Motivational Interviewing Introductory Workshop – part 1 Anya Sheftel, M.S. University of Oregon Member of international Motivational Interviewing Network of Trainers

Purpose: The purpose of this presentation is to give you a “taste” of MI. After this presentation you will be able to describe MI. You also will be familiar with basic MI concepts. Should you want an in-depth training in MI, please contact me.

Agenda:  Definition of MI  Ambivalence  Motivation for Change  MI Spirit  MI Principles  OARS  Debrief

Motivational Interviewing  Client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Miller & Rollnick, 2002).

What Does It Mean?  “We emphasize that MI is a method of communication rather than a set of techniques. It is not a bag of tricks for getting people to do what they don’t want to do. It is not something that one does to people; rather, it is a fundamental way of being with and for people - a facilitative approach to communication that evokes natural change” (Miller & Rollnick, 2002).

Applications of MI  Alcohol and Drug Abuse and Dependence  Co-Occurring Disorders  Eating Disorders  Behavioral Medicine  Medical Settings (Practice, ER, Hospital)  Medication Adherence  Weight Management  Sexual Risk Reduction (HIV, STD, Pregnancy)  Criminal Justice  Psychiatric Disorders (Depression, Anxiety, Psychosis)

Why MI?  Brief  Additive  Effective

Why Don’t People Want To Change?

 Positives of Current Behavior  Coping with stress  Social connections  Stable sense of self  Negatives of Change Change  Increased frustration  Social isolation  Painful self- recognition (guilt and shame)

You will come to a place where the streets are not marked. Some windows are lighted. But mostly they're darked. A place you could sprain both you elbow and chin! Do you dare to stay out? Do you dare to go in? How much can you lose? How much can you win? And IF you go in, should you turn left or right... or right-and-three-quarters? Or, maybe, not quite? Or go around back and sneak in from behind? Simple it's not, I'm afraid you will find, for a mind-maker-upper to make up his mind. You can get so confused that you'll start in to race down long wiggled roads at a break-necking pace and grind on for miles across weirdish wild space, headed, I fear, toward a most useless place. The Waiting Place... - Dr. Seuss Ambivalence

Exercise  Think of a change that you’ve been thinking about (health, lifestyle, education, etc), but haven’t made yet.  For how long have you been thinking about making this change?  By the end of the hour you have to tell me how exactly you are going to make this change.  How did it feel to hear me say this?  What did you want to say to me?

If ambivalence is not overcome through education, persuasion, or pressure, how it is resolved?

It is not the professional, but the client who has to make an argument for change

Motivation for Change “Ready, Willing & Able”  Willing  Importance of Change  Able  Confidence for Change  Ready  Relative Priority for Change

What would be helpful and supportive to YOU?

MI Spirit  Autonomy  Honoring and supporting client’s personal responsibility for change  Collaboration  Meeting of the client’s and professional’s aspirations  Evocation  Drawing out client’s concerns, wishes, hopes, strengths, goals, values, and intentions

MI Principles  Express Empathy:  Intra-view – understand where the client is coming from; understand their story and their ambivalence.  Develop Discrepancy:  Help the client see that the current behavior does not fit in with his/her goals and values.  “ On one hand, going to college is very important to you. On the other hand, you keep missing classes. Help me understand how these two things fit together. ”  Roll with Resistance:  Wrestling versus Dancing.  Don ’ t get stuck in a tug-of-war.  Drive into the ditch.  Support Self-Efficacy:  The client is the expert on change. He/She has accomplished change in the past. Build on it.

How to do it?  Resist the Righting Reflex!  Comes from a helpful place: We have a problem? Let ’ s fix it.  It shuts out the client.  You know that this is the right thing for you.  Here is how you should do it.  This is extremely important!  What do you mean you don ’ t want to? Don ’ t you want what ’ s best for you?  Instead, IntraView  Want to understand the client ’ s point of view.  Collaboration.  What are some of the good things about change?  Tell me why you think this is important.  Tell me more about what you think.  What do you want to do?

Core Skills – “OARS”  Open-ended questions  Affirmations  Reflections  Summaries

Close-Ended Questions  Yes/No response  Did you apply to this job?  Did you miss class?  Do you like chocolate?  Limited range of information  How many classes are you taking this term?  Was were your SAT scores?

Open-Ended Questions  Wide range of responses  Seek information, invite client’s perspective, encourage self- exploration  Where do you see yourself in 5 years?  Tell me more.  What else?  What do you make of that?  What do you like about coming here?

Open-Ended Questions: Exercise  Is there anything you like about school?  Did you miss class?  Do you want to go to college?  Did you do your homework?  Did you fill out your job application?  Did you call U of O to see if they offer classes in the summer?  Is there anything else?

Core Skills – “OARS”  Open-ended questions  Affirmations  Reflections  Summaries

Affirmations  Express appreciation of who the client is, or what s/he has done  Provide support  Strengthen rapport  Support self-efficacy  I really appreciate your willingness to be so honest with me.  It ’ s not easy to keep trying when things aren ’ t going so well, and yet you haven ’ t given up.  Affirmations are like salt – a little goes a long way.

Affirmations: Exercise  I really like your shoes.  Thank you for coming in to see me even though you’ve had a rough day.  You missed class again??  You worked really hard and succeeded.  Thank you for sharing this with me.  I know that this math class is hard and I am impressed with how well you’ve done in it.  Cute hair!  Oh, I am soooo happy for you! You are such a rock star! Go you!  Your preparation for this job interview really showed.

Core Skills – “OARS”  Open-ended questions  Affirmations  Reflections  Summaries

Listening Reflectively  Reflections can:  Check meaning  Reflect both sides of the ambivalence  Reflect the meaning  Reflect the feeling  Used to move the conversation forward  Create an intimate dialogue and rapport

Listening Reflectively  Form a reasonable guess as to what the person meant  Give voice to that guess in the form of a statement  A well formed statement is less likely to evoke resistance  Vocal tone should go gently down at the end of a statement (not up like a question)

Hot Potato Reflections: Exercise  I will say a statement and throw the ball to one of you. (Example: School is just too hard).  The person who catches the ball, will reflect my statement (Example: You feel frustrated).  She/he will say a different statement (something that one of her/his clients might say) and throw the ball to another person. (Example: I don’t think college is for me).  Everyone will have a turn reflecting.  Debrief.

Core Skills – “OARS”  Open-ended questions  Affirmations  Reflections  Summaries

Summaries  Collecting Summary  Bouquet metaphor: Draws together change talk and invites continued talk  Linking Summary  Ties together current and previously said ideas to encourage reflection of relationship between concepts  Transitional Summary  Marks and announces shift of topic

Summaries: Exercise  Break up into dyads: The Speaker and The Listener  The Speaker will talk for 3 minutes about an area in which they would like to make change.  The Listener will listen and not say anything.  After The Speaker is done, The Listener will summarize.  Switch roles.  Debrief.

Traps  Question-Answer Trap  Taking Sides Trap  Expert Trap  Labeling Trap  Premature Focus Trap

Sentence Stems I learned __________ I relearned ____________ I gained ______________ I appreciated ____________ One thing that surprised me was _________ I could use MI to _____________ One thing I hope to cover before the training is over is ____ I am more confident now that I can ________________ I can’t wait to try _________

Debrief