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Motivational Interviewing

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.”.

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Motivational Interviewing

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  1. Motivational Interviewing Kelley Gannon, LCSW Director of Clinical Services Bluegrass Regional MH-MR Board

  2. Motivational InterviewingDefinition: “A directive, client-centered counseling style for helping clients explore and resolve ambivalence about behavior change.” William R. Miller, 1991 2

  3. Benefits of MI • 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

  4. General Principles Fundamental to Motivational Interviewing • 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) 4

  5. Principle 1:Reflective Listening • Reflective listening facilitates change • Skillful reflective listening is essential to raising client awareness • Reflective listening builds a working alliance • Coming “alongside” the client • Show interest • Follow the client’s story Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press. 36

  6. Definition: Reflective Listening • 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…” 6

  7. Simple Reflections • 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.

  8. Complex Reflections • Paraphrasing: therapist implies the meaning in what was said and reflects it back to the client • Reflection of Feelings • Metaphors

  9. Principle 2:Develop Discrepancy • A discrepancy between present behavior and important goals for the future will motivate change. • Identify ambivalence to raise awareness • Invite the client to present the arguments for change. • Separate the behavior from the person Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press. 9

  10. Strategic Reflection- Double Sided Turn up the volume-Amplified Reflection Pros and Cons Develop Discrepancy

  11. Principle 3:Avoiding Direct Confrontation • Arguments are counterproductive • Resistance is a signal to change strategies • Defending breeds defensiveness

  12. When you get stuck get your OARS out! O - Open Questions A - Affirmations R - Reflections S - Summarize

  13. Open-ended Questions • 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 _______” 13

  14. Affirmations • Definition: appreciation, understanding, support • Affirm effort and achievement • Examples • “This is hard work you’re doing” • “It takes courage to face such difficult problems” • “Coping with that takes a lot of resourcefulness” 14

  15. Summary • Set up statement: “Let me see if I have this right…” • Reflection, reflection, reflection • Open question: “So where does that leave us? What else would you like to add?” or “Now, tell me about ….” (to re-direct) 15

  16. Principle 4:Roll with Resistance • Avoid arguing for change. • New perspectives/information are invited, but not imposed. • The client is a most valuable resource in finding solutions to their problems. • Use your OARS Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press. 37

  17. Therapist roadblocks • 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

  18. Principle 5:Support Self-Efficacy • Belief in the possibility of change is an important motivator. • The client is responsible for choosing and carrying out personal change. • Praise the client’s strengths • Express belief, hope • Focus on small changes Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press. 38

  19. Eliciting Change Talk • Evocative Questions -Disadvantages to the status quo -Advantages for change -Optimism about change -Intention to change

  20. Eliciting Change Talk • Importance Ruler • Identify Goals/Values

  21. Questions

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