Motivational Interviewing (MI) NYS Care Management Coalition Training Conference The latest updates from the new book MI 3
What Is Motivational Interviewing? Conversations about change The spirit of MI The method of MI
Conversations About Change Motivational interviewing is a collaborative conversation style for strengthening a person s own motivation and commitment to change
Ambivalence Most common place to get stuck Arguments both for and against change already reside within the person If you re arguing for change and the person is arguing against it it s exactly backward
It is a form of directing: The desire to fix what seems wrong with people and to set them promptly on a better course. What could possibly be wrong with that?
The Spirit of Motivational Interviewing MI is a person-centered counseling style for addressing the common problem of ambivalence about change Done for and with someone, not on or to them
Four Aspects of the Spirit Partnership Acceptance-absolute worth, accurate empathy, autonomy support and affirmation Compassion Evocation- that which is already present not installing what is missing
Why the Spirit? Benefits the people we serve; their needs have priority. Change is fundamentally self-change. Service providers facilitate natural processes of change People are the experts on themselves We don t have to make change happen
Living the Spirit We don t have to come up with all the good ideas-chances are we don t have the best ones People have their own strengths, motivations and resources Change requires a collaboration of expertise It is important to understand the person s own perspective
And Finally Dance in the relationship don t wrestle! Motivation is not installed, it is already there and just needs to be called forth We can not revoke people s own choice about their behavior. It is not a change goal until the person adopts it.
From the beginning, MI has been emerging, evolving
Four Fundamental Processes in MI 1. Engaging 2. Focusing Motivational Interview Relational Foundation 3. Evoking 4. Planning 12
5 Key Communication Skills *Activity 1. Asking OPEN questions 2. AFFIRMING 3. REFLECTIVE LISTENING 4. SUMMARIZING In addition: 5. Providing information and advice with permission
What About Engagement? Establishes a trusting and respectful helping relationship Think about how your program begins the relationship do you start with a consultation that leaves the person in a passive role-thus, compromising engagement
More About Engagement Expert-driven directing does not work well when personal change is desired Premature focus trap: trying to focus too early on goals before the person is sufficiently engaged Arguments about a diagnostic label are counterproductive Informal chatting is not likely to be helpful
Some additional thoughts about engagement-yours What influences your engagement in a new situation and whether you will return? Desire or goals-what are you looking for Importance-how much of a priority is it Positivity-did you feel good about the experience? Did you feel welcomed, valued and respected? Expectations-What did you think would happen Hope-Do you believe that it will help you
Core Interviewing Skills OARS: Open questions, Affirmations, Reflections, Summaries Open questions invite person to think before answering and provide lots of latitude for how to answer
Core Skills cont d Affirmations, based on the person s strengths and efforts, offer recognition, support, and encouragement The summary puts together information that the person has offered and can be part of collecting, linking and transitioning
Listening Reflective listening is a learnable skill fundamental in all four MI processes It is a statement that makes a guess as to what the person means Reflections vary in depth from simple repetition to complex such as completing the paragraph If you are going in circles, the reflections are too simple
Exploring Values and Goals Key to appreciating the person s internal frame of reference Self-actualization involves moving toward one s natural, ideal, mature state Values interview explores the person s core goals: why they are important and how they are expressed
More on Values To live with integrity is to engage in behavior that is consistent with and fulfills one s core values Discrepancy between current behavior and core value can be powerful motivator (within a safe and supportive relationship)
Values Self-regulation is the ability to formulate one s own plan and implement behavior to realize the goal. To confront means to come face to face: self-confrontation is more powerful that confrontation by someone else Values card set
Focusing It s no use setting off for a clear destination if the person won t go with you.
When goals differ I have not the right to want to change another if I am not open to be changed. --Martin Buber
Exchanging information Unsolicited advice is the junk mail of life. --Bern Williams It is easy to overestimate how much information and advice people need The purpose is not to deliver the advice, but rather to foster change.
Asking permission Within MI, information and advice are offered with the person s permission Regarding advice: engage first, use sparingly, emphasize personal choice, and offer a menu of options
THANKS for inviting me! What else do you want to know about MI? How important is it for you to integrate MI into the work you do? How confident are you that you can integrate MI into your work? How committed are you to make this change?