Motivational Interaction
Addictions Ontario
May 30th, 2011
Michael Dean & Associates
Learning Objectives
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Increase understanding of the technical
components of MI
Gain increased awareness as to the application
of MI
Obtain an overview of the day long training
session for Motivational Interaction
Identify components of MI you are already
using in your work
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Motivational Interviewing
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What is it?
A directive, client centred counselling style for
eliciting behaviour change by helping clients
to explore and resolve ambivalence.
The ‘spirit’ of MI : “a way of being with the
client”…Bill Miller
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What is Motivational Interaction
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Based on principles of Motivational
Interviewing PLUS
Incorporates some principles of Solution
Focused Brief Therapy
A way to work with short episodes of client
engagement
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WHY Motivational Interaction?
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As stated re: short episodes of engagement
Traditional MI can be intimidating as it was
intended for a process of “interviewing”
Literature supports some brief interventions as
being effective as some longer episodes of care
You are already doing some of it…lets label it.
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Some supportive literature
Single-Session Motivational Interviewing for Drug Detoxification Inpatients: Effects on
Self-Efficacy, Stages of Change and Substance Use
ANNE H. BERMAN,LARS FORSBERG, NATALIE DURBEEJ, HA° KAN KA¨ LLME´N,
AND ULRIC HERMANSSON. Substance Use & Misuse, 45:384–402. 2010
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SOLUTION-FOCUSED GROUP THERAPY FOR LEVEL 1 SUBSTANCE ABUSERS: Sara
A. Smock, Virginia Polytechnic Institute and State University; Terry S. Trepper and Joseph L.
Wetchler, Purdue University Calumet; Eric E. McCollum, Virginia Polytechnic Institute and
State UniversityRose , Ray and Kent Pierce, Purdue University Calumet.
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BRIEF INTERVENTION FOR SUBSTANCE USE:, A MANUAL FOR USE IN PRIMARY
CARE, World Health Organization, Department of Mental Health & Substance Dependence
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Practicality
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Traditional MI focuses on clients willingness
to change ( once change talk is occurring)
Brief Solution Focused therapy focuses on the
positive behaviors/decisions client is
demonstrating
We need to identify those opportunities to
apply principles of MI………….
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Application
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Addictions
Anxiety
PTSD
Obsessive Compulsive
Suicidality
General health issues
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Problem gambling
Medication adherence
Concurrent Disorders
Depression
Eating disorders
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Motivation
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“The most prevalent common-sense view of
motivation is that people do things because
they perceive them as being better in some
way than not doing them” (West, 1989)
“Motivation is the sum of the factors that
influence an individual to behave in a certain
way” (Saunders, 1994)
“People only change when the pain of change
is less then the pain of staying the same” (Saunders
law of behaviour change)
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Hand in Hand
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In order to elicit change behaviour we need to
determine the starting point.
Where is the client in regard to
willingness/readiness to change?
We can’t start talking of change until we know
what change is required.
To address the above we need a tool…a
process…….
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Need to know where client is in
Change Process
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Goals & Key Areas of MI
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The overall goal of MI is to explore and resolve clients’
ambivalence in order to enhance their motivation to
change
Successful resolution of said ambivalence will occur
by facilitating client statements that reflect:
Self-Esteem – their belief that they are “OK” (this must
happen so they feel powerful enough to change)
Concern – concern about their behaviours
Competence – their ability to make changes
Knowledge of Problem – recognize their problem
behaviour's)
Knowledge of Strategies – reflect on strategies for change
Desire to Change – reflect a desire for things to be
different
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Brief Interventions
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Hallway conversation
In residential settings while performing
residential related task
Pre and Post dialogue for other sessions e.g..
patient in to set broken arm or pick up
workfare funds
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The FRAMES Acronym
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Feedback
Responsibility
Advice
Menu
Empathy
Self-efficacy
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F, R, & A
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Feedback – through structure, clients are
encouraged to reflect on their lives, their
choices, and their behaviours
Responsibility – all responsibility for
change lies on the client
Advice – counsellor takes an active role
and gives advice that is clear, simple, and
non-authoritative
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M, E, & S
Menu – clients are given a menu of
treatment choices (increases ownership)
 Empathy – the active ability to understand,
and reflect that understanding, to the client
(can include confrontation and challenge)
 Self-efficacy – the clients’ belief that they
have the ability to succeed
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Helping Tasks to Support FRAMES
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Be empathic – expressing warmth,
acceptance, and a non-judgmental attitude
Point out discrepancies – between clients’
present behaviour and their long-term goals
Avoid arguments – confrontation leads to
resistance, refer back to responsibility
Roll with resistance – change strategies, allow
client to find their own solutions
Support self-efficacy – the most important
aspect of MI
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Motivational Strategies
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Ask open ended questions
Listen reflectively
Affirm
Summarize
Elicit self-motivational (or change ) statements
Use Visual cues and aids ( once again…we do
this already. Lets put it into the context of
motivation)
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Visual Aid
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Open Ended questions?
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What brings you to the office today?
What can we help you with?
What have you been doing in your recovery
since we last met?
How did your recent interaction with your
employer go?
WE DON’T NEED STRUCTURED
INTERVIEWS TO STATE THE ABOVE
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Affirmation?
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That is great, seems like you are making
progress
That was a big step for you
You stated that very well
WE DON’T NEED STRUCTURED
INTERVIEWS TO STATE THE ABOVE
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Summarize?
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What I am hearing you say is…
You have done A, B and C and what like to do
D
Can I clarify what I think you want to do
WE DON’T NEED STRUCTURED
INTERVIEWS TO STATE THE ABOVE
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Elicit Self Motivational (change )
statements?
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Recognizing a problem exist ( example?)
Articulating concerns ( example?)
Expressing and intention to change
( example?)
Showing optimism ( example?)
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Change Talk
DARN-C
Desire
 Ability
 Reasons
 Need
And
 Commitment ( taking steps)
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OARS
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Open Ended
Affirmation
Reflective listening
Summarizing
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Deploy Discrepancy
Possible questions include:
 “How does your (drug use) fit in with your goals?”
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“How does the you ‘as a drug user’ fit in with the
‘you as… (their goals or positive self)’?”
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“Is there anything about your drug use you need to
change to get the things you want?”
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“How would things be in a year if you stayed the
same?”
Give praise & support self-efficacy
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“You recognize that things have to change for you
to attain your goals…”
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Ask for a Decision
Restate the client’s dilemma or ambivalence
Possible questions/comments include:
 “You were saying that your were trying to decide
whether to continue or cut down...”
 “After this discussion, are you more clear about
what you would like to do?”
 “So have you made a decision?”
Give praise & support self-efficacy
 “Congratulations, you’ve made an important
decision today. How do you feel about that?”
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Set a Short-Term Goal
Possible questions include:
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“What will be your next (first) step now?”
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“What will you do in the next one or two days (week)?”
 “Have you already been doing things to achieve this?
Can you do more of this?”
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“Who will be helping you on this?”
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“On a scale of 1-10 how confident are you that you will do
this next step?”
Give praise & support self-efficacy
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“That sounds like a meaningful goal. What will you need
to make sure you achieve it?”
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Practice Case
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Youth not wanting to consider usage of
cannabis as a problem
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CASE : Client background
You are 26 yr old youth who has been using
cannabis (in all forms) for 12 years. You
dropped out of school early, have not held
regular employment…..your parents are now
wanting you to leave their house. You are
denying that cannabis is the root to your
problems.
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Case : Clinician background
You are a case manager in the out patient MH services.
This client ( 28 yr old male) was referred to you by
the crisis team, as the client presented two weekends
in a row at ER and ended up in CRISIS, the client
demonstrated signs of cannabis psychosis
(schizophrenia type behaviors, denying drug use),
though a joint was found on person in both episodes.
He is denying that Cannabis is a problem. He dropped
out of school early and is not very employable. His
parents want him out of the house. Your goal is to at
least have him admit some problem use.
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Next Steps
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Practice, practice, practice
Other?
BOOK training session
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Thank You
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Resources
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Motivational interviewing In the Treatment of
Psychological problems. ED Miller W. Arkowitz, H.
Westra, H. Rollnick, S., Guilford Press, New York
NY. 2008
Motivational Interviewing In Health Care.Rolnick,S.
Miller, W. Butler, C., Guilford Press, New York NY.
2008
Motivational interviewing: Preparing people for
change. Rolnick,S. Miller, W., Guilford Press, New
York NY. 2002
Addiction and Change; how addictions develop and
addicted people recover. DiClemente, C.,
Guilford Press, New York NY. 2003
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