1. UI/WSU Advising Symposium September 14, 2012 Lisa Laugher and Cindy Empey Special thanks to Cheryl Stolz, Ph.D. WSU Counseling and Testing Center and Jason Kilmer, Ph.D., University of Washington, Dept. of Psychiatry, Motivational Interviewing specialist

2.  Articulate basic principles and theoretical framework for MI  Apply principles in the utilization of MI techniques  Enhance current skills in application of foundational helping skills, specifically OARS techniques in advising sessions  Learn and employ strategies for eliciting self- motivational statements from students (“change talk”)  Employ techniques to “roll with resistance” to elicit change from advisees

3. A person-centered, directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Miller & Rollnick (2002) A series of strategies, informed by respect for autonomy and values, utilized to maximize the changes that individuals will choose appropriate behavior changes. Rosengren (2009)

4.  Motivation for change is elicited from the individual, and not imposed by the advisor or any others.  It is the student’s task, not the advisor’s, to articulate and resolve his or her ambivalence. Direct persuasion is not an effective method for resolving ambivalence.  The style is generally a quiet and eliciting one.  The advisor is directive in helping the individual to examine and resolve ambivalence.  The relationship is more like a partnership than expert/recipient roles.

5. 1. Express Empathy 2. Develop Discrepancy 3. Roll with Resistance 4. Support Self-Efficacy Miller & Rollnick (2002)

6.  More recently, Rollnick, Miller, and Butler (2008) expressed these principles using an acronym: R-Resist the righting reflex U-Understand the student’s motivation L-Listen to the student E-Empower the student

7.  Express Empathy ◦ Research indicating importance of empathy…  Develop Discrepancy ◦ Values and goals for future as potent contrast to status quo ◦ Student must present arguments for change and the advisor declines the expert role

8.  Roll with Resistance ◦ Avoid argumentation ◦ Confrontation increases resistance to change ◦ Advisor’s role is to reduce resistance, since this is correlated with poorer outcomes…Resistance is a signal to respond differently  Support Self-Efficacy ◦ The student is responsible for choosing and implementing change ◦ Confidence and optimism are predictors of good outcome in both the professional and the person he or she is working with

9.  Advising Goal - Elicit Self-Motivational Statements or “Change Talk” ◦ These statements indicate a student’s concern or recognition of need for change ◦ Types of self-motivational statements are:  Problem recognition  Concern  Intent to change  Optimism ◦ Arrange the conversation so that students makes arguments for change

10. Stage of ChangeCharacteristics Pre-Contemplation Ignorance is bliss Not currently considering change “Teachers are unfair.” Contemplation Sitting on the fence Ambivalent about change Not considering change within the next month “I can’t believe I’m deficient this semester” Preparation Testing the waters Some experience with change and are trying to change Planning to act within 1 month “I need to change how I study so this doesn’t happen again” ActionPracticing new behavior for 3-6 months “I’m studying more each day” MaintenanceContinued commitment to sustaining new behavior “My new study habits are working”

11.  OARS is an acronym for: ◦ Ask….. O pen-Ended Questions ◦ A ffirm ◦ Listen.. R eflectively ◦ S ummarize

12.  Ask Open-Ended Questions ◦ Cannot be answered with yes or no ◦ Advisor does not know where the answer will lead  “What do you make of this?”  “Where do you want to go with this now?”  “What ideas do you have about things that might work for you?”  “How are you feeling about everything?”  “How’s your chemistry class going for you?”

13.  Affirm ◦ Takes skill to find positives! ◦ Should be offered only when sincere ◦ Has to do with characteristics/strengths  “It’s important for you to be a good student.”  “You’re the kind of person that sticks to your word.”

14.  Listen Reflectively ◦ Effortful process: Involves Hypothesis Testing  A reflection is our “hypothesis” of what the other person means or is feeling ◦ Reflections are statements  Student: “I’ve got so much to do and I don’t know where to start.”  Advisor: “You’ve got a lot on your plate.”  Student: “Yes, I really wish things weren’t this way” or “No, I’m just not really motivated to get things started.” ◦ Reflections help to get more information

15.  Summarize ◦ Do this periodically to…  Demonstrate you are listening  Provide opportunity for shifting

16. Putting it into practice…

17.  “Hypothesis testing” approach to listening  Statements, not questions  Voice goes down  Can amplify meaning or feeling  Can be used strategically  Takes hard work and practice

18. 1. What student means 2. What student says 3. What advisor hears 4. What advisor thinks student means

19. “I’ve been feeling stressed a lot lately…”  Repeating ◦ “You’ve been feeling stressed.”  Rephrasing ◦ “You’ve been feeling anxious.”  Paraphrasing ◦ “You’ve been feeling anxious, and that’s taking its toll on you.”  Focusing on emotional component ◦ “And that’s taking its toll on you.”

20. “I don’t see any reason to change how much I hang out with friends… I mean, I need to have fun too.”  Amplified reflection: ◦ “Sounds like there are no bad things about having fun with your friends.”

21.  Double-Sided Reflection Student: I’ve been playing video games with my friends in my room. My parents have always lectured me about it. They’re worried it’s interfering with my schoolwork. Advisor: You get a hard time from your parents about how playing video games affects your grades. Student: Yeah. I mean, I know that it affects my grades a little, but I don’t play that much and when I do, I really enjoy it, you know?

22.  Double-Sided Reflection Advisor: What do you enjoy about video games? Student: I like the fact that it helps me chill out with my friends. Advisor: So, on the one hand you enjoy video games for the social element, and on the other hand you’ve noticed that it has some effect on your grades.

23. 1) “How strongly do you feel about wanting to stay at WSU? On a scale from 1 to 10, where 1 is “not at all” and 10 is “very much,” where would you place yourself now? 2) “How important would you say it is for you to become a veterinarian? On a scale from 1 to 10, where 1 is “not at all important,” and 10 is “extremely important,” what would you say? 3) Then, ask why a lower number wasn’t given The answer = CHANGE TALK!

25.  Resistance is verbal behaviors  It is expected and normal  It is a function of interpersonal communication  Continued resistance is predictive of (non) change  Resistance is highly responsive to style of the professional  Getting resistance? Change strategies!

26. ArgumentDenial Challenging Blaming Discounting Disagreeing Hostility Excusing Interruption Reluctance Talking over Claiming Impunity Cutting off Minimizing Ignoring Pessimism Inattention Non-response Non-answer Side-tracking

27.  Why is it important to pay attention to resistance? ◦ Research relevant to resistance and outcomes ◦ Motivational Interviewing focuses on reducing resistance

28.  Decisional Balance Exercise Continuing the Status Quo:+ and – Making a Change:+ and -

29.  Using Extremes ◦ “What concerns you the most?” ◦ “What are your worst fears about what might happen if you don’t change (or keep going the way you’re going)?”

30.  Strategies to Elicit Them ◦ Looking Back  “Think back to before this issue came up for you. What has changed since then?” ◦ Looking Forward  “How would you like things to turn out for you?”  “How would you like things to be different?  “What are the best results you can imagine if you make a change?” ◦ Exploring Goals – THIS CAN BE AN IMPORTANT ONE! Miller & Rollnick (1991)

31.  Argument ◦ Challenging, Discounting, Hostility  Interruption ◦ Talking over, Cutting off  Ignoring ◦ Inattention, Non-response, Non-answer, Side- tracking  Denial ◦ Blaming, Disagreeing, Excusing, Reluctance, Claiming impunity, Minimizing, Pessimism, Unwillingness to change

32.  “So, what do you make of all this now?”  “What do you think you’ll do?”  “What would be a first step for you?”  “What do you intend to do?” Rollnick, Miller, & Butler 2008

33. More “putting into practice” ideas…

34.  We tend to resist persuasion if we’re ambivalent.  When a person says he or she is o.k., the temptation might be to make a more forceful point… ◦ Advisor: “If you’d play video games less, you would do better in your classes and probably feel better about your future.” ◦ Student: “Yeah, I know. But I can’t help thinking that if I don’t have fun, I’d miss out on something. That doesn’t feel good to me.” Adapted from Rollnick, Miller, & Butler (2008)

35.  Person’s own reasons for change most likely to trigger behavior change  May be better off asking students why they would want to make a change and how they might do it rather than telling them that they should ◦ “If you were to make a change, what would that look like?” ◦ “What are the good things about having fun with your friends here? What are the ‘not-so-good’ things?... What would it be like if those ‘not-so- good’ things happened less often? Adapted from Rollnick, Miller, & Butler (2008)

36.  When it comes to behavior change, the answers most likely lie within the student ◦ “If you were to make a change in the way you study, what are the most important benefits you’d see?” ◦ “What problems with school would you like to decrease?” ◦ “How important is it to you to make a change?” ◦ “What might make those ‘not-so-good’ things we talked about earlier happen less often?” Adapted from Rollnick, Miller, & Butler (2008)

37.  Outcomes are better when students take an active role  Help students explore how they can make a difference in their academics  A student active in this process is more likely to do something after your appointment ◦ “How would you like things to turn out for you?” ◦ “How would you like things to be different?” ◦ “What are the best results you can imagine if you make a change?” ◦ “What will help get you there?” Adapted from Rollnick, Miller, & Butler (2008)

38. Miller & Rollnick (2002). Motivational Interviewing (2 nd Ed.): Preparing People for Change. Rollnick, Miller, & Butler (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. Rosengren, D.B. (2009). Building Motivational Interviewing Skills: A Practitioner Workbook. New York, NY: The Guilford Press.