Upload
tim-bingham
View
700
Download
2
Embed Size (px)
DESCRIPTION
Citation preview
Motivational Interviewing
Tim Bingham BA
Introduction to
What is motivational interviewing?“a therapeutic style intended to help
clinicians work with patients to address the patient’s fluctuation between opposing behaviors and thoughts.”
Source: Miller and Rollnick, Motivational Interviewing 1991.
Characteristics of Motivational InterviewingClient directed towards changeFeedback and information offered
selectivelyEmpathic reflection used selectivelyTherapist creates or amplifies client
discrepancies to enhance motivation
Characteristics of Motivational InterviewingDe-emphasis on labelsEmphasis on personal choiceTherapists elicits client’s own concernResistance is normal Client provides goals and change plans
ResistanceWhen we see our freedom to act in a
particular way threatened, the behaviour seems more desirable and we will be more likely to choose that behaviour
“You’re a drug addict”…”No I’m not”“You’ve got to stop”…”No I don’t”
Ambivalence Ambivalence is being in two minds about
something
Ambivalence is normal.
General principles of M.I.1. Express empathy2. Develop Discrepancy3. Roll with resistance4. Support self-effiacy5. Avoid Arguments
Express EmpathyEmpathy is the ability to see the issue from
the other persons point of view
Acceptance facilitates change
Skillful reflective listening is fundamental
Develop DiscrepancyThe client rather than the counselor should
present the arguments for change
A discrepancy between present behavior and important personal goals or values will motivate change
Roll with ResistanceAvoid arguing for change
Resistance is not directly opposed
Roll with the resistance by seeing it from the persons point of view
Support self efficacyThe counselor’s own belief in the person’s
ability to change becomes a self-fulfilling prophecy
A person’s belief in the possibility of change is an important motivator
5. Avoid Argumentation
Arguments are the least effective way of exploring a subject
The 5 skills of M.I.1: Ask open ended questions2: Affirm3: Listen Reflectively4: Summarising5: Eliciting “change talk”
Open ended questions are...Questions that do not invite brief answers.
Affirming is…Recognising the work that the client has
done in relation to their problem
Listening reflectively is...Statements to mirror back the clients
own experiences to themTypes of ReflectionNeutral: Emphasis not changed
Enhanced: Amplifying or minimising in direction of change
Double sided: Reflects both sides of ambivalence
Selective ReinforcementStatements supportive of the therapists
agenda are reinforced through neutral or amplified reflection
Statements inconsistent with the agenda are neither reinforced by words nor actions
Summarising is...Listening to the client and reflecting back
to the client the main points of what they are feeling or thinking every few minutes.
Eliciting changetalkIn MI.. The client…provides the argument
for change”There are 4 types of changetalk1: Problem recognition2: Expression of concern3: Intention to change4: Expression of optimism
Methods for Evoking Change Talk1: Ask open ended questions2: Use the importance ruler (1-10)3: Explore the decisional balance (pros and
cons)4: Elaborating5: Exploring Goals and Values
Do you feel motivated?
Thanks for your time