eNewsletter - Aug 2019

Behavioral Health Partners

12 Tips for Effective Motivational Interviewing 
Justin Wolfe, LCPC, CADC, CRC

 “The only learning which significantly influences behavior is self-discovered, self-appropriated learning.” -Carl Rogers
(The underpinning of Motivational Interviewing)

Motivational interviewing (MI) is a technique that allows behavioral health providers a means of helping clients through the process of change. It is an expansion of Carl Rogers’ theories about the human capability to exercise free choice and change through self-actualization.  Initially developed to help clients with substance use disorders, MI has application in assisting with many additional life challenges and changes. 

This way of engaging with the clients specifically addresses ambivalence to change, helping a client move from a precontemplative state where they don’t see something as a problem, to a contemplative one where they consider making a change. Once change is considered, a therapist utilizes mapping to help the client understand how they would be successful through change.

In order to effectively practice MI, it’s critical to understand the intended spirit of the therapy. Keep the following in mind to ensure your practice is effective:

1. Follow RULE
   Resist the righting reflex, understand your client’s motivation, listen to your client and empower the client.
2. Understand ambivalence
   Ambivalence is not a pathological disorder, but instead, a normal place for people to get stuck. (It can be helpful to relate this to yourself, identify a change you considered making and how long it took to take action on it.) If the therapist argues for change, the ambivalent person is likely to take the opposite position. It can be challenging, but it’s important for the therapist to be ok with clients choosing not to change and understand this is a normal part of the change process.
3. Know the difference between confidence and importance
   Using the importance/confidence ruler can clarify where to guide conversations by creating discrepancy. This helps identify what is interfering with change. Is it not that important to the client, or is it a lack of confidence in one’s ability to be successful? Discrepancy between values and actions (current behaviors) can facilitate the client in creating their own change talk and builds momentum towards planning for change.
4. Keep the spirit of MI with PACE
   Create partnership with the client, practice acceptance of their autonomy, exercise compassion and evoke motivation for change.
5. Roll with resistance
   Sustain talk is a clear sign to the clinician that what is currently being done is not effective. Recognize the resistance and respond with a reflection and open-ended question to encourage more exploration.
6. Encourage change talk, not sustain talk
   A skilled counselor will recognize sustain talk and shift focus by using reflections, agreement with a twist, devil’s advocate and reframing techniques.
7. Listen for the four categories of change talk
   As change talk begins, the client expresses what it is that they do not like about their current behaviors, such as “If nothing changes, I guess my relationship with my parents will get worse because I will be evicted."
   
   Successfully encouraging identification of the positives of change may sound like “If I stop smoking before school, I would be able to focus and that could help me with my grades and get my parents off my back." 
   
   As they move toward change, clients begin to talk positively about the ability to be successful with change, such as “I threw out all my alcohol so now there is nothing stopping me from not using." Finally, the intention to change becomes apparent when clients begin to set their identified plan into action: “I am going to attend that support meeting tonight and obtain phone numbers to support my recovery.”
   
   When change talk is heard, it is critical the clinician focus on it and encourage further exploration of change. An effective technique with clients is using the devil’s advocate technique by asking “Why change now?” This will further encourage change talk and can support client taking actions that would facilitate direct change.
8. Utilize the core skills of MI
   Open ended questions, affirming, reflective listening and summarizing (OARS) are critical skills for all therapists practicing MI.
9. Affirming is not praising
   We do not want the client to become reliant on therapist for approval, the client should provide this to themselves.
10. Practice reflective listening
    Responding with statements, not questions, continues to keep the other person talking while communicating that they are being heard. This will lower defensiveness and encourage more exploration.
11. Avoid common traps
    Keep conversation on track by avoiding traps such as question and answer, premature focus, expert, labeling, blaming and the chat trap (making insignificant small talk).
12. Practice good MI skills.
    In general, a counselor using MI should talk less than 50 percent, use more reflections than questions, and incorporate more complex reflections than simple ones. These practices not only help the client, they reduce clinician burnout!

Need more resources? If you feel additional help is needed for a patient in your care, consider consultation with a behavioral health specialist skilled in motivational interviewing. Connect with a Linden Oaks certified therapist by calling the Linden Oaks Help Line 24 hours a day at (630) 305-5027. One of our assessment professionals will be happy to assist.

References

• https://www.ncbi.nlm.nih.gov/books/NBK64964/
• https://www.centerforebp.case.edu/resources/tools/mi-list
• https://www.integration.samhsa.gov/clinical-practice/motivational-interviewing 
• https://www.therapistaid.com/therapy-guide/motivational-interviewing