MOTIVATIONAL INTERVIEWING: FOCUSING ON CHANGE TALK
Trainer Denna Vandersloot, M.Ed.
The ATTC Network
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HOW MI IS DIRECTIONAL Selective Selective Selective Selective Selective
eliciting questions reflections elaboration summarizing affirming (William Miller , 2010)
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Motivational Interviewing: Helping People Change Third Edition What’s new…..
Primary Source 4
A CLINICAL DEFINITION OF MI
“A person-centered counseling style for addressing the common problem of ambivalence about change.”
Miller & Rollnick, 2013 5
Change Talk
Ambivalence Sustain Talk
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Partnership
Evocation
Spirit of MI
Autonomy
Compassion 7
FOUR PROCESSES OF MI
Planning
Evoking Focusing
Engaging 8
ENGAGING “Shall we travel together?”
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FOCUSING “Where shall we go?”
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EVOKING Whether and Why?
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“We are usually convinced more easily by reasons we have found ourselves than by those that have occurred to others.” Blaise Pascal (1623-1662) 12
Evoke
Respond
CHANGE TALK
Recognize
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PREPARATORY CHANGE TALK
DESIRE ABILITY
REASON NEED
WHAT’S NEXT? DARN
statements by themselves do not trigger change.
COMMITMENT is missing: “I “I “I “I “I “I
will…” plan to…” intend to…” am ready to…” will think about…” will consider…”
Preparatory Mobilizing
Desire Commitment
Ability
Activation
Reason
Taking Steps
Need Behavior Change Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology.Vol 71(5) Oct 2003, 862-878.
CHANGE TALK
Evoke
Respond
CHANGE TALK
Recognize
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Eliciting Change Talk
Amrhein et al., (2003) 18
Can Counselor Influence Change Talk?
Glynn & Moyers (2010)19
HOW DO YOU ELICIT/EVOKE CHANGE TALK?
Asking evocative questions Exploring the decisional balance Good things/Not so good things Elaboration Querying extremes Looking back/looking forward Exploring goals and values Using the Importance Ruler Coming Alongside 20
WHAT TO DO IF THE PERSON DOESN’T SEEM TO EVEN BE AMBIVALENT?
Providing Feedback Exploring other’s concerns Exploring goals and values Honoring autonomy “Running Start” technique
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Evoke
Respond
CHANGE TALK
Recognize
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SNATCHING CHANGE TALK FROM THE JAWS OF AMBIVALENCE
Change talk often comes intertwined with sustain talk That’s the nature of ambivalence (William Miller, 2010)
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SNATCHING CHANGE TALK FROM THE JAWS OF AMBIVALENCE “I know I should keep taking the medication, and the voices do stop when I’m taking it, but I can’t handle the way it makes me feel.” You don’t like the way the meds make you feel. You recognize the importance of taking your meds One reason to take the meds is to stop the voices
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SNATCHING CHANGE TALK FROM THE JAWS OF AMBIVALENCE “I really don’t want to quit cutting altogether, I know I probably should. I’ve tried to stop before and it’s hard.” You really don’t want to stop cutting You recognize the importance of not cutting You’re not sure if you can quit.
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RESPONDING TO CHANGE TALK ALL EARS E: Elaborating: Asking for elaboration, more detail, in what ways, an example, etc.
A: Affirming – commenting positively on the person’s statement R: Reflecting, continuing the paragraph, etc. S: Summarizing – collecting bouquets of change talk 26
RESPOND USING YOUR EARS
Elaboration/Example Affirm Reflect Summarize
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EVOKING PHASE EXERCISE
Practices using Recognizing, Evoking and Responding strategies Work in triads or dyads Speaker plays role of script Listener plays role identified on card Identify change talk (internally) Use evoking strategy followed by EARS 28
LISTENER ROLE
1. You are moving from focusing to evoking 2. Listener: Select 2-3 Evoking strategies you want to use from card deck 3. Use one strategy at a time and follow up with EARS before moving to the next strategy 4. Goal: to practice skills and gather change talk 29
OBSERVER ROLE
• Listen carefully to the speaker and using the Change Talk Observer Sheet write-down each piece of change talk you hear….. • This is an important role because you can help your team “WIN” 30
EVOKING MENTAL SHIFTS & MI SKILLS Mental Shifts: • Evoke don’t install motivation • Requires a Focus • Letting go of gathering the facts first MI Skills: • Eliciting change talk strategies • OARS • Developing Discrepancy Miller, 2012
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School of Medicine Department of Public Health and Preventive Medicine Northwest Frontier Addiction Technology Transfer Center 3181 SW Sam Jackson Park Rd. CB669 Portland, OR 97239 Traci Rieckmann, Ph.D., Principal Investigator Denna Vandersloot, M.Ed., Project Director
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RESOURCES FOR LEARNING MOTIVATIONAL INTERVIEWING Motivational Interviewing (2013), Miller & Rollnick Enhancing Motivation to change in Substance Abuse Treatment, Tip 35 www.samhsa.gov National Clearing House www.motivationalinterview.net (training tapes, articles, bibliographies, training opportunities) www.motivationalinterview.org (MI resources ATTC website) Motivational Interviewing in Health Care (2008) Rollnick, Miller, and Butler. 33
REFERENCES Miller W. & Rollnick S. (3013) Motivational Interviewing: Helping People Change. Rollnick S., Miller, W. and Butler, C. (2008) Motivational Interviewing in Health Care. Glenn, L.H., Moyers, T. B. (2010) Chasing Change Talk: The clinicians role in evoking client language about change. Journal of Substance Abuse Treatment , 39, 65-70. Amrhein, P.C. et al. (2003) Client commitment language during MI predicts drug use outcomes. Journal of Consulting and Clinical Psychology, 71 (5), 862-878. D`Ofrino, G. et al. (2005) Yale Brief Negotiated Interview 34
