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Motivational Interviewing
Motivational Interviewing
Mia Croyle, MA
Fall 2017
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Continuing Education Disclosures Commercial Support or Sponsorship-None
Speaker or planner conflicts of interest – None
If off-label use, speakers will announce during presentation.No products or services are endorsed by MetaStar
or any accrediting agency.
For CME, CNE, CPHQ, NASW, Dietitian, or attendance certificate -Full session attendance and completion of one on-line evaluation.
Evaluation link –Will be sent to you via email within 24 hours of the session
Or, you can use the QR Code or link on handout.
Thank you!
About Me
Using MI since 2007• Primary Care• Phone coaching• Groups
Training & Coaching MI since 2009
• Healthcare• Social Services• Criminal Justice
Member of Motivational Interviewing Network of Trainers (MINT)
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Objectives
Following this educational opportunity, participants will be better able to:
• Identify the four key domains of the spirit of MI
• Employ the core skills in MI at a basic level• Utilize one MI strategy in current practice• Design a plan for future development
towards proficiency in MI
For Today
– Quiet phones
– Take breaks
– Share our experiences
– Learn from one another
– Adopt a beginner’s mind
– Be willing to “try it on”
– Create a safe space for all
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Comfort Zone
Growth Zone
Shutdown Zone
Best Space for Change
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What do you already know?
(about MI)
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Definition
Motivational interviewing is a
collaborative,
person‐centered,
guiding method designed to
elicit and strengthen
motivation for change
Another Definition
• a way of structuring conversations
• Goal: help other person hear
themselves talking about their own
arguments for making changes
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Key Concepts
Reducing resistance
1
Addressing ambivalence
2
Raising discrepancy
3
Eliciting change talk
4
AN EXERCISE
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Without MI
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Spirit of MI
Partnership
Evocation
Compassion
Acceptance
Most people do not listen with the intent to understand; they listen with the intent to reply.
‐Unknown
Empathy
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Listening
MIND
An Exercise
–Find a partner – someone you don’t know
well
–Two roles: – Speaker
– Listener
–Decide who will be in which role first
–This is not yet MI – but will stretch some
needed muscles
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MI Skills
Open QuestionsAffirmationsReflectionsSummaries
Open Questions
yes/no or set responseDon’t ask
for more context, perspectiveAsk
what the question asks for, not the response you getFocus on
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Questions
What brings you here today?
Are you exercising regularly?
Will you try this for one week?
How are you today?
Did you follow‐up?
How often did you test your sugar?
Are you willing to come back in about a month?
Can you tell me about that?
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Open Questions
What…
How….What was that like... Give me an example…
Tell me more about that…..
Are you exercising regularly?
Will you try this for one week?
Did you follow‐up?
Are you willing to come back in about a month?
Can you tell me about that?
Opening Up Closed Questions
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Supports enhanced understanding
01Directly ask for change talk
02Maintains engagement
03
Useful Asking
Affirm a person’s struggles,
achievements, values, and feelings
Emphasize strength Notice and appreciate a positive action
Express positive regard and caring
Not a compliment or praise
Description vs. appraisal
Affirmations
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– Non‐threatening
– Keeps focus on other person’s
content
– Deepens the conversation
– Helps people better
understand themselves
– Shapes direction
Reflective Listening
Expand
Refine
Correct
Verify
Etc…
Reflections offer opportunity for the other person to…
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Repeat
Rephrase
What was said
• Stabilizing• Empathy• Understanding
• Direction• “I’m listening”• “Go on…”
Simple Reflections
“I don’t know what I’m going to do. Sure, drinking has caused some big hassles lately, but I just really like beer.”
Try It
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Goes beyond what was said
Aims to capture meaning– Feelings– Intent– Interpretation– Metaphor– The next thing
Forward movement
Complex Reflections
“I don’t know what I’m going to do. Sure, drinking has caused some big hassles lately, but I just really like beer.”
Try It
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Questions vs Reflections
–Research says…
–Through the MI Spirit
perspective...
–And....
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Questions vs Reflections
I had an awful day… My meeting ran late, my husband left the car with an empty gas tank, and then I got a parking ticket!
Q: How frustrating was that for you?
R: That must have been frustrating.
Questions vs Reflections
I’m very worried about my diabetes. It runs in my family… I’ve lost many relatives to it, and I want to break that cycle.
Q: How many relatives of yours have had diabetes?
Q: How have you thought about breaking the cycle?
Reflections:
– There is a lot of diabetes in your family.
– You might have some thoughts about how to break that
cycle.
– You are scared about your diabetes getting worse
(It’s scary to think about your diabetes getting worse)
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Questions vs Reflections
I’ve tried to quit many times in the past…I think I’ve tried just about everything…but it just doesn’t work.
Q: How many times have you tried to quit in the past?Q: What methods have you used in the past?
Simple Reflections: – You have tried to quit many times in the past– You’ve tried several approaches to quit.
Complex Reflections: – You’ve tried several approaches but they haven’t seemed to work.
– You want to find something that is going to work for you this time.
• Support direction
• Choose content wisely!
Use strategically
• Capture key ideas & themes
• Change talk
Transitions
• “What’s next?”
Pair with Key Question
Summary
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Questions
Reflections
Putting the Pieces Together
Sharing Information in the Spirit of MI
Explore
• Existing knowledge
• Interest
• Permission
Offer
• Affirmation
• Information in small bits
• Menu of options
Explore
• Reactions
• Ideas
• Next Steps
• Questions
Ask permission!
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Possible Next Steps
Read, view videos, online
learning
Experiment on your own
MI Workbook
Join a learning community of
peers
Record yourself practicing and listen back
Attend an advanced training
Engage a coach
Resources
–Motivational Interviewing Network of Trainers www.motivationalinterviewing.org
–Guilford Press – Applications of
Motivational Interviewing Series
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Online Resources
– British Medical Journal: Learning Motivational
Interviewing
– American Academy of Pediatrics: Change Talk
– National Institute on Drug Abuse: Blending
Initiative Motivational Interviewing
– Indiana Prevention Resource Center:
Introduction to Motivational Interviewing
– Addiction Transfer Center Network: Tour of
Motivational Interviewing
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This material was prepared by Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MN-G1-17-86 101717
Follow us online @LakeSuperiorQIN
Thank you
