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