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An Overview

If you treat a person 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

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A Little About Shawn & MI

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1998

Read MI -1

2002 – 2009

Pretrial

Project Excel

Wiser Choice

2009

Convened Training for

New Trainers

2009 – 10

Coding & Coaching

MINT Review of Internal

WCS MI Trainings

2010 –Present

Trained over 300

professionals

September 2012

MINT

In helping people change,

your biggest challenge is…

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Why MI?

Definitions: Degrees of Practice

� “What works”� Link to general, positive outcomes� Are not necessarily measured

� “Best practices”� Produce a positive, measurable result� Do not necessarily pay attention to one outcome

over all others � “Evidence-based practices”

� Have a specific, targeted outcome (over all others)� Are measurable� Are defined in practical terms

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Example: Motivational Interviewing (MI)

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What Works• Collaborate with Clients to increase internal

motivation• Collaborate with Clients to increase internal

motivation

Best Practice • Identify and resolve ambivalence• Identify and resolve ambivalence

Evidence-Based

Practice

• Targeted outcome: Sustained behavior change

• Measureable: continued abstinence

• Practical terms: a person-centered, directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

• Targeted outcome: Sustained behavior change

• Measureable: continued abstinence

• Practical terms: a person-centered, directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

Evidence-Based Principle

• Enhance Intrinsic Motvation• Enhance Intrinsic Motvation

Why Implement EBPs?

�Aligns with Mission and Values

�Promotes positive behavioral change

�Reduces recurrence

�Improves quality of life

�Required by many funders

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Developments in MI

• Trainers and translations in 44 languages

• Over 200 randomized trials between 2003-2010

• Over 1000 publications

• Four meta-analyses

• Rapid diffusion into health care and corrections

• Newer diffusion into mental health and education

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TIC Alignment

My Goal For Our Explorations …

AM I … MI?

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L e a r n i n g M I

• You Do Learn MI by:

�Doing/Practicing

�Reflecting

�getting feedback

(coding

sessions/practice

groups/fidelity tools)

• You Don’t Learn MI:

• By the end of a two

hour overview

• By the end of a 2 day

skills training

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The 8 Stages of Learning MI

1. Overall Spirit

2. Client-centered Interviewing

Skills (OARS)

3. Recognizing Change Talk

4. Eliciting Change Talk (ECT)

5. Rolling With Resistance

6. Consolidating Commitment

7. Developing A Change Plan

8. Transition and Blending With

Other Methods

• Open Questions

• Affirmation

• REFLECTIVE

Listening

• SummariesAim for this

Class:

Our Choice: Presumption of Worth

Goals & Outcome

• Won’t/Will

• Sustain/Change

You:

•Awesome

•Skilled

•Helpful

•Artists

•Do-er

You:

•Awesome

•Skilled

•Helpful

•Artists

•Do-er

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C h a n g e C o n c e p t s

All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves; we must die to one life before we can enter another.

- Anatole France17

Coercion =

Short Term Change 18

WHY DO PEOPLE

MAKE CHANGES

IN THEIR BEHAVIOR?

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We are in the business of

Behavior Change

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Who is the expert

on the person’s life?

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Our Behavior

Effects

A Person’s Behavior

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Shawn’s MI NON-ADHERENT Example

� Volunteer:

“A change I should make that I’ve been putting off …”

\

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A Taste of MI• Speaker: “I’ve been thinking about …”

Interviewer: Ask,

� “Why would you want to make this

change?”

� “How might you go about it, in order to

succeed?”

� “What are the 3 best reasons to do it?”

� Summarize what you heard.

� Ask, “What will you do next?”Cue Sheet Exercise # 1

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What kind of questions are these?

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• “Why would you want to make this

change?”

• “How might you go about it, in order

to succeed?”

• “What are the 3 best reasons to do

it?”

O A R S

Open Ended Questions

Affirmations

Reflections

Summaries26

Open Ended Questions …

• Good conversation starters/continuers

• Changing the subject, topic, or agenda

• gather information, and increase

understanding

• opposite of closed-ended -- require brief

responses – “yay” or “nay”, “sure”,

“sometimes”, “I dunno” etc.

• invite others to “tell their story” in their own

words

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Motivational Interviewing is …

- a lay person’s definition

… a collaborative conversation style for

strengthening a persons’ own motivation and

commitment to change.

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Approach

4 Processes

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ENGAGING

FOCUSING

EVOKING

PLANNING

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ENGAGINGC H E C K I N G - I N

FOCUSINGA G E N D A M A P P I N G

EVOKINGE L A B O R A T I V E O P E N E N D E D Q U E S T I O N S

PLANNINGW H A T D O Y O U W A N T T O D O

B E T W E E N N O W A N D T H E N E X T T I M E

W E M E E T ?

Handout

O u r r o l e …

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Directing Guiding Following

MI

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Not Favorites. Favorites.

Authority Figure Qualities that Evoked …

Resistance Growth

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Partnership

Compassion

Evocation

Acceptance MISPIRIT

MI

SPIRIT

P a r t n e r s h i p

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Collaboration Between Experts

Requires:

Exploration

Interest

Support

Feels Like Dancing

A c c e p t a n c e

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Absolute Worth

Autonomy AffirmationAccurate Empathy

• Prizes Inherent

Worth & Potential

• Non-Judgmental

• We control our

perceptions, we

choose the

prophecy

• Recognizes the

FACT of self-

direction

• Relinquishes a

power we never

had

• Acknowledges the

persons strengths &

efforts

• Best if tied to

positive/healthy

behavior

• Active Interest to

understand the

world from the

others lens

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AcceptanceAcceptance

Accurate EmpathyAccurate Empathy

AutonomyAutonomy

Absolute Worth

Absolute Worth

AffirmationAffirmation

E m p a t h y

LISTENING UNDERSTANDING JUDGING HELPING

APATHY NO NO NO NO

ANTIPATHY YES NO YES NO

SYMPATHY YES YES YES NO

EMPATHY YES YES NO YES

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A PATHY No response to other’s distress

ANTI PATHY Minimizing other’s distress

SYM PATHY Sharing other’s distress

EM PATHY Understanding without sharing other’s distress

E m p a t h yEmpathy is not:

• Having had the same experience or problem

• Identification with the person

• “Let me tell you my story”

Empathy is:

• The ability to:

• accurately understand the person’s meaning

• reflect that accurate understanding back to

the person

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E v o c a t i o n

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Motivational Interviewing

(Practitioners Definition)

Motivational interviewing is a

person-centered counseling style

for addressing the common

problem of ambivalence about

change.

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Ambivalence

• Feeling 2

ways about

something

• Normal and

acceptable

• Must resolve

to move

forward with

change43

C h a n g e Ta l k and S u s t a i n Ta l k

Two Sides of the Same Coin

Change

• Desire

• Ability

• Reason

• Need

Sustain

• Desire

• Ability

• Reason

• Need

Ambivalence

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Research suggests that MI facilitates

change by promoting three conditions

reduces resistance.

Resistance

Sustain Talk

MI-N Helper

BehaviorDiscord

Approach

DIS-Engagement vs. Engagement

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M o t i v a t i o n a l Tr a p s

C o m e U p w / E x a m p l e s

• Question/Answer

• Confrontation/Denial

• Expert

• Labeling

• Premature Focus

• Blaming

� 49

�

Handout

2 Kinds of Levels of Change Talk

Preparatory:

• DESIRE: Want, wish, like

• ABILITY: Can, could, able

• REASON: Specific reason for change

• NEED: Need to, have to, must, important, etc.

Research suggests that MI facilitates

change by promoting three conditions

elicits change

talk.

Dear Science, HOW does MI Do IT?

Change

Taking Steps

Commitment

DARN

MI

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T h r e e T h i n g s R E C h a n g e Ta l k

• Identify it (hear it, listen for it)

• Respond to it

•Evoke it

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D A R N - C AT ?

1. I think I’m doing about as well as I can.

2. I don’t want to go to jail.

3. I’ve just always hated school.

4. I’d like to graduate.

5. Well, I wouldn’t mind doing the work.

6. I probably could get up earlier.

7. Yes, I’m going to go to school everyday.

8. But I love being high!

9. I’ve got to get my PO off my back!

10. I started going to the after school program.

P r e p a r a t o r y C h a n g e Ta l kWhat’s it sound like from a family member?

•Desire (want, like, wish …)

•Ability (can, could, …)

•Reason (if … then)

•Need (need, have to, got to …)

• Change talk often comes intertwined with sustain talk.

• That’s the nature of ambivalence.

Ambivalence

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Snatching Change Talk From the Jaws of Ambivalence …

“I’m tired of drinking but I have to so I don’t have

the shakes in the morning. I don’t use cocaine like I

was but if the guys call me - I can’t say no - I end up

going over there and using. But they are just using

me they only call me when they want me to buy the

stuff they never have beer or cocaine to give me. I

don’t think I can stop drinking because both of my

parents were alcoholics I didn’t stand a chance. I

think I drink because I’m depressed. If I lived in low

income housing I would be okay.”

Responding to Change Talk: EARS

Elaborating: Asking for elaboration, more detail, in what ways, an example, etc.

Affirming – the person’s statement or behavior

Reflecting, continuing the paragraph, etc.

Summarizing – collecting bouquets of change talk

OARSOpen Ended Questions

Affirmations

Reflections

Summaries59

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LISTENING: That’s what I’m talkin’ about!

Twelve Roadblocks to Listening (Thomas Gordon, Ph.D.)

1. Ordering, directing, or commanding

2. Warning or threatening

3. Giving advice, making suggestions, or providing solutions

4. Persuading with logic, arguing, or lecturing

5. Moralizing, preaching, or telling clients what they "should" do

6. Disagreeing, judging, criticizing, or blaming

7. Agreeing, approving, or praising

8. Shaming, ridiculing, or labeling

9. Interpreting or analyzing

10. Reassuring, sympathizing, or consoling

11. Questioning or probing

12. Withdrawing, distracting, humoring, or changing the subject62

Reflective Thinking

• interest in what

the person has

to say

• and respect for

the person's

inner wisdom

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Express INTEREST & RESPECT

• What’s good listening

look like?

• Don’ts/Do’s of

nonverbal listening

• Value of silence?

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Express INTEREST & RESPECT

Exercise:

1. Pairs

2. Speaker Topics (pick one):

a. Growing up in my home.

b. What is X-person like?

c. How’d I end up in my career.

3. Listener: Nonverbal Active

Listening

4. 2 minutes, debrief, switch

Reflections …• Form of a statement (inflection down)

• “You feel that if you do that you will lose?”

• “You feel that if you do that you will lose.”

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Let’s HYPOTHOSIZE

• A good reflective

listening response tests

a hypothesis.

• (You mean that you …)

Engaging:

Reflect to Understand (no fixing)

� Break into Two’s:

� One Speaker, One Listener,

� Speaker: One thing I like about myself is … (abstract)

� Listener responds: “You mean that you_________ .”

� Speaker responds briefly. (Couple of sentences).

� Deepen the reflection each time.

� Do this five times then rotate.

� Example.

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Forming Reflections

• You mean that you …

• Sounds like …

• You’re feeling …

• Seems that you …

• So you …

• What I hear you saying …

• (And then let go …)

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ENGAGING• R E F L E C T T O E X P R E S S U N D E R S TA N D I N G

FOCUSING• R E F L E C T T O G U I D E T O A T A R G E T B E H A V I O R

EVOKING• R E F L E C T C H A N G E T A L K

PLANNINGR E F L E C T T O S U M M A R I Z E

• C H A N G E T A L K

• M E N U O F O P T I O N S

MI Technical Definition

Motivational Interviewing is a

collaborative, goal-oriented style of

communication with particular attention

to the language of change. It is designed

to strengthen personal motivation for and

commitment to a specific goal by eliciting

and exploring the persons reasons for

change within an atmosphere of

acceptance and compassion.