MOTIVATIONAL

INTERVIEWING

This PPT was compiled by Bhavani Harikrishnan Rollnick & Miller 2013
Bhavani Harikrishnan

B.Sc. Computer Sc., Web content writer, Needlework tutor, P.G. Dip in Guidance and
Counseling, (P.G. Dip in Child & Adolescent counseling), M.Sc. Clinical Psychology,
Certification in Past Life Regression Therapy, Parenting Coach, Career Coach,
Addiction Management Therapist (Accreditation NIMHANS)

Phone:94878 64894 email:connect2choice@gmail.com website: auriel.in

 VOICE THAT CARES

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 Key Concepts
• Within the client’s personal experiences lies the potential for change
• To strengthen the client’s motivation to change.
• Enhance it in an atmosphere of therapeutic acceptance, collaboration and
compassion.
MI Spirit
 Four Processes
• Engaging: Connecting and establishing a therapeutic relationship
• Focusing: Choosing a direction for Motivational enhancement
• Evoking: Eliciting the client’s own motivations and commitment to change.
• Planning: Formulating a specific change plan.
 Engaging
• To build a strong therapeutic alliance between therapists and their client.
• To make them feel heard, cared for and supported.
 Engagement: Traps that Promote
Disengagement -1
Traps that lead to defensiveness and passive stance.
• Assessment: Asking too many questions
• Expert: I have all the answers, I know how to help you get out of your
problem with addiction.
• Blaming: “Are you aware of how much your family is suffering because of
your addiction?”
 Traps that Promote Disengagement -2
• Premature Focus: Focusing on the issue before a therapeutic relationship
has been established can lead to power struggle and discord.
• Labeling: Emphasizing a diagnostic label (e.g. schizophrenic, he’s in denial)
can come across as insensitive and judgmental.
• Getting Chatty: Can lead to insufficient direction and dissatisfaction with
treatment.
 Engaging with OARS
• O- Open ended questions
• A – Affirmations
• R – Reflective listening
• S – Summary statements
 Engaging: Open-ended Questions
• What brings you here today?
• What are your thoughts about what your wife just said?
• How can I help you?
• What would be the benefits of cutting back on your alcohol use?
 Engaging: Purpose of Open-ended Questions
• You get answers other than yes, no, or other very specific information
• Encourages clients to talk about what is important to them
 Engaging: Affirmations
• Recognition of Effort: You are working hard on understanding your
motivations.
• Appreciation of Strengths: You seem to have a good sense of what your
substance use has cost you in your life.
• Positive Reframes: Your willing to let me know exactly where you stand on
the issue is helpful to me in understanding the situation
 Engaging: Purpose of Affirmations
They highlight the client’s positive qualities or characteristics important for
change.
• Affirmations help create a less tense atmosphere.
• Affirmations arrived at directly from the conversation have relevance and the
client will experience the affirmation as sincere and genuine.
 Engaging: Reflective Listening
• Simple Reflections
• Complex Reflections
 Engaging: Simple - Reflective Listening
• Client: I like to drink, but I really like to slow down.
• Therapist: You are thinking of slowing down
OR
• You are considering making a change
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Selective reflection to elicit additional client change talk
 Engaging: Complex – Reflective Listening - I

• Client: I’ve tried everything and nothing seems to be working, so I don’t

know what to do.
• Therapist: Even though you are struggling, you are committed to making a
change.
 Engaging: Complex Reflection Listening - II

• Client: I am so sick and tired of people always telling me what to do. I mean, really,
it’s my life and they should mind their own business.
• Therapist: You are an independent-minded person, and you want others to respect
your feelings
OR
• You are aggravated by the unsolicited advice.
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Roll with resistance
 Engaging: Reflective Listening
Simple Reflections:
• No new meaning is added
• The therapist sometimes choses to selectively respond only to the portion of the
client verbalization that is focused on the potential to change
Complex Reflections:
• Identify a deeper understanding of the client’s experience.
• The therapist reflects the inferred meaning or the unstated emotional aspect of it.
Engaging: Purpose of Reflective Listening
• Encourage more discussion
• Attempts to elicit more change talk to enhance motivation to change
 Engaging:
Open-ended Questions Vs. Reflections
• Open-ended questions tend to focus on the direction of the exploration
• Reflections especially complex reflections give the client more leeway to
respond the way they feel comfortable responding.
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To gain most out of sessions, it is a good practice to use more reflections than
questions.. Weave reflective statements between questions to show empathy
while directing conversation.
 Engaging: Summary
• Collecting summary
• Linking summary
• Transitioning summary
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Summary is a special form of reflection that brings together what the client
said at different points in time.
 Engaging: Collecting Summary
• Therapist: So far, you have expressed concern about how your drug use has
negatively impacted your family, work and health.
 Engaging: Linking Summary
• Therapist: …That sounds a bit like what you told me during our last session
about how lonely you feel. Today, you are saying that maybe you should start
inviting people over. Looks like you want to start taking charge of your life.
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The therapist captures various elements of the client’s ambivalence by connecting
something just said, to something that was said in an earlier session.
 Engaging: Transitioning Summary
• Let me summarize what you have told me so far. You mentioned about your
problems at work and how it led to drinking…. You also mentioned
marijuana. Tell me more about that.
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This serves to wrap up a topic before moving on to the next.
 Engaging: Summary of OARS
• It is a good practice to use more reflections than open-ended questions.
• Open-ended questions is about the direction of the exploration.
• Reflections give the client more freedom on how to respond
• Affirmations foster the client’s belief that change is possible.
• Summarizing like other forms of reflections gives the client an the
opportunity to set right any misinterpretations of what they say.
 Focusing
Multiple areas of concern
• Health
• Work
• Finances
• Friends
• Substance use
• Relationship with family members
 Focusing – Agenda Mapping
• Prioritize collaboratively
• Emphasize client autonomy on what they want to work on
• Work together to create sessions plan based on their priorities
• At the start of each session, refer back to the agenda to ensure that you are
both on the same page.
• Priorities may shift with time. Be open to that.
 Evoking to Elicit Change Talk
• Recognizing change talk vs sustain talk
• Evocative questions
• Reflections
• Importance and confidence ruler
• Decisional Balance
• Exchanging information – elicit-inform-elicit
• Exploring goals and values – discrepancy with current behavior
• Looking backward and forward
• Querying extremes-worst thing/continue- best thing/stop
 Evoking Change/Sustain Talk
• Change talk: If I stop drinking, I may get my job back.
• Sustain talk: I think my wife is exaggerating on how big my problem with
drinking is. How can my drinking contribute to her health, poor work
performance and family life?
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Roll with the Resistance:
Your are really struggling with figuring this out.
Evoking: Importance/Confidence Ruler
 Evoking: Ruler Questions
• Why are you a 5 and not a 2?
• Why are you 5 and not an eight?
• What would it take for you to move from 5-8?
Evoking-Decisional Balance
 Planning
• This step follows eliciting a commitment to change.
• Clear identification of targeted behavior change
• The reasons why the client wants to make these changes
• The specific steps that need to take place
• Who can be their support in making and sustaining the change
• What can get in the way of the plan and how to address it.
• What will the client do if the plan does not work?
MI Spirit
 Takeaways
• Engage, focus, evoke, plan
• Resist the righting reflex - DARES
- Develop discrepancy – values and goals vs. current scenario
- Affirmations
- Roll with resistance
- Express Empathy
- Support Self-efficacy
• MI spirit – PACE (partnership, Acceptance, compassion, evocation)
 Applications of MI
• Health care setting
• Addiction counselling
• Weight management
• Mental health treatment
 VOICE THAT CARES

Whether you want to volunteer with us

Or

Seek help
--------------------------------------------------------------------------------------------------

E- mail us at: vtc@rocf.org or Call us at: 8448 8448 45

Thank you
Any Questions?