Introduction to Motivational Interviewing

hello everyone and welcome to this brief introduction to motivational interviewing I'm dr. bill matulak clinical psychologist a motivational interviewing trainer and the author of the ebook how to do motivational interviewing which is available as they say wherever fine ebooks are sold so today I just want to share with you a brief slide presentation outlining the basic concepts of motivational interviewing for you and the best place to start I guess is with a definition so here's my definition of motivational interviewing motivational interviewing is an effective way of talking with people about change so this is a

simple definition it's not as technical as a textbook definition but I think it will suffice for the simple introduction to motivational interviewing that I'm outlining for you on these slides so what do I mean by effective I mean that it's evidence-based that motivational interviewing has about 1,200 publications or more and all kinds of prestigious journals covering motivational interviewing is use in a wide variety of problem areas professional settings and actually many different countries as well so why is it even necessary to have something like motivational interviewing shouldn't people just naturally change their behavior when they

know how important it is for them to change well common practice would certainly suggest that this is the case oftentimes counselors will just give people information or advice and expect them to change their behavior but professional counselors change agents of one kind or another know that change is not quick and easy in fact sometimes change is very slow and difficult so what kind of changes am I talking about well people face many decisions that require some sort of change at every stage of life children need to decide whether or not to do their homework for

example people make career decisions and who to marry how many children to have one day have children things like that later in life difficult decisions include things like medical decisions retirement living alone or moving into a retirement home or senior living for example or sometimes just accepting help people have been used to being independent all their lives may have a making the change - just accepting the help that they need but as I've mentioned before these decisions a change you're often very difficult occasionally I'll ask my workshop students for example how long it was between

the time that they knew that they had to make it a significant change in their lives and the point at which they actually made the change it doesn't surprise me anymore that many people say that it took six months or longer to actually make the change so when change is hard it's usually not because or it's often not because of lack of information or laziness or oppositional personality or denial or resistance or any of those kinds of things sometimes it is you know matter of lack of information that person is already motivated and just needs

some information but oftentimes it's because it's a motivational issue and when change is hard it's sometimes because people are ambivalent they're stuck in an ambivalent stage and ambivalence is just wanting and not wanting the change or wanting incompatible things at the same time the problem with ambivalence is that it leads it's uncomfortable it leads to anxiety or produces anxiety and anxiety because we like to avoid anxiety we oftentimes will procrastinate about making a change or making a decision in our lives because we don't like to be anxious as a person gets stuck though in this

ambivalent stage continually procrastinating about making a decision this oftentimes is mistaken on the part of the counselor for resistance now in motivational interviewing we don't talk much about resistance anymore we don't use that word what is thought of as resistance or what used to be thought of as resistance is to a great extent simply ambivalence it's a natural ambivalence is actually a natural condition of being unsure about making a change it's a normal consequence about thinking of thinking about the pros and the cons of making a change when people get stuck here though and change

doesn't happen as quickly as the counselor thinks it should it could look like the client is being resistant so how does motivational interviewing help well motivational interviewing helps by resolving this ambivalence and helping the client the person move towards healthy behavior change it also helps by eliciting a person's own motivation to change listening their own arguments for making a change in in a healthy direction so what are the some of the underlying concepts of motivational interviewing well the first one is the spirit of motivational interviewing and this is described by four words the first word

is partnership which refers to the fact that in motivational interviewing the counsellor and the client work collaboratively together and the counsellor avoids the expert role the second word is acceptance and this refers to the fact that the the client respects that the counsellor respects the clients autonomy their irrevocable right to make decisions about their own lives their potential their strengths and their perspective we try to see the world through the clients perspective compassion refers to the fact that we keep the clients best interest in mind and the last word is II vocation which refers to

the idea that the best notions the best ideas about change come from the client those are the ones that the client is going to act on much more readily than ideas that come from the counsellor so in order to do motivational interviewing there are four skills that are necessary to master these core skills are open questions affirmations reflections and summaries these are nothing new to motivational interviewing or nothing unique to motivational interviewing these are basic counseling skills that people have learned if they take a basic counseling class if you take the first letter of each

one of these skills it spells out the word ORS and we use that acronym sometimes to refer to the four skills we say that we are using our oars skills so here are some examples of some of the oars skills open questions are questions of course that call for more than a yes or no answers so this question up there are you in pain is not an open question it's a closed question a more skillful open question would be something like how do you feel how much alcohol do you drink a day is a closed

question that could be changed to what role does alcohol play in your life an open question don't you want to move to a safer place cause pretty much for a yes or no answer what are the advantages that you see in moving to a safer place is an open question that calls for more of a discussion in motivational interviewing we try to ask more open questions than close questions we do this in order to encourage the client to talk about what's on his or her mind rather than questioning the client based on what's on the

counselors mind or based on the counselors agenda the second skill is the skill of affirmations now affirmations are simply statements about anything positive that the counselor notices about the client Awards attempts achievements accomplishments prior successes anything that we can point out to the client here's some examples of affirmations you really care a lot about your family this is hard work you're doing you were successful in changing in the past that took a lot of courage coming in today knowing that you had a dirty urinalysis these can all be examples of affirmations now we use affirmations

in motivational interviewing to build a sense of self-confidence or a sense of self-efficacy the third skill is maybe the most important skill in motivational interviewing or the most important of the four core skills at any rate and that's the skill of reflective listening reflections are simply understanding what the client is thinking and feeling and then saying it back to the client reflections are statements not questions here's some examples of reflections this is a person coming in to talk about post-traumatic stress disorder to a counselor and he might say something like I don't think that I

have post-traumatic stress disorder so a reflection might be you're not sure about the diagnosis of PTSD I've been this way for so long I think it's just my personality so all of this seems normal to you well I don't like the road rage or getting angry with my wife road rage and anger at your wife or a couple of things you'd like to change so you see that there are no questions there those are all reflections now we use reflections in motivational interviewing to convey empathy and understanding and especially to be able to start to

see the world through our clients eyes the fourth skill is summarizing and summaries are simply long reflections of more than one client statement here's a woman thinking about moving to a retirement home or senior housing something like that and she's in the ambivalent stage and she's making arguments for both moving and not moving at the same time so she might say something like I don't want to move I like my house I've been there for a long time I'm worried about falling though I'm a bit unsteady on my feet these days but I'd have to

change doctors and that would be a hassle for me but if I move maybe I could move closer to my grandchildren I might be able to see my grandchildren more often and I might feel safer in senior housing so there's lots of different ways that you can respond to these statements that the woman is making but if you wanted to summarize the summary might go something like this if I understand you correctly you've been thinking of moving to senior housing there's a downside and that you'd have to find new doctors and it would be unfamiliar

you also think you'd be safer and senior housing and could be closer to your grandchildren and there's a number of different uses for some reason motivational interviewing the most important maybe is that summaries provide an opportunity for the council to become strategic and guide the client toward healthy behavior change by selectively summarizing the clients own reasons for change now I'm motivated interviewing there are four processes there's engaging focusing evoking and planning and these four processes are somewhat sequential in nature and that you have to engage your client before you can focus on a particular topic

or behavior to change you need to focus on that topic before you can evoke motivation then you have to add motivation before you can do any planning so let's look at each one of these in a little bit more detail engaging is defined as the process of establishing a trusting and mutually respectful relationship now this isn't unique or exclusive to the practice of motivational interviewing but it just makes sense that you need some connection with your client before you can even begin to talk about the client changing their behavior so other words that you may

have may be more familiar with or tuning to your client aligning with your client you with your client establishing a therapeutic relationship connecting with your client all of these kinds of things refer to the same process in motivational interviewing it's the process of engaging now in motivational interviewing it's just as important to know what not to do what to avoid as it is to know what to do and nowhere is this more important than in the first process of motivational interviewing process of engaging one of the things that you want to avoid then is the

assessment trap or assessing your client asking a whole bunch of questions right off the bat is off-putting your client is not really going to be engaged with you if that's all that you're doing is just asking a bunch of questions and all I have to do is just sit there and answer question after question that's not engaging to your client so you want to avoid assessing your client right off the bat another thing that you want to avoid is telling your client how to fix their problem so if you make a quick diagnosis the council

makes a quick diagnosis and then offers a solution this also is not going to be engaging so you want to avoid telling your client how to fix their problem a power differential is something else that may turn your client off in terms of these establishing a useful relationship if you come across as some authority figure for example sometimes people don't really like that and that may interfere with the engaging process labeling is something else that also may interfere especially if you insist that the client accept the label before they can be helped in any way

so all of those are ways that that you can interfere with the engaging process and things that you want to avoid so what is engaging well anything that helps the client feel welcome comfortable understood if you exceed your clients expectations if your client feels that she and you have mutual goals or if the client leaves feeling hopeful then you've engaged your client in the process now there's a number of different ways that you can do these kinds of things for example helping them feel welcome just shaking their hand using their name pronouncing it correctly these

kinds of things but one of the most important things is for a client to feel understood the second process in motivational interviewing is focusing focusing is defined as an ongoing process of seeking and maintaining direction now focusing involves setting an agenda or agreeing on an agenda we set this agenda while considering the clients goals and priorities as well as the councilors goals and priorities as well as the agency's goals and priorities for example and the whole purpose is an effort to create a clear direction for ultimately developing a change plan so how the council accomplishes

this is again with the use of the four basic or skills and the skillful use of listening carefully to your client the third process and motivational interviewing is evoking and evoking is defined as eliciting a client's own motivation for change what you're evoking here really is change talk so what is change talk well change talk is defined as client speech that favors movement in the direction of change any kind of conversation that your client is giving you any kind of statements about I want to change I wish I could the reasons are I will I

can it would solve these problems and so forth that's all change talk well in motivational interviewing we pay a great deal of attention to change talk when we get it we reinforce it we encourage it we try to get more change talk because we know that the more a client engages in change talk the more that they argue for change themselves more likely it is that they're going to change their behavior so if we're not getting much changed talk then we want to do some things to encourage that one of which is that you can

just ask questions that would generate quite change talk so here's some examples of a few questions that you could use to generate some change done why do you want to make a change what are the reasons from your point of view to make a change what would some of the benefits be as far as you're concerned how might you go about making the change if you wanted to be successful how might you go about doing it and what would be your first step or what would you be your next step or what options do you

see yourself having so all of these would generate some change time the fourth and final process of motivational interviewing is the planning process and planning is defined as developing a specific change plan that the client agrees to and is willing to implement in using the four basic skills the or skills the skillful motivational interviewing counselor has already engaged the client focused on a particular topic elicited some change talk and within that change talk there are not only reasons that the client sees for making the change and benefits that would accrue if they were to make

the change but also ways that the client could make the change and be successful at that and these are important to pay attention to during those phases or those processes of motivational interviewing so that when it comes to the planning phase then it's just a process of going from a general concept to developing a specific plan the plan needs to be a smart plan it needs to be specific measurable achievable relevant and time and once you get a plan that is smart then that would be the end of motivational interviewing so that's a brief introduction

to motivational interviewing motivational interviewing in a nutshell so to speak so I hope it's been useful to you and helpful if you'd like further information you're welcome to visit my web site ww-will interviewing online.com and until next time we meet I wish you joy and success in your work and peace and happiness in your life thank you very much for watching see you next time