Motivational Interviewing: Steps and Core Skills Learning Objectives
Motivational Interviewing: Steps and Core Skills Learning Objectives At the end of the session, you will be able to: 1. Identify motivational interviewing (MI) basic steps. 2. Identify MI core skills. 3. Demonstrate and practice MI using core skills.
Motivational Interviewing Steps Fours Steps of the MI Process 1. Engage 2. Focus 3. Evoke 4. Plan
Fours Steps of the MI Process Engage Ask permission Express empathy Ask open-ended questions Use affirmations Support autonomy
Fours Steps of the MI Process Focus Agreeing on an agenda Reflecting Summarizing Developing discrepancies Fours Steps of the MI Process
Evoke Motivation Concerns Fours Steps of the MI Process Plan Raise the subject Support self-efficacy Address elements of
change Motivational Interviewing: Core Skills Core MI
Open-ended questions Affirmations Reflections Summaries Open-Ended Questions Using open-ended questions:
Enables the client to convey more information Encourages engagement Opens the door for exploration Open-Ended Questions What are open-ended questions? Gather broad descriptive information Require more of a response than a simple yes/no or fill in the
blank Often start with words such as: How What Tell me about Usually go from general to specific Open-Ended Questions
Why open-ended questions? Avoid the question-answer trap Puts client in a passive role No opportunity for client to explore ambivalence Open-Ended Questions
Why open-ended questions? Opportunity to explore ambivalence Closed-Ended Questions Present Conversational Dead Ends Closed-ended questions typically: Are for gathering very specific information
Tend to solicit yes-or-no answers Convey the impression that the agenda is not focused on the client Exercise Turning a closed-ended question into an open-ended one: Do you feel depressed or anxious?
Exercise Turning a closed-ended question into an open-ended one: How has your mood been recently? Can you tell me how you have been feeling? How have you been feeling emotionally? Affirmations
What is an affirmation? Compliments or statements of appreciation and understanding Praise positive behaviors Support the person as they describe difficult situations Affirmations Why affirm?
Support and promote self-efficacy, prevent discouragement Build rapport Reinforce open exploration (client talk) Caveat Must be done sincerely
Affirmations Examples: Commenting positively on an attribute You are determined to get your health back. A statement of appreciation I appreciate your efforts despite the discomfort youre in. A compliment
Thank you for all your hard work today. Exercise Which of the following are examples of affirmations? Select all that apply. a. I appreciate how hard it must have been for you to decide to come here. You took a big step. b. Ive enjoyed talking with you today and getting to know you a bit.
c. You need to change before something really bad happens. d. You seem to be a very giving person. You are always helping your friends. Exercise Which of the following are examples of affirmations? Select all that apply. a. I appreciate how hard it must have been for you to decide to come here. You took a big step.
b. Ive enjoyed talking with you today and getting to know you a bit. c. You need to change before something really bad happens. d. You seem to be a very giving person. You are always helping your friends. Reflective Listening Reflective listening is one of the hardest skills to learn.
Reflective listening is a way of checking rather than assuming that you know what is meant. (Miller and Rollnick, 2002) Reflective Listening Involves listening and understanding the meaning of what the
client says Accurate empathy is a predictor of behavior change Reflective Listening Reflections are statements, not questions
Be mindful of the intonation of your voice Reflective Listening Why listen reflectively? Demonstrates that you have accurately heard and understood the client
Strengthens the empathic relationship Reflective Listening Why listen reflectively? Encourages further exploration of problems and feelings Avoid the premature-focus trap
Can be used strategically to facilitate change Levels of Reflection Simple Reflectionstays close Repeating Rephrasing (substitutes synonyms)
Example Client: I hear what youre saying about my blood pressure, but I dont think its such a big deal. Clinician: So, at this moment youre not too concerned about your blood pressure. Levels of Reflection Complex Reflectionmakes a guess Paraphrasingmajor restatement, infers meaning, continuing
the paragraph Examples Client: Who are you to be giving me advice? What do you know about drugs? Youve probably never even smoked a joint! Clinician: Its hard to imagine how I could possibly understand. *** Client: I just dont want to take pills. I ought to be able to handle this on
my own. Clinician: You dont want to rely on a drug. It seems to you like a crutch. Levels of Reflection Complex Reflection Reflection of feelingdeepest Example
Client: My wife decided not to come today. She says this is my problem, and I need to solve it or find a new wife. After all these years of drinking around her, now she wants immediate change and doesnt want to help me! Clinician: Her choosing not to attend todays meeting was a big disappointment for you. Double-Sided Reflections A double-sided reflection attempts to reflect back
both sides of the ambivalence the client experiences. Client: But I can't quit smoking. I mean, all my friends smoke! Clinician: You can't imagine how you could not smoke with your friends, and at the same time you're worried about how it's affecting you. Client: Yes. I guess I have mixed feelings. Communication Roadblocks
Examples of non-reflective listening: Ordering, directing, commanding
Warning, cautioning, threatening Giving advice, making suggestions, providing solutions Persuading with logic, arguing, lecturing Telling what to do, preaching Disagreeing, judging, criticizing, blaming Communication Roadblocks
Agreeing, approving, praising Shaming, ridiculing, blaming Interpreting or analyzing
Labeling Reassuring, sympathizing, consoling Questioning, probing Withdrawing, distracting, humoring, changing the subject Summaries Periodically summarize what has occurred in the counseling
session Summary usages Begin a session End a session Transition Summaries Strategic summaryselect what information should be included and what can be minimized or left out
Additional information can also be incorporated into summariesfor example, past conversations, assessment results, collateral reports Summaries Examples So, let me see if Ive got this right So, youre saying is that correct? To make sure Im understanding exactly what youve
been trying to tell me Double-sided reflections are often highly effective as summaries to illustrate ambivalence Whats Next In the next session, you will use: Core skills
Other selected tools Acknowledgements Content in this educational module was provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) under grant to the University of Iowa with permission to adapt and use in training. Grant #1H79TI025939-01
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