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A TASTE OF MOTIVATIONAL INTERVIEWING

Alan Lyme, LISW, MAC

MINT

Training Director, Phoenix Center, Greenville SC

Goals

Present a brief overview of Motivational Interviewing

Look at the intersection of MI within the EMPath “Coaching for Economic Mobility Model”

A Taste of MI 2016 2

A taste of MI

Motivational Interviewing is

making KNOWN what You KNOW


Compassionate Conversation


6 A Taste of MI 2016

What most people really need is a good listening to. ~Mary Lou Casey


LISTEN! LISTEN! LISTEN!


Motivational interviewing is a

person-centered, evidence-

based, goal-oriented method

for enhancing intrinsic

motivation to change by

exploring and resolving

ambivalence with the

individual.

Motivational Interviewing 3rd Ed.

Miller and Rollnick, (2012)

10 MI for PC 2015

Motivational Interviewing

Collaboration

Acceptance

Evocation

Compassion MI

Spirit

MI literature

1991, 2002, 2013 Motivational

Interviewing: Helping People Change. Miller & Rollnick


2011 Motivational Interviewing in Social Work Practice. Melinda Hohman

Four Fundamental Processes of MI

Engaging

Focusing

Evoking

Planning


The processes are somewhat linear……

Engaging necessarily comes first

Focusing (identifying a change goal) is a prerequisite for Evoking

Planning is logically a later step

Engage - Shall we walk together?

Focus - Where?

Evoke - Why?

Plan - How?


How Coaching for Economic Mobility fits with the Four Fundamental Processes of MI

Engaging - Engaging the Participant in Self Assessment

and Developing the Capacity to Aspire

Focusing - Motivation and Allowing the

Participant to Develop Her Own Goals

Evoking - Strategizing and

Creating Momentum

Planning - Providing Expertise


ENGAGING: Open the Conversation

• Explain role • State appointment length • Ask permission

EVOKING: Build Motivation •Ask evocative questions

•Encourage elaboration

•Looking back/Looking forward

•Explore/Amplify ambivalence

•Explore goals and values

•Assess importance/confidence

FOCUSING: Negotiate the Agenda

PLANNING: Strengthening Commitment •Brainstorm ideas and opinions

•Negotiate a plan

•Explore barriers

•Identify support

•Elicit final commitment

Close the Encounter: •Summarize the session

•Show appreciation

•Support self-efficacy

•Arrange follow-up as

appropriate

•Link with available resources

Support the Transition: •Recognizing readiness

•Summarizing the big picture

•Ask about next steps

Provide Clinical Feedback •Use visual support materials

•Be clear, succinct, and non-

judgmental

•Compare to norms and

standards

•Elicit Participant's

interpretation

Elicit -

Provide -

Elicit • Education

• Advice

• Feedback

• Skills

• Referral

Clinical

Roadmap

Motivational Interviewing

Assumes motivation is fluid and can be influenced

Motivation influenced in the context of a relationship – developed in the context of a participant encounter

Principle tasks – to work with ambivalence and resistance

Goal – to influence change in the direction of health


AMBIVALENCE

IS....


Motivational Interviewing UNDERLYING ASSUMPTIONS

Acceptance/Potential for Growth

Autonomy/Choice

Less is better

Elicit versus Impart

Michelangelo Belief

Ambivalence is normal

Care-frontation

Unconditional positive regard

Change talk

Righting reflex


Fundamental Belief

• The capacity and potential for

change and adherence is within

every person!

20 MI Core Skills 2015

O – Open questions

A – Affirmations

R – Reflections

S – Summaries

A Taste of MI 2016

Closed Questions sound like…

“Do you…Are you… Did you… Could you…Have you…?”

“Did you get a job yet?” “Do you care about finishing

your studies?” “Did you think before you did

that?” “Do you have a drinking

problem?”

Open-Ended Questions sound like…

“What…. Which…. Where… How… Tell me…”

“How does it feel to be back at work?”

“Where do you think your biggest challenge lies?”

“What do you think you’ll take care of first?”

“Tell me about your relationship with your boss/partner/daughter”

23

Affirmations…

• Affirmations are sincere, specific and immediate.

• Affirmations are not cheerleading.

Affirmations

Emphasize a strength

Notice and appreciate a positive action

Should be genuine

Build feelings of empowerment

Instill hope and “can-do” attitude

Express positive regard and caring

Strengthen the coaching relationship


Reflections

How to Form a Reflection

1. You can reflect the

participant’s…

• speech,

• facial expressions,

• behavior

2. Make a guess about the

deeper meaning (therapeutic

hunch)

How to Form a Reflection (cont.)

3. Capture only the key elements

GOAL: One reflection to each question

4. Make a statement rather than a

question

“You feel…because…”

29

A hypothesis (guess) about speaker’s meaning

A statement to convey understanding

Intonation down

Short stems

– “So…”

– “Sounds like…”

– “So you…”

– “Seems like …”

– “Its like…”

– “You feel…”

The summary is like a bouquet of flowers that we give to the

client.

A Taste of MI 2016

31

Set up Bookend:

“Let me see if I have this right…”

“Let me summarize what you’ve said…”

Reflection, Reflection, Reflection

Follow up Bookend:

“So where does that leave you?

“What else would you like to add?”

“Now, tell me about ….”

“Tell me more about…”

32

Give the message that the participant is being heard

Allow the participant to add important information

Shift the direction of the interview

Facilitate and guide

Reflect ambivalence

Accentuate “change talk”

Tuning into Change Talk


Change and Sustain Talk


Change talk is like gold!

• As Participants speak about change, they begin to see the possibilities

• No pressure or persuasion is needed


Types of Change Talk:

• Desire I want to…. I’d really like to… I wish…

• Ability I would… I can…. I am able to... I could…

• Reason There are good reasons to…

This is important….

• Need I really need to…

• Commitment I intend to… I will… I plan to…

• Activation I’m ready… I’m able

• Taking Steps I completed my class assignment on time

A Taste of MI 2016

DARN CATs

A Taste of MI 2016

(Pre-) Action Preparation Contemplation

Yet another metaphor:

MI Hill

Thanks to Bill Miller A Taste of MI 2016

Evoking Change Talk: Desire, Ability, Reason, Need, Commitment

1. Why have you been thinking about changing your ------? (Reveals desire)

2. If you were to change your --------, how would you do it? (Evokes ability)

3. What are your three most important reasons for wanting to change? (Evokes reasons)

4. How would things be different (better) if you decided to change? ( Reveals the need)

5. What is the next step? On a scale of 1-10 , how willing are you to change. (Encourages commitment)

6. Summarize


What is Resistance? CHANGE TALK SUSTAIN TALK

DISCORD

A Taste of MI 2016

Sustain Talk and Discord

Sustain Talk is about the target behavior

I really don’t want to quit smoking

I need my pills to make it through the day

Discord is about your relationship

You can’t make me quit

You don’t understand how hard it is for me

Both are highly responsive to mentor style

A Taste of MI 2016

Change-talk Eliciting Strategies

Decisional Balance

Ambivalence is a normal part of the change process

Use ambivalence to promote positive change

Weigh pros and cons of behavior

Increase discrepancy


Importance/Confidence/Readiness Rulers

0 1 2 3 4 5 6 7 8 9 10


Negotiate a plan of action

• Invite active participation by the Client

• Participant determines goals & priorities

• Participant weighs options

• Together, work out details of the plan


Giving Information and Advice: 3 Kinds of Permission

1. The participant asks for advice

2. You ask permission to give advice

3. You qualify your advice to emphasize autonomy

45 45 MI Core Skills 2015

Finalizing the motivational interview

Review the commitment

Review the plan

Set up a new time to meet/follow up

Express encouragement


ENGAGING: Open the Conversation

• Explain role • State appointment length • Ask permission

EVOKING: Build Motivation •Ask evocative questions

•Encourage elaboration

•Looking back/Looking forward

•Explore/Amplify ambivalence

•Explore goals and values

•Assess importance/confidence

FOCUSING: Negotiate the Agenda

PLANNING: Strengthening Commitment •Brainstorm ideas and opinions

•Negotiate a plan

•Explore barriers

•Identify support

•Elicit final commitment

Close the Encounter: •Summarize the session

•Show appreciation

•Support self-efficacy

•Arrange follow-up as

appropriate

•Link with available resources

Support the Transition: •Recognizing readiness

•Summarizing the big picture

•Ask about next steps

Provide Clinical Feedback •Use visual support materials

•Be clear, succinct, and non-

judgmental

•Compare to norms and

standards

•Elicit Participant's

interpretation

Elicit -

Provide -

Elicit • Education

• Advice

• Feedback

• Skills

• Referral

Clinical

Roadmap

Some EMPath Qualities of a Good Coach

Being Present

Curiosity

Positivity

Honesty

Desire to Learn and Openness to Being Coached

Sense of Humor


The MI Shift

From feeling responsible for changing participants’ behavior to supporting them in thinking & talking about their own reasons and means for behavior change.


Source: National Training Laboratory Institute (Alexandria, VA)

Post-Training Knowledge Retention Levels

By Training and Follow-Up Strategy

Training 1-on-1 w/ Feedback & Coaching 90%

75%

50%

30%

20%

10%

5%

Skills Practice

Group Discussion

Demonstration Only

Audio/Visual Presentation

Reading Only

Lecture

Training 1-on-1 w/

Feedback and Coaching

Skills Practice

Group Discussion

Demonstration Only

Audio/Visual

Presentation

Reading Only

Lecture

Post Training Knowledge Retention Levels by Training and Follow-Up Strategy

Phoenix Center is following Implementation Science

Agencies are used to the “Train and Pray” model for learning new skills

Little to no incorporation of new skills into job duties

Building Skills –

Initial live training series

Incorporation of skills into job duties

Coding of recorded conversations

Coaching to competency

Communities of Practice (CoP)

Thank you!

Alan Lyme

[email protected]

864 467-2797


mailto:[email protected]

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