title of presentation - unc school of social work · motivational interviewing with marty weems,...

Motivational Interviewing with Marty Weems, LCSW, LCAS Sept 20-21, 2018

UNC Chapel Hill School of Social Work Clinical Institute 1

Motivational InterviewingIn Small Moments for Impactful Change

Marty Weems, LCSW, LCASMINT Trainer

September 20-21, 2018

UNC SCHOOL OF SOCIAL WORK CLINICAL LECTURE INSTITUTE



What is Motivation?

The probability that a person will enter into, continue, and adhere to a specific change strategy.

A Working Definition of MI

“Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.”

(Miller & Rollnick, 2013)



Core Concepts

Motivational Interviewing is comprised of…

MI

Spirit

Principles

Change Talk

OARS



Spirit of MI

• Collaboration

• Acceptance

• Compassion

• Evocation

Four Points of Acceptance

Absolute Worth

Affirmation Autonomy

Accurate Empathy



MI Principles

1. Express Empathy

2. Develop Discrepancy

3. Roll with Resistance

4. Support Self Efficacy

Embodying the Spirit & Principles of MI

• Understand the person’s frame of reference

• Accept and affirm

• Elicit self-motivational statements (change talk)

• Monitor readiness to change

• Support client’s autonomy



Understanding Ambivalence

• Ambivalence is feeling two ways about something.

• Types of ambivalence:

• Approach-Approach X Y

• Avoidance-Avoidance X Y

• Approach-Avoidance X

• Double Approach-Avoidance X Y

• Ambivalence is feeling two ways about something.



Inviting the Client to Change

Facilitating Change- MI ProcessesEngaging

Establish a working relationship

Focusing

Focus on what the person came to talk about

Evoking

Eliciting the client’s own motivation for change

Planning

The when and how change will take place



Change Talk vs. Sustain Talk

Sustain talk is language in support

of the status quo

Change talk is any language about

change

MI Hinges on Change Talk

•Desire

•Ability

•Reasons

•Need

•Commitment

•Activation

•Taking Steps



Sign of Readiness to Change

•Decreased resistance

•Decreased questions about the problem

•Resolve

•Change talk

• Increased questions about change

•Envisioning

•Experimenting



An In Depth Look at MI Processes



Engaging Skills

Key MI Skills

•Open-ended questions

•Affirmations

•Reflections

•Summaries

“Rowing with OARS”



Focusing Skills

• Sources of focus include:

• The client

• The setting

•Clinical expertise

•Styles of focusing:

•Directing

•Guiding

• Following



Focusing Techniques

• Agenda mapping

• Menu of options

• Providing feedback

• Summarizing

• Offering a concern

• Top three concerns

Easy as 1-2-3

• Write down 3 or 4 statements about some change that you are thinking about making within the next six months:

• D: Why do you want to make this change?

• A: How might you be able to do it?

• R: What is one good reason for making the change?

• N: How important is it, and why? (0-10)

• C: What do you intend to do?

• A: What are you ready or willing to do?

• T: What have you already done?



Providing Feedback

• Elicit-Provide-Elicit

• Elicit- ask permission to give information

• Querying interest in what information you have to provide

• Provide- impart information

• Elicit- ask client about understanding of information/how or she he feels about information

• MI Sandwich

Giving Advice

• Engage first

• Ask permission

• Emphasize personal choice

• Offer a menu of options



Evoking Skills

How Do We Elicit Change Talk?

• First use OARS

• Ask evocative questions

• Decisional balance

• Use rulers

• Ask for elaboration

• Querying extremes

• Looking forward

• Looking back

• Exploring goals and values

Focusing and Evoking Using Values



Responding to Change Talk?

• Elaborate (ask for an example)

• Affirm

• Reflect

• Summarize

• Clarify ambivalence

• Clarify values

Only reflect what you want to hear more of!



Planning Skills

Questions to Consider in Planning

• What are some specific areas or ways in which you want to change?

• What are some positive goals that you are thinking about? What do you hope will

• happen as a result of the change?

• What benefits can you expect from the change?

• Which motivations for change seem most important to you?



More Questions to Consider

• Within the general plan, what are some specific first steps you might take?

• When, where and how will you take these steps?

• What are some specific ways that others can help support you in your change attempt?

• How will you go about eliciting others’ support?

Planning Techniques

• Testing the waters

• Recapitulation

• Key question

• Recognizing and evoking CATs

• Change plan worksheet

Change Plan Worksheet



Dealing with Discord

Traps to Avoid

• Assessment

• Expert

• Premature Focus

• Labeling

• Blaming

• Chat

https://www.youtube.com/watch?v=RZWf2_2L2v8

https://www.youtube.com/watch?v=RZWf2_2L2v8



A Good RULE

• Resist the righting reflex

• Understand your client

• Listen to your client

• Empower your client

(Beware of the “righting reflex”)

Signs of Discord in the Relationship

• Defending

• Squaring off

• Interrupting

• Disengagement “Smoke signals” are a cue

For YOU to change course!

Also, be aware of what you

bring to the table.



Strategic Responses

• Reframing

• Shifting focus

• Apologizing

• Affirming

• Emphasizing personal choice

• Running head start

• Coming along side

(metaphor of Batting Practice)

• Review of learning

• Questions, comments, concerns

Thank you so much for your participation in the workshop!

Summary

title of presentation - unc school of social work · motivational interviewing with marty weems,...

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