MI Strategies to Evoke Change Talk Preparatory Change Talk - DARN DARN Desire (intrinsic motivation) I want to change • • • Ability Confidence/selfefficacy I can do it • • • • Reason (Benefits of changing) It’s important to me • • • Need (Adverse consequences) I should do this • • • • Sample Questions How would you like things to be different? If you could change one thing about yourself, what would it be? Why would you want to make this change? If you decided you want to change this, how would you go about it? If you decide you want to change this, how confident are you that you could succeed? If you decide you want too change this, what, if anything, might get in your way? How can you draw on experience with success in the past to move forward now? Imagine succeeding with this. How might your life improve? If you did want to change this, how might your family benefit? What do you imagine other people who succeed at this report about their lives after they’ve succeeded? You’ve mentioned what you like about___. On the other hand, what is the downside? If you continue on this way, what do you see when you look down the road? What’s at stake if you don’t change this? What would your family say that they worry about? Implementing Change Talk – CATs CAT Commitment I will make changes • • • Sample Statements I want to… I would like to… I wish… • • • I could… I can… I might be able to… • • I would probably feel better if… I need to have more energy to keep up with my kids/grandkids… I don’t want to end up like my mom/friend/grandmother, etc. • • • • • I ought to… I really should… I have to … I need to… (highlight their personal choice) • • Sample Questions So, what will you do? Is that what you intend to do? • • Sample Statements I am going to… I intend to… Activation I am ready and willing • • • Are you willing to give that a try? What are you willing to do? How ready are you? • • I am ready to… I will start tomorrow… Taking Steps I am making changes • What steps have you taken? • • I actually went out and… This week I started… Source: Miller, W.R., Rollnick, S. (2013). Motivational interviewing: Helping people to change. New York: Guilford Press. Other Change Talk Strategies Strategy Elaboration When you begin to hear change talk, ask for more detail. Ask for examples When change talk emerges, ask for specific examples. Looking Back Ask about a time before the current focus became an issue. Looking Forward Ask about the future. Examples • In what ways? • How do you see this happening? • What past experiences can you relate to this situation? • Tell me about a specific example. • What else? • When was the last time that happened? • Describe a specific example of what it’s like when this happens. • What was your life like before this became an issue? • Tell me about how things were different before. • • • What do you see happening if things stay the same? If you were 100% successful making the changes you want, what would be different? How would you like your life to be in the future? Querying Extremes Ask them about best and worst-case scenarios to elicit more information. • Explore Goals & Values Ask what their guiding values are. • • • • What values are most important to you? What do you want in life? How does this behavior fit into your value system? In what ways does it conflict with your values system? Come Alongside Explicitly side with the negative (status quo) side of their ambivalence. • Perhaps ______ is so important to you that you won’t give it up no matter what the cost. This may not be the main area that we need to focus on in our work together. Change Rulers (Importance, Confidence, Readiness) Ask open questions about where they are on the scale of 0-10. • • • • What are the worst things that might happen if you don’t make this change? What are the best things that might happen if you make this change? On a scale of 0-10, where 0 is not at all important, and 10 is extremely important, how important, confident, ready, are you to change _______? Why did you pick ___, and not ____ (always say 1 number lower than they did, this will get them to say why they can do better, evoking self confidence Source: Miller, W.R., Rollnick, S. (2013). Motivational interviewing: Helping people to change. New York: Guilford Press. Getting Permission Asking Permission In MI, it’s very important to only provide information or express concern if the client asks you to, or if you ask permission. Make sure that you remain brief and focused here. Even if they seem interested, be brief and ask for their opinion of what you shared. Then reflect and roll if they express any resistance. Examples • • • • Would it be alright if…? If you’d permit, I’d like to… I’d like to share a concern if you are open to that. I’m wondering if I could ask for 2-3 minutes to provide you with some pieces of information that may be helpful to you. After Advice or information, ask for their reaction • • What part of this information, if any, applies to you? What are your immediate thoughts and reactions? Elicit – Provide – Elicit Technique Elicit First Provide Information and/or Advice Elicit Feedback • • • • • • • • • • • • • • What do you already know about_____? What have you heard about____? Would it be ok if I shared a piece of information/advice with you? What would you like to change about your current situation? Why do you think others area concerned about____? Be brief. Stay relevant. Present 2-3 options or make 2-3 points Watch their reactions carefully for resistance or disengagement What do you make of this? What do you think? How relevant is this to you? What do you agree or disagree with? Who in your life can you team up with? Is there someone you could share this with? Source: Miller, W.R., Rollnick, S. (2013). Motivational interviewing: Helping people to change. New York: Guilford Press. MI & The Stages of Change Stage of Change Pre-contemplative Contemplative Presents As… • “Nothing needs to change” • Not considering change, either avoids thinking about it, or has decided that the benefits of the current behavior outweigh the costs • “I am considering change” • Thinks there may be a problem but hasn’t decided what to do about it • May present as ambivalence or mixed feelings Strategies • Build rapport and trust • Increase problem awareness • Raise sense of importance and change • • • • Preparation • • • • • Action • • • • Maintenance • • Relapse • • • “I am figuring out how to change” “I am preparing to make a change” Preparing to make a change by making small initial steps Attitude can become more positive with an action plan May ask questions about how others have done it “I’m working on reaching my goals” “I’m eating a healthy diet” Actively making changes May have found ways to cope with triggers • • Maintaining changes Actively engaged in the process of getting healthier “I’ve fallen back, now all is lost” Has a slip and revisits the problem behavior Appears as demoralization or denial • • • • • • • • • • • Acknowledge ambivalence (mixed feelings) about the change Explore discrepancy between present behavior and goals/values Discuss pros and cons of change Talk about ways to experiment with change Build confidence Talk about the timing of the change Present information, options, and advice (after getting permission) Resist the urge to push, let them determine the pace Assist with planning Develop reachable goals and celebrate their successes along the way with them Support and encourage efforts Affirm success Encourage and assist with ongoing relapse planning Address relapse Do not add to feelings of shame Discuss what might work better next time Raise importance and confidence level for next time Source: Miller, W.R., Rollnick, S. (2013). Motivational interviewing: Helping people to change. New York: Guilford Press.
