Motivational Interviewing
Stages of Change
Learning Objectives
Identify the stages of change.
 Identify the core principles of
Motivational Interviewing.
 Demonstrate active listening skills.

Listening is a Foundational Skill

It is the basis for cultural competency

Remaining open and curious
It is what consumers and family
members say is most helpful
 For people with co-occurring disorders,
listening is a core skill taught in
Motivational Interviewing

Motivational Interviewing - Definition
Motivational Interviewing is a directive,
client centered counseling style for
eliciting behavior change by helping
clients to explore and resolve
ambivalence.
Rollnick and Miller
Motivational Interviewing
Motivational Interviewing is a way of
working with people who are in the
process of change.
 MI is focused on really understanding
where a person is at in the stages of
change.
 Then, making stage-wise interventions.

Stages of Change
Pre-contemplation
Relapse
Contemplation
Maintenance
Preparation
Action
Exercise

What Stage of Change Are You In?
The Dilemma of Change
Sometimes we are ambivalent – we feel
two ways about things.
 Motivational Interviewing helps people
look more closely at their own pros and
cons for change.
 Ultimately, this style of working with
people builds their motivation to change.

Study of therapist’s behaviors
The more a therapist confronted, the
more likely the client would be drinking
(more than a year later)
 The more the therapist had been
supportive and listening, the more the
client had changed.


Miller and Sovereign (1989)
Core Strategy of Motivational
Interviewing

To elicit from the ambivalent client
the reasons for concern
 and the arguments for change.

Five General Principles of MI

Express empathy

Develop discrepancy

Avoid argumentation

Roll with resistance

Support self-efficacy
Empathy
Listen and be supportive in your
comments. Show respect and
acceptance.
 Your goal is to build an alliance with the
client.

Develop Discrepancy

Your task is to help the client focus on
their current behavior and how it differs
from their ideal or desired behavior. The
use of reflection can be very valuable
here.
Avoid Argumentation

Avoid trying to convince the client of your
point of view and avoid power struggles.
Your job is to “walk” with the client not to
drag them along.
Roll with Resistance

When the person is highly resistant it
may be viewed as the client
understanding the issue differently than
you do. This is a sign to you to change
direction and listen more carefully and
express empathy.
Support Self Efficacy

Listen for statements that support the
person’s strengths and bring those to the
fore when possible. Elicit and support
hope, optimism and the possibility to
make positive changes.
Five Opening Strategies
Asking open-ended questions
 Reflective listening
 Summarizing
 Affirming
 Listening for self-motivational statements

Open-ended Questions

Facilitates dialogue and helps you to
understand their point of view
Tell me, what brings you here today?
 So, what do you think you want to do about
your drinking?
 Tell me about your family?

Reflective Listening
It is a means to demonstrate that you
have heard and understood what the
client has said.
 Use the three options in reflections:

Use exact words
 Paraphrase – use your own words
 Reflect emotions

Exercise

Listening Relay
Summarizing

Taking all of the information and
condensing it down to its essential
meaning.
Summaries reinforce what has been said
 They show that you have been listening

Affirming

Sincere affirmation promotes selfefficacy and validation of the clients
experiences and feelings.
I think it’s great that you want to do
something about this problem.
 That must have been very difficult for you.
 You’re certainly a resourful person to have
been able to live with the problem this long
and not fall apart.

Elicit Self-Motivational Statements

Your role is to entice the client to voice their
concerns and desires. MI requires the client,
not the clinician, to argue for change and
persuade themselves to change.



I guess this has been affecting more than I realized.
I feel terrible about how my drinking has affected
my family.
I think I could become clean and sober if I wanted
to.