1. Motivational Interviewing
Bambi A. Carkey DNP, PMHNP-BC, NPP
Clinical Assistant Professor
Director of Clinical Affairs
SUNY Upstate Medical University
College of Nursing
June 5, 2015

2. History
Motivational Interviewing has it’s roots in person –centered therapy.
Expands on person –centered therapy by incorporating therapeutic goals about desired change into a methodology for intervention
“Motivational Interviewing with Problem Drinkers” (Miller, 1983).

3. Motivational Interviewing (MI)
A beginning definition “ Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change” (Rollnick & Miller, 2013

4. Philosophical Assumptions
Relationship - Collaborative & Friendly
Persuasion versus coercion
Challenging versus argumentative
Priority – Resolving Ambivalence
Avoid prescribing methods / techniques
Pt. is responsible for own progress
Focus on self – efficacy
Sobczak(2012)

5. Central Purpose Examination and Resolution of Ambivalence
MI is intentionally directive

6. Key Points
The overall style of MI is one of guiding , which lies between and incorporates elements of directing and following styles
Ambivalence is a normal part of preparing for change and a place where a person can remain stuck .
(Rollnick & Miller, 2013)

7. Key Points
Attempting to influence change by arguing for change with a person who is ambivalent, brings about the person’s natural resistance.
People are more likely to be persuaded toward change by hearing their words reflected by the therapist.

8. The Spirit of MI
“If you treat an individual as he is, he will stay as he is, but if you treat him as if he were what he ought to be and could be, he will become what he ought to be and could be.” Johann Wolfgang von Goethe

9. The Aspects of the Spirit of MI
Partnership
Acceptance
Compassion
Evocation

10. Change
Engaging – The process of establishing a relationship of mutual respect and positive regard
Focusing – The process of discovering and maintaining direction
Evoking – The process intended to help resolve ambivalence in the direction of change
Planning – The process of planning behavioral change

11. Acceptance There are Four aspects of Acceptance Absolute Worth
Autonomy
Affirmation
Accurate Empathy

12. The Spirit of MI: Partnership
MI is a person –centered counseling style for addressing ambivalence about change
MI is a collaborative process. It is done for and with someone, not on or to them
MI is not a way of tricking people into changing; it is a way of activation their own motivation and resources for change
(Rollnick & Miller, 2013)

13. Techniques of MI OARS Open –ended questions Affirmations
Reflective Listening
Summarize

14. Therapist Behaviors Reflective listening
Expression of acceptance and affirmation
Evoking the pt.’s self motivational statements
Reinforcing the pt’s self motivational statements
Assessing the pt’s readiness to change
Affirming the pt’s freedom of choice
Sobczak (2012)

15. Therapist Behavior Expression of empathy Support self efficacy
Roll with resistance
Develop discrepancy : Pt’s identification of where he/she is, and where he/she would like to be
Sobczak(2012)

16. Examples:Clinical
10 yr. old obese child comes in with mother at well child visit
52 yr old male presents post MI, with a hx of smoking
1 ppd x 35yrs
46 yr old woman is referred by PCP for Alcohol abuse
43 yr ols male presents with newly diagnosed DM type I

17. Examples Reframing Reflective Listening Rolling with resistance
Summarization

18. References
Miller, R. and Rollnick,S.(2013). Motivational Interviewing: Helping People Change. New York: Guilford Press.
Sobczak, J.(2012). Motivational Interviewing (2012). Powerpoint.

19. Questions