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MOTIVATIONAL INTERVIEWING
IDENTIFY BEHAVIOR CHANGES
Open-Ended Questions
Affirmation
Reflection
Summarize
1. Ask about their concerns, share
yours.
7. Evaluate 2. Good things (mixed feelings)/
Outcome Not-So-Good things.
6. Negotiate Plan.
3. Importance /
Confidence Rulers.
5. Menu of Options
The “BIG 5” Traps
1. Playing the Expert. 4. Change in the
2. Arguing the Positive. Hypothetical.
3. Giving Unsolicited Advice.
4. Premature Focus on Change.
5. Asking Too Many Questions.
Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation
and commitment to change.
CRIMINOGENIC NEEDS:
Things to Focus On
1. Family Problems 6. Pro-Social Modeling
2. Vocational Skills and Employment 7. Antisocial Attitudes
3. Anger Management 8. Substance Abuse treatment
4. Self Control 9. Reducing Antisocial contacts
5. Self-Management Skills 10. Relapse prevention
NON- CRIMINOGENIC NEEDS:
They Don’t Predict Recidivism
1. Stress and Anxiety 5. Vague Emotional Problems
2. Self-Esteem 6. Fear of Official Punishment
3. Cohesiveness of Peer Group 7. Physical Activity
4. Discipline 8. Creativity
Matching Approach to Stages of Change
Individuals are either unconvinced that they have a problem or are unwilling to Pre-contemplation Raise Consciousness
consider changes Highlight discrepancy
A person is actively considering the possibility of change; evaluating options Contemplation Tip Balance toward change
but not ready to take action at present. Experiment with change?
Clarify goals, plan
Individuals make a commitment as well as initial plans to change the behavior. Preparation Reduce barriers
Identify people who will help
Once people take effective action to make the change, they are considered to Engage in plan
be in the action stage. In action a person adopts strategies to prevent a Action Reinforce change
relapse and a return to the problem behavior.
The individual consolidates the changes and integrates it into his or her Maintenance Support changes
lifestyle. Relapse prevention
SIGNS OF RESISTANCE COMMONALITIES OF EFFECTIVE BRIEF INTERVENTIONS
Feedback or information about alcohol/drug Menu of options for what the client would like to
Negating –– Blaming, disagreeing, minimizing, assessments, tests results, etc. talk about or would address the problem.
pessimism, reluctance
Arguing –– Challenging, discounting Responsibility for change left with the client. Empathy is critical in brief approaches. In the
Body Language –– Looking around, checking Ambivalence about change is normal. absence of empathy, change rarely occurs.
watch, answering cell phone
Verbal Avoidance –– Interrupting, changing Advice, clear and well timed, especially if solicited Self-Efficacy supported and promoted. An
the subject by the client and not pushed by the agent. Direct individual’s belief in ability determines whether
Ignoring, Withdrawal persuasion rarely produces change. Ask or not they will attempt to change.
permission first.
Phases of MI Develop Discrepancy: “Look for the Hooks” Good / Not-So-Good Things
What are some of the What are some of the Not-
Engaging Ask about their concerns or share your own. Good things about ….? So-Good things about …..?
Focusing Provide non-judgmental feedback or
Evoking information. Social interactions…. Hangovers……...
Planning Watch for signs of discomfort with the status Fit in with friends..... Cost money……..
quo, or interest or ability to change. Helps me relax…… Girlfriend nags….
Use reflection, questions, and summaries to Quenches thirst …. Legal problems…
draw out positive talk.
Explore Change in the Abstract Importance / Confidence Rulers – On a scale of 1 to 10 …
Conditional Statement Plan of Action How important is it for you to make a change in How confident are you that you could change if
your….. ? you wanted to?
If you wanted to ……... How would you do it?
1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10
If you decided you How would you go “Not Important” “Very Important” “Not Confident” “Very Confident”
wanted to ……… about it?
a. What makes it that important? a. What makes you that confident?
If the time were right… What would you do? b. Why are you at a ?? and not a 1? b. Why are you at a ?? and not a 1?
c. What else? … What else?... c. What would it take to raise your score to a ?? ?
d. How can I help you get there?
Motivational Interviewing - Condensed Training Notes
An Overall Person-Centered Approach
o Collaborative: Working in partnership and consultation; negotiating
o Evocative: Listening more than telling; eliciting rather than installing
o Respectful: Honoring the person’s autonomy, resourcefulness, ability to
choose
Ambivalence
o “Lack of motivation” is often ambivalence: Both sides already within the
person
o If you argue for one side, an ambivalent person is likely to defend the other
o As a person defends the status quo, the likelihood of change decreases
o Resist the “righting reflex” - to take up the “good” side of the ambivalence
Four Basic Micro-skills: OARS
o Ask OPEN questions - avoid short-answer, yes/no, or rhetorical questions
o AFFIRM the person - comment positively on strengths, effort, intention
o REFLECT what the person says - “active listening”
o SUMMARIZE - draw together the person’s own perspectives on change
Reflective Listening: A Valuable Skill in Itself
o A reflection tries to summarize what the person means; it makes a guess
o A reflection is a statement, not a question
o Levels of reflection
Repeat/Rephrase - Saying the same thing in similar words
Paraphrase - Making a guess about meaning; continuing the
paragraph; inferring some additional meaning that was not said directly
Double-sided reflection - Captures both sides of ambivalence (On the
one hand…on the other hand)
Amplified reflection - Overstates what the person says
Responding to Resistance
o Remember that “resistance” is just the other side of the ambivalence
o Don’t argue against it; pushing against resistance entrenches it
o Some responses that tend to defuse resistance
Reflection - Acknowledge resistance by reflecting the gist back
Amplified reflection - Overstating it a bit
Double-sided reflection - On the one hand . . . . and on the other . . . .
Emphasize the person’s ability to choose, control, autonomy
Ask about action – What would you like to do?
Change Talk
o Talk in a way that invites the person to make the arguments for change, and
reduces resistance toward change
o Common types of change talk (DARN)
Desire - want, prefer, wish, etc.
Ability - able, can, could, possible
1
Reasons - specific arguments for change - Why do it? What would be
good?
Need - important, have to, need to, matter, got to
Commitment language – What will the person actually do?
o People most often imbed change talk in other kinds of talk, so the skill is to
identify and respond to the DARN elements, while leaving the rest.
Eliciting Change Talk
o The simplest way: Ask for it. Use open, forward focused questions to elicit
desire, ability, reasons, need
In what ways would it be good for you to . . . .?
If you did decide to . . . ., how would you do it?
What would be the good things about . . . .?
Why would you want to . . . .?
o Decisional balance:
What are the good things about . . . And what are the not so good
things?
o Importance and Confidence rulers:
On a scale from 1 to 10, how important is it for you to . . . . .
Why are you at ____ and not one? (The answer is change talk)
On a scale from 1 to 10, how confident are you that you could . . . . .
Why are you at ____ and not one? (The answer is ability talk)
o Looking forward:
If you don’t make any change, what do you think will happen?
Where would you like to be in ___ years? What do you hope will be
different?
And how does _[smoking]_ fit into that?
Responding to Change Talk
o When you hear change talk, don’t just sit there! Use your EARS:
ASK FOR (E)LABORATION: When was the last time; in what ways,
What else? What other reasons?
AFFIRM - reinforce, encourage, support it
REFLECT it back to the person, infer meaning, add to what has been
said
SUMMARIZE
Giving Advice
o The person is more likely to hear and heed your advice if you have
permission to give it
o Three forms of permission:
1. The patient offers it (e.g., asks for advice)
2. You ask permission to give it
There’s something that worries me here. Would it be all right if I . . .
Would you like to know . . .
Do you want to know what I would so, if I were in your situation?
I could tell you some things other patients have done that worked. .
3. You preface your advice with permission to disagree/disregard
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