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![Page 1: Motivational Interviewing: Empowering Self-Directed Behavioral Change A desire to be in charge of our own lives, a need for control, is born in each of.](https://reader033.fdocuments.net/reader033/viewer/2022051819/5514d34a55034693478b50a5/html5/thumbnails/1.jpg)
Motivational Interviewing: Empowering Self-Directed
Behavioral Change
“A desire to be in charge of our own lives, a need for control, is born in each
of us. It is essential to our mental health, and our success, that we take
control.”Robert F. Bennett
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A Brief History of Motivational Interviewing MI: a counseling modality, evolved from Carl Rogers’s
Client-Centered Therapy (Rogers, 1951) and Prochaska’s Stages of Change Theory (Prochaska & DiClemente, 1984).
Developed by William Miller and Stephen Rollnick (Miller & Rollnick, 2002) as a treatment protocol to reverse adult alcohol and substance abuse.
Adapted for use with adolescent cannabis users Further adapted for other risk behaviors such as
smoking cessation, medical treatment protocols, and now,
Academic environment: adult literacy, traditional education and underachievement applications to improve persistence and academic performance
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What is Motivation and Where Does it Come From?
External –vs- Internal Motivation: The difference between the “gold-star” reward system of reinforcement and internally-driven goal setting and acquisition.
Self-Determination Theory (Deci & Ryan, 1985) The internal dynamics of human motivation.Illuminates the function of attributional mechanisms that fuel goal setting and behavior-modification and empowers the individual to effect behavioral change by redirecting intrinsic motivation.
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Behavior… to Change
“Behavior is the result of an interaction between [a] situational pull and personal tendencies” (Miller & Rollnick, 2002, pp.287)
Possible Selves Values
Create discrepancy
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Possible Selves?
Self-knowledge delineated by both the personal and the social context.It represents an individual’s ideals of
What they might become,
What they would like to become,
What they are afraid of becoming (Markus & Nurius, 1986).
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Values: How important? “Rules for living; important, desirable or
worthwhile needs and wants; fundamental ideas about what is right and wrong, good and bad; stimuli which can induce positive or negative emotional states; and preferred events (Fraenkel, 1980).
“What is prized or held in high esteem (values) implies standards of appropriate human behavior (morals) compatible with principles (ethics) governing what is good for the person and for the society to which the individual belongs” (Irwin, 1988).
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Congruence –v- Discrepancy Discrepancy, like Piaget’s notion of
Disequilibrium, is the energy behind change. Self seeks congruence between Possible
selves and the present self…but you need a conductor to encourage orchestration…
Motivational Interviewing works to reveal ambivalence, elevate discrepancy, and elicit change talk —in the direction of a self-identified Possible Self.
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Values
StrategiesPlan
of
Action
Evaluative Bench-marks
Role models
Individual
Goal Setting and Goal Acquisition…
Motivational Interviewer
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How Does it Work?
Motivational Interviewing is
a counseling modality that effects behavioral change by:
•Developing discrepancy and ambivalence;•Encouraging CHANGE TALK; and
•Calling upon internal or intrapsychic mechanisms such as Resilience (Henderson & Milstein, 1996),
Personal Values (Miller and Rose, 2009), and
Intrinsic Motivation (Miller & Rollnick, 2002)
to empower the individual.
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MI: a Variety of Applications Adult In-Patient and Out-Patient
Drug Abuse Treatment (Miller, W. R., 1995)
Correctional Settings (William R. Miller; reprinted from the MINUET)
Adolescent Outpatient Substance Abuse Treatment (Lauren Aubrey Lawendowski, 1998)
Emergency Room Interventions:Adolescents with alcohol-related injuries (Nancy Barnett)
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MI: a Variety of Applications Dual Diagnosis Treatment (Kathleen Sciacca,
1997)
High-Risk Sexual Practices (by Douglass Fisher and Rosemary Ryan)
Adolescents engaged in risk-behaviors (Chris Dunn)
Smoking Cessation Treatment (Mary M Velasquez, Jacklyn Hecht, Virginia P Quinn, Karen M Emmons, Carlo C DiClemente, Patricia Dolan-Mullen) (pdf link to article in Tobacco Control, 2000)
Eating Disorders (Motivational Interviewing for Eating Disorders, Janet Treasure, Dr. Ulrike Schmidt and Gill Todd, Eating Disorder South London & Maudsley NHS Trust)
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Some important data on MI: Project MATCH, 1997
(Journal of Studies on Alcohol, 58:7-29) Design Randomized clinical trial Population Outpatient and aftercare Nation US (9 sites) N 1,726 adults MI 4 session Comparison 12 session CBT or TSF Follow-up 15 months post-treatment (Miller, W. R., 1995)
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4 Principles of MI
1) Express “Empathy” Communicate understanding & genuine
caring “Unconditional positive regard” “Non-possessive warmth” Impact upon client – Validation, connection,
& empowerment (willingness to take more control & responsibility)
“Pacing” is the 1st step toward “Leading”
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4 Principles of MI
2) Develop “Discrepancy” Help to reveal the gap between client’s
goals, values, and current behavior Allow natural unfolding of psychic tension Discomfort provides opportunity for
change – “No pain, no gain” Co-create plan that resolves tension via
change (i.e., return to balance at new level and/or lifestyle change)
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4 Principles of MI
3) Roll with “Resistance” A signal to do something different (e.g.,
relent, stop “fight”, don’t personalize) “1-Up” position produces “1-Down” result Client’s energy must stay aligned with
his/her desires, not our own, or we both lose
Client ALWAYS makes the argument for change, or lasting change will not occur
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4 Principles of MI
4) Support “Self-Efficacy” Explore & reframe past change efforts, both
successes & failures (e.g., “Failing Forward”)
Elicit & attend to client’s own views/ideas of why & how to change
Avoid explicit direction & confrontation Elicit commitment to a simple course of
action Liberate client’s actual, unrealized power
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How It Works
Client-centered, directive style elicits increased change talk &
decreased resistance Resolution of ambivalence is
promoted by accurate empathy Direction of resolution is influenced
by the coach’s selective reinforcement of the client’s speech
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The 2 Phases of MI
Phase 1 Increasing readiness for change Focus upon the “Why” of change, how
it is personally meaningful Promote general sense of ability to
change Phase 2
Strengthening commitment to change Focus upon the “How” of change & plans
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The MI “Spirit”
Autonomy-support Acceptance that client
might choose not to change
Collaboration Negotiation vs. an
authoritarian stance Evocation
Drawing out the client’s ideas & motivation
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Fundamentals of MI:“OARS”
Open-Ended Questions Affirmations Reflections Summaries
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Fundamentals of MI:“OARS”
Open-Ended Questions Avoid “Yes” or “No” response Elicit broader answers Use client’s own words Avoid bias/prejudgment Make few assumptions Not judgmental or preachy Don’t label emotions
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Open-Ended Starters
Open: To what extent…? How often…? Why…? Tell me about… Help me
understand… What, if any…? What else…?
Closed: Did you..? Will you…? Can you…? Is it…?
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Fundamentals of MI:“OARS”
Affirmations Recognition of client’s
strengths & qualities Your “vote of confidence” Reality based appraisal Positive truths, based upon
past successes & future potential
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Fundamentals of MI:“OARS”
Reflections Keep the conversation
client-centered & equal Focus in on 1 part of a
complex statement Reflect both sides of
client’s ambivalence
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Fundamentals of MI:“OARS”
Summaries Capture essence of client’s
motivational conflict Link current & previous topics Transition from 1 topic to
another
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BibliographyBurke, B., Arkowitz, H., & Menchola, M. (2003). The efficacy of Motivational Interviewing: A meta-analysis. Journal of Consulting and Clinical Psychology, 71(5), 843–861.
Deci, E.L., & Ryan, R.M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum.
Henderson, N., & Milstein, M. (1996). Resiliency in schools. Thousand Oaks, CA: Corwin Press, Inc.
Markus, H. & Nurius, P. (1986). Possible selves. American Psychologist, 41(9), 954-969.
McCambridge, J. & Strang, J. (2004). The efficacy of single-session motivational interviewing in reducing drugconsumption and perceptions of drug-related risk and harm among young people: Results from a multi-sitecluster randomized trial. Addiction, 99, 39-52.
Miller, W., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. 2nd ed. New York: The Guildford Press
Oyserman, D., Terry, K., & Bybee, D.(2002). A possible selves intervention to enhance schoolInvolvement. Journal of Adolescence, 25(3), 313-326.
Project MATCH. (1997). Journal of Studies on Alcohol, 58, 7-29.