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Presented by:Thomas Wood, PhD, LPC
“Compassion is the wish to see others free from suffering.”
-The Dalai Lama“… when you are listening to somebody, completely, attentively, then you are listening not only to the words, but also to the feeling of what is being conveyed, to the whole of it, not part of it.”
- Jiddu Krishnamurti
Miller, William R.; Rollnick, Stephen P. (2012)
Layperson’s definition: Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
Practitioner’s definition: Motivational interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change.
Technical definition: Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.
Miller, William R.; Rollnick, Stephen P. (2012)
MI is not a way of manipulating people into doing what you want them to do.
MI cannot be used to manufacture motivation that is not already there.
MI is to be used to promote others’ welfare and best interests, not one’s own.
Miller, William R.; Rollnick, Stephen P. (2012)
Four Central Aspects:
Partnership
Acceptance
Compassion
Evocation
Miller, William R.; Rollnick, Stephen P. (2012)
“Compassion is the wish to see others free from suffering.”
-The Dalai Lama
Collaboration vs. ConfrontationEvocation vs. ExhortationAutonomy vs. Authority
Motivational Interviewing, Miller and Rollnick, 1991
Precontemplation
Contemplation
Preparation
Action
Maintenance
Prochaska & DiClementi, Norcross (1992)
Express empathy
Develop Discrepancy
Roll With Resistance
Support Self-efficacy
Motivational Interviewing, Miller and Rollnick, 1991
Developing DiscrepancyAmbivalence is normal and 1st step toward Change
Acceptance vs. Denial of the condition (at any stage of change this can occur)
Ambivalence intensifies as Discrepancy increases
Let the consumer voice Arguments for Change
Motivational Interviewing, Miller and Rollnick, 1991
Engaging
Focusing
Evoking
Planning
Miller, William R.; Rollnick, Stephen P. (2012)
Establishing Rapport: a helpful connection, a collaborative working relationship
“MI is like dancing rather than wrestling…”
“…not a process of overpowering and pinning an adversary.”
This is important because “when the goal is for another person to change, the counselor can’t do it alone.”
Miller, William R.; Rollnick, Stephen P. (2012)
Focusing is the process by which clinican develops and maintains a specific direction in the conversation about change
The Client’s agenda and Clinician’s agenda
May or may not involve a behavior change, might be an internal decision (decision to learn how to counter automatic negative thoughts)
Miller, William R.; Rollnick, Stephen P. (2012)
Involves eliciting the client’s own motivations for change
Occurs when there is a Focus on a particular change or goal
We harness the client’s own ideas and feelings about why and how they might do it.
Miller, William R.; Rollnick, Stephen P. (2012)
Developing a commitment to change
Formulating a concrete plan of action
Miller, William R.; Rollnick, Stephen P. (2012)
OARS
Open-ended questions
Affirming statements
Reflections
Summarizations
Motivational Interviewing, Miller and Rollnick, 1991
Open-ended questions
Reflective Listening
Affirm
Summarize
Listen for and reinforce “change talk”
Motivational Interviewing, Miller and Rollnick, 1991
Client identifies--
Disadvantages of the status quo
Advantages of change
Optimism for change
Intention to change (aka Commitment Talk)
Motivational Interviewing, Miller and Rollnick, 1991
Expert trap
Closed-ended questions
Taking sides
Labeling trap
Premature focus
Blaming trap
Motivational Interviewing, Miller and Rollnick, 1991
1. Ordering, directing, or commanding2. Warning, cautioning or threatening3. Giving advice, making suggestions, or
providing solutions4. Persuading with logic, arguing or
lecturing5. Telling people what they should do;
moralizing6. Disagreeing, judging, criticizing, or
blaming7. Agreeing, approving, or praising8. Shaming, ridiculing, or labeling9. Interpreting, or analyzing
10. Reassuring, sympathizing, or consoling11. Questioning or probing12. Withdrawing, distracting, humoring, or
changing the subject.
Miller & Rollnick (2013)
Stress is a major trigger Survival system activated Stress-tolerance, adaptive emotional coping and
resiliency decrease as prefrontal lobe activity decreases
Decreased access to reason, rational thinking, values, ability to weigh consequences vs. benefits
Stress/anxiety can be both a consequence and a trigger for hypomania and depression
Impulsivity/compulsivity can increase
Motivational Interviewing, Miller and Rollnick, 1991
Blaming
Placating
Passive Aggressive vs. Straightforward
Super Reasonable
Irrelevant
Following◦ Listening predominates ex. Patient in tears following delivery
of bad news
Guiding◦ A good guide knows what is possible and can offer you
alternatives from which to choose.
Directing◦ Implies an uneven relationship; sometimes this approach
saves lives.
Natural Tendency as Helpers (and support team/encouragers
Persuade
Counsel
Argue for Change
Provide Alternative Solutions (“fix”)
Inhibit the righting reflex
Motivational Interviewing, Miller and Rollnick, 1991
Many benefits of integrating MI into everyday communicationFollow-through from assessment to attendance (and your
support of these activities)Increase in self-generated investment in wellness &
wellness maintenance & thus self-efficacyReduction of support system distress (exhaustion)Fosters harm reduction and likelihood of return to
treatment if interrupted or disrupted
Miller, William R., & Rollnick, Stephen. (2013). Motivational Interviewing: Helping People Change 3rd edition)
Motivational Interviewing in Health Care, Helping Patients Change Behavior (Rollnick, Miller, Butler, 2008)
Motivational Interviewing: Preparing People for Change (2nd edition) (Miller/Rollnick) (April 2002)
Burke, B.L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.
Lundahl, B.W., Tollefson, D., Kunz, C., Brownell, C., & Burke, B. (in press). Meta-analysis of Motivational interviewing: Twenty five years of research. Research on Social Work Practice.
Vasilaki, E., Hosier, S., & Cox, W. (2006). The efficacy of motivational interviewing as a brief intervention for excessive drinking: A meta- analytic
review. Alcohol and Alcoholism, 41, 328–335. www.motivationalinterview.org
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