CCSP Motivational Interviewing: Skills Building Webinar and Workshop Denise Barnes, MA, LPC Member of the Motivational Interviewer Network of Trainers
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CCSP Motivational Interviewing:
Skills Building Webinar and Workshop
Denise Barnes, MA, LPC
Member of the Motivational
Interviewer Network of Trainers
Motivational Interviewing (MI)
Why is MI a hot topic these days?
• It can be hard to change
• If you force change, you get push back
• MI helps understand ambivalence
• This can make navigation easier
• It often helps client understand themselves
Learning Objectives At the conclusion of the webinar and
workshop, you will be able to:
• Describe motivational interviewing (MI).
• Identify the four key MI principles and SPIRIT.
• Understand how conversation can facilitate change
• Demonstrate the four MI Skills (OARS)
• Demonstrate basic strategies that will enhance patient readiness to change.
What is MI?
Motivational Interviewing
in a Nutshell
Motivational interviewing is a client-
centered, guiding communication
style for enhancing a person’s
intrinsic motivation for change.
Motivational Interviewing
Developed by William Miller
(University of New Mexico),
Stephen Rollnick (University of
Wales College of Medicine), and
their colleagues over the past two
decades.
MI Spirit - A key foundation
MI Spirit
• Autonomy
• Honoring and supporting client’s personal responsibility for change
• Collaboration
• Meeting of the client’s and professional’s hopes
• Sharing power and respecting dual expertise
• Evocation
• Drawing out client’s concerns, wishes, hopes, strengths, goals, values, and intention
• Compassion
• Demonstrating genuine concern for the wellbeing of your client
MI Spirit from a long time ago…
Out beyond ideas of wrongdoing and
rightdoing, there is a field.
I’ll meet you there.
Rumi, 13th Century poet
Characteristics of an MI Practitioner
• Able to listen with heart and mind
• Genuinely warm and caring
• Respectful of client autonomy
• Collaborative (doesn’t need to always be in charge or take the expert role)
• Appreciate the complexity of your client’s lives and the difficulty of behavior change
Basketball Perception Test
What are the Four Processes of MI
Four Processes of MI
1. Engaging
2. Focusing
3. Evoking
4. Planning
Engaging
Engaging is laying the relational foundation.
Engaging is that beginning process where
you let them know the agenda and how
things works. If an ongoing session, this
might be where you summarize last work
and check in about the current focus.
You can try adding MI spirit in.
Focusing
Focusing involves steering the course of the
conversation in a strategic – and
collaborative - manner.
Evoking
Evoking is drawing out the client views,
beliefs and values – what is important to
them.
The client’s “change talk” , their words that
express interest in changing, are what you
spotlight in your responses.
Planning
Planning in an MI framework is negotiating
goals and plans that name the necessary
actions and commitment needed.
A Final Note on the Processes
• Using all the principles together defines MI
• Using only one or two of them will not
necessarily be MI
• For the best outcome, work toward using
all of these principles with clients
• It does take practice, but with MI spirit and
intention, you can’t go wrong
Not the MI Way
Group Discussion
1 2 3 4 5 6 7 8 9 10 Not Somewhat Highly
at all motivated motivated
motivated
Group Discussion
How motivated was this patient at the beginning of the session?
How motivated was she at the end?
What happened in between?
What specifically did the health care provider do to increase or decrease motivation?
The MI Way
Group Discussion
1 2 3 4 5 6 7 8 9 10 Not Somewhat Highly
at all motivated motivated
motivated
Group Discussion
How motivated was this patient at the beginning of the session?
How motivated was she at the end?
What happened in between?
What specifically did the health care provider do to increase or decrease motivation?
What is Motivation Anyway?
Motivation Is:
An ever changing state (not trait)
Fundamental to change
Fluctuates in response to the influence of others, especially helping professionals and peers
Strongly influenced by the interpersonal “style” of helping professionals
Stages of Change – a process
Precontem-plation
(start here)
Contemplation
Preparation
Action
Maintenance
Relapse is common
Adapted from DiClemente & Prochaska, 1982
Banksy The Dog
Demonstrates…
The Six Stages of Change
1) Pre-contemplation
Perhaps more exercise would do me good
2) Contemplation
To get ready I went shopping for the right work out gear!
3) Preparation
Let’s play ball – I’m ready to go!!!
4) Action
Look at me – I’m still ready for more!!!
5) Maintenance
6) Relapse
Stages of Change – a process
Precontem-plation
(start here)
Contemplation
Preparation
Action
Maintenance
Relapse is common
Adapted from DiClemente & Prochaska, 1982
Why Don’t People Want To Change?
Ambivalence is a normal
part of the process of change.
Successfully addressing
ambivalence is a crucial MI
skill.
The Two Sides of Ambivalence MI model: A schematic…
Ambivalence
ResistanceChange Talk
Importance Confidence
“Resistance”
“Advantages of Status quo”
“Disadvantages of change”
“Pessimism about change”
“Yes, but…”
“Change Talk”
“Disadvantages of Status quo”
“Advantages of change”
“Optimism about change”
“I want to do something different…”
Change Talk = Importance & Confidence
Resistance & Change Talk
Yellow Toadflax
(Butter 'n Eggs)
(WEEDS! )
Yellow
Daffodils
Two Sides of Ambivalence:
=sustain talk
It is not the professional, but the
client who has to make an
argument for change.
MI for pre-contemplation
Let’s practice
Write out any change talk
Analyze the Situation
• Amy is your client.
• What is her Stage of Change
• What are your goals based on
SOC?
• What small seeds of change talk, if
any, did you hear?
• How might you engage Amy and
elicit change talk?
How Best to Enhance Motivation?
ROLL WITH RESISTANCE:
• Avoid getting stuck in a tug-of-war
• Don’t drive into the ditch
• MI is more like dancing than wrestling
• Reflect, Reflect, Reflect…..
Argument Trap
How Best to Enhance Motivation?
Facilitate Change Talk – DARN-C
Disadvantages of not getting screened for cancer
Advantages of being screened
Reasons for screening
Need to be screened
Commitment to be screened
Four MI Skills
Open ended Questions
Reflective Listening
Affirmations
Summary
Can You Recognize Change Talk?
LET’S TAKE THE
CHANGE TALK QUIZ!
(Next 2 slides attached as worksheets
too, so you can bring to training.)
Change
Talk
Quiz
CHANGE TALK QUIZ
1) I’ve been doing better on my blood sugars but I don’t know what my AIC is. Sometimes I cheat on my diet, so I know it’s not as good as it could be.
2) I don’t need to stop drinking soda. I need to cut down for sure, but I don’t
need to stop.
3) This heart-healthy diet is too hard. I can’t figure out all these different kinds of oils and fats. It’s all grease to me.
4) What about exercise? Well, I used to swim every week and I liked it.
5) Yeah, I know I need to get a pap smear but I’ve got a lot of other more
important things to think about right now.
6) You might be good at helping some people, but not me. I need to help myself.
7) Yeah, yeah, yeah … I know smoking is bad for my health. I feel it
sometimes when I run to catch the bus. I can’t breathe like I used to. But cigarettes can be my best friend sometimes, like when I get in from a hard day. There’s nothing that settles me down like a cigarette.
8) Colonoscopies may detect cancer early but just the thought of getting one
makes me sick. I’d much rather try another test, instead, or just take my chances.
9) If I had a symptom, I’d be screened; but I feel fine. I’m not the kind to go
looking for trouble.
10) I like sweets but I’m not crazy about the weight gain.
Coding
Sheet
Change Talk Observed What Occurred Just Before?
Where is the change talk in these statements? Sometimes it
can be more implied than explicitly stated.
You might use your empathy sills to try on the shoes of the
speaker, to see what occurs to you about their situation, and
if any additional aspects of change talk become clearer.
Optional exploration
Two key MI skills are using Open-ended
questions, and Reflections (reflecting back
what you hear).
Over the next weeks, in casual
conversations say at the work water cooler,
try using these skills instead of the usual
way you might converse.
Make notes of what you notice, if anything.
Additional MI
training and
supervision
just ahead
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