1. HOW CAN I PUT MOTIVATIONAL INTERVIEWING INTO PRACTICE?
Lynn S. Massey, LMSW
University of Michigan
Departments of Psychiatry and Emergency Medicine

2. Why do people change? Consequences Dose of treatment
Faith, hope, “self-efficacy”
Counselor effects – empathy vs. confrontation
Change talk
Willing to Change - importance
Able to Change - confidence
Ready to Change - priority
Steve

3. MI Integration in Behavior Change Counseling
Behavior change is at the heart of most modern health care concerns (heart disease, obesity, depression, cancers, diabetes, liver disease, respiratory problems)
Most health care practitioners have conversations / encounters regarding behavior change in daily work
More attention has been on information vs how to approach (style) behavior change with the person

4. What types of settings? Mental Health Substance Abuse Access/Intake
Primary Care
Emergency Department
Hospital
School Setting
Probation

5. How do I determine if MI would be useful in my setting?
Are you working with people who need/want to change a behavior?
Are you working with people who would benefit from being more motivated?
Would you like to increase participation in a treatment program?

6. Overworked

7. Elements of mi MI Spirit Change Talk OARS MI Principles
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.

8. Learning Motivational Interviewing: Is a process of learning about and using strategies to boost problem recognition, motivation and strengthen commitment to change
Steve

9. Assumptions of mi Motivation
“the probability that a person will enter into, continue, and adhere to a specific change strategy” or plan
Motivation is a dynamic state (of readiness to change)
Part of clinician’s job
Occurs in an interpersonal context
“Noncompliance”, “resistance” and ”lack of motivation” are all partially due to therapists strategies

10. Assumptions of MI Ambivalence is normal, acceptable and understandable
helps clinician to appreciate the complexity of the individual and their situation
is at the heart of motivation
Usually mistaken for resistance (yes, but…)

11. Elements of mi: MI SPIRIT
Change Talk
MI Principles
OARS
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.

12. MI SPIRIT
Empathy – genuine curiosity about client’s perspective (understanding)
MI Spirit:
Collaboration – fostering power sharing in the interaction
Evocation – elicitation / acceptance / understanding of client’s own ideas about change
Respect Autonomy – active fostering of client perception of choice

13. Elements of mi: OARS OARS MI Spirit Change Talk MI Principles
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.

14. Early strategies: OARS
Open Ended Question: (“are you concerned about your health?” vs “to you, what are important reasons to cut down on your drinking?”) Affirmation: (“It really sounds like you have been committed to being the best father you can”) Reflection: (“It sounds like on one hand you feel …..and were scared by the emergency room visit, but on the other hand, you don’t want to give up drinking completely right now”) listening Summary(“Let me try to pull together what we have been talking about, let me know if I missed something……”)
Kate

15. Responding to Resistance
Simple Reflection – you feel stuck, etc.
Amplified Reflection – C: My wife thinks its worse than it is. I: It seems to you she has no reason for concern.
Double-sided Reflection - You don’t like the way this makes you feel sometimes, and you’re not sure how you might change things.
Reframing – C: I’ve tried to quit 3 times and failed. I: You’ve given it 3 good tries, and every try gets you closer. Its probably helped you learn some things that will and won’t work for you.
Emphasize personal choice and control – What you decide to do is completely up to you

16. Elements of mi: MI Principles
MI Spirit
Change Talk
MI Principles
OARS
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.

17. 4 Principles of MI
Acceptance of people as they are frees them to change whereas non- acceptance immobilizes the change process
Between present behavior and broader goals and values; helping people get un-stuck
Avoid arguing for change; new ideas/goals/options are not imposed; used as a signal
Belief in ability to change is a powerful predictor of change; counselor self-fulfilling prophesy

18. MI principles
Practitioners want to help! Leads to strong urge to correct behavior that is harmful – Righting reflex. But, it is a natural human tendency to resist persuasion – Resist
The patients own reasons for change are much more powerful than ours – Understand
The answers regarding behavior change come from the patient – Listen
Outcomes are better when patient takes and active role in deciding on outcomes - Empower

19. Elements of mi: Change talk
MI Spirit
Change Talk
MI Principles
OARS
Reference: Rosengren, D. B. (2009). Building Motivational Interviewing Skills; A Practitioner Workbook. NY: The Guilford Press.

20. Change Talk (Bem Self Perception Theory)
“It is the truth we hear ourselves speak rather than the treatment we receive that heals us.” - O. Hobart Mowrer
Lynn – Change Talk

21. Desire, Ability, Reasons, Need
The Flow of Change Talk MI
Desire, Ability, Reasons, Need
Commitment
Change

22. Eliciting Change Talk Evocative Questions Importance Ruler
Exploring Decisional Balance
Querying Extremes (worst thing if you continue. . ., best things if you change)
Looking Back (prior to the problem and compare with now)
Looking Forward (If you make a change . . ., Suppose you don’t make a change, what do you think your live might be like)

23. Video example
Reference: Demonstration of the motivational interviewing approach in a brief medical encounter. Produced by University of Florida Department of Psychiatry. Funded by Flight Attendant Medical Research Institute Grant #63504

24. PRIMARY CARE

25. Brief Interventions in the ED

26. Virtual Therapist

27. Brief Intervention

28. Brief Intervention

29. Brief Intervention

30. RESOURCE: thank you MI website to visit: www.motivationalinterview.org
Contact information: Lynn Massey, LMSW