1. Bill Miller’s Introduction to MI in 3 Exercises: An Illustration David B. Rosengren, Ph.D. Alcohol and Drug Abuse Institute University of Washington Stephanie Ballasiotes, M.C. Family Planning Public Health Seattle King County

2. Introduction u Overview of MI concepts u You determine if there is value u Train like I do MI u Experiential and didactic u Won’t focus on research

3. Persuasion Exercise u Groups of 4 for the duration u No boss or supervisor in your group u Three roles: speaker, clinician & observers

4. Speaker role – Persuasion u Play a patient presenting for TX u There is a clear behavior change goal u You are ambivalent and somewhat resistant

5. Observer roles - Persuasion u Pay attention u Offer observations when asked

6. Clinician role – Persuasion u Explain why s/he should make this change u Give 3 specific benefits of making the change u Tell him/her how to change u Emphasize importance of the change u Tell the client to do it! u P.S. – This is NOT motivational interviewing

7. Debrief

8. Stages of Change Model – Four Points u Readiness is not static u Change is nonlinear u Importance of matching strategies to readiness u Role of Ambivalence

9. How Many Patients Are Ready? Prep Contemplation Precon Action

10. Ambivalence u is normal u occurs throughout the change process u reflects costs and benefits of change and status quo u is uncomfortable u may become chronic u resolved by client – Bem’s Self-Perception Theory

11. Righting Reflex u Born of concern and caring u There’s a problem? Let’s fix it! u Fails to consider ambivalence in change process u May engender resistance

12. Readiness Real Play Exercise u Remain in your groups u Four roles – speaker, clinician 1, clinician 2 and observer u Change roles from last time

13. Speaker role – Real Play u Talk about something real that you: Want to change Need to change Should change Have been thinking about changing u But, haven’t yet changed. u Not your deepest, darkest secret!

14. Observer role – Real Play u Pay attention u Offer observations when asked

15. Clinician 1 role – Real Play u Listen carefully - goal to understand the dilemma u Ask these four questions: Why would you want to make this change? How might you go about it, in order to succeed? What are the three best reasons to do it? On a scale of 1-10, how important would you say it is to make this change? And why are you a ___ and not zero?

16. Clinician 2 role – Real Play u Listen carefully because… u There will be a test

17. Clinician 2 – Summary & Key Question! u Give a short summary of speaker’s motivations for change, including... : Desire for change Ability to change Reasons for change (positives) Need for change (negatives) u Then ask, “So what do you think you’ll do?” u And now just listen with interest

18. Debrief

19. Change Statements – DARN-C u Desire u Ability u Reasons (for change) u Need (negative consequences of status quo) u Commitment