Motivational Interviewing

Basics of Motivational Interviewing Motivation for change is a state, not a trait. People are at different levels of motivation or readiness to change for different changes. Understand the cx’s readiness to change and support movement to the next stage. Stages of change are predictable

Application to yourself Think of three different changes you would like to make in your life. How ready do you feel to make each of these changes? Use a rating ruler to rate your readiness to change: NOT READY TO CHANGE UNSURE READY TO CHANGE TAKING ACTION 1 2 3 4 5 6 7 8 9 10

Stages of Change

Stages of change Precontemplation-several types Reluctance Rebellion Resignation Rationalizing

Four principles of Motivational Interviewing

1. Express Empathy Validate cx feelings and perspective Recognize, name and explore ambivalence

2. Develop Discrepancy Provide objective information Cost/benefit analysis of “change” or “no change” Heighten awareness of incongruities

Challenges/Confrontation-3 Steps Recognize the incongruity Present it to the cx On the one hand… Evaluate the effect: how did the cx respond? (see box 9-3) Write down a challenge response for the following statements:

Some examples Cx: I have good genes…my grandma ate whatever she wanted and she smoked…she lived to 98…I’m not worried about that kind of thing. Cx: No friendship is perfect. Sometimes her criticism hurts my feelings, but that’s just how she is. I’m not going to take it personally. Cx: I can always study more, but this teacher just doesn’t like me…it’s not really worth putting more time into because he’s not fair and picks on me.

The CCS Denial Partial examination Acceptance and recognition without change Generation of a new solution Transcendance; development of new, larger, more inclusive patterns, beliefs, thoughts, behaviors

3. Roll with Resistance: it is a sign you are moving too quickly Acknowledge cx response Amplified reflection Double-sided reflection-on the one hand… Avoid arguing Avoid a power struggle Avoid trying to convince Acknowledge Explore reality of changing or not

4. Support Self-Efficacy Identify successes Explore what cx can do Affirm cx thinking, action, decisions, etc. Change language re: self Change the script

Fish bowl Role Play Observe for: 1. Expressing Empathy and Developing Discrepancy 2. Rolling with Resistance and Supporting Self Efficacy Stage of change? Readiness ruler? Incongruities and opportunity to confront

Skills that may be useful Give advice Remove barriers Provide choices Decrease desirability Practice empathy Provide feedback Clarify goals