Motivational Interviewing

1. Client
2. Setting/Context
3. Cousellor

1. Following (Listening)

   Annotations:

   • client is in charge of the agenda
2. Directing (Informing)

   Annotations:

   • counsellor provides the focus (agenda) based on their expertise/setting
3. Guiding (Negotiating)

   Annotations:

   • collaborative search for direction, the focus of treatment is negotiated

1. Structuring: step outside of conversation

   Annotations:

   • step back to discuss direction, ask permission and offer a structuring statement
   1. Considering options (hypothetical)

      Annotations:

      • allow client time to list and reflect on options, use affirmations and support autonomy, use reflective listening
      1. Zooming in (provisional)

         Annotations:

         • exchanging information and agreement on focus, use summary before moving on

Annotations:

• 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

Annotations:

• 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

1. Assumptions

Annotations:

• "passive" should be said as "active listening" to patient/client

1. The Opening Session

   Annotations:

   • 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
   1. OARS
      1. Open Questions

         Annotations:

         • invite the person to reflect/elaborate
         1. 3 reflections per open question no more than 3 open questions in a row
      2. Affirmations

         Annotations:

         • 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
      3. Reflections

         Annotations:

         • 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...
         1. Simple

            Annotations:

            • Repeating or rephrasing. Useful to demonstrate understanding and to keep the conversation alive
         2. Complex

            Annotations:

            • Paraphrasing and Emphasizing. Used when you want to add to the client's understanding, to find meaning, or to direct conversation
      4. Summaries

         Annotations:

         • reflections that pull together several things the client has told you
         1. Collecting

            Annotations:

            • recalls a series of interrelated items as they accumulate, usually within one session
         2. Linking

            Annotations:

            • used to contrast and tie together things the person has said, often from multiple sessions. Use AND not BUT
         3. Transitional

            Annotations:

            • use to wrap-up or move from one process to another

Annotations:

• Question-Answer (assessment) Taking Sides Expert Labelling Premature Focus Blaming Chat

1. Testing the Waters
   1. Simply Ask

      Annotations:

      • "would it make sense to consider how you might go about..." "are you willing to think about..."
   2. Recap
   3. Pregnant Pause
2. Signs of Readiness
   1. Increased Change Talk
   2. Taking Steps
   3. Diminished Sustain Talk
   4. Resolve

      Annotations:

      • Resolution Resignation Pensiveness Passivity
   5. Envisioning
   6. Asking questions about change
3. Strengthening Commitment
   1. Is the client satisfied

1. Dynamics of Changing

   Annotations:

   • goal>specfc actions>self efficacy general>specific SMART goals
   1. 3 scenarios of planning
      1. 1 Path

         Annotations:

         • Summarize the plan. Calling the CATs. (evoke activation, get more specific, set a date, preparing, ask for commitment) Troubleshoot.
      2. Many Paths

         Annotations:

         • Path mapping. - confirm goal - itemize options - elicit the client's hunches/preferences - summarize the plan and strengthen commitment - Troubleshoot
      3. Clear goal w/o clear path

         Annotations:

         • Collaborating. - confirm the goal - generate possibilities (avoid evaluation!) - summarize - Troubleshoot

Annotations:

• 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

1. Types of Change Talk
   1. DARN
      1. Desire
      2. Ability

         Annotations:

         • signals change might be possible
         1. Strategies for Strengthening Confidence
            1. Elicit Confidence Talk

               Annotations:

               • open questions, confidence ruler
               1. Identify Options

                  Annotations:

                  • ask client first, then give advice, brainstorm!
                  1. Find the Positive

                     Annotations:

                     • identify/affirm strengths identify past successes reframe
      3. Reasons
      4. Need
2. Mobilizing Change Talk
   1. CATs
      1. Commitment

         Annotations:

         • I will
      2. Activation

         Annotations:

         • I am willing...shows movement toward action
      3. Taking Steps

         Annotations:

         • I tried
3. Eliciting Change Talk
   1. Ask Evocative Questions
   2. Query Extremes
   3. Looking Back/Forward
   4. Explore Goals and Values
   5. Importance Ruler

      Annotations:

      • ask, "why a 5 and not a 2?" to further elicit change talk
4. Strategies for Responding to Sustain Talk
   1. Simple Reflection
      1. Amplified Reflection
         1. Double-Sided Reflection
            1. Emphasizing Autonomy
               1. Reframing
                  1. Agreeing With a Twist
                     1. Coming Alongside
   2. Responding To Discord

      Annotations:

      • Apologizing, affirming, shifting focus 

Annotations:

• Partnership Acceptance Compassion Evocation