Motivational Interviewing (2017)

Welcome to the E-Learning module Introduction to Motivational Interviewing.
This module provides an overview of the fundamental skills, principles and strategies used in motivational interviewing

 Course Objectives: 

Click on start course to begin the E-Learning module. 

Transtheoretical Model of Change (Stages of Change) (copy)

Introduction

The “Stages of Change” model, developed by Prochaska and DiClemente (1982), shows how people change their behavior. The model is a way of understanding and conceptualizing the process of behavior change and developing treatment interventions that are tailored to the needs of individual clients. The stages apply equally well to self-change as to therapy-assisted change. People seem to pass through similar stages and employ similar processes of change whether they are in or out of treatment. The model identifies six separate stages, with each requiring certain tasks to be accomplished and certain processes to be used in order to achieve change (Prochaska & DiClemente, 1982). 

This part of the module will examine the common characteristics and therapeutic strategies for  each stage of change. At the end of each stage there will be a link to a video of a "client" who represents that stage of change. Formulate a response to the "client" using the therapeutic strategies learned. (Source: Adapted from Rawson, R. (2008). Motivational Interviewing [PowerPoint slides]). 

Pre-Contemplation

Characteristics Strategies

 1) Characterized as resistant or unmotivated

 

2) Tend to avoid information, discussion or thought with regard to the targeted health behavior

 

3) Doesn’t see or acknowledge that there is a problem

 

4) Not considering a change.

 

5) “I don’t have a problem”

-Build rapport

 

-Decrease defensiveness (Affirmations, Reflections)

 

-Decrease rationalization of behavior (Summaries, double reflections)

 

-Raise doubt (Focus on concerns they bring up…is this really working for them?)

–        -Reflect identified pros/cons

–        -Reflect identified good things/less good    

          things

–        -Explore history…how has this behavior fit

          (or not fit) into their life?

 

Click the link below to view an example of a client in the pre-contemplation stage:

https://www.youtube.com/watch?v=ZB4GzvL6714

Write down 2 statements from the client that demonstrate the client is in the pre-contemplative stage and write a response to the client using the strategies listed above. Note that you may be asked to share and defend your response during a live role-play in class.  

Contemplation

Characteristics Strategies

1) Seen as ambivalent to change or procrastinators

 

2) More aware of the benefits of changing, but aware of the “costs”

 

3) Admits to the possibility of having a problem.

 

4) Very vague considering change

 

5) “I might have a problem”

–-Tip the balance, selectively reinforce change talk

–

-Give reasons to change/not to change

–

-Support confidence in changing behavior

–Encourage commitment to change

–

-Continue affirmations

 

-–Continue reflections

–

-Some open-ended questions with non-expert approach

–

-Support information gathering about possible solutions/options

 

Click the link below to view an example of a client in the contemplation stage:

https://www.youtube.com/watch?v=DU72qRV6D_U

Write down 2 statements from the client that demonstrate the client is in the contemplative stage and write a response to the client using the strategies listed above. Note that you may be asked to share and defend your response during a live role-play in class.  

Preparation

Characteristics Strategies

1)States intent to change within the next 6 months

 

2) Viewed as a transition rather than a stable stage

 

3) Client comes to realization that he/she should do something about the problem.

 

4) Strongly considering change, actively making plans for change.

 

5)“I have a problem and I need to do something about it”

-Help determine best course of action

 

-Brainstorm/problem solve/solution generate/option generate…can offer suggestions with permission!

 

-Find acceptable concrete strategies for change via open-ended questions

 

-Strengthen commitment – use reflections, affirmations, summaries, open-ended questions

 

-Encourage that if action “fails”, they are only limited by their creativity for other options

 

-Selectively focus conversation

 

-Do NOT seem committed to one way – remain open

 

Click the link below to view an example of a client in the preparation stage:

https://www.youtube.com/watch?v=iU5kirdpa94

Write down 2 statements from the client that demonstrate the client is in the preparation stage and write a response to the client using the strategies listed above. Note that you may be asked to share and defend your response during a live role-play in class.  

Action

Characteristics Strategies

1) Has made overt lifestyle modifications for fewer than 6 months

 

2) Ready to make plans to correct the problem and takes action to do so; actively engaged in efforts to change.

 

3) “I have a problem and I’m doing something to rectify it.  I’m ready to start.”

–-Start increasing open-ended questions, decreasing reflections

–

-Help identify steps necessary to change, open-ended questions, reflections, summaries

–

-Help problem solve, open-ended questions

–

-Support confidence in abilities, –affirmations

 

-–Help identify additional resources, –who can help them? How?

 

Click the link below to view an example of a client in the action stage:

https://www.youtube.com/watch?v=56kZgUZW9qc

Write down 2 statements from the client that demonstrate the client is in the action stage and write a response to the client using the strategies listed above. Note that you may be asked to share and defend your response during a live role-play in class.  

Maintenance/Relapse Prevention

Characteristics Strategies

1) Working to prevent relapse and consolidate gains secured during action

2) Uses strategies to prevent the problem from re-occurring.

3) Actively engaged in continuing change efforts

4) “How do I keep going?”

-Continued goal setting

 

–-Help problem solve, use –open-ended questions

–

-Help identify potential causes of relapse and develop relapse prevention plan

 

-Support confidence in skills /abilities, affirmations

–

-Help identify additional resources, who can help them? How?

 

Click the link below to view an example of a client in the maintenance stage:

https://www.youtube.com/watch?v=WQhlvgufMKQ

Write down 2 statements from the client that demonstrate the client is in the maintenance stage and write a response to the client using the strategies listed above. Note that you may be asked to share and defend your response during a live role-play in class.  

Relapse

Characteristics Strategies

1) Lapses into old ways of behaving / acting. 

 

2) End up at any stage after this

 

3) Goal is to keep them in the stages

 

4) “What went wrong?”

-Review relapse prevention plan

 

-–Help identify steps necessary to change, open-ended questions, reflections, summaries

–

-Help problem solve, open-ended questions

–

-Support confidence in abilities, affirmation

 

 

 

Click the link below to view an example of a client in the relapse stage:

https://www.youtube.com/watch?v=ON9W0QxlhK0

Write down 2 statements from the client that demonstrate the client is in the relapse stage and write a response to the client using the strategies listed above. Note that you may be asked to share and defend your response during a live role-play in class.  

Principles of Motivational Interviewing (copy)

What is Motivational Interviewing?

"Motivational interviewing is a person-centered, directive method of communicating with the goal of enhancing a person's intrinsic motivation to change by exploring and resolving ambivalence and resistance"

(Miller & Rollnick, 2002). 

Take some time to think about the most difficult change that you had to make in your life....

How much time did it take you to move from considering that change to actually taking action?

Guiding Principles

Motivational interviewing is guided by four principles listed below. Hover over the bullet points for more in-depth information on the use of these principles in OT practice. 

Guiding Principles Puzzle Activity

Match the guiding principles with the associated strategy. 
  • Support Self-Efficacy
    The client is responsible for choosing and carrying out personal change
  • Roll with Resistance
    Value the client as a resource for finding solutions to problems
  • Develop Discrepancy
    Clarify important goals for the client
  • Express Empathy
    Skillful reflective listening is fundamental to the client’s feeling understood and cared about.

OARS: A review.

Motivational interviewing makes use of four specific skills. These skills are used together to encourage clients to talk and to explore their ambivalence about making changes. The four basic skills are often known by the acronym OARS – (1) open-ended questions, (2) affirmation, (3) reflective listening, and (4) summarising.

Successful use of these skills will result in the therapist being able to eliciting “change talk” in which the client will present the arguments for making a particular change. When clients are making “change talk" they are moving in the direction of being more motivated to change. This is the goal of motivational interviewing (Source: Adapted from Rawson, 2008). 

Hover over the bullet points for tips on how to incorporate OARS skills into OT practice. 

MI Methods

Read through some of the examples of how to use motivational interviewing in a clinical setting. Then, watch the videos of a therapist working with a client to elicit change behaviors. 

Watch the video linked below and write down three MI strategies used by the interviewer. 

 https://www.youtube.com/watch?v=EvLquWI8aqc

Watch the video linked below and write down three MI strategies the interviewer did not use well. 

 https://www.youtube.com/watch?v=_VlvanBFkvI

Demonstrate Skills with MI Concepts (copy)

Introduction

In this exercise, you will be presented with statements from several different clients. Identify the stage of change they're in. Then, quickly provide a response to each statement that you think would be most congruent with MI principles and a client-centered approach.  

Client: Mr. Smith

Mr. Smith says: "I'm tired of taking my medicine. They're expensive, make me fat, and don't make me feel any better anyways." 

Client: Ms. Jackson

Ms. Jackson says: "I'm going to be sick for the rest of my life, so why should I even keep trying?"

Client: Dr. Jones

Dr. Jones says: "I'm so embarrassed that I can't take care of myself. Maybe that's why I'm depressed on top of it all."

Client: Ms. Daisy

Ms. Daisy says: "For 6 weeks now, I've been waking up early 3 days a week to go on walks with my neighbor. Hopefully keep that up because I enjoy it."