Motivational Interviewing: Walking Through the Four Processes William R. Miller, Ph.D. University of New Mexico Hong Kong December 17, 2018 1
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1. Engaging 2. Focusing 3. Evoking 4. Planning Can we walk together? Where are we going? Why do you want to go there? How will we get there?
Conversations with four volunteers on a specific topic Not rehearsed or scripted MI Process Engaging Focusing Evoking Planning Conversation Topic Something you feel two ways about (ambivalence) What things do you want, hope, or need to accomplish within the next six months? What is a change that you want or hope to make in your life, but have not yet made? What is a goal or change that you have decided to pursue, but you are not sure how to go about it?
What is Motivational Interviewing? 5
A collaborative way of having a conversation about change in order to strengthen the person s own motivation for and commitment to change From the provider s perspective: A person-centered counseling style for addressing the common issue of ambivalence/reluctance about change
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Partnership Compassion MI Spirit Acceptance Evocation 8
Four Processes in Motivational Interviewing Engaging Planning Focusing Evoking 9
Four Processes of MI Planning Evoking Focusing Engaging (The Relational Foundation) 10
1. Engaging Engaging Focusing Can we walk together? Planning Evoking 11
! Listening with curiosity and acceptance, in order to understand your client! Communicating your understanding and acceptance to the client! Honoring the client s self-determination Motivational interviewing guides by yielding
OPEN Questions AFFIRM REFLECT SUMMARIZE 13
! Are statements rather than questions! Make a guess about the client s meaning (rather than asking)! Yield more information and better understanding! Often a question can be turned into a reflection 14
! Accurate Empathy described and studied by Carl Rogers! Counselors who show high levels of empathic skill have clients who are:! Less resistant! More likely to stay in treatment! More likely to change! Less likely to relapse! High counselor empathy is a strong predictor of positive change! Low counselor empathy predicts poor outcome, worse than no treatment 15
Conversation Topic: Something you feel two ways about
! Central goal: To understand the dilemma! No intention to produce change! Neutrality is the conscious clinical decision not to influence a client s direction of choice or change
Engaging
2. Focusing Engaging Focusing Where are we going? Planning Evoking 19
Negotiating a clear goal or goals for change
! The client! The context! The counselor
! One provisional goal! A set of goals to be prioritized! A first approximation goal! A set of changes toward a clear longer-term goal 22
Focusing Topic: Six-month priorities 23
3. Evoking Engaging Focusing Why do you want to go there? Planning Evoking 24
Recognizing Change Talk Eliciting Change Talk Strengthening Change Talk Softening Sustain Talk 25
Opposite Sides of a Coin Preparatory (DARN) Desire Ability Reasons Need Mobilizing (CATs) Commitment Activation Taking steps
! I wish I could quit smoking (Desire)! I think I could be a non-smoker (Ability)! I spend too much money on cigarettes (Reason)! I have to quit (Need)! I will quit (Commitment)! I m willing to quit (Activation)! I filled that prescription you gave me (Taking Steps) 27
! I really enjoy smoking (Desire)! I don t think I can quit (Ability)! I have to smoke to relax (Reason)! I don t think I need to quit (Need)! I intend to keep on smoking and you can t stop me (Commitment)! I m not ready to quit (Activation)! I bought four cartons of cigarettes today (Taking Steps) 28
Pro Con Change Talk Sustain Talk
! 9 counselors switched every 12 minutes between: " MI: Seeking to evoke change talk and " FA: Functional analysis of drinking! in conversations with 47 people about their drinking concerns! Coded client change talk (CT) and sustain talk (ST) 30
80 70 60 50 40 30 20 10 1.63 0.85 2.00 1.17 0 MI1 FA1 MI2 FA2 Glynn & Moyers (2010), Journal of Substance Abuse Treatment 39: 65-70 31
! Asking questions the answer to which is change talk " It matters what questions you ask!! Using The Importance Ruler! Querying Extremes (Best and Worst)! Looking Back / Looking Forward! Exploring Goals and Values 32
MI Hill (Pre-) Contemplation Preparation Action 33
What is a change that you want or hope to make in your life, but have not yet made?
4. Planning Engaging Focusing How will we get there? Planning Evoking 35
good engagement AND a clear shared change goal AND sufficient client motivation for the change 36
! Planning is still a negotiation process of listening, collaborating, encouraging, evoking! Avoid switching into directing and prescribing
! Setting Goals! Considering Change Options! Offering Information or Advice if Needed! Arriving at a Plan! Strengthening Confidence! Building Commitment 38
Planning TOPIC: What is a goal or change that you have decided to pursue, but you are not sure how to go about it?
You don t have to make change happen. You can t You don t have to come up with all the answers You probably don t have the best ones You re not wrestling You re dancing 40
www.motivationalinterviewing.org www.williamrmiller.net WRMILLER@UNM.EDU