Introduction Motivational Interviewing Non Clinicians

An Introduction to Motivational Interviewing  1
for Non Clinicians

AN INTRODUCTION
TO MOTIVATIONAL
INTERVIEWING
For Non-Clinicians
PART 2

Kate Speck, PhD, MAC LADC

OBJECTIVES - PART 2

Discuss the Elements of Ambivalence
Review the Principles of Motivational

Interviewing
Identify Motivational Interviewing Micro

Skills - OARS

TRADITIONAL APPROACH (2)

You better!
Or else!

If the stick is big enough,
there is no need for a carrot.

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  2
for Non Clinicians

TRADITIONAL APPROACH (3)

Someone who continues to use is
“in denial.”

The best way to “break through” the
denial is direct confrontation.

TRADITIONAL APPROACH (1)

The Stick

Change is motivated by discomfort.
If you can make people feel bad enough, they will

change.
People have to “hit bottom” to be ready for change
Corollary: People don’t change if they haven’t suffered

enough

LOOKING AT IT DIFFERENTLY…..

 A natural human state with different
possibilities for understanding and
action?

 A state of openness and opportunity?
 A capacity to see and understand

things in more than one way?

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  3
for Non Clinicians

ANOTHER APPROACH: MOTIVATING (1)

People are ambivalent about change
People continue their behavior because of their

ambivalence

The carrot

ANOTHER APPROACH: MOTIVATING
(1)

Motivation for change can be fostered by an accepting,
empowering, and safe atmosphere

The carrot

POLL QUESTION 1

When clients are resistant, nothing can be done to
move them toward change,

Yes
No
Maybe
I don’t know

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing 
for Non Clinicians

Involves feelings, actions and behaviors
of an interpersonal nature where there

is ambivalence and/or a lack of
collaboration.

• A state of mind in which a 4
person has co-existing, but
conflicting feelings, thoughts,
and actions about something

• Reasons People
Change/Reasons People
Don’t Change

• The “I do, but I don’t dilemma”

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  5
for Non Clinicians

WHAT IS AMBIVALENCE?

 Hesitance
 Uncertainty
 Indecision
 Irresolution
 Doubt
 Vacillation
 Inconstancy
 Fickleness

A FOOT IN BOTH CAMPS …..AMBIVALENCE

AMBIVALENCE

 To be on the verge of…
 To stand between two …
 To have mixed feelings …
 To be in two minds …

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  6
for Non Clinicians

AMBIVALENCE

Ambivalence: Feeling two ways about something.

 All change contains an element of ambivalence.
 Resolving ambivalence in the direction of change is a key

element of motivational interviewing

 Girl Interrupted:
 http://www.youtube.com/watch?feature=player_detailpage&v=RmVnIRgf

ngc

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  7
for Non Clinicians

• Ambivalence (feeling two ways
about something) is a normal
component of psychological
problems.

• Both sides seek expression.
• Acknowledge and protect the

side that doesn’t want to
change.
• MI is basically a conversation
about the client’s ambivalence.

• ROLE WITH AMBIVALENCE
• Goal for processing ambivalence

o Identify as normal
o Client argues for change

• Help client get unstuck
• Help client make a decision
• Move to change

REFLECTIVE RESPONSES TO
AMBIVALENCE

• Simple reflection
• Amplified reflection
• Double sided reflection

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  8
for Non Clinicians

VIDEO EXAMPLE

Health Habits – 5.5 minutes
 http://www.youtube.com/watch?v=_an2K9Wjgos&feature=player_detail

page#t=122s

POLL QUESTION 2

Ambivalence
…. is a normal and common human experience
…. needs to be worked through by the client
….. will often be resolved if the client is given the
opportunity, guidance and support to do so

23

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  9
for Non Clinicians

BASIC SKILLS………… OARS

O pen ended questions
A ffirmations
R eflective Listening
S ummaries

26

OPEN QUESTIONS

 “What are you thinking as you say that?”
 “How have you been successful with this approach before?
 When has this happened in the past?
 “Why that particular word?”
 “Describe your methods for getting to this decisions”
 WHAT ….. HOW ….WHEN ….WHY …. DESCRIBE …

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  10
for Non Clinicians

AFFIRMATION

 Statements of recognition of client strengths.
 Build confidence in ability to change.
 Must be congruent and genuine.

28

AFFIRMATION

I appreciate your honesty (if you know the
client is being honest).

I can see that caring for your children is
important to you.

It shows commitment to come regularly and
that you are making progress .

You have good ideas.

29

Affirmation

Affirm the client in an authentic way -
complements with a direction:

Affirm movement toward a goal
Affirm completion of a goal
It is important to keep the direction

moving forward for the target behavior.

30

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing 
for Non Clinicians

Reflective Listening

• A hypothesis (guess) about speaker’s
meaning

• A statement: to convey understanding

• Intonation down

• Short stems Ques

Reflec

31

REFLECTIONS

Simple Reflection:
Client: I don’t have anything to say.
Counselor:You’re not feeling talkative today.

Amplified Reflection:
Cjulsitenset:eNmos oliknee iIt kwnoouwldtabkeessumchedaichaatsioslne,.it
Practitioner: You can’t imagine ever taking
medication for something.

REFLECTIONS 11

Double – sided reflection:
Playing out both sides of the dilemma
as equal
Oconnstihseteonntley hisanchda, ltlreynignigngto, bwutoorkn othuet
other hand, you think your self-esteem
would improve if you lost weight.

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  12
for Non Clinicians

Summarize

Set up statement:“Let me see if I have this
right…”
Reflection, reflection, reflection
Open question:“So where does that leave us?
What else would you like to add?” or “Now, tell
me about ….” (to re-direct)

34
34

Summaries can…

Give the message that the client is being
heard
Allow the client to add important
information
Shift the direction of the interview

35

One of the biggest differences
between MI conversation and other

techniques is that the CLIENT is
the one who verbalizes the need

for change.

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing 
for Non Clinicians

SIGNALS OF READINESS

PRIMARY PRINCIPLES OF MI 13

MI creates a collaborative environment
where individuals are empowered, accepted,
supported and understood

The Primary principles include

 Express Empathy
 Develop Discrepancy
 Roll with Resistance
 Support Self-Efficacy

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing  14
for Non Clinicians

EXPRESSING EMPATHY

Communicating acceptance through skillful
reflective listening that helps individuals resolve
confusion without fear of embarrassment or shame

Reflections are used in order to convey
understanding to the individual about his/her
experience

Reflections can be of content, feeling, or meaning

DEVELOPING DISCREPANCY

This creates doubt about the consistency of values
and current behavior

For example, if a person has talked about wanting
to have a career and be successful in the future, ask
questions about how current behavior may or may
not affect this

Discuss “both sides of the coin”—On one hand
client wants to change, and on the other, he/she
may want to stay the same

ROLLING WITH RESISTANCE

This is harder than it sounds!
Since we are concerned about others, we have the

desire to tell them that what they are doing may not
be in their best interests and this leads to advising,
teaching, persuading, and even arguing
Resistance usually indicates that we must respond
differently:

 Use more reflections
 Shift Focus, return to it later
 Emphasize personal control

Kate Speck, PhD University of Nebraska –
PPC ‐402 472‐0501

An Introduction to Motivational Interviewing 
for Non Clinicians

SUPPORTING SELF-EFFICACY

Self-Efficacy - “a person’s belief in his/her ability to
carry out and succeed with a specific task”

Person-centered and instilling hope about being
able to change

Be aware of your beliefs about change as they will
come through when speaking to others

NEXT TIME

PART 3 –
CHANGE TALK
 Stages of Change

Kate Speck, PhD University of Nebraska – 15
PPC ‐402 472‐0501