Motivational Interviewing (MI) – an introduction Sine Møller The National Board of Services MTFC Conference, 2011

Origins Miller and Rollnick (both professors in psychology) started developing Motivational Interviewing in the early ’80es. The original MI book Motivational Interviewing: Preparing people to change addictive behaviour came out in 1991.

Definition and purpose ”MI is a client-centered directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (Miller & Rollnick, Motivational Interviewing: Preparing people for change, 2002). “MI is a collaborative, person-centered form of guiding to elicit and strengthen motivation for change” (Miller and Rollnick, 2009). Although the definition has changed MI is still an interviewing method that is focusing on facilitating behavioural changes.

Areas of application MI was developed to facilitate behavioural changes in relation to substance abuse. Since then the areas of application has spread to: Smoking MI before or after psychotherapy Changes in health behaviour (diet, exercise etc.) Diabetes management and management of other chronic diseases Adolescents and risk behaviour (for example unprotected sex and drink-driving) Behavioural problems

What is MI? MI themes: Behaviour – it is difficult to change behaviour! If it was not, the client would have made the changes on his/her own. Behavioural patterns are often learnt over many years, and the client is often ambivalent about changing disregarding the seriousness of the present behaviour. Motivation – is not static, you cannot insert motivation into people. The therapist must facilitate the process of expanding the clients “inner” motivation. Resistance – is an interpersonal process and can be increased or reduced by the therapist.

What is MI? Commitment Change talk Responding to resistance Person-centered guiding skills Spirit From: Naar-King & Suarez; Motivational Interviewing with Adolescents and Young Adults Guildford Press

The spirit Commitment Change talk Responding to resistance Person-centered guiding skills Spirit The MI spirit is characterised by the 3 themes: autonomy, collaboration and evocation. resist the righting reflex understand your clients motivation listen to your client empower your client #

The spirit Commitment Change talk Responding to resistance Person-centered guiding skills Spirit When working with adolescents: Support and guide without taking responsibility for change. In spite of the restrictions of youth (from parents etc.) there is still room for personal choice.

Person-centered guiding skills Commitment Change talk Responding to resistance Person-centered guiding skills Spirit MI is based on a Rogererian person- centered approach yet MI is also a directive and goal-oriented approach. The guiding skills: OARS – Open- ended questions, Affirmations, Reflections and Summaries. It only takes a few minutes of active listening to improve working alliance with the client.

Responding to resistance Commitment Change talk Responding to resistance Person-centered guiding skills Spirit Resistance develops in an interpersonal process. For adolescent resistance is the norm! Resistance talk, sustain talk and lack of conversation. Roll with resistance by stepping back and not persuading.

Responding to resistance Commitment Change talk Responding to resistance Person-centered guiding skills Spirit Use reflections to respond to resistance: Simple reflection (very few changes to what the youth actually said) Complex reflection (adds content or meaning – reflects the meaning behind what the youth said) Amplified reflection (emphasize and intensify – “there is no reason at all…”

Responding to resistance Commitment Change talk Responding to resistance Person-centered guiding skills Spirit RESIST THE RIGHTING REFLEX!

Change talk Commitment Change talk Responding to resistance Person-centered guiding skills Spirit Any speech that favours movement towards change: Desire, Ability, Reason, Need, Commitment, Activation, Taking steps. Person-centered skills are used to respond to and reinforce change talk.

Commitment Change talk Responding to resistance Person-centered guiding skills Spirit Decrease in sustain talk and increase in change talk in the form of commitment language “I will…”, I am going to…”, “I am ready…” signals the time for developing a plan for change. Use a summary and then ask a key question: “What do you think you will do?”.

A taste of MI Don’t persuade or fix. Why would you want to make this change? If you decided to make this change, how would you go about it to succeed? What are the three best reasons for you to do it? How important is it for you to make the change on a scale from 0 to 10? So what do you think you’ll do?

Readiness for change Ask questions about lifestile – the focus of the conversation Not ready Ambivalent Ready Offer Information Create discrepancy Explore ambivalence Support Action and Self-efficacy Relapse Follow-up

When the youth is not ready for change Elicit – provide – elicit: Ask for permission to give information – give the information (make it short!)– ask what the client thinks of it. # Use open/explorative questions to create discrepancy (is the current behaviour fitting in with the life the youth wants to live).

When the youth lacks self-efficacy Use the VAS-scale: “on a scale from zero to ten how much do you believe that you have the ability to….” Ask questions about past change successes and underline personal strengths and/or social support.

When the youth is ready for change Help the youth make a plan asking questions like: What is your first move? What do you have to do? What do you need to succeed? When will you start? Pick the flowers of change talk and serve it to the youth in the form of a summary.