1. Bettina O’Brien, MA Patrick Barresi, MPH April 4, 2003
…but the light bulb has to WANT to change... Motivational Interviewing: Principles and Skills
Bettina O’Brien, MA
Patrick Barresi, MPH
April 4, 2003

2. How many counselors does it take to change a light bulb?

3. Just one, but the light bulb has to WANT to change!

4. Goals
1. Participants establish and build their knowledge of Motivational Interviewing
2. Increase knowledge of how MI could be used with their populations of interest.
3. People set personal goals for what they want to do next with MI.

5. Objectives 1. Promote reflection on how to apply MI to current work.
2. Obtain a first understanding (felt-sense, intuitive, body-based) of what the MI spirit is.

6. Origins William R. Miller and Stephen Rollnick
Univ of New Mexico and Univ of Wales
Motivational Interviewing: Preparing People for Change. 1st Ed (1993); 2nd Ed. (2002).
Then: Problem Drinkers
Now: Broad Applications

7. MI Defined Inter-Viewing; “looking together”
Client-centered method for
enhancing intrinsic motivation to
change by
exploring and
resolving
ambivalence.

8. The Spirit of Motivational Interviewing
Collaboration
Evocation
Autonomy

9. Critical Conditions of Change Carl Rogers
Accurate Understanding (Empathy)
Unconditional Positive Regard (Warmth)
Genuineness (Congruence)

10. Ready, Willing, and Able Willing: How important is change?
Able: How confident in ability to change?
Ready: Where does change fit in priorities?

11. The Righting Reflex (overcoming it…)

12. Ambivalence: the dilemma of change

13. Who Argues for Change? Client is ‘ambivalent’ about change
If counselor argues FOR change, s/he elicits further resistance to change from client.
If counselor intentionally sides with status quo, client will side with change as evidenced by change talk.

14. Confrontation: A goal, not a style

15. Four General Principles
Express Empathy
Develop Discrepancy
Roll with Resistance
Support Self-Efficacy

16. PHASE ONE: BUILDING MOTIVATION FOR CHANGE

17. CHANGE TALK Self-Motivating Speech
Disadvantages of Status Quo
Advantages of Change
Optimism for Change
Intention to Change

18. Change Talk vs. Resistance Talk
disadvantages of status quo
advantages of change
intention to change
optimism about change
Resistance Talk
advantages of status quo
disadvantages of change
intention not to change
pessimism about change

19. FIVE EARLY METHODS O Ask Open-Ended Questions A Affirm R
Listen Reflectively
Summarize
Elicit Change Talk

20. PHASE TWO: STRENGTHENING COMMITMENT FOR CHANGE

21. Signs of Readiness for Change:
Decreased resistance
Decreased discussion about problem
Resolve
Change talk
Questions about change
Envisioning
Experimenting

22. Phase II: Traps to Avoid
Underestimating Ambivalence
Over-prescription
Insufficient Direction

23. Goal of Phase II:
1. Channel intrinsic motivation into a negotiated, workable plan for change
2. Strengthen the person’s commitment for carrying out that plan.

24. Negotiating a Plan: 1. Setting goals 2. Considering change options
2. Arriving at a plan

25. Unity’s Problem-Solving Steps
1. Identify the factor/stressor/barrier
2. Determine the goal
3. Brainstorm alternative solutions
4. Evaluate those solutions
5. Choose most appropriate and best solution
6. Develop and action plan
7. Act

26. Goal Card “My goal for the next session is:…” Realistic Clear
Not too easy
Not too hard
Have a clear end point

27. So What? What are your next steps -- learning more about MI?
What are ways MI can be integrated into your work and the work of your organization?