Motivational Interviewing

Motivational Interviewing

1. 2. Focussing

   • Sources of Focussing
     • Client
     • Setting/Context
     • Cousellor
   • Styles of Focussing
     • Following (Listening)
       • client is in charge of the agenda
     • Directing (Informing)
       • counsellor provides the focus (agenda) based on their expertise/setting
     • Guiding (Negotiating)
       • collaborative search for direction, the focus of treatment is negotiated
   • Agenda Mapping
     • Structuring: step outside of conversation
       • step back to discuss direction, ask permission and offer a structuring statement
       • Considering options (hypothetical)
         • allow client time to list and reflect on options, use affirmations and support autonomy, use reflective listening
         • Zooming in (provisional)
           • exchanging information and agreement on focus, use summary before moving on
   • Ethical Self-Check
     • Check when:  Clinician-client aspirations differ  When change imposed by 3rd party  When clinician has conflict of interest  When clinician has coercive power   When MI would not beneficial
   • Fedback & Infformation Exchange
     • WHAT - sharing expertise with clients- sharing one's concerns with client- providing information about client's current situation- offering advice/providing options for improving client's current situation
     • WHEN - when the client asks for it - when the councellor thinks it could be helpful
     • HOW - offer information, don't impose anything - Find out if clients want the information before you give it  - Ask permission   - Provide information in the context of other clients   - Give clients permission to disagree with you   - Use a menu of options   - Use client statements   - Use information that is factually or normatively based - Invite clients to decide what the information means for them   - Your client is a person, not an information receptacle
     • Assumptions

2. 1. Engaging

   • Establishment of a trusting and mutually respectful working relationship
     • "passive" should be said as "active listening" to patient/client
   • Agreement on treatment goals
     • The Opening Session
       • Sets the tone and expectation for the counsellor-client relationship: - introduction - time available - counsellor's role - client's role - specific questions - taking notes? ask permission - open question
       • OARS
         • Open Questions
           • invite the person to reflect/elaborate
           • 3 reflections per open question no more than 3 open questions in a row
         • Affirmations
           • Recognizing and commenting on the client's particular strengths, abilities, good intentions, and efforts (must be sincere)...can use re-framing to recognize weakness as a strength
         • Reflections
           • statements (not questions) that are used to check for meaning, words may be similar but delivery and tone of voice change
           • So you feel... It sounds like you... You're wondering if... You...
           • Simple
             • Repeating or rephrasing. Useful to demonstrate understanding and to keep the conversation alive
           • Complex
             • Paraphrasing and Emphasizing. Used when you want to add to the client's understanding, to find meaning, or to direct conversation
         • Summaries
           • reflections that pull together several things the client has told you
           • Collecting
             • recalls a series of interrelated items as they accumulate, usually within one session
           • Linking
             • used to contrast and tie together things the person has said, often from multiple sessions. Use AND not BUT
           • Transitional
             • use to wrap-up or move from one process to another
   • Collaboration on mutually negotiated tasks to reach these goals
   • Traps to Avoid
     • Question-Answer (assessment) Taking Sides Expert Labelling Premature Focus Blaming Chat

3. 4. Planning

   • When is the right time to plan?
     • Testing the Waters
       • Simply Ask
         • "would it make sense to consider how you might go about..." "are you willing to think about..."
       • Recap
       • Pregnant Pause
     • Signs of Readiness
       • Increased Change Talk
       • Taking Steps
       • Diminished Sustain Talk
       • Resolve
         • Resolution Resignation Pensiveness Passivity
       • Envisioning
       • Asking questions about change
     • Strengthening Commitment
       • Is the client satisfied
   • Developing a change plan
     • Dynamics of Changing
       • goal>specfc actions>self efficacy general>specific SMART goals
       • 3 scenarios of planning
         • 1 Path
           • Summarize the plan. Calling the CATs. (evoke activation, get more specific, set a date, preparing, ask for commitment) Troubleshoot.
         • Many Paths
           • Path mapping. - confirm goal - itemize options - elicit the client's hunches/preferences - summarize the plan and strengthen commitment - Troubleshoot
         • Clear goal w/o clear path
           • Collaborating. - confirm the goal - generate possibilities (avoid evaluation!) - summarize - Troubleshoot

4. 3. Evoking

   • Change Talk vs Sustained Talk
     • Approach-Approach: person is torn between two positive choices Avoidance-Avoidance: person is torn between to negative choices (think: grass looks greener on the other side; stuck between a rock and a hard place) Approach-Avoidance: only one choice is being considered but it has both positive and negative aspects Double Approach: two choices considered, both with important positive and negative aspects
     • Types of Change Talk
       • DARN
         • Desire
         • Ability
           • signals change might be possible
           • Strategies for Strengthening Confidence
             • Elicit Confidence Talk
               • open questions, confidence ruler
               • Identify Options
                 • ask client first, then give advice, brainstorm!
                 • Find the Positive
                   • identify/affirm strengths identify past successes reframe
         • Reasons
         • Need
     • Mobilizing Change Talk
       • CATs
         • Commitment
           • I will
         • Activation
           • I am willing...shows movement toward action
         • Taking Steps
           • I tried
     • Eliciting Change Talk
       • Ask Evocative Questions
       • Query Extremes
       • Looking Back/Forward
       • Explore Goals and Values
       • Importance Ruler
         • ask, "why a 5 and not a 2?" to further elicit change talk
     • Strategies for Responding to Sustain Talk
       • Simple Reflection
         • Amplified Reflection
           • Double-Sided Reflection
             • Emphasizing Autonomy
               • Reframing
                 • Agreeing With a Twist
                   • Coming Alongside
       • Responding To Discord
         • Apologizing, affirming, shifting focus 

5. Spirit of MI

   • PACE
     • Partnership Acceptance Compassion Evocation