Motivational Interviewing: Steps and Core Skills Learning Objectives

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

Acknowledgements

Recently Viewed Presentations

  • Region 5 Recovery Efforts for the Bog Turtle

    Region 5 Recovery Efforts for the Bog Turtle

    Results are positive for BT detection = - Avoid all wetland impacts OR - Formal consultation or HCP necessary Use when Phase 2 surveys fail to detect BT in: Large wetland complexes Areas of dense vegetation and/or Low density Must...
  • CS295: Modern Systems: Application Case Study Neural Network

    CS295: Modern Systems: Application Case Study Neural Network

    Cache invalidation/work assignment… how? Computation is very regular and predictable. Processing Element. Register file. A class of accelerators deal only with problems that fit entirely in on-chip memory. This distinction is important.
  • Basic Macro Relationships Income, Consumption & Savings  Income

    Basic Macro Relationships Income, Consumption & Savings Income

    MPC + MPS = 1. APS Around the Globe. Consumption Schedule andSavings Schedule. The relationship between disposable income and consumption as well as disposable income and savings (or dissavings) can also been seen via Consumption and Savings Schedules.
  • Conditioned Inhibition - FACULTY

    Conditioned Inhibition - FACULTY

    Conditioned Inhibition Conditioned inhibition is an internal state that prevents an organism from making some response, like salivation. As an intervening variable, it must be operationally defined. To say that that an organism has acquired a conditioned inhibitory response, two...
  • The Hajj Muslim Pilgrimage to Mecca A What

    The Hajj Muslim Pilgrimage to Mecca A What

    The Hajj Muslim Pilgrimage to Mecca A special journey to special holy places. The Hajj is a pilgrimage that Muslims make. They make the trip once in their lifetime as it is one of the five pillars. What is the...
  • The Biologic Basis of Migraine

    The Biologic Basis of Migraine

    Migraine Attack Begins With Activation of the Hypothalamus and Functional Coupling Between Hypothalamus and Trigeminal Nucleus . Aura Phase Involves a Cortical Spreading Depolarization (Depression) and Secondary Blood Flow Changes.
  • Formas de energía alternativas - vecinadelpicasso

    Formas de energía alternativas - vecinadelpicasso

    Medgaz es un gaseoducto submarino que está proyectado entre Argelia y España. En Almería se conectará con el existente gaseoducto Almería-Albacete. El gas fluye desde el 2011. El gasoducto tiene una longitud de 210 km y cuenta con una capacidad...
  • Symbolism Symmetry Operation Schnflies Notation International Notation Proper

    Symbolism Symmetry Operation Schnflies Notation International Notation Proper

    Symbolism. In Schönflies notation, what does the symbol S 2 mean?. In International notation, what does the symbol mean? (x,y,z)