Video: Approaches to Treatment: Motivational Interviewing

This video looks at the theory behind Motivational Interviewing and introduces basic counselling techniques.

About this video

Production date: November 2009
Length: 1 hour, 18 minutes
Presenter: Kevin Fisher
Download slide notes for this video (PDF, 32 pages)

Kevin Fisher is a Registered Psychologist and a Motivational Interviewing Network Trainer with a private practice in Edmonton, and Wetaskiwin, Alberta. His past work with the Alberta Alcohol and Drug Abuse Commission involved persons with FASD. Kevin has consulted on motivational interviewing and brain injury for the Northern Alberta Brain Injury Society, the Alberta Brain Injury Network, and the Centennial Centre for Mental Health and Brain Injury in Ponoka, Alberta.

Outcomes

This video will help you understand:

  • philosophy and theory behind Motivational Interviewing (MI)
  • basic counseling techniques
  • how to identify and work with client resistance

Content

  1. Introduction (12:26)
  2. Stages of change (5:39)
  3. The philosophy and principles of MI (12:00)
  4. What is motivational interviewing? (14:39)
  5. An introduction to OARS (13:19)
  6. Change-talk (19:45)

Introduction

  • MI research in relation to FASD examines effectiveness with pregnant women, women of child bearing age and prevention
  • the purpose of MI is to evoke behavioural change
  • MI usually involves certain goals, such as targeting a behaviour or series of behaviours
  • client resistance is often rooted in fear of change or failure or may also be related to practices or behaviours of the interviewer
  • client interview is a conversation with questions of interest visited
  • interviewer role is mainly one of listening and guiding conversation
  • not for everyone at all times
  • MI works well for unsure clients who have two conflicting feelings about something
  • most people are not resistant to change, but they often resist being changed
  • adopt a non-cohesive approach, encouraging client to talk through alternatives and make their own changes

Stages of change

  1. Pre-contemplation – don’t want to change or don’t care about other side
  2. Contemplation – belief that 2 things are possible, but not sure which one they are committed to (most people are contemplative)
  3. Preparation – planning to change (no actual change yet)
  4. Action – doing things in order to make change
  5. Maintenance – until they experience a lifestyle change
  6. Termination – terminated change process or completed the change

The philosophy and principles of MI

To be effective, the practitioner has to agree with the philosophy and principles of MI.

Philosophy

3 philosophical qualities

  1. Autonomous vs. authoritative
  2. Collaborative vs. persuasive
  3. Evocative vs. instilling

Principles

Express empathy

  • reflective listening (listen honestly, reflect openly)
  • accept the person, not necessarily their action
  • attitude has to express a desire to engage and connect

Roll with resistance

  • respect their decision
  • avoid arguing for change
  • acknowledge that resistance is a natural reaction to change

Develop discrepancy

2 choices:

  1. change behaviour to correspond to value system, or
  2. change value system to correspond with behavior

Use discrepancy to increase client’s awareness of the importance of change.

Support self-efficacy
  • encourage change-talk
  • focus on qualities to increase confidence and ability to bring about change

What is motivational interviewing?

Motivation is the expressed likelihood that someone will engage in a certain behaviour at a particular time.

  • it can change radically and rapidly
  • it’s a state, not a trait

Motivational interviewing is a client-centered direct method for enhancing a core drive to change by exploring and resolving ambivalence.

  • it’s optimistic and humanistic
  • ambivalence and resistance are viewed as normal
  • it’s an interpersonal phenomenon

Three goals of MI

  1. Get client to express their concerns about current behaviour and begin to make arguments about change
  2. Assist client to develop readiness, willingness, and ability
  3. Help client move from state of confusion to “change talk”
    • how, why and when they will make change includes anything that favours movement in the direction of intended change

Eight dangerous assumptions

  1. The counselor is the expert.
  2. A tough approach is best.
  3. Clients are either motivated or not.
  4. The person is ready to change.
  5. The person ought to change.
  6. The person’s health is a prime motivating factor.
  7. If the person decides not to change, the counseling has failed.
  8. Now is the right time to change.

Six traps to avoid

  1. Question-answer
  2. Taking sides
  3. Expert role
  4. Labeling
  5. Blaming
  6. Premature focus

An introduction to OARS

OARS stands for:

  • Open ended questions
  • Affirmations
  • Reflective listening
  • Summarize

Open ended questions

Questions that invite the client to speak at least 50% of the time without agenda, with no ‘yes’ or ‘no’ answers.

  • with FASD clients, questions need to be more concrete and specific and/or closed-ended questions when client lacks insight
  • forced choice questions such as ‘would you choose this or that?’
  • discuss events directly after questioning
  • when information comes out, abandon questioning and reflect on what they are saying, as it’s important to them

Affirmations

Anything you can say positively increases the likelihood that they can change in the future.

  • especially true with FASD clients
  • need to be based on something concrete
  • used as rapport building, highlight strengths and resources
  • used as a directive element

Reflective listening

What people say is what they hear, think about and do. By reflecting positive change, statements and healthy choices, you can increase likelihood of positive change.

  • repeat back to them the healthy things they say
  • rule of thumb: listen reflectively, at least twice as often question
  • with FASD clients: reflect it immediately since it may be forgotten later; reflect and affirm
  • use short sentences, less abstract speaking and thought
  • reflect actions and behaviours, not just words; for example “I heard that you did” is a form of reflection

Summarize

Summaries are a form of reflection, bundling up all the good stuff they’ve said and giving back to them.

Summaries allow people to hear their own change-talk 3 times:

  • once when they say it
  • once again when reflected back to them
  • when you summarize it

Types of summaries

  • Collecting summary – like collecting flowers one at a time and giving back to the client in a bouquet.
  • Linking summary – very important with FASD clients. Use to make a connection between one thing and another. FASD clients may like linear insight; you are connecting the dots for them.
  • Transitional summary – a way of tying something up, moving conversation along while acknowledging that you have heard what they are saying.

Summary tips for clients with FASD

  • always note the important points of the session and restate them at the end
  • can help to write them down to keep them mindful of them
  • talk about the connections (connecting the dots), reflect back results of their actions and behaviours
  • summarize past sessions to remind them

Change-talk

What people say about change effects the likelihood that it actually occurs:

  • the more one argues against change the less the likelihood of making a change
  • the client needs to hear themselves talk about Desire, Ability, Reasons, Needs (DARN)
  • reflective listening to DARN language often moves the client to the intentional stage of change
  • confrontation at this point increases resistance
  • next part of change talk is CAT:
    • Commitment
    • Activation
    • Taking steps

Responding to 2 categories of change talk (DARN CAT):

  1. Change-talk for people who are ambivalent.
    • Do not reflect action or this will produce resistance.
    • Listen to change.
  2. People who are in preparation and talking about making change.
    • Recognize negative of status quo, but do not reflect that.
    • Emphasize optimism and reflect.
    • Intention Change talk.
    • Recognize positives of change.

Working with FASD clients

  • role playing is helpful, and helps practice skills
  • use narrative story telling
  • give reflections and affirmations
  • simplify
  • involve supports in MI process
Created:
Modified: 2015-09-09
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