BuildingSkillsinMotivationalInterviewing

HelpingPeopleChange

AllHomeSeattle,WA

October17,2017

KenKraybillCenterforSocialInnovation/t3

www.thinkt3.com

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BuildingSkillsinMotivationalInterviewing

TrainingObjectivesParticipantswillbeableto:

• Describethefourelementsofthemindsetandheart-setofMI• ExplainthefourprocessesthatguideMIconversations• ProvideexamplesofthecoreinterviewingskillsofMI• Namethreestrategiestoelicitchangetalk

9:00 OverviewofMIBasics

Whatwouldyousaynext?RelevancyofMIforyourworkEmbodyingthemindsetandheart-setofMIFourprocessesthatguidetheflowofMI

10:40 BREAK

10:50Respondingwithreflectivestatementsandsummaries

Formingreflectivestatements Usingreflectivestatementsstrategically

Offeringthreetypesofsummaries12:10 LUNCH 12:40Usingevocativequestionsandaffirmations

Formingthoughtful,compellingopenquestionsUsingopenquestionstodeepentheconversation

Combiningreflectivestatementswithquestions Offeringaffirmationstohighlightstrengths

1:50 BREAK

2:00 Recognizing,eliciting,andrespondingtochangetalk Recognizingchangetalk Strategiestoelicitchangetalk Respondingtochangetalktostrengthenit Providinginformationandsuggestions

3:30 ADJOURN

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ABriefHistoryofMotivationalInterviewingMotivationalInterviewing(MI)isawayoftalkingwithpeopleaboutchangerelatedtothingsweoftenhavemixedfeelingsabout–exercise,diet,alcoholandotherdruguse,relationshipissues,riskysexualbehaviors,schoolandjobrelatedconcerns,spiritualpractices,certainattitudes,andotherissueswefaceinourlives.TheMIapproachgrewoutWilliamR.Miller’sworkwithproblemdrinkers.Inthepast,itwasbelievedthatpeoplewhodranktoomuchwereunabletoseehowtheirusewasharmingthemselvesandothers.Theyweresaidtobeindenial.Counselorsandotherswhowantedtohelpwouldtrytobreakthroughthisdenialbyusing“in-your-face”tacticssuchasconfrontationandshametotrytoconvincepeopleoftheirneedtochange.Asyoucanimagine,thisapproachdidn’tworkverywell.Noneofuslikeitwhenotherpeoplethinktheyknowwhat’sbestforusortrytogetustochange.Wewanttodecideforourselveshowtoliveourlives.In1991,WilliamR.MillerandStephenRollnickwroteabooktitledMotivationalInterviewing:PreparingPeopletoChangeAddictiveBehavior.Itexplainedhowtotalkwithpeopleabouttheiralcoholanddruguseinwaysthatrespectedtheirabilitytodecideforthemselveswhethertheywantedtochange.Inthebook,theauthorsdescribedthespirit(coreattitudesandbeliefs)ofthisapproachandthespecificskillsandstrategiesofMI.Asecondedition,MotivationalInterviewing:PreparingPeopleforChange,waspublishedin2002.ItfurtherexplainedhowMIworks,theresearchbehindit,andhowtogetbetteratusingMI.ItalsodescribedthespreadofMItootherareasbeyondsubstanceusedisordersincludinghealthcare,mentalhealth,corrections,andschoolsettings.Athirdedition,MotivationalInterviewing:HelpingPeopleChange,2013,expandedontheMIapproachandincludedsomenewideassuchasthefourprocessesofMIconversations:engaging,focusing,evoking,andplanning.MIisdefinedas“acollaborativeconversationstyleforstrengtheningaperson’sownmotivationandcommitmenttochange.”MIcanalsobedescribedas“awayofhelpingpeopletalkthemselvesintochanging.”Thisapproachembodies“amind-setandaheart-set”thatincludespartnership,acceptance,compassion,andevocation.MotivationalInterviewingisaguidingstylethatinvitespeopletoexaminetheirownvaluesandbehaviorsandcomeupwiththeirownreasonstochange.Itdoesn’ttrytoconvincepeopleorarguewiththem.Instead,itdrawsoutpeople’sownhopes,experience,andwisdomaboutthemselvesincludingwhetherornottochange.AsWilliamR.Millersays,“Youalreadyhavewhatyouneed,andtogetherlet’sfindit.”Peoplewhoareusedtoconfrontingandgivingadvicewilloftenfeellikethey’renot“doinganything.”But,asMillerandRollnickpointout,theproofisintheoutcome.Moreaggressivestrategiesoftenpushpeopleaway.MI,ontheotherhand,increasestheoddsthatpeoplewillgivechangeachance

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TheSpiritofMI:Partnership,Acceptance,Compassion,andEvocation

“MIisdonefororwithsomeone,notonortothem.”

MotivationalInterviewing,3rdedition

Imaginetakingadrinkofacarbonatedbeveragethathasgoneflat.Itstilltastesvaguelylikeitself,butthefizzhasgoneoutofit.It’snolongerworthdrinking,andyou’llprobablypouritdownthedrain.ThespiritofMIisthefizzofahelpingconversation.It’swhatshowsyouthatapersontrulycaresaboutyouandisn’tjustpretendingtocare.IndescribingMIspirit,MillerandRollnicknote:“WhenwebeganteachingMIinthe1980swetendedtofocusontechnique,onhowtodoit.Overtimewefound,however,thatsomethingimportantwasmissing.AswewatchedtraineespracticingMI,itwasasthoughwehadtaughtthemthewordsbutnotthemusic…ThisiswhenwebeganwritingabouttheunderlyingspiritofMI,itsmind-setandheart-set.”(MotivationalInterviewing,3rdedition)ThespiritofMIiscommunicatedinourbodylanguage,facialexpressions,toneofvoice,andattitudes.Itcomesfrominsideusandcan’tbefaked.Ithastobereal.Spiritisaboutthewaywearewithpeople,notjustwhatwesay.MillerandRollnickidentifyfourpartsofthespiritofMI:partnership,acceptance,compassion,andevocation.Eachoftheseisrelatedbutalsounique.PARTNERSHIP–showingrealrespectfortheotherperson;assumingbothofyouhaveimportantinput;dancingratherthanwrestlingACCEPTANCE–meetingpeople“wherethey’reat”withoutjudgingthem;believinginthem;tryingtounderstandwherethey’recomingfrom;shiningalightonthegoodstuffyouseeintheminsteadofpointingoutwhat’swrongwiththemCOMPASSION–hangingintherewithpeoplewhenthey’rehurtingorstrugglingwithanissue;doingwhateverisintheperson’sbestinterestsEVOCATION–“callingforth”oraskingpeopleaboutthingssuchaswhatmakesthemtick,whattheyalreadyknow,what’simportanttothem,howwouldtheyliketheirlivestobedifferent

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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FourProcessesofMI:Engaging,Focusing,Evoking,Planning

MIconversationshaveapurposeanddirection.Theyseektohelppeopleidentifyandexploretheirhopes,values,andchangegoalsusinganempathic,guidingapproach.Theguidingapproachusedinmotivationalconversationsgenerallymovesthroughfourprocesses.Theseprocesses–engaging,focusing,evoking,andplanning–tendtofollowalogicalorderbeginningwithengagingandendingwithplanning.However,itdoesn’tmeanthattheyalwaysfollowastraightlineorthateveryconversationwillincludeallfour.UsingMIissimilartoimprovtheatre;youdon’thaveascript,butthereisabasicstorylinethatyou’retryingtofollow.Engaging–gettingtoknowsomeoneandbuildingtrust

• “It’sreallygoodtomeetyou.”• “Whatdoyoudoforfun?”• “Tellmeabitaboutyourself.”

Focusing–figuringouttogetherwhattotalkabout

• “Whatwouldyouliketotalkabouttoday?”• “Youmentionedsomeproblemsatschool,someissueswithyourgirlfriend,and

wantingtofindawaytomakesomemoney.Wheredoyouwanttostart?”• “Woulditbeallrightifwetookacloserlookatyourrelationshipwithalcohol?”

Evoking–drawingouttheperson’sowndesire,reasonsandabilitytochange

• “Howwouldyoudescribetheroleofalcoholinyourlife?”• “Ifyoudiddecidetohaveahealthierlifestyle,wherewouldyoustart?”• “Howconfidentareyouthatyoucouldmakethischangeifyouwantedto?”

Planning–developingaspecificchangeplanthatthepersoniswillingtoputinaction

• “Whatdoyouthinkyou’lldonext?”• “Whatmightgetinthewayofyourplan?”• “HowcanIandotherssupportyouincarryingoutyourplan?”

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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OARS:OpenQuestions

Openquestionsinvitepeopletosayasmuchoraslittleastheywantaboutatopic.Theyallowpeopletodecideforthemselveswhatideas,thoughtsorfeelingstheywanttoshare.Answeringopenquestionstendstohelppeopleunderstandthemselvesbetterandthinkinnewwaysabouttheirsituation.Herearesomeexamplesofopenquestions:

What’sgoingwellinyourlife?What’snotgoingsowell?Whatwouldyouliketotalkabouttoday?Howdoesalcoholfitinyourlife,ifatall?Whenyoudodrink,whatdoesitdoforyou?Whatdoyouvaluemostinafriend?Ifyoucouldchangeanythinginyourlife,whatwoulditbe?Whatspecificchangesareyouthinkingaboutmaking?

Closedquestions,incontrast,limittheconversation.Theyaremostoftenusedtogatherspecificinformationoraskyesornoquestions.Forexample:

Whatisyourdateofbirth?Howmuchdoyoudrink?Whenisthelasttimeyougotaphysicalexam?Whichdaywouldyouliketomeetnextweek?

OpenquestionsareusedthroughoutthefourprocessesofMIandhelptoengagewiththeperson,increaseunderstanding,strengthencollaboration,findafocus,drawoutmotivation,anddevelopaplanforchange.Asageneralguideline,openquestionsshouldbeusedmorethanclosedones.

OARS:Affirmations

Affirmationsarestatementsthatshinealightonwhatisgoodaboutaperson.Theyputemphasisonpeople’sstrengthsratherthantheirweaknesses.Strengthscanincludeaperson’stalents,qualities,knowledge,skills,efforts,andmuchmore.Affirmationsoftenhelppeopleseestrengthstheypossessthattheymayhaveahardtimeseeingforthemselves.Affirmationscanalsobuildaperson’sconfidenceinbeingabletomakechanges.Anaffirmationmustberealandfromtheheart.Peoplewillknowifitseemsfalseandmightbelesslikelytotrustyou.Affirmingsomeone’sstrengthsisdifferentthancheerleadingorpraising.Praisestatementsputyouina“one-up”positionandareusuallybasedonjudgingsomeone’sperformance.Furthermore,praisecanbebothgivenandwithdrawn.Whenformingaffirmations,it’susuallybesttoavoidstartingwith“I”andinsteadcenterthecommenton“you.”It’salsohelpfultobespecific.Hereareafewexamplesofaffirmation.

Youwereverycourageoustospeakupforwhatyouthoughtwasright.Youknowwhat’sbestforyouandyouaren’tgoingtobeeasilyswayed.Youshowedalotofpatienceinthewayyouwaiteduntilhefinishedspeaking.Itwashard,yetyoureffortstonotdrinkontheweekendpaidoff.Thankyoufortakingthetimetotalkwithmetoday.

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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OARS:ReflectiveListening

“Whatpeoplereallyneedisagoodlisteningto."–MaryLouCasey

“GoodlisteningisfundamentaltoMI.TheparticularskillofreflectivelisteningisonetolearnfirstbecauseitissobasictoallfourprocessesofMI.Ittakesafairamountofpracticetobecomeskillfulinthiswayoflisteningsothatreflectionscomemorenaturallyandeasily.”[p.48]Reflectivelisteningistheskillof“bendingback”topeoplewhatwehearthemsayinginanefforttounderstand“wherethey’recomingfrom.”Inotherwords,toseetheworldthroughtheotherperson’seyes.Thiskindoflisteningmeansgivingapersonyourfullattention.Wedothiswithourwords,actions,andbodylanguage.Reflectivelisteningisaspecialgiftwecanoffertoothersinbothourworkandpersonallives.Reflectivelisteningtakestheconversationtoadeeperlevel.Thisisespeciallytrueofreflectivestatementsthatgobeyondrepeatingwhatwassaidbymakingareasonableguessabouttheperson’smeaning.Suchstatements“havetheimportantfunctionofdeepeningunderstandingbyclarifyingwhetherone’sguessisaccurate.Reflectivestatementsalsoallowpeopletohearagainthethoughtsandfeelingstheyareexpressing,perhapsindifferentwords,andponderthem.Goodreflectivelisteningtendstokeepthepersontalking,exploring,andconsidering.Itisalsonecessarilyselective,inthatonechooseswhichaspectstoreflectfromallthatthepersonhassaid.”[p.34]Formingreflectionsrequirestheabilitytothinkreflectively.Sincewordscanhavemultiplemeanings,andpeopledon’talwayssayexactlywhattheymean,itisusefultoregardpeople’sstatementsasa“firstdraft.”Inotherwords,ratherthanassumingwhatsomeonemeans,checkitout.Becausereflectionsarestatements,notquestions,theinflectionusuallyturnsdownattheend.Forexample,noticethedifferencebetween: “Youdon’tthinkyourdrinkingisaproblem?” “Youdon’tthinkyourdrinkingisaproblem.”Somereflectivestatementsbasicallyrepeatorslightlyrephrasewhatapersonhassaid.Thesesimplereflectionscanconveybasicunderstandingandhelptheflowoftheconversation.However,theyaddlittleornomeaningtowhatthepersonsaid,andcanstoptheconversationfromgoingtoadeeperlevel.Forexample:

Statement:I’mfeelingprettydepressedtoday.Response:You’refeelingdepressed./You’refeelingkindofdown./Prettydepressed…

Complexreflectionsaddmeaningoremphasistowhatsomeonehassaidbymakingaguessaboutwhatisunspoken.Complexreflectionstendtohelppeoplethinkmoreabouttheirsituation.Whenfirstlearningtousecomplexreflections,itcanfeelabitstrange.However,whenyougetusedtoit,suchreflectionscommunicaterealunderstanding.Forexample:

Statement:I’mfeelingprettydepressedtoday.Response:You’renotfeelinglikeyourusualself./Youwishyouhadmoreenergyand

interestindoingthings./Itsoundslikesomethinghashappenedsincewelasttalked.

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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OARS:Summaries

Asummaryisastatementthatdrawstogethertwoormorethingsthatsomeonehassaidpreviously.Itisbasicallyaparagraphofselectedreflectivestatements.Decidingwhattochoosetoincludeinasummarydependsonthesituation.However,usuallyyouwanttopickthethingsthatmoveinthedirectionofchange–kindoflikepickingthetastiestchocolatesfromaboxofcandy.Summariescanbeofferedatvarioustimesinaconversationtodrawideastogetherandguidetheconversation.Summaries,liketheotherOARSskills,areusedthroughoutthefourprocessesofMI.Particularlyintheengagingandfocusingprocesses,summariesshowthatyouhavebeenlisteningcarefullyandthatyouvaluewhatthepersonhassaid.Theyalsoprovideanopportunityforaskingthepersontofillinwhatyouhavemissed.Intheevokingprocess,summariesareoftenusedtoemphasizethingsthatsupportaperson’schangegoal.Summariescanhavedifferentpurposes.Collectingsummariespulltogether“inonebasket”variousstatementsthepersonhasmade.Linkingsummariesconnectwhattheindividualhassaidwithsomethingtheysaidinapriorconversation.Transitionalsummariesareusedasawrap-upattheendofaconversation,ortocreateabridgeforshiftingtheconversation.Inallthreecases,emphasisisplacedonshiningalightonthepersonschangetalk(seemoreonpage9).DuringtheplanningprocessofMI,summariesaregenerallyusedtorecaptheperson’sreasonsforwantingtochangeandwhattheyintendtodo.Thiscanhelpstrengthencommitmenttomakethechange.Belowaresomeguidelinesfordevelopingandofferingsummaries.Remembertokeepsummariesbriefandtothepoint.1.Beginwithastatementindicatingyouaremakingasummary.Forexample:

LetmeseeifIunderstandsofar… HereiswhatI’veheard.TellmeifI’vemissedanything.

2.Ifthepersonis“feelingtwoways”aboutchanging,namebothsidesoftheuncertaintyinthesummary.Forexample: Ontheonehandyou...ontheotherhand...”3.Highlightchangetalkyouheard–statementsindicatingtheperson’sdesire,ability,reasons,need,andcommitmenttochange.Forexample: Youmentionedseveralreasonswhyyouwouldwanttomakethischange,including...4.Endwithaninvitation.Forexample:

Whatwouldyouadd?AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013andhandoutscreated

byDavidB.Rosengren,Ph.D.

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InformingandAdvisingWhileMIisaninherentlyperson-centeredapproach,thisdoesnotmeanthatinformationandsuggestionsareneveroffered.InMI,bothpartiesareviewedashavingexpertise;thus,theremaybeoccasionswhenthiskindofinputisappropriate,suchaswhenapersonrequestsit.However,informationandsuggestionsareprovidedsparinglyandnotasafirstlineofresponse.TherearetwomaindifferencesastohowinformationandsuggestionsareofferedinMI,ascomparedtobeingdispensedinanunsolicited,authoritativemanner.Thefirstisthatitisofferedonlywithpermissionfromtheperson.Secondly,itisprovidednotasthe“finalword”butratherinthecontextofhelpingpeoplecometotheirownconclusionsaboutitsrelevanceandvalue.Itisoftenhelpfultoverballyacknowledgethiswithpeople.IntentofprovidinginformationandsuggestionsinMI

• Notanattempttoconvincepeopleofthefollyoftheirways• Providesanopportunitytoexpressconcernsandhelptheindividualmovefurther

alongintheprocessofchange• Canhelpapersoncometoadecision

Afewconsiderations

• It'sallrighttoexpressyourconcerns• Therearemanypathwaystochange;yourwaymaynotbethewayofanother• Focusonhelpingthepersonevaluateoptions• Offerinformationandadvice,don'timposeit

Suggestedmethod:Evoke-Provide-Elicit(E-P-E)Elicit

• Askwhattheindividualalreadyknowsaboutthetopic/issue• Inquirewhatsheorhewouldliketoknow• Askpermissiontoprovideinput–e.g.,“WoulditbeallrightifIsharesome

ideas/impressions/possibleoptionswithyou?”Provide

• Offersmalldoseofinformationoradviceinakind,nonjudgmentalmannerElicit

• Askfortheperson’sresponse–e.g.,“Iwonderwhatyouthinkofthat”• Emphasizechangetalk,provideaffirmations,andinstillhope.• Recognizeandaffirmitistheindividual'sdecisiontomake–e.g.,“Ofcourse,you’re

theonlyonewhocanmakethisdecision.”

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013andhandoutscreatedbyDavidB.Rosengren,Ph.D.

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EvokingChangeTalk

Changetalkreferstoanythingsomeonesaysthat“favorsmovementtowardaparticularchangegoal.”Evoking,or“callingforth,”changetalkhelpspeoplecomeupwiththeirownreasonstochange.Thisisfarbetterthansomeoneelsetryingtoconvincethemtochange,whichoftenmakespeopledefensiveandargueagainstchanging.AsaworkeryoucanusetheOARSskills(Openquestions,Affirmations,Reflectivelistening,andSummaries)to“askfor”andrespondtochangetalk.NoticethatchangetalkcomesindifferentflavorsthatformthephraseDARN-CAT.PreparatoryChangeTalk–“thinkingaboutchanging”

Desire–Iwantto,Iwouldliketo,Iwish,IhopeAbility–Ican,Icould,IamabletoReasons–Itwouldhelpme,I’dbebetteroffifNeed–Ineedto,Ihaveto,somethinghastochange

MobilizingChangeTalk–“takingaction”

Commitment–Iwill,Ipromise,IgiveyoumywordActivation–I’mwillingto,Iamreadyto,IampreparedtoTakingsteps–Icutbackonmyweekenddrinking

MethodsforEvokingChangeTalkAskingevocativequestions Whatworriesyouaboutyourcurrentsituation? Whywouldyouwanttomakethischange? Howmightyougoaboutit,inordertosucceed?Usingtheimportanceruler(alsouseregardingperson’sconfidencetochange) Onascaleof0to10,howimportantisitforyoutomakethischange?Tellmeabout beingat___comparedto(severalnumberslower)?Whatwouldittaketomovefrom ___to(nexthighestnumber)?AndhowImightIhelpyouwiththat?

Exploringextremes–Whatconcernsyouabsolutelymostabout____?Whataretheverybest resultsyoucouldimagineifyoumadeachange?

Lookingback–Whatwerethingslikebeforeyoubegandrinkingmorefrequently?

Lookingforward–Howwouldyoulikethingstobedifferentinthefutureregarding____?

Exploringgoalsandvalues–What’smostimportanttoyouinlife?Whataretherulesyou’d sayyouliveby?Howdoesdrinkingfitwithyourpersonalgoals?

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely important important

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RespondingtoDiscord

Whatdoyoudowhensomeone“pushesback”atyouinawaythatfeelslikeit’spersonal?Maybethepersonsays,“Whoareyoutotellmewhattodo!”or“Youdon’treallycareaboutme!”Or,theindividualrefusestotalk.Or,perhapsagreestodosomething,butthendoesn’tdoit.Whenthesethingshappen,youcanbeprettysurethatsomething’sgonewrongintherelationship.InMI,wecallthisdiscord.Thisriftcanoccurforvariousreasonsasnotedbelow.Ratherthanplacingblameontheindividual,itisimportantforworkerstolookattheirownbehaviortoconsiderwhatmightbepromptingthepersontoreact.Thepresenceofdiscordintherelationshipisasignaltotryadifferentapproach.Commoncausesofdiscordintherelationship

• Thetwoofyouhavedifferentgoals• You’retryingtogetthepersontochange• Wheneitherofyoubringsangerandfrustrationintothesituation• You’renottrulylistening,oryou’remakingassumptionsorinterrupting• There’salackofagreementaboutrolesintherelationship

Practitionerbehaviorsthattendtoincreasediscord• Pushingtoohardonthepersontochange• Assumingyou’retheexpert;notworkingcollaboratively• Criticizing,shaming,blaming;usingnegativeemotionstogetthepersontochange• Labeling;“that’sbecauseyou’reanalcoholic/addict”• Beinghurried• Givingtheimpressionthatyou“knowwhat’sbestfortheindividual”

Practitionerbehaviorsthattendtodecreasediscord

• Usingsimpleandcomplexreflectivestatementso “You’rewonderingifIcanhelpyou”o “You’renotsureyoucantrustme”

• Otherresponseso Apologizing–“Sorry,Ididn’tmeantolectureyou.”o Affirming–“You’vebeendoingthisforalongtimeandknowhowtokeep

yourselfsafe.”o Shiftingfocus–“Maybethere’ssomethingelsethatwouldbemoreusefulto

talkaboutfornow.”o Emphasizingpersonalchoiceandcontrol–“Itisentirelyuptoyou.Thisis

yourdecision.Nooneelsecanmakeitforyou.”

AdaptedfromMotivationalInterviewing,3rdeditionbyMiller&Rollnick,2013

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MotivationalInterviewing:AGuidedConversationHereisanoutlineofhowamodelMIconversationmightflow.Inthiscase,drinkingisthefocus.Ofcourse,reallifeconversationsrarelyplayoutinsuchastraightforwardmanner.NotethatthespiritandcoreskillsofMIareappliedthroughoutthefourprocessesofMI.Asageneralguideline,itisusefultofollowabasicrhythmofaskinganopenquestionfollowedbyoneormorereflections,beforeaskinganotherquestion.ENGAGINGProvideawarmwelcome;offerabeverage;exchangesmalltalk;makesurethepersonfeelssafe;showthatyoucare;gettoknowthepersonasaperson;behopeful

§ “Hi.It’sreallygoodtoseeyou.Wouldyoulikesomejuiceortea?”“Howhavethingsbeengoinglately?”(Respondwithreflectivestatements)

FOCUSINGAgreeonwhattotalkabout

§ “What’sonyourmind?”“Youmentionedseveralthings.Whereshallwestart?”“Woulditbeallrightifwetookacloserlookatyouanddrinking?”(Reflect)

EVOKINGExploreambivalence

§ “Whatdoesdrinkingdoforyou?Whatconcerns,ifany,doyouhaveaboutit?”(Reflect)

Elicitchangetalk§ DESIRE(want,wish,like)

“Howwouldyoulikethingstobedifferentthantheyarenow?”(Reflect)

§ REASONS(specificreasonsforchange) “Ifyouweretocutbackorstopdrinking,whataresomereasonsyoumightdothat?” (Reflect)

§ ABILITY(can,could,able)

“Howmightyougoaboutitinordertosucceed?”(Reflect)

§ NEED(havetoorimportantto-withoutstatingspecificreason)“Howimportantisittoyoutomakethischange?”(use0-10scalingquestion)(Reflect)

PLANNING

§ TESTINGTHEWATER(readinessandconfidence)“Howreadyareyoutomakethischange?”“Howconfidentareyoutomakethischange?”(oruse0-10scalingquestion)(Reflect)

§ COMMITMENT(will,planto,intendto,goingto,willing,ready,etc.)

“Whatdoyouthinkyouwilldonext?”“Whatisyourplan?”“HowcanIhelpyouwiththat?”(Reflect)

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MISelf-Appraisal

Astheinterviewer,I…

0-not5-extremelyatallwell

1.Providedasafe,welcomingpresencewithmywordsandactions.Example:

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2.Engagedwithandshowedgenuineinterestintheperson,e.g.,whatsheorheenjoys,needs,values.Example:

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3.Foundoutandclarifiedwhatthepersonwantedtofocusoncurrently.Example:

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4.Helpedexplorebothsidesoftheperson’sdilemma,e.g.,what’sworkingandwhat’snot;upsidesanddownsides.Example:

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5.Avoidedtryingto“fix”theproblemorgetthepersontochangebyadvising,confronting,warning,orteaching.Example:

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6.Elicitedwhatmightbesomepossiblereasonstochange,ifthepersonweretodecidetochange.Example:

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7.Learnedaboutpossiblewaysthatheorshemightgoaboutmakingthischange.Example:

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8.Askedhowimportantitisatthistimeforthepersontomakethischange.Example:

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9.Askedhowconfidentsheorhefeelstobeabletomakethischange.Example:

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10.Inquiredaboutwhatsteps,ifany,thepersonmighttakenext.Example:

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11.Askedpermissionbeforeprovidinginformationorsuggestions.Example:

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12.UsedthecoreskillsofMI(openquestions,affirmations,reflectivelistening,summaries)throughouttheconversation.

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13.ConsistentlydemonstratedthespiritofMI:>Partnership

>Acceptance

>Compassion

>Evocation

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DevelopedbyKenKraybillbasedonMiller,W.R.&Rollnick,S.,MotivationalInterviewing:HelpingPeopleChange,2013

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MISelfCheckforPractitioners

IndividualsImeetwithwouldsaythatI…

o Believethattheyknowwhat’sbestforthemselves

o Helpthemtorecognizetheirownstrengths

o Aminterestedinhelpingthemsolvetheirproblemsintheirownway

o Amcuriousabouttheirthoughtsandfeelings

o Helpguidethemtomakegooddecisionsforthemselves

o Helpthemlookatbothsidesofaproblem

o Helpthemfeelempoweredbymyinteractionswiththem

AdaptedfromHohman.&Matulich.MotivationalInterviewingMeasureofStaffInteraction,2008

SelectedResources

Arkowitz,H,Westra,H.A.,&MillerWR,RollnickS.(Eds.).(2015).MotivationalInterviewinginTheTreatmentofPsychologicalProblems(2ndedition).NewYork,NY:GuilfordPress.CenterforSubstanceAbuseTreatment.(1999).EnhancingMotivationforChangeinSubstanceAbuseTreatment:TreatmentImprovementProtocol(TIP)Series35.Rockville,MD:DHHSPublicationNo.(SMA)99-3354. Hohman,M.(2011).MotivationalInterviewinginSocialWorkPractice.NewYork,NY:GuilfordPress.Miller,W.R.,&Rollnick,S.(2013).MotivationalInterviewing:HelpingPeopleChange(3rdEd.).NewYork,NY:GuilfordPress.Miller,W.R.,&Rose,G.(2009).TowardaTheoryofMotivationalInterviewing.AmericanPsychologist,64(6),527-537.Naar-King,S.,&Suarez,M.(2011).MotivationalInterviewingwithAdolescentsandYoungAdults.NewYork,NY:GuilfordPress.Rollnick,S.,Miller,W.R.,&Butler,C.(2008).MotivationalInterviewinginHealthCare.NewYork,NY:GuilfordPress.Rosengren,D.B.(2009).BuildingMotivationalInterviewingSkills:APractitionerWorkbook.NewYork,NY:GuilfordPress.WagnerCC,IngersollKS.(2012).MotivationalInterviewinginGroups.NewYork,NY:GuilfordPress.Website:www.motivationalinterviewing.orgZuckoff,AllanwithGorscak,B.(2015).FindingyourWaytoChange.NewYork,NY:GuilfordPress.