Motivational Interviewing The Language of Change Presented by

Motivational Interviewing: The Language of Change Presented by Brett Dowdy, Psy. D.

Why do people Change?

“Given a choice between changing and proving that it is not necessary, most people get busy with the proof. ” John Galbraith

Components of Change Resistance Ambivalence Motivation

“People often get stuck, not because they fail to appreciate the down side of their situation, but because they feel at least two ways about it. ” Miller & Rollnick

Ambivalence Experiment • • • Choose a partner. One will be the speaker & one the interviewer. Identify something you want to, need to or should change about yourself but haven’t – something you’re ambivalent about!

Ambivalence Experiment • Interviewer – Find out what change the person is considering, and then: • • • Explain why the person should make the change. Give at least 3 specific benefits that would result from making the change. Tell the person how they could make the change. Emphasize how important it is to change. Persuade the person to do it. If you meet resistance, repeat the above.

Motivational Interviewing MI is a collaborative, goal-oriented style of communication with a particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.

Essential Ingredients: Moving individuals toward change!

Listening Strategically: Change Talk vs. Sustain Talk Change Talk - words that favor moving in the direction of change Sustain Talk - words that favor leaving things the way they are

Change Talk Invite the client to argue for change! Explore DARN-CATs Preparatory Change Talk Desire – want, prefer, wish, etc. Ability – able, can, could, possible Reasons – specifics for change (i. e. , Why do it? What would be good? ) Need – important, have to, need to, got to Implementing Change Talk Commitment – intention, decision, promise Activation – willing, ready, preparing Taking Steps

Recognizing Change Talk Plucking Change Talk from the Jaws of Ambivalence “I really don’t want to do another treatment program, but I know that I should. I’ve tried them before and it’s really hard to leave my family. ” Would you say: • You really don’t want to get better. • It’s pretty clear to you that you ought to give it another try. • You’re not sure you can do it again. It’s been so hard.

Eliciting Change Talk Plucking Change Talk from the Jaws of Ambivalence “You know, I’ve been able to accomplish a lot of things in my life, but this one is just too big for me. Every time I think I’ve got it beat, it comes back to bite me. I’m no match for cocaine. It gets me every time. ” What might you say to elicit change talk?

Eliciting Change Talk Plucking Change Talk from the Jaws of Ambivalence “I just don’t agree that my drinking is a problem for me. My mom over-reacts and then she gets my dad to take her side. They need to loosen up a little. It might not be a bad idea for me to cut down a little during the week – get rid of those morning jitters – but stop completely – no way! ” What might you say to elicit change talk?

Open Ended Questions Strategic use of questions to elicit change talk: • What concerns you about your current situation? • What strengths are present that makes change possible for you? • How does your behavior interfere with who you want to be? • What do you think will happen if you don’t make a change?

Other Strategies to Elicit Change Talk

Decisional Balance Worksheet No Change PROS (Behavior) • _______________ • ________ CONS (Behavior) • _______________ • ________ PROS (Change) • _______________ • ________ CONS (Change) • _______________ • ________

Looking Back 1. Do you remember a time when you weighed a good weight for you? What was it like then? 2. What were things like before you stopped exercising? 3. What are the differences between the John of 10 years ago and the John today? 4. How has your weight stopped you from doing things you might want to do?

Looking Forward 1. If you make a change, what do you hope to be different? 2. How would you like things to be 10 years from now? 3. It seems like you are anxious about how things are with you now, how would you like things to be different? 4. Suppose you don’t make any changes and just continue as you are now, what do you think your life will be in 5 years from now? 5. Given how you feel now, if you don’t make any changes, how do you think you will feel a year from now?

Query Extremes 1. What are the worst things that might happen if you don’t make this change? 2. What are the best things that might happen if you do make this change?

Change Ruler Ask, “On a scale from zero to ten, how important is it to you to [target change] - where zero is not at all important, and ten is extremely important? Follow up: And why are you at ___ and not zero? What might happen that could move you from ____ to [higher score]? Instead of “how important” (need), you could also ask how much you want (desire), or how confident you are that you could (ability), or how committed are you to ____ (commitment). Asking “how ready are you? ” tends to be confusing because it combines competing components of desire, ability, reasons and need.

Explore Values & Goals Ask what the person’s guiding values are. What do they want in life? If there is a “problem” behavior, ask how that behavior fits in with the person’s goals or values. Does it help realize a goal or value, interfere with it, or is it irrelevant?

Coming Alongside Explicitly side with the negative (status quo) side of ambivalence. “Perhaps ______ is so important to you that you won’t give it up, no matter what the cost. ”

“They say you can lead a horse to water, but you can’t make him drink …but I say, you can salt the oats. ” Madeline Hunter

www. motivationalinterview. org Motivational Interviewing: Preparing People for Change. William R. Miller & Stephen Rollnick. 2 nd Edition. Guilford Press www. lindnercenterofhope. org 513 -536 -HOPE (4673)