1. Motivational Interviewing: 101
Luis Lopez MS Implementation Specialist, Trainer
Center for Practice Innovation
@ Columbia Psychiatry
New York State Psychiatric Institute

3. Today’s Outline Welcome What Is Motivational Interviewing (MI)?
MI Spirit and Processes
Roadblocks and Traps
Core Skills – Open questions, Affirmations, Reflective Listening & Summaries
Putting It all Together

4. Q & A Raise your hand if you had at least some training in MI?
How have you used motivational interviewing?

5. Ambivalence: Exercise
Find a Partner
Each of you write down something you want to change, need to change, should change, have been thinking about changing but you haven’t changed yet
Select who will speak first
The speaker then presents what it is they would like to change (but haven’t done yet)

6. Ambivalence: Exercise
The listener (counselor) then:
Explains WHY the person should change, tells the person HOW they should make the change, emphasizes HOW IMPORTANT it is to change and PERSUADES the person to do it
Speaker your job is now to listen and note what you are thinking and feeling
Debrief

7. Motivational Interviewing: Definition
A person-centered counseling style for addressing the common problem of ambivalence about change
It is a collaborative conversation style that helps strengthen an individual’s own motivation and commitment to change
Miller and Rollnick (2013)

8. The Spirit – the Heart of MI
Collaboration (partnership and share decision making)
Acceptance (empathy, affirmation, autonomy)
Compassion (caring what happens to the person)
Evocation (eliciting a persons own reasons fro change)
(Miller and Rollnick 2013)

9. The Spirit – the Heart of MI
Openness to a way of thinking and working that is collaborative rather than prescriptive
Honors the consumer’s autonomy and self-direction, and is more about evoking than installing
Involves at least a willingness to suspend an authoritarian role

10. The Spirit – the Heart of MI
Explore consumer capacity rather than incapacity (strength based)
Genuine interest and active curiosity in the consumer’s experience and perspectives
The spirit in which we work with consumers is key to engagement – engagement is key to everything else!

11. Four Processes
Engaging: the process by which both parties establish a helpful connection and a working relationship “Shall we work together?”
Focusing; a collaborative process by which you develop and maintain a mutually agreed direction in your conversation based on what the consumer wants to talk about “What do we want to do together?”

12. Four Processes
Evoking is the process of eliciting the consumer’s own reasons for making a change “How important is this to you?”
Planning collaboratively designed action plans. In MI it is to be with someone while he or she forms plan of change that will work “How” and “When”
(Martino, S., et al. 2007)

13. ONE STOP: ROADBLOCKS Gordon (1970) outline 12 communication roadblocks
Ordering Name Calling
Warning Diagnosing
Preaching Praising
Advising Sympathizing
Lecturing Cross Examining
Blaming Sarcasm

14. Traps to Avoid Question-Answer Trap Expert Trap Premature Focus Trap
The Labeling Trap
Confrontational Trap
The Blaming Trap

15. Core Skills - OARS Affirm strengths Summarize Ask Open questions
Listen actively and Reflectively
Summarize

16. Open-Ended Questions
Can’t be answered with a “yes/no” or otherwise limited response
Invites elaboration
Deeper thinking
Creates forward momentum in exploring reasons for change
Melanie
We’re now ready to move on to the O and A in OARS.
Open ended questions:
What (might be some) reasons do you have for changing…staying the same?
What steps have you already taken?
What about a time when you were successful in making a change? What worked?
If you do nothing about changing, where do you suppose you might be in about 5 years?
What’s might your life look like if you did decide to change?
Affirmations: Ties into a strength's based approach. Builds self efficacy. Shows young people that you see then good in them and that they are trying.
I see how important this change is to you
You’ve made some huge changes thus far
Its your tenacity that has gotten you this far
You clearly have a lot of skills and abilities to tap into

17. Open Ended Questions
Practice

18. What is Reflective Listening?
A guess at what consumer means by what they just said (not an interpretation)
Is always in the form of a statement never a question
It can be simple or complex
Complex reflections add meaning or emphasis to what has just been said

19. What is Reflective Listening?
It is collaborative/non-authoritarian
It is never critical, judgmental, confrontational
It can be directive (selective) but never directs by giving advice/suggestions without permission
It is reinforced by consumer’s response

20. Advantages of Responding with a Reflective Listening Statement
It is unlikely to evoke resistance
It encourages consumers to keep talking and exploring the topic
It communicates respect and caring and builds the therapeutic alliance
It clarifies for you exactly what the consumer means
It can be used to reinforce ideas expressed by the consumer

21. Thinking Reflectively
The first step in using reflective listening is to listen carefully and think reflectively
The key to doing this is to think in terms of hypotheses
This means that when you hear someone say something, you form a hypothesis or a best guess about what the consumer means

22. Types of Reflections Repeat what the person said using exact words
Rephrase what the person said using slightly different words to clarify meaning
Paraphrase what the person said using different words to emphasize contradictions, convey underlying meaning, or complete a thought
Communicate understanding of underlying emotions or feeling, particularly when the person has not explicitly stated them
Melanie:
With that practice, you can see that thinking reflectively can be translated into using reflections as you’re talking with young people.
This slide lists different types of reflections.
Repeat what the person said using exact words
Rephrase what the person said using slightly different words to clarify meaning
Paraphrase what the person said using different words to emphasize contradictions, convey underlying meaning, or complete a thought.
Communicate understanding of underlying emotions or feeling, particularly when the person has not explicitly stated them
Summarize by grouping several reflections together

23. Examples of Reflections
“Everyone keeps telling me to take this medication, it will make me feel better. They don’t understand that the side effects make me feel really bad.”
Repeating: “Your medication gives you side effects that make you feel bad.”
Rephrasing: “While you are hopeful that the medication will help you in many ways, right now you’re finding that it’s hard to deal with the side effects.”
Paraphrasing: “People just don’t get what it is like to take this medication.”
Underlying emotion: “You’re tired of feeling bad from the medication side effects.”
Melanie

24. Reflections
Practice

25. Affirmations Recognize strengths Build rapport
Help see the individual in a positive light
Must be congruent and genuine
Instills hope that change is possible
Affirmations different than rewards

26. Affirmations I appreciate that you are willing to meet with me today
You are clearly a very resourceful person
You handled yourself really well in that situation
That’s a good suggestion. You’ve really thought about this
If I were in your shoes, I don’t know if I could have managed nearly so well
Melanie
Not reinforcement (“good job”, “great question”)
Examples of affirming responses:
I appreciate that you are willing to meet with me today.
You are clearly a very resourceful person.
You handled yourself really well in that situation.
That’s a good suggestion. You’ve really thought about this.
If I were in your shoes, I don’t know if I could have managed nearly so well.
I’ve enjoyed talking with you today. You helped me understand what’s going on.

27. Affirmations
Practice

28. Summaries Summarize by grouping several reflections together
Gather what was said and present them back to the consumer
Used strategically to attend to aspects of change
Can highlight both sides of ambivalence
Can be used to end a session, or move on during a session “what’s next?”
Examples
Rusty:
Let’s start with the R and the S in OARS.
Reflections:
Conveys that you heard the individual (the young person and understood what they meant)
Involves statements, not questions
Use of openers such as: “it sounds like you…” or “So you’re feeling…”
Ratio should be 3+ reflections for everyone 1 question
Summaries:
A type of reflection
Gathering parts of what the client has said and presenting them together
Selective in which parts are presented back

29. Putting It All Together - You Try It
Find a partner, decide who will be the first speaker
Speakers, your role is to talk to the listener about the following topic “one thing about myself that I would like to change is…”
The listener’s task is to respond using the OARS but primarily with reflective listening statements
The speaker responds by continuing to elaborate
Stay in role. Do not discuss or break role until we tell you to switch roles.
Be prepared to discuss experience

30. Thank You!!!