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Motivational Interviewing

Motivational Interviewing (MI) is a therapeutic approach designed to help clients navigate their ambivalence towards change by employing specific strategies tailored to their stage of change. Research indicates that MI is an effective intervention that enhances client engagement and supports self-efficacy. Key techniques include expressing empathy, developing discrepancy, and using reflective listening to facilitate client motivation and address resistance.

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3 views

Motivational Interviewing

Motivational Interviewing (MI) is a therapeutic approach designed to help clients navigate their ambivalence towards change by employing specific strategies tailored to their stage of change. Research indicates that MI is an effective intervention that enhances client engagement and supports self-efficacy. Key techniques include expressing empathy, developing discrepancy, and using reflective listening to facilitate client motivation and address resistance.

Uploaded by

DarkkKnight
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Motivational

Interviewing
TIP 35 by
William R. Miller, PhD
Motivational
Interviewing:a
therapeutic style
intended to help
clinicians work with
clients to address
the client’s
continuous
fluctuation between
opposing behaviors
and thoughts.
Effectiveness of
Motivational Interviewing
A recent review of 11 clinical trials of
motivational interviewing concluded
that this is a "useful clinical
intervention...[and] appears to be an
effective, efficient, and adaptive
therapeutic style worthy of further
development, application, and
research" (Noonan and Moyers, 1997,
p. 8).
Appropriate Motivational Strategies for
Each Stage of Change
Client's Stage of Change Appropriate Motivational
Strategies for the
Clinician

Precontemplation Establish rapport,


ask permission, and
build trust.
The client is not yet
considering change Raise doubts or
or is unwilling or concerns in the
unable to change. client about.
substance-using
patterns
Express concern
and keep the door
open.
Client's Stage of Change Appropriate Motivational
Strategies for the Clinician

Contemplation Normalize
ambivalence.
Help the client "tip
The client the decisional balance
acknowledges scales" toward
concerns and is change.
considering the Elicit and summarize
possibility of change self-motivational
but is ambivalent statements of intent
and uncertain. and commitment from
the client.
Elicit ideas
regarding the client's
perceived self-efficacy
Client's Stage of Change Appropriate Motivational
Strategies for the Clinician

Preparation Explore treatment


expectancies and
the client's role.
Clarify the client's
The client is own goals.
committed to and Negotiate a
planning to make a change--or
change in the near treatment--plan and
future but is still behavior contract.
considering what to Consider and
do. lower barriers to
change.
Help the client
Client's Stage of Change Appropriate Motivational
Strategies for the Clinician

Action Engage the client in


treatment and
reinforce the
importance of
The client is actively remaining in
taking steps to recovery.
change but has not Acknowledge
yet reached a stable difficulties for the
state. client in early stages
of change.
Help the client
identify high-risk
situations through a
functional analysis
Client's Stage of Change Appropriate Motivational
Strategies for the Clinician

Maintenance Support lifestyle


changes.
Affirm the client's
The client has resolve and self-
achieved initial goals efficacy.
such as abstinence Help the client
and is now working practice and use new
to maintain gains. coping strategies to
avoid a return to
use.
Develop a "fire
escape" plan if the
client resumes
substance use.
Client's Stage of Change Appropriate Motivational
Strategies for the Clinician

Recurrence Help the client


reenter the change
cycle and commend
The client has any willingness to
experienced a reconsider positive
recurrence of change.
symptoms and must Explore the meaning
now cope with and reality of the
consequences and recurrence as a
decide what to do learning opportunity.
next. Assist the client in
finding alternative
coping strategies.
Maintain supportive
Skills
Express Avoid argument
EMPATHY and direct
through reflective confrontation.
listening. Adjust to client’s
Develop resistance rather
discrepancy or than opposing it
inconsistencies directly.
between client Support self-
goals and current efficacy and
behavior. optimism.
Expressing
Empathy
Acceptance facilitates change
Skillful reflective listening is
fundamental to expressing
empathy
Ambivalence is normal.
Source: Miller and Rollnick, 1991.
Reprinted with permission.
Develop
Discrepancy
Motivation for change is enhanced
when clients perceive discrepancies
between their current situation and
their hopes for the future.
One useful tactic for helping a client
perceive discrepancy is sometimes
called the "Columbo approach"
(Kanfer and Schefft, 1988).
Developing
Discrepancy
Developing awareness of
consequences helps clients
examine their behavior.
A discrepancy between present
behavior and important goals
motivates change.
The client should present the
arguments for change.
Source: Miller and Rollnick, 1991.
The Columbo
Approach
Using the Columbo approach, the
clinician plays the role of a
detective who is trying to solve a
mystery but is having a difficult
time because the clues don't add
up. The "Columbo clinician"
engages the client in solving the
mystery.
Four Types of Client
Resistance

Arguing
The client contests the
accuracy, expertise, or
integrity of the clinician.
“Resistance
Continued”
Interrupting
The client breaks in and
interrupts the clinician in
a defensive manner.
“Resistance
Continued”
Denying
The client expresses
unwillingness to recognize
problems, cooperate,
accept responsibility, or
take advice.
“Resistance
Continued”
Ignoring
The client shows
evidence of ignoring or
not following the
clinician.
Simple Reflection
The simplest approach to
responding to resistance is with
nonresistance, by repeating the
client's statement in a neutral
form. This acknowledges and
validates what the client has
said and can elicit an opposite
response.
Amplified
Reflection
Another strategy is to reflect the
client's statement in an
exaggerated form--to state it in
a more extreme way but without
sarcasm. This can move the
client toward positive change
rather than resistance.
Double-sided
Reflection
A third strategy entails
acknowledging what the client
has said but then also stating
contrary things she has said in
the past. This requires the use of
information that the client has
offered previously, although
perhaps not in the same session.
Shifting Focus
You can defuse resistance by
helping the client shift focus
away from obstacles and barriers.
This method offers an opportunity
to affirm your client's personal
choice regarding the conduct of
his own life.
Agreement With a
Twist
A subtle strategy is to
agree with the client, but
with a slight twist or
change of direction that
propels the discussion
forward.
Reframing
A good strategy to use when a
client denies personal problems is
reframing--offering a new and
positive interpretation of negative
information provided by the client.
Reframing "acknowledges the
validity of the client's raw
observations, but offers a new
meaning...for them"
(Miller and Rollnick, 1991, p. 107).
Rolling With
Resistance
Momentum can be used to good
advantage.
Perceptions can be shifted.
New perspectives are invited but
not imposed.
The client is a valuable resource in
finding solutions to problems.
Source: Miller and Rollnick, 1991.
Reprinted with permission.
Siding With the
Negative
One more strategy for adapting to
client resistance is to "side with
the negative"--to take up the
negative voice in the discussion. If
your client is ambivalent, your
taking the negative side of the
argument evokes a "Yes, but..."
from the client, who then
expresses the other (positive)
side.
Self-Efficacy
Belief in the possibility of change is
an important motivator.
The client is responsible for
choosing and carrying out personal
change.
There is hope in the range of
alternative approaches available.
Source: Miller and Rollnick, 1991.
Reprinted with permission.
Avoiding
Arguments
Arguments are counterproductive.
Defending breeds defensiveness.
Resistance is a signal to change
strategies.
Labeling is unnecessary.
Source: Miller and Rollnick, 1991.
Reprinted with permission.
Ask Open-Ended
Questions
Asking open-ended questions helps
you understand your clients' point of
view and elicits their feelings about
a given topic or situation. Open-
ended questions facilitate dialog;
they cannot be answered with a
single word or phrase and do not
require any particular response.
Listen Reflectively
"Reflective listening is a
way of checking rather
than assuming that you
know what is meant"
(Miller and Rollnick,
1991, p. 75).
Summarize
"Summaries reinforce what
has been said, show that
you have been listening
carefully, and prepare the
client to move on" (Miller
and Rollnick, 1991, p. 78).
Affirm
When it is done
sincerely, affirming
your client supports
and promotes self-
efficacy.
Four types of
Motivational Statements
Cognitive recognition of the problem (e.g., "I
guess this is more serious than I thought.")
Affective expression of concern about the
perceived problem (e.g., "I'm really worried
about what is happening to me.")
A direct or implicit intention to change
behavior (e.g., "I've got to do something
about this.")
Optimism about one's ability to change
(e.g., "I know that if I try, I can really do it.")
Sample Questions To Evoke
Self-Motivational Statements

Problem Recognition.
Concern.
Intention to Change.
Optimism.
Training and Technical
Assistance
Should you have any questions about the
presentation, please call:
Melva Moore, MSSW
Program Specialist II
1-800-832-9623 or 1-512-349-6693
Valerie Shown, LMSW – ACP
Program Specialist II
1-800-832-9623 or 1-512-349-6681

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