Motivational Interviewing

24seven

Tobias SandbergMI-trainer

Member of: Motivational Interviewing Network of Trainers

Motivational Interviewing

• Developed by William R. Miller and Stephen Rollnick

• Evidence-based method• Focus on motivation and change• Person-centered• Humanistic psychology

Motivational Interviewing • Motivational interviewing is a

collaborative conversational style for strengthening a person’s own motivation and commitment to change.

A way of being

Structured conversation

Influencing time(24seven)

A Continuum of Communication styles

Directing Guiding Following

CommandDecide LeadRuleTake chargeTell

ElicitCollaborateMotivateSupportAssistInspire

AllowGo along withPermitListenAttendStick to

Directing Guiding Following01234567

InformingAskingListening

A Continuum of styles

MI is like dancing

Spirit of MI

• Collaborativ

• Evoking

• Autonomy support

• Empathy

• Rule• Listen to me!• I decide• Antipathy

X

What we know

We have to avoid…”Roadblocks”/Righting

reflex• Ordering, or commanding• Warning, or threatening• Giving advice• Telling people what to do• Shaming, ridiculing• Judging

How to do…

• Active listening• Try to understand the person’s dilemma

Show Empathy

Empathy

Treatment provider who shows a high degree of empathy in meeting with clients increases the likelihood that:

• "Resistance" is reduced.• Reduces relapse.• Reduction of interruptions in treatment.• Increases the change tendency.• Does not damage or worse treatment.

MI’sCommunication skills

Open questionsAffirmationsReflectionsSummaries

When Worlds CollideResistance/Discord

You are always nagging and complaining!

I will always smoke weed!

I don’t know if I want to!

I hate this place!

Feelings

• Anger• Sadnes• Powerlessness• Frustration• Loneliness• Misunderstood

Increases Resistance

• Argue• Ignore• Raise our voice• Warn• Reduce

Reduce Resistance

• Listen• Give choices• Confirm• Show empathy• Be present

We can choose to try to reduce the resistance or cause it to increase

Some examples that can reduce resistance

- You are always nagging and complaining!- You think I demand too much of you…

- I will always smoke weed!- You think you’re going to smoke weed when you are forty…

- I don’t know if I want to!- You feel unsure about what you want…

- I hate this place!- How do you think I can help you to feel a little better?

We try

Consistent and inconsistent with MI • What do you think you need to do?• You have really exerted yourself.• You are the one who know yourself best.• If I'm able to help you, you must do as I say.• I'm warning you!• I really appreciate you taking the time for this.• Now you listen to me!• How do you see it?

We use the MI-spirit and MI’s

Communication skills to show Empathy and elicit the

Clients dilemma.

Change TalkDesireAbilityReasonsNeed

Commitment ActivationTaking Steps

“I want”, “I wish”

“I could do it”, “I am able to”

“I want to live with my parents”

“I must”, “I need to”

“I've decided to ...”,

“I am ready to…”

“I went to the meeting this week”

Change Talk

………but………It would feel good to practice, but I love to watch TV

Change Talk and Sustain Talk“Other Side of the Coin”

It would be good for me to take my medicine, but I ignore it.

I want to stop drinking, but not now!

I need help, but this is no help.

We try

• I actually have time to exercise• If I work out, I will be more alert• It's no fun to run in the rain• I'm too old to go to the gym.• I'll take the bike to work.• On Thursday I'll go out and run.• I will never find the strength to work

out.• I know I can.• I've decided to start training

The first meeting Perhaps one of the most important encounter at the

institution.

We have to:

• Remind us of the MI spirit• Be active listeners and show empathy

by using the OARS.• Make use of an MI strategy,

Meny/Agenda

Meny/Agenda

What happens nextSmoke

Call home

Råby

Most important for you1.

2.3.

4.

5.

Spirit of MI

• Collaborativ

• Evoking

• Autonomy support

• Empathy

The essens of MI

The MI-Spirit

Avoid confrontationand

The righting reflex

Elicit and respondChange talk

MI is simpel but not easy

We need to train and assist each other in MI

Summary of ”how to do”

• The importance of MI-Spirit:- Collaborative, Evoking, Autonomy support, Empathy- MI is like dancing, you need to be controlling and following

at the same time.• Most of the time use a guiding style• When we listen, we use active listening and try to show

empathy• The first meeting is important• We can reduce resistance by our way of being• We listen and respond to change talk• We know that the more a person expresses change talk

the more likely it is that she makes a change

Thank you very much!

Tobias Sandberg

MI-trainer

Member of: Motivational Interviewing Network of Trainers

Tobias.Sandberg@stat-inst.se