1. Rolling with Resistance : Using a Motivational Interviewing Approach
Presented by
Danette Heckathorn, M.S., L.P.C.
4/19/2017

2. Motivational Interviewing
A Humanistic approach to counseling developed by Miller and Rollnick (1991, 2002).
Motivational interviewing (MI) is not a theory. It is a tool to be used in conjunction with other theories.
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3. Agenda Motivation What this training will do for you
Stages of Change Model
Major goals of motivational interviewing
How to address negative behavior
Rolling with Resistance
Practice
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4. Motivation
What motivates?
Is motivation enough?
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5. What will this training do for you?
You will learn ways to use motivational interviewing as a tool to roll with client resistance.
This training will give you a taste of MI and introduce you to some resources, but it cannot substitute for a 4-Day comprehensive MI training.
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6. Cycle of Change 4/19/2017 Precontemplation Contemplation Preparation
Action
Maintenance
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7. Stages of Change (Prochaska et. al., 1994)
Precontemplation – either unaware of problems related to negative health behavior or lack the desire to change their negative behavior, and they do not report any intention to change their negative habit within the next 6 months.
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8. Contemplation
Individuals recognize that some aspect of their negative behavior is a problem, and they plan to take action in the next 6 months. They are often seen as ambivalent because the perceived costs and benefits of the negative behavior are equivalent (Rollnick et. al., 1991).
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9. Preparation Action Maintenance
Commitment to change has been made and they plan to take action in the near future.
Action
Begin to actively change behaviors and environmental conditions to overcome problem.
Maintenance
Changes have become a regular part of the individual’s lifestyle.
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10. Why Determine Stage of Change?
Identifying a clients stage of change will help you determine the best approach to take with them.
Change is the responsibility of the client but the caregiver is responsible for enhancing motivation to change.
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11. Ways to Determine Their Stage of Change
I noticed (behavior) is this something that is creating a problem for you or something you would like to change?
People differ in how ready they are to change their (behavior) habits. What about you?
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12. Precontemplative Client
“I don’t have any problems with (behavior)”
They may come across defensive
Reluctant
Resigned
Rationalizing
Rebellious
No intention to change
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13. Comtemplative Client “I have been thinking about changing (behavior)”
They have identified the behavior may be problematic
More troubled about the behavior
Ambivalent but may be weighing pros and cons
Decisional balance exercise useful
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14. Preparation Stage and Client
“How can I change (behavior)?”
More committed
Ready to start
Sharing plans for change
Change becomes a priority
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15. Action Stage and Client
“Here I go”
They decide on a change strategy and try it out
Actively modify behavior including thoughts, feelings, and the environment
Treatment and/or self-help
Persistence and completion or drop-out
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16. Maintenance Stage and Client
“I think this will work and I am going to continue”
Trying to keep the ball rolling
Preventing relapse – learning new coping skills
Watching out for triggers
Acknowledging self for changes made and taking credit
Moving toward more balance
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17. Practice Identifying Stage of Change
Quick Exercise
We will come back to the stages of change after discussing motivational interviewing
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18. Motivational Interviewing
Defined as “...a client-centered directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (Miller & Rollnick, 2002, p. 25)
Let’s break it down
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19. Four Main Principles of MI
Express empathy
Develop discrepancy
Roll with resistance
Support self-efficacy
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20. Strategies Used in MI
Eliciting Change Talk – motivational statements from the client
OARS Method
Open-Ended Questions
Affirming the client
Reflective listening
Summarizing
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21. Change Talk Client identifies that behavior might be problematic
Client expresses concern about a behavior
Client expresses a desire to change the behavior
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22. Reflective Listening What is it? How do you do it?
Levels of reflective listening
Optimal reflective listening
Let’s Practice…
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23. Affirming the Client The idea here is to enhance self-efficacy
Self-efficacy is our belief in our own ability to achieve a goal or accomplish a task
Strengthen the relationship
Enhance self-esteem
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24. Summarizing A technique to be used throughout the meeting
Strategically repeat a client’s self-motivational statements
Include reluctance/resistance
Reflect optimism for change
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25. Knowing When a Client is Ready to Change
What do you expect to hear when a client is ready to change?
What do you not expect to hear?
What will the client look like?
What other indications might the client make?
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26. How to Elicit Change Talk
Open-ended questions (handout)
Ruler (handout)
Pros/Cons exercise
Looking forward
Looking back
Goals and values
Open – ended questions
Disadvantages – “in what ways does this concern you?
Advantages to change – What would be a reason for making this changes?
Optimism about change – What might excite you about making this change? What other problems have you tackled successfully?
Intention to change – what might you do? What might the change look like?
Conviction, confidence, readiness – ruler
How convinced are you that you need to attend to this?
How confident are you in your ability?
How ready are you to do something different?
Pros and Cons – help them tip the balance – what could help you make this change and what could get in the way?
Looking forward – Look forward in your life and talk about what it might look like if you make this change, and if you don’t make this change.
If you do make these changes, what advantages do you see for yourself in the future? What disadvantages?
If you don’t make these changes, what do you see happening in your life in the near future?
Looking back – before this concern was an issue, what was life like?
As you look back in your life, how has this issue effected things for you? In what areas?
Goals and values
How do your goals in your life fit in with your current way of conducting your life?

27. Change Planning What changes? Why change? Goals – SMART Steps to take?
First steps – concrete
Help
I will know it is working if
Potential obstacles
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28. Resistance to Change 4 Categories Arguing Interrupting Denying
Ignoring
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29. NO NO’s for Dealing with Resistance
Arguing, disagreeing and challenging
Judging, criticizing, blaming
Warning of negative consequences
Seeking to persuade with logic
Analyzing
Confronting with authority
Sarcasm
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30. How to Respond to Resistance
Simple reflection
Amplified reflection
Double-sided reflection
Agreement with a twist
Shifting focus
Reframing
Rolling with resistance
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31. Simple Reflection Stating what you here the client saying
It is sometimes helpful for the client just to hear their own words
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32. Amplified Reflection Reflect with modification
Client: I just don’t think that I have a problem with gambling.
Caregiver: There is no cause for concern for you.
Client: I don’t know how changing my eating habits could help me.
Caregiver: You feel your eating habits are perfectly reasonable.
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33. Double-Sided Reflections
Reflect back the statement but also use the other side of the client’s ambivalence
Client: I can’t quit eating sweets. I look forward to having a nice desert each day.
Caregiver: It sounds like you are going to miss eating deserts, but you also don’t want to take diabetic medication. What do you think would be the best way to resolve this situation?
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34. Agreement with a Twist and Shifting Focus
Defuse resistance by shifting focus
Add a slant or twist to the meaning when you reflect back to the client
Client: I can’t imagine quitting drinking. All of my friends drink!
Caregiver: It sounds like you’ll really miss the social interaction. And at the same time, it might provide an opportunity to expand your social network like you were wanting.
Client: I can’t imagine quitting drinking. All of my friends drink!
Caregiver: It’s hard to imagine giving up a lifestyle that you’re accustomed to. I’m wondering, what can you imagine?
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35. Reframing
Placing something in a more positive light – (what are the benefits?)
Client – It is really going to be hard for me to quit eating sweets.
Caregiver: While it will be hard to quit eating sweets, you are determined to do it because it will allow you to control your diabetes without taking medication.
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36. Rolling with Resistance
This is where you just want to validate what the client is telling you by letting them know you have heard their problem and understand their ambivalence
It can be one of the most difficult techniques
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37. MI – The BASICS Let’s Practice…
Don’t ignore the behavior – even if you simply say “Hey, (name) I noticed (behavior).
Try to determine where they are with regards to stage of change.
Let’s Practice…
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38. Summary The Basics of MI Can be used to address any negative behavior
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39. Feedback and/or Questions dheckat@uark.edu or (479) 601-2164
Thank you.