Motivational Interviewing 24seven Tobias Sandberg MI-trainer Member of: Motivational Interviewing Network of Trainers

Motivational Interviewing Developed by William R. Miller and Stephen Rollnick Evidence-based method Focus on motivation and change Person-centered Humanistic psychology

Motivational Interviewing Motivational interviewing is a collaborative conversational style for strengthening a person’s own motivation and commitment to change.

A way of being Structured conversation Influencing time (24seven)

A Continuum of Communication styles Directing Guiding Following Command Decide Lead Rule Take charge Tell Elicit Collaborate Motivate Support Assist Inspire Allow Go along with Permit Listen Attend Stick to

A Continuum of styles

MI is like dancing

X Spirit of MI Collaborativ Rule Evoking Listen to me! Autonomy support Empathy Rule Listen to me! I decide Antipathy X

What we know

”Roadblocks”/Righting reflex We have to avoid… ”Roadblocks”/Righting reflex Ordering, or commanding Warning, or threatening Giving advice Telling people what to do Shaming, ridiculing Judging

Show Empathy How to do… Active listening Try to understand the person’s dilemma Show Empathy

Empathy Treatment provider who shows a high degree of empathy in meeting with clients increases the likelihood that: "Resistance" is reduced. Reduces relapse. Reduction of interruptions in treatment. Increases the change tendency. Does not damage or worse treatment.

MI’s Communication skills Open questions Affirmations Reflections Summaries

When Worlds Collide Resistance/Discord

You are always nagging and complaining! I hate this place! I don’t know if I want to! I will always smoke weed!

We can choose to try to reduce the resistance or cause it to increase Increases Resistance Argue Ignore Raise our voice Warn Reduce Feelings Anger Sadnes Powerlessness Frustration Loneliness Misunderstood Reduce Resistance Listen Give choices Confirm Show empathy Be present We can choose to try to reduce the resistance or cause it to increase

Some examples that can reduce resistance You are always nagging and complaining! You think I demand too much of you… I will always smoke weed! You think you’re going to smoke weed when you are forty… - I don’t know if I want to! You feel unsure about what you want… I hate this place! How do you think I can help you to feel a little better?

We try Consistent and inconsistent with MI   What do you think you need to do? You have really exerted yourself. You are the one who know yourself best. If I'm able to help you, you must do as I say. I'm warning you! I really appreciate you taking the time for this. Now you listen to me! How do you see it?

We use the MI-spirit and MI’s Communication skills to show Empathy and elicit the Clients dilemma.

Change Talk Desire Ability Reasons Need Commitment Activation Taking Steps “I want”, “I wish” “I could do it”, “I am able to” “I want to live with my parents” “I must”, “I need to” “I've decided to ...”, “I am ready to…” “I went to the meeting this week”

………but……… Change Talk Change Talk and Sustain Talk It would feel good to practice, but I love to watch TV Change Talk and Sustain Talk “Other Side of the Coin”

It would be good for me to take my medicine, but I ignore it. I want to stop drinking, but not now! I need help, but this is no help.

We try I actually have time to exercise If I work out, I will be more alert It's no fun to run in the rain I'm too old to go to the gym. I'll take the bike to work. On Thursday I'll go out and run. I will never find the strength to work out. I know I can. I've decided to start training

Perhaps one of the most important encounter at the institution. The first meeting Perhaps one of the most important encounter at the institution. We have to: Remind us of the MI spirit Be active listeners and show empathy by using the OARS. Make use of an MI strategy, Meny/Agenda

Meny/Agenda 4. Call home 1. 3. What happens next 2. Smoke 5. Råby Most important for you 4. 1. What happens next 3. Smoke 2. Råby 5.

Spirit of MI Collaborativ Evoking Autonomy support Empathy

The essens of MI The MI-Spirit Avoid confrontation and The righting reflex Elicit and respond Change talk

MI is simpel but not easy We need to train and assist each other in MI

Summary of ”how to do” The importance of MI-Spirit: Collaborative, Evoking, Autonomy support, Empathy MI is like dancing, you need to be controlling and following at the same time. Most of the time use a guiding style When we listen, we use active listening and try to show empathy The first meeting is important We can reduce resistance by our way of being We listen and respond to change talk We know that the more a person expresses change talk the more likely it is that she makes a change

Member of: Motivational Interviewing Network of Trainers Thank you very much! Tobias Sandberg MI-trainer Member of: Motivational Interviewing Network of Trainers Tobias.Sandberg@stat-inst.se