Motivational Interviewing - Addiction Management

Motivational Interviewing
Preparing
People for
Change
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You would think…
You would think after two heart attacks she
would stop smoking, exercise, take meds…
You would think after numerous blackouts,
hangovers, and killing someone while drinking
and driving, he would quit the booze…
You would think after taking a chainsaw to his
face he would stop using drugs…
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So…why do people change?
People change naturally
Formal treatment mirrors natural change
Change influenced by interpersonal factors
In therapy, change happens early in the process
Therapist makes a difference
Empathetic style facilitates change
Level of motivation predicts change
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Motivation - Defined
Ready: : A matter of priorities
Willing: : The importance of change
Able: : Confidence for change
When changing a behavior is of high importance,
and a person feels confident in their ability to
change, and changing is prioritized as needing
to happen now – a person is MOTIVATED!
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“Constructive behavior change seems to
arise when the person connects it with
something of intrinsic value, something
important, something cherished. Intrinsic
motivation for change arises in an accepting,
empowering atmosphere that makes it safe
for the person to explore the possibly
painful present in relation to what is wanted
and valued.”
MI 2 nd Ed. (p. 12)
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What is the goal of MI?
To get people to resolve
their ambivalence (i.e.
conflict) about changing
their behavior, while not
evoking resistance (e.g.
get confrontational,
blame, label).
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What is Motivational Interviewing?
A directive, client-centered centered counseling style
Elicits behavior change by helping clients
explore and resolve ambivalence
Helps resolve ambivalence by increasing
discrepancy between current behavior and
desired goals while minimizing resistance
It is a way of being with a person more than a
toolbox of techniques
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MI helps clients change by…
Recognizing their high risk behaviors
Evaluating how much of problem their behavior
is for them relative to the rest of their life
Looking at ways to begin the process of change
Resolving ambivalence
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The “Righting Reflex”
Built in desire to help people set things right
We are drawn to the field to help others
Ms. Righting Reflux meets Mr. Ambivalence
Mr. A talks about the problem and Ms. R
provides advice, counsel, and direction
What happens next……
……?
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The Spirit of MI
Collaboration: : counselor tone emphasizes
partnership that respects client’s s view of problem
and offers nonjudgmental space to explore
Evocation: : counselor facilitates the client’s s own
exploration of the issues related to behavior
change, including pros and cons of changing
Autonomy: : responsibility for change resides with
the client – who must decide if, how, and when
change will occur
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Four General Principles
Express empathy
Develop discrepancy
Roll with resistance
Support self-efficacy
efficacy
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Five Basic MI Skills
Ask open-ended ended questions
Listen reflectively
Affirm
Summarize
Eliciting change talk
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References
Motivational Interviewing: Preparing people to
change addictive behavior by William R. Miller &
Stephen Rollnick (1991) – The Guilford Press
Motivational Interviewing: Preparing people for
change (2 nd Ed.) by William R. Miller & Stephen
Rollnick (2002) – The Guilford Press
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