1. Motivational Interviewing Kelley Gannon, LCSW Director of Clinical Services Bluegrass Regional MH-MR Board

2. “ A directive, client-centered counseling style for helping clients explore and resolve ambivalence about behavior change.” Motivational Interviewing Definition: William R. Miller, 1991 2

3. Benefits of MI MI increases treatment retention MI increases treatment adherence MI increases clinician job satisfaction MI decreases clinician burnout MI decreases clinician cynicism MI works concurrently with other EBP

4. General Principles Fundamental to Motivational Interviewing Reflective Listening Develop Discrepancy Avoid direct confrontation Roll with resistance Support Self-efficacy Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press, and MI Network of Trainers (MINT) 4

5. Principle 1: Reflective Listening Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press.  Reflective listening facilitates change  Skillful reflective listening is essential to raising client awareness  Reflective listening builds a working alliance  Coming “alongside” the client  Show interest  Follow the client’s story 36

6. Definition: Reflective Listening  A hypothesis (guess) about speaker’s meaning  A statement to convey understanding  Intonation down  Short stems  “So…”  “Sounds like…”  “So you…”  “Seems like …”  “Its like…”  “You feel…” 6

7. Simple Reflections Repeats an element of what the client has said Rephrasing: stay close to what the client has said but substitutes synonyms or rephrases what was said.

8. Complex Reflections Paraphrasing: therapist implies the meaning in what was said and reflects it back to the client Reflection of Feelings Metaphors

9. Principle 2: Develop Discrepancy  A discrepancy between present behavior and important goals for the future will motivate change.  Identify ambivalence to raise awareness  Invite the client to present the arguments for change.  Separate the behavior from the person Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press. 9

10. Develop Discrepancy Strategic Reflection- Double Sided Turn up the volume-Amplified Reflection Pros and Cons

11. Principle 3: Avoiding Direct Confrontation Arguments are counterproductive Resistance is a signal to change strategies Defending breeds defensiveness

12. When you get stuck get your OARS out! O - Open Questions A - Affirmations R - Reflections S - Summarize

13. Open-ended Questions  Invite discussion and elaboration; do NOT invite brief answers  Stems  “What would you like to discuss?”  “How do you feel about coming here?”  “You mentioned ___. What concerns you about that?”  “What was that like for you when…?”  ““What are your views about that?”  “Tell me more about _______” 13

14. Affirmations  Definition: appreciation, understanding, support  Affirm effort and achievement  Examples  “This is hard work you’re doing”  “It takes courage to face such difficult problems”  “Coping with that takes a lot of resourcefulness” 14

15. Summary  Set up statement: “Let me see if I have this right…”  Reflection, reflection, reflection  Open question: “So where does that leave us? What else would you like to add?” or “Now, tell me about ….” (to re-direct) 15

16. Principle 4: Roll with Resistance Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press.  Avoid arguing for change.  New perspectives/information are invited, but not imposed.  The client is a most valuable resource in finding solutions to their problems.  Use your OARS 37

17. Therapist roadblocks Premature problem solving Being logical with your client Expert Stance Doesn’t elicit client ideas about change Not believing the client can change Confrontational Become frustrated when client doesn’t change

18. Principle 5: Support Self-Efficacy Miller and Rollnick (1991), “Motivational Interviewing”, Guilford Press.  Belief in the possibility of change is an important motivator.  The client is responsible for choosing and carrying out personal change.  Praise the client’s strengths  Express belief, hope  Focus on small changes 38

19. Eliciting Change Talk Evocative Questions -Disadvantages to the status quo -Advantages for change -Optimism about change -Intention to change

20. Eliciting Change Talk Importance Ruler Identify Goals/Values

21. Questions