Motivational Interviewing

This is linked in to the SDT post a few days ago. Motivational Interviewing (MI) was developed for alcohol problems as a result of dissatisfaction with previous treatment approaches (e.g. alcoholics failing to respond to treatment are in denial so you confront them… which will not have positive results and persuading someone to change can be seen as a threat to their autonomy).

MI emphasizes your autonomy and personal responsibility, and negotiates in developing goals and the strategies to achieve them.

Four General Principles:

  1. Express empathy – reflective listening ensures you show understanding of their perspective
  2. Develop a discrepancy – make sure client can see that where they are is not where they want to be (however, this can result in the pressure to make yourself change, not intrinsic)
  3. Roll with resistance – gently persuade not full on confrontation
  4. Support self-efficacy – if the client does not believe they can implement solutions to problems they will not try (do or do not , there is no try).

Next time you give people advice or encourage them to do something, think of that darn cat.

DARN –sdt4 preparatory change talk.
Desire – I want to change
Ability – I can change
Reason – It’s important to change
Need – I should change

Great, they know they need to change… it doesn’t mean somebody will. I want to eat less chocolate because I know I can cut down and it’s important that I do not eat as much sugar, and I really should stop before I get diabetes – but will I? Debatable.

CAT – Implementation change talk
Commitment – I will change
Activation – I’m ready to change
Taking steps – I am changing

Core Skills
At the heart of MI are many of the core skills seen in other talking therapies. Another acronym coming…

OARS

  • Open Questions – ask for specific examples and seek elaboration
  • Affirm – conveys respect for the client, reframe apparent weaknesses as strength but must be genuine
  • Reflect – Reflective listening demonstrates understanding, empathy, and allows therapist to step into client shoes
  • Summarise- chance to be directive, changes direction, good strategy when stuck, seek elaboration; can be simple, amplified, double-sided, shift the focus, or reframe

Other techniques:
MI uses many, many techniques to evoke change in the client. Below are just a few:
– Problem recognition
– Concern for present condition
– Intention to change
– Optimism to change
– Imagining extremes
– Looking backwards/forwards
– Exploring pros/cons short/long term
– Rating importance and confidence (0-10)

When giving advice follow the elicit-provide-elicit rule… Elicit their permission “what do you know about/can I tell you about”; provide the advice; elicit a response “how does that fit/what do you think?”

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