MOTIVATIONAL

INTERVIEWING
By Thien Do, Jackelyn Huerta, Itzel Mendez, Shyemaa Shehata
Agenda

1. History of Motivational Interviewing

2. Theory of change
3. Role of therapists
4. Strategies for Helping Clients
5. Research on Efficacy
6. Evaluation
7. Role Play
 What is Motivational Interviewing?

Motivational Interviewing is a person-centered counseling style for addressing the common

problem of ambivalence about change
About Motivational
Interviewing | Stephen
Rollnick
 History of Motivational Interviewing

WILLIAM R. MILLER AND HIS WORK WITH ALCOHOLIC CLIENTS

● Summer internship under Dr. Hall
○ Had no prior experience with problem drinkers
○ Value of listening
● Research at University of New Mexico
○ Therapist empathy accounted for two thirds of the
variance in client drinking outcomes

NORWAY SABBATICAL
● Role-played with psychologists and taught reflective listening
● Students asked questions about his approach ⇨ helped him realize decision rules he was using
○ Avoided confrontation (e.g. “You need to do this”)
○ Arranged the conversation for clients to express arguments for change
● Wrote article titled Motivational Interviewing with Problem Drinkers (1983)
 History of Motivational Interviewing

AUSTRALIA SABBATICAL
● Met Steve Rollnick who encouraged Miller to write more about MI
● They wrote Motivational Interviewing: Preparing People to Change Addictive Behaviors (1991)
○ Client ambivalence: “I want it but I don’t want it”
○ Client commitment language
○ Spirit of MI

MILLER AND ROLLNICK COLLABORATION

● Motivational Interviewing: Preparing People for Change (2002)
○ MI in areas beyond substance abuse (e.g. healthcare, mental health, education)
● Motivational Interviewing: Helping People Change (2013)
○ Presented four processes ⇨ engaging, focusing, evoking, and planning
Theory of Change

● MI was not derived from a preexisting theory, but was developed based on strategies that were
found to increase clients’ motivation to change and reduce ambivalence in clinical settings
● It is important to understand the underlying processes of MI, in order to know when and how
treatment works
● There are a variety of processes by which MI can facilitate behavior change

Miller & Rose, 2009

 Therapist Style Predicts Client Outcomes

● A predictor of change is the client-therapist relationship

○ A strong positive relationships between therapist empathy and client
outcomes have been reported
○ The extent to which the counselor practices the MI Spirit is a
predictor of change
○ Other MI Consistent Methods predict change

MI Spirit and
Empathy
Behavior
MI Training Change
(Miller & Rollnick, 2012)
Use of MI-
Consistent
Methods
MI influences Change Talk

● Clients who are thinking about change are in a state of ambivalence

● Ambivalence is characterized by a combination of change talk and sustain talk
○ Change talk: client statements in favor of change
○ Sustain talk: client arguments for not changing
● When therapists seek to persuade clients for the need for change, resistance result
○ Promotes sustain talk
● MI practices move clients away from sustain talk and towards change talk

Persuading
Clients of the Sustain Talk
Need for Change

MI Spirit and
Change Talk
Practices
 Change Talk Predicts Behavior Change

● There are several categories of change talk: Sustain Talk No Behavior

Change
○ Desire
○ Ability
○ Reason Change Talk Commitment to Behavior
○ Need Behavior Change Change
○ Commitment
● Only commitment talk has been found to be a strong predictor of change
● Desire, ability, reason and need are preparatory steps towards commitment
● Using MI encourages a client’s statements of desire, ability, reason and need for change, with the
goal of eliciting an increasingly strong commitment to change in the form of specific goals and
plans
Theory of Change
 Role of Therapists

When individuals face life changes that lead Career

to ambivalence, the role of the interviewer in
motivational interviewing is to elicit a
person’s own motivation to change through
self-motivational statements. School Diet
Decisions that
Interviewers create a non confrontational
require change
environment that is a collaborative effort
during lifetime
between the interviewer and client.

The client may express his or her feelings

and ambivalence about changes and by not
acting in a combatic way, the interviewer Marriage
could spark motivation and change.
 Role of Therapists

In MI, the therapist asks questions that will make it more likely that the client
will talk about change, rather than spending time telling the client what to
do. This creates a shift from sustain talk→ change talk
Effective questions ask about:
○ problems with the status quo (how does your behavior make
your life more difficult now?)
○ advantages of changing (how would your life be better if you
changed the behavior?)
○ disadvantages of not changing (if you don’t do anything, what
might be some bad things that could happen?)
○ intention to change (how certain are you that you will follow
through with your plan by next week?)

Example: “I think my blood pressure would go down if I quit smoking”

 Role of Therapist in the Context of the MI Spirit

The MI spirit is more than a set of techniques, it is more of a

“way of being” and is the foundation of every MI conversation
The MI Spirit includes 5 principles:
Collaboration: MI is a collaborative conversation between two equals
Acceptance: The therapist accepts the absolute worth of the client and
honors his or her autonomy
Compassion: the therapist practices MI with the best interest of the client
at heart
Evocation: The therapist recognizes that the potential for change and
growth exists within the client and the therapist’s role is to guide the
conversation to strengthen and evoke this potential
 Role of Therapists

Things to remember….

Express Empathy Develop Discrepancy Roll with Resistance Support Self-Efficacy

(a belief in change)
✻ Build an understanding of the ✻ Have the client point ✻ Expect there to be some
client’s issues, struggles, and out the disparity resistance and reluctance ✻ Work to illustrate areas of
barriers of improvement. between what they are from the client strengths and compile a
✻ client becomes more open and doing and what their ✻ Work to understand the number of instances
goals are. client’s point of view where the client was able
free since there is a lack of
✻ If the goal is to be ✻ Avoid the desire to correct to accomplish their goal.
judgment and criticism
happy and have a what may be viewed as
✻ A therapist might say, “I can successful career, flawed ways of thinking
understand why using drugs using drugs daily may while offering alternative
seems appealing in this get in the way of that. ways of thinking for the
situation.” client to consider
Strategies for Helping

Feedback
Responsibility
Advice
Menu
Empathy
Self-efficacy
(Lewis & Osborn, 2004)
Strategies for Helping

There are four fundamental processes in MI:

 Strategies for Helping

Basic Skills:
● Core Interview Skills: OARS
● Using DARN-CAT acronym to gauge
where client is in his/her commitment
to change
● Responding to Change Talk vs Sustain
Talk
Using Your OARS: Putting the MI Spirit into Action

● Open ended Questions: Question that invites the client to think before
responding and offers broad latitude in how to respond
● Affirmations: Observations of strengths and resource of the client that are
● based on evidence from the conversation with the client
○ Different from praise
● Reflections: An empathic interviewer statement intended to mirror
meaning of client’s speech
● Summaries: reflections that pull together several things that the client has
said
Research on Efficacy

PROJECT MATCH (1997)

● Studied which types of alcoholics respond best to which

forms of treatment
○ Cognitive Behavioral Coping Skills Therapy (CBT)
○ Motivational Enhancement Therapy (MET; MI +
feedback)
○ Twelve-Step Facilitation Therapy (TSF)
● All three techniques were equal in effectiveness
○ Increased percentage of abstinent days and
decreased number of drinks per drinking days
○ Four MET sessions had same effects to 12
sessions of CBT and TSF on treating disordered
drinking
 Research on Efficacy

Lundahl, B., & Burke, B. L. (2009)

● Review of four meta-analyses using MI for a wide variety of problems from substance use, diet/exercise, and risky behaviors
● All studies showed positive small-medium effect sizes
○ More effective than no treatment: 20% would do better after only 2 sessions of MI
○ Equal and potentially more effective to other treatments
● MI averaged about 100 minutes less
● MI effects are durable up to 6 months beyond treatment
Using MI in Schools

● There has recently been interest to use MI with middle and high school
students
● MI’s brevity makes it appealing to be used in schools
● Several factors make MI conducive to be used with younger populations
(Herman, Reinke, Frey, & Shepard, 2013)
○ Youth, like adults like to experience consistency between their actions and
values
○ MI’s principle of emphasizing autonomy and personal responsibility is
consistent with an adolescent’s strive for autonomy
○ Imposing and enforcing goals is rarely effective at promoting lasting
change in children and adolescents
 Using MI in Schools

● Until now, there have been only a few controlled experimental research studies in
school settings, or with people under the age of 17
● In two studies, middle school students who participated in a single session of MI
showed significant improvements in class participation, self-reported positive
academic behavior, and higher math grades (Strait et al., 2012; Terry, Strait, Smith,
& McQuillin., 2013)
○ MI can be used to motivate students to make and commit to academic goals
Using MI in Schools

● Group MI with teenagers has been shown to be associated with decreased

alcohol intentions, alcohol use, and heavy drinking 3 months after intervention
(D’Amico et al., 2015)
● A meta-analysis of 21 studies showed that MI intervention produced small but
significant results for changing adolescent substance abuse (tobacco, alcohol,
marijuana, illicit drug use) (Jensen et al., 2011)
○ Majority of MI interventions consisted of a single session
● Although these studies did not take place in a school setting, they suggest the
potential of using MI in schools to help students engaging in risky behavior
● Research currently being conducted to explore the use of MI to promote
behavior change among youth who bully
MI with Elementary Age Children

● Caution should be used in implementing MI with younger,

elementary age students, as it may not be developmentally
appropriate for them
● Young children may not have the cognitive skills needed to
benefit from MI
○ Long-term planning, awareness of one’s values (Strait,
McQuillin, Smith, & Englund, 2012)
● More research needed
The Use of MI with Parents and Teachers

● MI can be used with parents of young children

● MI has been integrated into the Family Check-Up, which is an intervention designed to reduces
children’s problem behaviors by improving parenting and family management practices (Frey et
al., 2011)
○ Parenting strengths are identified, autonomy of decision making is promoted, and the
development of a menu of options for effective family management practices is developed
○ The result has been increased parent involvement, increased school-readiness, and
decreased conduct problems for at-risk children
● The Classroom Check-Up is an intervention designed to increase teachers’ use of evidence-based
classroom management strategies
○ MI is integrated into this intervention that are used to identify teacher strengths, promote
autonomy in the decision making process, give guidance when requested, encourage
teacher self-efficacy, and development of a menu of change options
The Use of MI in Everyday Conversations

● The spirit principles of MI can be used in everyday conversations about change with
students, teachers and parents
○ expressing empathy, using reflective listening and and supporting self-efficacy
○ supporting a consultee’s personal choice, while avoiding taking on an ‘expert role’
○ these principles support the establishment of a relationship based on respect and
trust
● Examples:
○ Talking with a parent about a student’s behavior or performance problem (e.g.
tardiness)
○ Talking with a teacher who struggles with classroom management
○ Talking with a student about why he/she is not completing school work
Similarities between SFBT and MI

● Both are client-centered approaches that can be considered

reactions to problem-focused type therapies
● Collaboration is key in both MI and SFBT
○ Client and therapist are equals in the relationship and the
client is considered an expert
● Both MI and SFBT make use of client strengths and resources
as a means of promoting change
● Both take the perspective that the clients have the ability to
evoke positive change in their lives
● Both are designed to be brief interventions

(Lewis & Osborn, 2004)

 Differences Between SFBT and MI

SFBT MI

Emphasizes identifying exceptions with little time spent on Emphasizes assessing what step towards change a client is at
assessing the client’s relationship with the problem (Desire, Ability, Reason, Need, Commitment)

Therapist takes more of a following style, honoring the client’s Therapist takes more of a guiding style, moving client from
preferences for change and believing that the client can comes up ambivalence to a commitment to change; includes offering advice
with solutions with permission

Present and future focused; emphasizes what client will be doing Present-focused, addressing client’s current stage of change
differently when the problem is solved

Lack of empirical research supporting efficacy; most evidence is More than 200 research articles supporting efficacy
anecdotal

(Lewis & Osborn, 2004)

Role Play

Itzel is a 17 year old high school senior. Her

parents have brought her in to see a counselor
because they are concerned about her alcohol
use.
Role Play Analysis

● What differences did you notice between the two

scenarios?
● What Motivational Interviewing strategies did you
notice the counselor use in the second scenario?
● What was different about the student’s response?
Role Play Analysis: Scenario 1

● Counselor conveys judgement and puts the student on the

defensive→ encourages sustain talk and discourages client
from opening up
● The counselor lectures and uses scare tactics about the
potential consequences of drinking
● Counselor takes on an expert role and comes up with the
goals
● Counselor tries to push his own goals on the client
 Role Play Analysis: Scenario 2

● Student’s autonomy is emphasized from the outset; the counselor tries to convey that they are equals
● Open ended questions and reflections are used throughout to encourage client to open up to the
counselor
● Counselor uses affirmations of client’s good decisions, and expresses empathy with the current stress
she is experiencing
● Summaries are used by the counselor throughout to tie ideas together and convey to the client that he
understands and empathizes with her
● Counselor evokes the client’s values and elicits her own reasons for change and setting limits
○ encourages the client to talk about what concerns she had about drinking
○ helps to develop a discrepancy between values and actions
○ encourages the client to set her own goals and come up with a change plan
● The client’s speech can be observed to be shifting from sustain talk to change talks as the session
progresses
 References

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