Motivational Interviewing Christopher C. Wagner, Ph.D., Lic. Clin. Psy., CRC Virginia Commonwealth University Departments of Rehabilitation Counseling, Psychology and Psychiatry

Two styles of interacting Consider something about yourself that you might… Want to change Think you should change Have been thinking about changing Made efforts earlier, but stopped Other people think you should change (something you’re ambivalent about)

Persuasion Exercise - Helper’s task (2-3 mins) Explain why the person should make this change Describe 2-3 specific benefits that would result from changing Tell the person how to make the change Emphasize risks they face if they don’t change Persuade the person to follow through on your recommendations P.S. This is NOT motivational interviewing No reflective listening or exploring

Motivational Exercise - Helper’s task (3-4 mins) Listen carefully to deeply understand the dilemma (Don’t give advice) Ask these open questions (then listen): (1) T ell me a little about the change you’re considering. (2) What benefits would there be if you make this change? (3) How might you go about it in order to succeed? Give a short summary Ask, “So what do you think you’ll do?” (and just listen with interest) Thank them for the conversation

Which people would you rather work with? Open Cooperative Listening Engaged Active Empowered Hopeful Defensive Oppositiona l Arguing Disengaged Passive Inert Hopeless

Highly motivated people: Participate more actively in services Explore and disclose more Take greater ownership and pride in efforts toward change Motivation is a key element in any lifestyle change

Ambivalence

Status Quo Positive Change Ambivalence

Status Quo (Sustain talk) Positive Change (Change talk) Ambivalence

1. Involves establishing a helpful connection in which the client feels respected, open, and heard 2. Focuses mostly on future possibilities related to a specific issue 3. Evokes clients’ sense of importance and confidence about change while helping to resolve lingering ambivalence Motivational Interviewing….

MI involves a change of role You don’t have to make change happen You can’t anyway You don’t have to come up with all the answers You probably don’t have the best ones You’re not wrestling You’re dancing

A continuum of communications Practitioner-centered……...Client-centered……...Practitioner-centered

MI & Addiction Engaging Help clients feel comfortable, inform what process may look like and invite input Invite them into a collaborative relationship Focusing Re-discovering the motivation to live a life without depending on substances to get by Use guiding approach (directing may push away… following may collude with avoiding important topics)

MI & Addiction Evoking Desire – I want to feel normal again Ability – I can live the life I choose Reasons – I want to be around to see my grandchildren Needs – I don’t need a substance to be okay Commitment – I am going to do whatever it takes Activation – I am starting now Taking Steps – I’ve added other things into my life Planning “What do you think you could do to make life worth living?” Develop a plan and a backup plan

MI & Addiction 12 Steps TIPS: Encourage them to “check out” multiple meetings Evoke interest/commitment to attend at a high-risk time Encourage them to consider all ideas, but not feel compelled to agree Evoke their thoughts on value of having a non-using supportive network Process their pros & cons after sampling a few meetings Let them know that attending meetings is not required or necessary, but can be helpful over time

MI & Addiction 12 Steps MI is not in conflict with original 12-steps, though sometimes a conflict with traditional rehabilitation as practiced in America Big book: He must decide for himself whether he wants to go on. He should not be pushed or prodded … If he thinks he can do the job in some other way…encourage him to follow his own conscience… In any case, be friendly…. a spirit of intolerance might repel alcoholics whose lives could have been saved… Not one drinker in a thousand likes to be told anything about alcohol by one who hates it.

Building MI skills Most clinicians master 8 tasks as they learn MI Collaborative attitude/open mind Staying with the spirit of MI: Partnership, Acceptance, Compassion, Evocation Mastering OARS Developing broad patient centered counseling skills Recognizing change talk Eliciting the patient’s own solutions Consolidating commitment to change Blending MI with other skills