Elizabeth Conway-Williams, M.A.
William T. Dalton III, Ph.D.
Doctoral Student
Licensed Psychologist & Assistant Professor
Assistant Director of Clinical Training
Department of Psychology
East Tennessee State University
 At
the conclusion of this presentation you
should be able to…
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Describe the characteristics of MI
Understand the guiding principles of MI
Understand the foundational clinical skills of MI
Understand additional clinical tools for practice
of MI
 Objectives
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will be met via…
Lecture
Video demonstrations
Practice via case studies
 MI
is a collaborative, person-centered form
of guiding to elicit and strengthen motivation
to change
1200
1000
800
600
400
200
0
1980-1989
1990-1999
2000-2009
 Lundahl
& Burke (2009) summarized results
of four meta-analyses on effectiveness of MI
 Effect sizes (Cohen’s D):
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Weak comparison groups (e.g., wait-list): 0.280.40
Strong comparison group (e.g., CBT or 12-step
program): 0.04- 0.32
 Suggest
that MI is significantly better than no
treatment and generally equal to other
established treatments for a wide range of
problems
 Alcohol-related
problems
 Marijuana
dependence
 Tobacco use
 Other drugs (e.g.,
cocaine, heroin)
 Engaging
clients in
treatment
 Reducing risky
behavior
 Increasing healthy
behavior
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Asthma/COPD
Brain Injury
Cardiovascular
Health/Hypertension
Dentistry
Diabetes
Diet/Lipids
Domestic Violence
Dual Diagnosis
Eating Disorders/Obesity
Emergency
Department/Trauma/
Injury Prevention
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Family/Relationships
Gambling
Health Promotion
/Exercise/Fitness
HIV/AIDS
Medical Adherence
Mental Health
Offenders
Pain
Parenting Interventions
Reproductive Health
Sexual Behavior
Speech/Vocal Therapy
 Motivational
Interviewing Professional
Training DVD (1998)

Interview With Founders
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
William Miller, Ph.D. (Clinical Psychology)
Stephen Rollnick, Ph.D. (Clinical Psychology)
 Motivation
was once considered a trait or
ingrained quality
 MI was first described in 1983 to help
motivate drinkers to change behavior
(resistance)
 Ambivalence was being considered a normal
and defining state and the recognition that
change is not usually made without
inconvenience
 Around the same period the trans-theoretical
model of stages of change was being
proposed
Precontemplation
Contemplation
Preparation
Action
Maintenance
 Recognizes
behavior change as a process
 Individuals are considered to be in different
stages of behavior change
 Assists individuals in moving through stages
via a combination of a strong patientprovider relationship and specific techniques
that encourage patients to discuss the
possibility of behavior change
 Directive
 Client-centered
 Honors
autonomy
 Counseling style
 Resolve ambivalence
 Evocative
 Collaborative
 Minimizes resistance
 Offers acceptance
 Arguing
that a person has a problem and
needs to change
 Offering advice without the patient’s
permission
 Doing most of the talking
 Simply giving a “prescription”
 A quick trick or simple procedure
 Resisting
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the Righting Reflex
Roll with resistance
 Understand
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Develop discrepancy
 Listen
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To Your Patient
Express empathy
 Empower

Your Patients Motivations
Your Patient
Support self-efficacy
 Open-ended
questions
 Affirmations
 Reflective
listening
 Summarizing
 Open-ended
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questions
Questions that encourage patients to elaborate,
feel respected, and elicit change talk
Examples
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“Would you tell me more about ____?”
“How does smoking fit with your dreams of becoming a
pro basketball player?”
“How does your current weight interfere with the
activities you most enjoy?”
“In what ways is your diabetes a problem for you?”
“How have you overcome other obstacles in the past?”
 Open-ended
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questions
Avoid questions that can be answered yes/no
Examples
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“Did you ____?”
“Will you ____?”
“Can you ____?”
“How many ____?”
 Affirmations
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Statements reinforcing positive choices,
strengths, and self-efficacy
Examples
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“Coming in every week for therapy and doing
homework is really tough. You are handling a difficult
treatment protocol really well.”
“I’m impressed with how mature you are.”
“Absolutely! It is really tough to do all that you need
to do when you’re not feeling well. And sticking to
your diet makes it easier for you to do your chores,
complete your homework, and hang out with your
friends.”
 Reflective
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
listening
Following along by restating what is said,
clarifying, adding meaning, or highlighting
emotions
Examples
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“It sounds like you are feeling ____.”
“It appears that you see no real problem with your
current drinking.”
“On the one hand your family really enjoys several
hours of television each day and on the other hand you
find that it is interfering with your family’s ability to
be physically active which you also enjoy and find
important.”
 Summarizing
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Sum up patients stories, add insight and
reinforce statements in favor of change
Examples
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“It’s important for you to fit in with your friends.
Sometimes adhering to your chest physiotherapy
regimen makes that tough.”
“On the other hand, when you don’t adhere to your
therapy, you notice that you don’t feel as well. And
when you don’t feel as well, it’s even harder for you
to keep up with the energy of your friends. Is there
anything that you want to add that I may have
missed?”
 Setting
an agenda
 Assessing readiness to change
 Developing discrepancy
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Pros/cons
Values and current behavior
 Ask permission to discuss a specific topic
 “Would you be willing to spend a few minutes

discussing your drinking?”
“Are you interested in discussing ways to better
take your medicine?”
 Ask
patient to name an area of concern with
the help of a menu of options

“There are several topics we could discuss
related to your health. For example, taking your
medicine, eating patterns, amount of physical
activity or time spent watching television,
smoking or drinking behavior, sexual activity, or
even others. What is of most concern to you?”
 Use
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Two useful tools for assessing and enhancing
patient readiness for health behavior changes are
the Importance and Confidence Rulers
Both on a 11-point scale
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of Rulers and Scaling
0 = least importance or confidence
10 = most importance or confidence
Scaling or follow-up questions may be used to
facilitate change talk
 “On
a scale of 0 to 10, with 10 being ‘very
important,’ how important is it for you to
decrease your drinking?”
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Reflect patient’s answer
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“You chose _____.”
Ask follow-up questions
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“Why did you not choose a lower number?”
“Why did you not choose a higher number?”
“What would it take to move to an _____?”
 “On
a scale of 0 to 10, with 10 being ‘very
confident,’ assuming you decided to drink
less, how confident are you that you could
succeed?”
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Reflect patient’s answer

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“You chose _____.”
Ask follow-up questions
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“Why did you not choose a lower number?”
“Why did you not choose a higher number?”
“What would it take to move to an _____?”
 Allows
patients to list the pros and cons of
changing or of not changing health-related
behaviors , and then to assign subjective
weights (of importance) to each
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“Tell me some good and not so good things about
taking your medicine.”
“Let’s list together and discuss the pros and cons of
completing your homework. Afterwards, let’s list
together and discuss the pros and cons of not
completing your homework.”
 Values
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for You
Good parent
Responsible
Disciplined
Good spouse
Respected at home
On top of things
Spiritual
Others: ____
 Values
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for Your Family
Cohesive
Healthy
Peaceful meals
Getting along
Spending time together
Others: ____
 What
do you value most? How does your/your
child’s/family’s current lifestyle fit in with
that?
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“On the one hand you value a healthy family and
on the other hand you and your child have excess
weight and you report that your diets are poor?”
“So where does that leave you?”
 Characteristics
 Guiding
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Principles
Resisting the righting reflex
Understand your patients motivations
Listen to your patient
Empower your patient
 Foundational
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Clinical Skills
Open-ended questions
Affirmations
Reflective listening
Summarizing
 Additional
Clinical Tools
 Review
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case studies
Case 1
Case 2
 Turn
to your neighbor
 Develop a plan
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Stage of change?
Goals?
What foundational clinical skills would you
emphasize?
Which additional clinical tools may you use?
 Role-play
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Divide into groups of 3
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between group members
One person patient
One person health care provider
One person evaluator
Patient reviews script
Health care provider practices foundational
clinical skills (OARS) and at least 1 additional
clinical tool (i.e., Assessing readiness to change,
Pros/cons, or Values and current behavior)
Evaluator monitors progress and provides
feedback

Barlow, S. E., & the Expert Committee. (2007). Expert Committee
recommendations regarding the prevention, assessment, and treatment of
child and adolescent overweight and obesity: Summary report. Pediatrics,
120 (Suppl. 4), 164-192.

Erickson, S. J., Gerstle, M., & Feldstein, S. W. (2005). Brief interventions
and motivational interviewing with children, adolescents, and their parents
in pediatric health care settings. Archives of Pediatrics and Adolescent
Medicine, 159, 1173-1180.

Glynn, L. H., & Levensky, E. R. (2009). Promoting treatment adherence
using motivational interviewing: Guidelines and tools. In L. C. James & W. T.
O’Donohue (Eds.), The primary care toolkit: Practical resources for the
integrated behavioral care provider (pp. 199-231). New York: Springer.

Lundahl, B., & Burke, B. L. (2009). The effectiveness and applicability of
motivational interviewing: A practice-friendly review of four meta-analyses.
Journal of Clinical Psychology, 65(11), 1232-1245.

Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010).
A meta-analysis of motivational interviewing: Twenty-five years of empirical
studies. Research on Social Work Practice, 20(2), 137-160.

Resnicow, K., Davis, R., Rollnick, S. (2006). Motivational interviewing for
pediatric obesity: Conceptual issues and evidence review. Journal of the
American Dietetic Association, 106, 2024-2033.

Rollnick, S., Heather, N., & Bell, A. (1992). Negotiating behaviour change
in medical settings: The development of brief motivational interviewing.
Journal of Mental Health, 1, 25-37.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing
people for change. New York: The Guilford Press.

Miller, W., & Rose, G. (2009). Towards a theory of motivational
interviewing. American Psychologist, 64, 527-537.

Rollnick, S., Miller, W. R., & Butler, C. C. (1999). Health behavior change: A
guide for practitioners. New York: Churchill Livingston.

Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing
in health care: Helping patients change behavior. New York: The Guilford
Press.

Sindelar, H. A., Abrantes, A. M., Hart, C., Lewander, W., & Spirito, A.
(2004). Motivational interviewing in pediatric practice. Current Problems
in Pediatric and Adolescent Health Care, 34, 322-339.

Motivational Interviewing: Resources for Clinicians, Researchers, and
Trainers

http://www.motivationalinterview.org/