1. Motivational Interviewing
Understanding the language of change

2. What do you know already?
What do you know or what have you already heard about Motivational Interviewing?

3. Motivational Interviewing is…
Motivational Interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. So what does this mean?

5. Old Assumptions
People in treatment / therapy were considered motivated if they…
Agreed with the professional’s views / opinions
Accepted their diagnosis
Expressed a desire for help
Showed distress
Based on these signs, early decisions about the person’s potential for success were often made.

6. After 12 Months Individuals involved in the HARP study had…
Higher rates of abstinence
Longer spans of abstinence
Fewer slips
Higher rates of employment

7. Motivational Enhancement
15 minutes of MI utilized before beginning an assessment affects patient outcomes up to a year after treatment.
Brief interventions make a difference!
Patient responses are highly dependent on professional approach.

8. Who is Motivated?

9. Who is Motivated?
100% of all people are motivated all of the time.

10. Who is Motivated? 100% of all people are motivated all of the time.
The question isn’t whether or not people are motivated, it’s what is motivating them?

11. MI Approach Assumptions
Motivation is influenced by numerous internal and external conditions, including relationships.
Ambivalence about change is normal.

12. MI Approach Assumptions
Direct persuasion is not an affective method for resolving ambivalence.
Individuals can develop solutions for problems on their own.

13. MI Approach Assumptions
Belief in ability to change is an important source of motivation.
Expectations of the clinician affect outcomes.

14. MI Approach Assumptions
Pressure to change often evokes resistance.
Think of something you want to change, need to change, or someone has said you should change. What if…

15. Helper’s Righting Reflex
Humans have a built in desire to set things right
People in helping professions are more likely to have this tendency
It is important to inhibit this tendency
Analogy: Turn into the skid

16. Brehm’s Theory on Reactance
Perceived threats to personal freedom and choice will elicit behavior's designed to demonstrate and restore that freedom.
When behavioral autonomy and freedom are threatened, the probability and perceived desirability of the to-be-lost behavior will increase.

17. Ambivalence Is not pathological
Feeling two ways about something is a common human experience
Is a friend and a precursor to change

18. Ambivalence Is a sign that something is happening
The issue is that people get stuck in ambivalence
The purpose of MI is to help explore and resolve ambivalence

19. Continuum of Readiness
Not Ready Unsure Ready Behavior Specific

20. Ready, Willing, and Able Willing: How important a change is
Able: The confidence in ability to change
Ready: A matter of priorities
If the change is IMPORTANT and you are CONFIDENT, you will feel more READY.

21. 1 X Y 10 Assessing Importance
How important is the change on a scale of 1 to 10?
Why an X and not a 1?
What would have to happen for you to go from an X to a Y?

22. 1 X Y 10 Assessing Confidence
If you did decide to change, how confident would you be that you could do it?
Why an X and not a 1?
What would it take…
How can I help?

23. Practice
On a scale of 1 to 10 how important would you say it is for you to change _________?
Why are you at a ____ and not a (lower number)?
If you decided to change, on a scale of 1 to 10 how confident are you that you could change ________?

24. Readiness Rulers (Behavior Specific)
Importance
Not Important Unsure Very Important
Confidence

25. Simplified Motivational Categories
Strategies
Principles
Spirit

26. Language as a Convention for Change

27. Language as a Convention for Change

28. The Spirit is as Important as the Tools…
Autonomy
Collaboration
Evocation

29. What are You Pulling For?
A + B = C

30. What are You Pulling For?
Client’s Internal
State
A + B = C

31. What are You Pulling For?
Client’s Internal
State
A + B = C
Clinician’s Reflection
Or Question

32. What are You Pulling For?
Client’s Internal
State
Client’s Response
A + B = C
Clinician’s Reflection
Or Question

33. What are You Pulling For?
Client’s Internal
State
Client’s Response
Think
Here
A + B = C
Clinician’s Reflection
Or Question

34. It’s All About Slope

35. Develop Discrepancy Roll with Resistance Express Empathy
The Principles…
Develop Discrepancy
Roll with Resistance
Express Empathy
Support Self Efficacy

36. Summaries Open Ended Questions Affirmations Reflective Listening
The Tools…
Open Ended Questions
Affirmations
Reflective Listening
Summaries

37. Some Final Thoughts
Our assumptions about our patients can become self-fulfilling prophecies.
Being aware of our internal dialogue about patients can help us influence outcomes.
A collaborative approach with patients is predictive of success. “Therapeutic Alliance”

38. Some Final Thoughts
Sometimes you can be effective or right, but not necessarily both.
It’s okay and normal if our client’s motivation for change fluctuates frequently.
Keep the destination in mind when having conversations with your clients.

39. Some Final Thoughts
Managing conversations productively with clients is a skill that is developed over years.
It’s a skill that improves with conscious practice.
Increasing change talk over the course of a conversation with a client increases odds.

40. Questions?

41. The Recovery Village at Palmer Lake
Thanks for Playing!
Michael Hunter
Executive Director
The Recovery Village at Palmer Lake
ext. 5001