MOTIVATIONAL INTERVIEWING
IDENTIFY BEHAVIOR CHANGES
Open-Ended Questions
Affirmation
Reflection
Summarize
1. Ask about their concerns, share
yours.
7. Evaluate
Outcome 2. Good things (mixed feelings)/
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 Raise Consciousness
consider changes Pre-contemplation Highlight discrepancy
A person is actively considering the possibility of change; evaluating options Tip Balance toward change
but not ready to take action at present. Contemplation 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 Support changes
lifestyle. Maintenance 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
Ambivalence about change is normal. absence of empathy, change rarely occurs.
Body Language –– Looking around, checking
watch, answering cell phone
Verbal Avoidance –– Interrupting, changing
Advice, clear and well timed, especially if solicited Self-Efficacy supported and promoted. An
by the client and not pushed by the agent. Direct individual’s belief in ability determines whether
the subject
persuasion rarely produces change. Ask or not they will attempt to change.
Ignoring, Withdrawal 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……...
Watch for signs of discomfort with the status Fit in with friends..... Cost money……..
Planning Girlfriend nags….
quo, or interest or ability to change. Helps me relax……
Use reflection, questions, and summaries to Legal problems…
Quenches thirst ….
draw out positive talk.
Explore Change in the Abstract Importance / Confidence Rulers – On a scale of 1 to 10 …
How important is it for you to make a change in How confident are you that you could change if
Conditional Statement Plan of Action
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
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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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This may or may not be important to you . . .
I don’t know if this will make sense to you . . .
You may not agree . . .
Tell me what you think of this . . .
o It’s often better to offer several options, rather than suggesting only one, and
ask the person to choose
Strengthening Commitment
o Change talk (desire, ability, reasons, need) increases commitment;
Commitment language signals behavior change
High-strength commitment language (I will; I’m going to; I promise; I’ll
do my best)
Encourage even low-strength commitment language (I’ll think about it; I
might; I’ll try; I could)
Certain language signals desire, but low confidence/ability (I’ll try; I
wish I could; I would if I could; I’ve tried)
Sources
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.).
New York: Guilford Press.
Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational interviewing in healthcare. New York:
Guilford Press.
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Very Useful Questions
What concerns do you (does your wife, girlfriend, etc.) have?
How has…caused trouble for you?
What are some good things about…? What are some not-so-good things about…?
How would things be better for you if you made that change?
What thoughts have you had about change?
What do you think will happen if you don't…?
If there were no more drugs or alcohol in the world, what do you think would replace how
drugs make you feel?
If you look forward to, say, a year from now, how would you want your life to be
different?
How do you want things to end up when you’re done with probation? Where do you
want to be?
How would that pay off for you, if you went ahead and made this change?
In what situations is it hardest for you to stay sober?
There are a few things that might work for you (provide a short list). Which of these
would you like to try?
Here are some things that we need to talk about (provide a short list). Which of these
would you like to talk about first?
On a scale of 1-10, how important is it for you to make a change in your…?
On a scale of 1-10, how confident are you that you could change if you wanted to?
If you wanted to change, how would you go about it?
Who would (or will) help you to…?
What worked for you in the past?
What would you like to work on first?
When would be a good time to start?
How could (or will) you do that?
How can you make that happen?
What can I do to help you succeed at…?
What else?
Very Useful Statements
Thanks for coming in on time.
It feels to you that people might be blowing this out of proportion.
You don’t feel like I can understand where you’re coming from.
At this point, it doesn’t seem that big a deal to you.
Drinking has some positive aspects for you.
It’s frustrating. (You’re frustrated with having to be here.)
It’s difficult. (I know this must be difficult for you.)
It’s hard for you. (It might be hard for you.)
I can see why you might think that.
So the thing that most concerns you is…
You want to do the right thing.
That’s a good idea.
I think you could do it if you really wanted to.
I think that will work for you.
Thanks for talking with me.
I appreciate your honesty.
(Restatement of anything that indicates concerns about present behavior or interest in
change.)
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Abbreviated MI Observation Sheet
Behavior Counts
Reflections Complex
Simple
Questions Open
Closed
Information/Advice
MI Style
Evocation Low: Provider provides reasons for change, relies on 1 2 3 4 5
information/education, little interest in client’s ideas.
High: Provider actively works to evoke client’s reasons and low high
ideas around change.
Collaboration Low: Provider assumes role of expert for the majority of the 1 2 3 4 5
session.
High: Provider encourages power sharing so that client’s ideas low high
influence the direction of the interaction.
Autonomy Low: Provider de-emphasizes, downplays client’s perception of 1 2 3 4 5
control, or relies on authoritative arguments.
High: Provider actively emphasizes client’s own personal low high
control and choice in deciding outcome.
Empathy Low: Provider has little interest in the client’s perspective. 1 2 3 4 5
High: Provider shows a deep understanding of the client’s
perspective, not just what has been explicitly stated, but what low high
the client means and how he/she feels.
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Amy Winehouse – “Rehab”
They tried to make me go to rehab but I said 'no, no, no'
Yes I've been black but when I come back you'll know know know
I ain't got the time and if my daddy thinks I'm fine
He's tried to make me go to rehab but I won't go go go
I'd rather be at home with Ray
I ain't got seventy days
Cause there's nothing
There's nothing you can teach me
That I can't learn from Mr Hathaway
I didn't get a lot in class
But I know it don't come in a shot glass
They tried to make me go to rehab but I said 'no, no, no'
Yes I've been black but when I come back you'll know know know
I ain't got the time and if my daddy thinks I'm fine
He's tried to make me go to rehab but I won't go go go
The man said 'why do you think you here'
I said 'I got no idea
I'm gonna, I'm gonna lose my baby
so I always keep a bottle near'
He said 'I just think you're depressed,
kiss me, yeah baby, and go rest'
They tried to make me go to rehab but I said 'no, no, no'
Yes I've been black but when I come back you'll know know know
I don't ever wanna drink again
I just ooh I just need a friend
I'm not gonna spend ten weeks
have everyone think I'm on the mend
It's not just my pride
It's just 'til these tears have dried
They tried to make me go to rehab but I said 'no, no, no'
Yes I've been black but when I come back you'll know know know
I ain't got the time and if my daddy thinks I'm fine
He's tried to make me go to rehab but I won't go go go
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Source: Miller, W. R., C’deBaca, J., & Matthews, D. B. (1994). Values Card Sort. Unpublished manuscript:
University of New Mexico.
ACCEPTANCE DUTY
to be accepted as I am to carry out my duties and responsibilities
ACCURACY ECOLOGY
to be correct in my opinions and actions to live in harmony with and protect the environment
ACHIEVEMENT FAME
to accomplish and achieve to be known and recognized
ADVENTURE FAMILY
to have new and exciting experiences to have a happy, loving family
ATTRACTIVENESS FLEXIBILITY
to be physically attractive to adjust to new or unusual situations easily
AUTHORITY FORGIVENESS
to be in charge of others to be forgiving of others
AUTONOMY FRIENDS
to be self-determining and independent to have close, supportive friends
BEAUTY FUN
to appreciate beauty around me to play and have fun
CARING GENEROSITY
to take care of others to give what I have to others
COMFORT GENUINENESS
to have a pleasant, enjoyable life to behave in a manner that is true to who I am
COMMITMENT GOD'S WILL
to make a long-lasting and deep commitment to to seek and obey the will of God
another person
GROWTH
COMPASSION to keep changing and growing
to feel and show concern for others
HEALTH
COMPLEXITY to be physically well and healthy
to have a life full of variety and change
HELPFULNESS
CONTRIBUTION to be helpful to others
to make a contribution that will last
after I am gone HONESTY
to be truthful and genuine
COURTESY
to be polite and considerate to others HUMILITY
to be modest and unassuming
CREATIVITY
to have new and original ideas HUMOR
to see the humorous side of myself and the world
DEPENDABILITY
to be reliable and trustworthy
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INDEPENDENCE REALISM
to be free from depending on others to see and act realistically and practically
INDUSTRY RESPONSIBILITY
to work hard and well at my life tasks to make and carry out important decisions
INNER PEACE RISK
to experience personal peace to take risks and chances
INTIMACY ROMANCE
to share my innermost experience with others to have intense, exciting love in my life
JUSTICE SAFETY
to promote equal and fair treatment for all to be safe and secure
KNOWLEDGE SELF-ACCEPTANCE
to learn and possess valuable knowledge to like myself as I am
LEISURE SELF-CONTROL
to take time to relax and enjoy to be self-disciplined and govern my own activities
LOGIC SELF-ESTEEM
to live rationally and sensibly to feel positive about myself
LOVED SELF-KNOWLEDGE
to be loved by those close to me to have a deep, honest understanding of myself
LOVING SERVICE
to give love to others to be of service to others
MASTERY SEXUALITY
to be competent in my everyday activities to have an active and satisfying sex life
MODERATION SIMPLICITY
to avoid excesses and find a middle ground to live life simply, with minimal needs
MONOGAMY SPIRITUALITY
to have one close, loving relationship to grow spiritually
ORDERLINESS STABILITY
to have a life that is well-ordered and organized to have a life that stays fairly consistent
PLEASURE STRENGTH
to have experiences that feel good to be physically strong
POPULARITY TOLERANCE
to be well-liked by many people to accept and respect those different from me
POWER VIRTUE
to have control over others to live a morally pure and excellent life
PURPOSE WEALTH
to have meaning and direction in my life to have plenty of money