in MI: Closed questions Advice giving
“Righting Reflex”
Second Core of MI
TechnicalOARS: Open-ended questions, Affirmations,
Reflective listening, and SummarizingEvoking Change Talk
#3 predictor of success
OARS Techniques for Establishing Good Rapport(Technical Core)
O = Open-ended questions
Elicit and explore topics and extended answers
A = Affirm the person
Focus on client strengths, efforts, patience, etc.
R = Reflect what the person says
Nondirective initially, then directive
S = Summarize
Capture “essence”, link topics, transition conversation
Closed vs. Open-Ended Questions
Closed questions can be answered finitely, often with “yes” or “no.”
Questions are restrictive and can be answered in a few words.
Open-ended questions will solicit additional information from women.
Questions are broad and require more than one- or two-word answers.
Exercise:Closed vs. Open-ended Questions
Do you use birth control methods?
How many times have you used birth control methods in the past three months?
What birth control methods you have used in the past three months?
Role Play 1: Counselor Closed Questions
Your client’s self-reported drinking is at a level that you know is considered risky and could cause an alcohol-exposed pregnancy.
You would like to talk with her about this.
Counselor Questions How often do you drink this much?
Why are you doing that? You know it can only cause you all sorts of problems.
I don’t understand why you can’t just decrease your drinking and drink less!
Role Play 2: CounselorOpen-Ended Questions
Your client’s self-reported drinking is at a level that you know is considered risky and could cause an alcohol-exposed pregnancy.
You would like to talk with her about this.
Counselor Questions You said earlier that you’ve been drinking pretty
heavily for about a year. If I recall you correctly, you said earlier that you are
really feeling like you want to decrease your drinking, but that your partner does not want you to. Tell me a bit more about that.
What concerns do you have about drinking? What are some consequences for you when you
drink? What else could you do besides drinking and
partying?
Summary: Open-Ended Questions
Foster a dialogue, not an interrogation
Establish rapport
Provide more information than closed questions
Allow your clients to tell their stories - you talk less and listen more
Permit a better understanding of the issues and build empathy
OARS Techniques for Establishing Good Rapport
O = Open-ended questions Elicit and explore topics and extended answers
A = Affirm the person Focus on client strengths, efforts, patience, etc.
R = Reflect what the person says Nondirective initially, then directive
S = Summarize Capture “essence”, link topics, transition
conversation
Affirmation Genuine, direct statements of support that
demonstrate you understand and appreciate at least part of what your client is dealing with, and is supportive.
Focus on client strengths, efforts, patience, etc.
Affirming may be compared to the seasoning in a recipe: The right amount is appropriate, but overdoing it can be problematic.
OARS Techniques for Establishing Good Rapport
O = Open-ended questions Elicit and explore topics and extended answers
A = Affirm the person Focus on client strengths, efforts, patience, etc.
R = Reflect what the person says Nondirective initially, then directive
S = Summarize Capture “essence”, link topics, transition
conversation
Reflective Listening
MI requires a special type of listening
Listening reflectively involves observing verbal and nonverbal cues
Reflective Listening Statements
Mirror the client’s perspectives Can be simple – repeat a word or two
“depressed” or “angry”
Can be sophisticated - substitute new words for what your client said or guess about unspoken meaning “It sounds like you are uncertain about whether you will
remember to take your birth control pills regularly”
Encourage exploration and establish rapport
Summary: Reflective Listening
Demonstrates that you understand what your client says
Validates your client’s concerns and feelings Is an important way to express empathy
High levels of empathy are associated with positive outcomes
Reflective Listening Leads to Change Talk(Change talk = #3 predictor)
Type of Change Talk Example
Desire “I want to . . .”
Ability “I could…”
Reasons “I know I would feel better if…”
Need “I ought to…”
Commitment “I am going to…”
Taking steps “This week I started…”
Responding to Change Talk
Listen to and reflect the client’s perspectives:
Pro-change
Anti-current behavior
Reasons
Confidence
desire
Go beyond reflecting change talk to evoking it:
Explore existing readiness for change
Explore possible first steps towards change
Eliciting Change Talk
Client presents her reasons for changing
You reflect those back to underline and emphasize them
Client hears herself moving towards change
Part of the Evoking Process of MI
Eliciting Change Talk: Readiness Ruler
Assessing Readiness to Change
Not ready Extremely ready at all to change
On a scale of 1–10, how ready are you at the present time to change [insert behavior]?
OARS Techniques for Establishing Good Rapport
O = Open-ended questions Elicit and explore topics and extended answers
A = Affirm the person Focus on client strengths, efforts, patience, etc.
R = Reflect what the person says Nondirective initially, then directive
S = Summarize Capture “essence”, link topics, transition
conversation
Summarize Capture “essence”, link topics, transition conversation
Communicates that you follow what your client said and understand the big picture.
Can help structure a session so that you and your client focus on the most relevant topics.
Summarizing can be an opportunity to emphasize certain elements of what your client has said.
Questions on MI?
MI is different and feels different from persuading or arguing.
MI is a goal-oriented, client-centered counseling style that enhances motivation by helping your client resolve ambivalence about behavior change.
The goal of MI is to prepare people to consider changing and to maintain their motivation for change, but not to push them into it.
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