Transcript Motivational Enhancement Therapy

Motivational Interviewing
Kelley Gannon, LCSW
Director of Clinical Services
Bluegrass Regional MH-MR Board
Motivational Interviewing
Definition:
“A
directive, client-centered counseling
style for helping clients explore and
resolve ambivalence about behavior
change.”
William R. Miller, 1991
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Benefits of MI
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MI increases treatment retention
MI increases treatment adherence
MI increases clinician job satisfaction
MI decreases clinician burnout
MI decreases clinician cynicism
MI works concurrently with other EBP
General Principles Fundamental to
Motivational Interviewing
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Reflective Listening
Develop Discrepancy
Avoid direct confrontation
Roll with resistance
Support Self-efficacy
Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press, and MI Network of Trainers (MINT)
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Principle 1:
Reflective Listening
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Reflective listening facilitates change
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Skillful reflective listening is essential to raising client awareness
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Reflective listening builds a working alliance
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Coming “alongside” the client
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Show interest
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Follow the client’s story
Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press.
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Definition: Reflective Listening
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A hypothesis (guess) about speaker’s meaning
A statement to convey understanding
Intonation down
Short stems
 “So…”
 “Sounds like…”
 “So you…”
 “Seems like …”
 “Its like…”
 “You feel…”
Simple Reflections
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Repeats an element of what the client has
said
Rephrasing: stay close to what the client has
said but substitutes synonyms or rephrases
what was said.
Complex Reflections
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Paraphrasing: therapist implies the meaning
in what was said and reflects it back to the
client
Reflection of Feelings
Metaphors
Principle 2:
Develop Discrepancy
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A discrepancy between present behavior and
important goals for the future will motivate change.
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Identify ambivalence to raise awareness
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Invite the client to present the arguments for change.
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Separate the behavior from the person
Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press.
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Develop Discrepancy
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Strategic Reflection- Double Sided
Turn up the volume-Amplified Reflection
Pros and Cons
Principle 3:
Avoiding Direct Confrontation
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Arguments are counterproductive
Resistance is a signal to change strategies
Defending breeds defensiveness
When you get stuck
get your OARS out!
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O - Open Questions
A - Affirmations
R - Reflections
S - Summarize
Open-ended Questions
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Invite discussion and elaboration;
do NOT invite brief answers
Stems
 “What would you like to discuss?”
 “How do you feel about coming here?”
 “You mentioned ___. What concerns
you about that?”
 “What was that like for you when…?”
 ““What are your views about that?”
 “Tell me more about _______”
Affirmations
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Definition: appreciation, understanding, support
Affirm effort and achievement
Examples
 “This is hard work you’re doing”
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“It takes courage to face such difficult
problems”
“Coping with that takes a lot of
resourcefulness”
Summary
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Set up statement: “Let me see if I have this right…”
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Reflection, reflection, reflection
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Open question:
“So where does that
leave us? What else
would you like to add?”
or “Now, tell me about ….”
(to re-direct)
Principle 4:
Roll with Resistance
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Avoid arguing for change.
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New perspectives/information are invited, but not imposed.
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The client is a most valuable resource in finding solutions to
their problems.
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Use your OARS
Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press.
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Therapist roadblocks
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Premature problem solving
Being logical with your client
Expert Stance
Doesn’t elicit client ideas about change
Not believing the client can change
Confrontational
Become frustrated when client doesn’t change
Principle 5:
Support Self-Efficacy
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Belief in the possibility of change is an important
motivator.
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The client is responsible for choosing and carrying
out personal change.
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Praise the client’s strengths
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Express belief, hope
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Focus on small changes
Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press.
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Eliciting Change Talk
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Evocative Questions
-Disadvantages to the status quo
-Advantages for change
-Optimism about change
-Intention to change
Eliciting Change Talk
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Importance Ruler
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Identify Goals/Values
Questions