Foundational skills

Foundational skills
theory, modeling & practice
Listening
Simple and complex reflective listening
statements
Summarising

Key tasks in consultations about behaviour change
(Road map)
Establish rapport
(room set; pts expectations; permission; a typical day)
Exchange Information
Set agenda
(ask permission; agenda setting)
Multiple behaviours
(Pt selects)
Single behaviour
(reflective listening; stage; information exchange; reducing resistance)
Assess readiness to change:
importance & confidence
Reduce resistance
Explore importance
Build confidence
Problem solve

Definition
(Revised)
Motivational interviewing is a person-centered,
goal-oriented method of communication for
eliciting and strengthening intrinsic motivation
for positive change.
Miller & Rollnick 2008. Ten Things that Motivational Interviewing Is Not, in press with Behavioural and Cognitive Psychotherapy

3 Communication Styles
Following
Guiding
Directing

3 basic communication skills
Listening
Asking
Informing

Contrasting Styles of Conversation
Answer
Contracted
Answer
This is
beginning to
feel like an
interrogation
Closed
Question
Another
Question

Contrasting Styles of Conversation
I m following
I m following
reluctantly
I know
what you re
trying to make
me say.
I m leading
I m leading
again

Contrasting Styles of Conversation
Expansive
Answer
Thoughtful
Elaborating
Response
This feels
like I m
being
understood
Open
Question
Reflections
& Questions

4 Guiding Principles (R.U.L.E)
Resist the Righting Reflex
Understand patients motivations
Listen to your patient
Empower your patient

Importance of listening in MI
The guiding process of listening helps the person to
keep talking and moving toward change.
• You help the person keep thinking about and exploring
the reasons …… for change…
• When you reflect something that a person has said,
you express interest in it and invite the person to say
more about it ….
• When you reflect their own change talk they hear you
saying again …….. what they themselves have said,
and they explore it further.

Shaping Reflective Listening
Exploring Non-verbal, Passive Listening Skills: select a partner.
One speaks while the other listens. The speaker talks for 5 minutes on a topic
chosen from this list:
How I’ve changed in the last decade.
What I hope to do over the next few
years.
What it was like growing up in my home.
My employment history.
What I like about my best friend.
The things I’m most concerned about.
The listener says nothing at all. Instead, may only communicate
listening, interest and understanding using non-verbal skills.

Reflective Listening
Is that what you mean
Most important & most challenging skill.
Involves keeping quiet and listening. Crucial element is how you
respond.
Statements of understanding.
A guess as to what the speaker means rather than assuming you
know. Voiced in a statement
Rather than echoing the client, a skilled reflection continues the
paragraph.
They often begin with, “so you…”, “you feel…”, “you’re wondering if”,
“you….”

MI Skills/Techniques
“OARS”
Used to help people explore their ambivalence and
clarify reasons for change. They support the goal of
encouraging client speech or ‘Change Talk’ - i.e.
talk that favours change.
Open-ended Questions
Affirmations
Reflections
Summarising

Reflective Listening Statements
Do you think your partner understands how depressed you ve been feeling
lately
A question requires an answer.
An incomplete component.
It seems that your partner doesn t appreciate how depressed you ve been
feeling lately.
A statement invites a response.
A complete component.
Its active listening, that demonstrates accurate understanding.

Reflective Listening Statements: An example dialogue
One thing about myself I would like to change is my moodiness.
You never know if you re going to be up or down.
No, it’s not that. I can tell how I m going to feel. It’s just that I overreact to things.
Even little things can upset you.
Sometimes, yes. I think I worry too much.
You sit and fret about things too much.
Yes. Often there is nothing I can do about it, but still I go over and over it in my mind.
And that gets you moody.
Absolutely! I get myself worked up and I can’t sleep.
Even at night you re worrying.
Yes, thats right. That is what I want to change.
The speaker is accurately identifying the problem; not the listener.

Demonstrating Accurate Understanding
Questions : Reflections
3:1 - Good
2:1 - Better
1:1 - Best
Empathic Reflection is the curious and sensitive exploration
of meaning.

Forming Reflections:
Some useful statement openers
So, you feel ...
It sounds like you ...
You re wondering if ...
It seems like you ...
You re thinking, perhaps, that ...
Empathic Reflection: the curious and sensitive exploration of meaning.

Shaping Reflective Listening
Thinking Reflectively. Groups of 3 or 4.
In turn, each person completes this sentence, One thing I like about
myself is .... The others respond with: Do you mean that you ... The
speaker may only respond with, Yes. or No. Elaboration is not allowed.
When the topic is fully explored, swap round. Everyone should have a turn
as speaker. Please don t stop to discuss - we ll do that afterwards.
15 minutes of curious enquiry!

Batting practice
Forming reflections on your feet
In groups of 4 or 5 and form a “batting cage”
One person at a time takes turn as a batter –
Any group member makes a “pitch” and the
batter takes a swing at it. i.e. the group members
throw out specific client statements to which the
batter responds with a short, simple reflection.
Each “batter” in the group responds to 4-5
different statements from the group
Once 1 person is finished as the batter, swop to
the next person in the group. Everyone must
play the batter.

Active Listening using Reflection
In groups of 3 or 4. Each person think of something about yourself that you would like
to change - pick something you feel comfortable discussing.
Start with one as speaker, completing this sentence, One thing about myself that I d like
to change is......
The others act as listeners and respond only with reflective listening statements. Try not
to ask questions. The speaker responds in turn and may elaborate. The goal is to
understand the dilemma, not to find a solution. When the subject is explored, change
around.
Twenty minutes of thoughtful reflection!

Some Suggestions:
Be curious rather than intrusive.
Try to be impartial as to the outcome.
Demonstrate accurate understanding through reflection & summary.
Use open questions that provide elaboration.
Seek permission to ask questions and give advice.
Maintain focus & direction.
Find the potential for change through understanding ambivalence.

Some questions to ask
yourself when in
conversation ...
Quality, not quantity!
What am I doing
Where are we going, and who ’s
deciding
What am I saying, and to
what end
Am I actively listening
Are we dancing or wrestling

“OARS”
Open-ended Questions
Affirmations
Reflections
Summarising

Summarising
Periodic summaries which reinforce what has
been said.
Demonstrates that the client has been listened to.
Prepares client to elaborate further. It’s useful to
end them with “…and what else”

Summarising
Return to listening exercise:
• Each take a turn to summarise what was
heard and to receive feedback from the
speaker
• Comment on how it felt to be heard

Briefly review of session
What was learned
What are the likely challenges in your setting
How may you overcome these