Introduction to Motivational Interviewing
hello everyone and welcome to this brief
introduction to motivational
interviewing I’m dr. bill matulak
clinical psychologist a motivational
interviewing trainer and the author of
the ebook how to do motivational
interviewing which is available as they
say
wherever fine ebooks are sold so today I
just want to share with you a brief
slide presentation outlining the basic
concepts of motivational interviewing
for you and the best place to start I
guess is with a definition
so here’s my definition of motivational
interviewing motivational interviewing
is an effective way of talking with
people about change so this is a simple
definition it’s not as technical as a
textbook definition but I think it will
suffice for the simple introduction to
motivational interviewing that I’m
outlining for you on these slides so
what do I mean by effective I mean that
it’s evidence-based that motivational
interviewing has about 1,200
publications or more and all kinds of
prestigious journals covering
motivational interviewing is use in a
wide variety of problem areas
professional settings and actually many
different countries as well so why is it
even necessary to have something like
motivational interviewing shouldn’t
people just naturally change their
behavior when they know how important it
is for them to change well common
practice would certainly suggest that
this is the case oftentimes counselors
will just give people information or
advice and expect them to change their
behavior but professional counselors
change agents of one kind or another
know that change is not quick and easy
in fact sometimes change is very slow
and difficult so what kind of changes am
I talking about
well people face many decisions that
require some sort of change at every
stage of life children need to decide
whether or not to do their homework for
example people make career decisions and
who to marry how many children to have
one day have children things like that
later in life difficult decisions
include things like medical decisions
retirement living alone or moving into a
retirement home or senior living for
example or sometimes just accepting help
people have been used to being
independent all their lives may have a
making the change – just accepting the
help that they need
but as I’ve mentioned before these
decisions a change you’re often very
difficult occasionally I’ll ask my
workshop students for example how long
it was between the time that they knew
that they had to make it a significant
change in their lives and the point at
which they actually made the change it
doesn’t surprise me anymore that many
people say that it took six months or
longer to actually make the change
so when change is hard it’s usually not
because or it’s often not because of
lack of information or laziness or
oppositional personality or denial or
resistance or any of those kinds of
things sometimes it is you know matter
of lack of information that person is
already motivated and just needs some
information but oftentimes it’s because
it’s a motivational issue and when
change is hard it’s sometimes because
people are ambivalent they’re stuck in
an ambivalent stage and ambivalence is
just wanting and not wanting the change
or wanting incompatible things at the
same time the problem with ambivalence
is that it leads it’s uncomfortable it
leads to anxiety or produces anxiety and
anxiety because we like to avoid anxiety
we oftentimes will procrastinate about
making a change or making a decision in
our lives because we don’t like to be
anxious as a person gets stuck though in
this ambivalent stage continually
procrastinating about making a decision
this oftentimes is mistaken on the part
of the counselor for resistance now in
motivational interviewing we don’t talk
much about resistance anymore we don’t
use that word what is thought of as
resistance or what used to be thought of
as resistance is to a great extent
simply ambivalence it’s a natural
ambivalence is actually a natural
condition of being unsure about making a
change it’s a normal consequence about
thinking of thinking about the pros and
the cons of making a change when people
get stuck here though and change doesn’t
happen as quickly as the counselor
thinks it should it could look like the
client is being resistant so how does
motivational interviewing help well
motivational interviewing helps by
resolving this ambivalence and helping
the client the person move
towards healthy behavior change it also
helps by eliciting a person’s own
motivation to change listening their own
arguments for making a change in in a
healthy direction so what are the some
of the underlying concepts of
motivational interviewing well the first
one is the spirit of motivational
interviewing and this is described by
four words the first word is partnership
which refers to the fact that in
motivational interviewing the counsellor
and the client work collaboratively
together and the counsellor avoids the
expert role the second word is
acceptance and this refers to the fact
that the the client respects that the
counsellor respects the clients autonomy
their irrevocable right to make
decisions about their own lives their
potential their strengths and their
perspective we try to see the world
through the clients perspective
compassion refers to the fact that we
keep the clients best interest in mind
and the last word is II vocation which
refers to the idea that the best notions
the best ideas about change come from
the client those are the ones that the
client is going to act on much more
readily than ideas that come from the
counsellor so in order to do
motivational interviewing there are four
skills that are necessary to master
these core skills are open questions
affirmations reflections and summaries
these are nothing new to motivational
interviewing or nothing unique to
motivational interviewing these are
basic counseling skills that people have
learned if they take a basic counseling
class if you take the first letter of
each one of these skills it spells out
the word ORS and we use that acronym
sometimes to refer to the four skills we
say that we are using our oars skills so
here are some examples of some of the
oars skills open questions are questions
of course that call for more than a yes
or no answers so this question up there
are you in pain is not an open question
it’s a closed question a more skillful
open question would be something like
how do you feel how much alcohol do you
drink a day is a closed question that
could be changed to what role does
alcohol play in your life an open
question
don’t you want to move to a safer place
cause pretty much for a yes or no
answer what are the advantages that you
see in moving to a safer place is an
open question that calls for more of a
discussion in motivational interviewing
we try to ask more open questions than
close questions we do this in order to
encourage the client to talk about
what’s on his or her mind rather than
questioning the client based on what’s
on the counselors mind or based on the
counselors agenda the second skill is
the skill of affirmations now
affirmations are simply statements about
anything positive that the counselor
notices about the client Awards attempts
achievements accomplishments prior
successes anything that we can point out
to the client here’s some examples of
affirmations you really care a lot about
your family this is hard work you’re
doing you were successful in changing in
the past that took a lot of courage
coming in today knowing that you had a
dirty urinalysis these can all be
examples of affirmations now we use
affirmations in motivational
interviewing to build a sense of
self-confidence or a sense of
self-efficacy the third skill is maybe
the most important skill in motivational
interviewing or the most important of
the four core skills at any rate and
that’s the skill of reflective listening
reflections are simply understanding
what the client is thinking and feeling
and then saying it back to the client
reflections are statements not questions
here’s some examples of reflections this
is a person coming in to talk about
post-traumatic stress disorder to a
counselor and he might say something
like I don’t think that I have
post-traumatic stress disorder so a
reflection might be you’re not sure
about the diagnosis of PTSD I’ve been
this way for so long I think it’s just
my personality so all of this seems
normal to you well I don’t like the road
rage or getting angry with my wife road
rage and anger at your wife or a couple
of things you’d like to change so you
see that there are no questions there
those are all reflections now we use
reflections in motivational interviewing
to convey empathy and understanding and
especially to be able to start to see
the world through our clients eyes the
fourth skill is summarizing and
summaries are simply long
reflections of more than one client
statement here’s a woman thinking about
moving to a retirement home or senior
housing something like that and she’s in
the ambivalent stage and she’s making
arguments for both moving and not moving
at the same time so she might say
something like I don’t want to move I
like my house I’ve been there for a long
time I’m worried about falling though
I’m a bit unsteady on my feet these days
but I’d have to change doctors and that
would be a hassle for me but if I move
maybe I could move closer to my
grandchildren I might be able to see my
grandchildren more often and I might
feel safer in senior housing so there’s
lots of different ways that you can
respond to these statements that the
woman is making but if you wanted to
summarize the summary might go something
like this if I understand you correctly
you’ve been thinking of moving to senior
housing there’s a downside and that
you’d have to find new doctors and it
would be unfamiliar you also think you’d
be safer and senior housing and could be
closer to your grandchildren and there’s
a number of different uses for some
reason motivational interviewing the
most important maybe is that summaries
provide an opportunity for the council
to become strategic and guide the client
toward healthy behavior change by
selectively summarizing the clients own
reasons for change now I’m motivated
interviewing there are four processes
there’s engaging focusing evoking and
planning and these four processes are
somewhat sequential in nature and that
you have to engage your client before
you can focus on a particular topic or
behavior to change you need to focus on
that topic before you can evoke
motivation then you have to add
motivation before you can do any
planning so let’s look at each one of
these in a little bit more detail
engaging is defined as the process of
establishing a trusting and mutually
respectful relationship now this isn’t
unique or exclusive to the practice of
motivational interviewing but it just
makes sense that you need some
connection with your client before you
can even begin to talk about the client
changing their behavior so other words
that you may have may be more familiar
with or tuning to your client aligning
with your client you
with your client establishing a
therapeutic relationship connecting with
your client all of these kinds of things
refer to the same process in
motivational interviewing it’s the
process of engaging now in motivational
interviewing it’s just as important to
know what not to do what to avoid as it
is to know what to do and nowhere is
this more important than in the first
process of motivational interviewing
process of engaging one of the things
that you want to avoid then is the
assessment trap or assessing your client
asking a whole bunch of questions right
off the bat is off-putting your client
is not really going to be engaged with
you if that’s all that you’re doing is
just asking a bunch of questions and all
I have to do is just sit there and
answer question after question that’s
not engaging to your client so you want
to avoid assessing your client right off
the bat another thing that you want to
avoid is telling your client how to fix
their problem so if you make a quick
diagnosis the council makes a quick
diagnosis and then offers a solution
this also is not going to be engaging so
you want to avoid telling your client
how to fix their problem a power
differential is something else that may
turn your client off in terms of these
establishing a useful relationship if
you come across as some authority figure
for example sometimes people don’t
really like that and that may interfere
with the engaging process labeling is
something else that also may interfere
especially if you insist that the client
accept the label before they can be
helped in any way so all of those are
ways that that you can interfere with
the engaging process and things that you
want to avoid so what is engaging well
anything that helps the client feel
welcome
comfortable understood if you exceed
your clients expectations if your client
feels that she and you have mutual goals
or if the client leaves feeling hopeful
then you’ve engaged your client in the
process now there’s a number of
different ways that you can do these
kinds of things
for example helping them feel welcome
just shaking their hand using their name
pronouncing it correctly these kinds of
things but one of the most important
things is for a client to feel
understood the second process in
motivational interviewing is focusing
focusing is defined as an ongoing
process of seeking and maintaining
direction now focusing involves setting
an agenda or agreeing on an agenda we
set this agenda while considering the
clients goals and priorities as well as
the councilors goals and priorities as
well as the agency’s goals and
priorities for example and the whole
purpose is an effort to create a clear
direction for ultimately developing a
change plan so how the council
accomplishes this is again with the use
of the four basic or skills and the
skillful use of listening carefully to
your client the third process and
motivational interviewing is evoking and
evoking is defined as eliciting a
client’s own motivation for change what
you’re evoking here really is change
talk so what is change talk well change
talk is defined as client speech that
favors movement in the direction of
change any kind of conversation that
your client is giving you any kind of
statements about I want to change I wish
I could the reasons are I will I can it
would solve these problems and so forth
that’s all change talk well in
motivational interviewing we pay a great
deal of attention to change talk when we
get it we reinforce it we encourage it
we try to get more change talk because
we know that the more a client engages
in change talk the more that they argue
for change themselves more likely it is
that they’re going to change their
behavior so if we’re not getting much
changed talk then we want to do some
things to encourage that one of which is
that you can just ask questions that
would generate quite change talk so
here’s some examples of a few questions
that you could use to generate some
change done why do you want to make a
change what are the reasons from your
point of view to make a change what
would some of the benefits be as far as
you’re concerned how might you go about
making the change if you wanted to be
successful how might you go
about doing it and what would be your
first step or what would you be your
next step or what options do you see
yourself having so all of these would
generate some change time the fourth and
final process of motivational
interviewing is the planning process and
planning is defined as developing a
specific change plan that the client
agrees to and is willing to implement in
using the four basic skills the or
skills the skillful motivational
interviewing counselor has already
engaged the client focused on a
particular topic elicited some change
talk and within that change talk there
are not only reasons that the client
sees for making the change and benefits
that would accrue if they were to make
the change but also ways that the client
could make the change and be successful
at that and these are important to pay
attention to during those phases or
those processes of motivational
interviewing so that when it comes to
the planning phase then it’s just a
process of going from a general concept
to developing a specific plan the plan
needs to be a smart plan it needs to be
specific measurable achievable relevant
and time and once you get a plan that is
smart then that would be the end of
motivational interviewing so that’s a
brief introduction to motivational
interviewing motivational interviewing
in a nutshell so to speak so I hope it’s
been useful to you and helpful if you’d
like further information you’re welcome
to visit my web site
ww-will interviewing online.com and
until next time we meet I wish you joy
and success in your work and peace and
happiness in your life thank you very
much for watching see you next time
