Motivational Interviewing

1. Motivational Interviewing Learning the A-B-Cs

2. Definition Motivational Interviewing is a people-centered, directive method for increasing a person’s inner motivation to change by exploring and helping them to resolve ambivalence about a new behavior.

3. Guiding Values • Collaborating Together: honors the person’s experience and perspective. MI does not attempt to force someone to change. • Bringing Forth Strength for Change: recognizes that the person already has the resources and motivation to change, and works to enhance them. We help people to “drink from their own wells.” • Free Choice: respects the person’s right to decide what to do for themselves, and helps them make an informed decision. • Ambivalence is Normal

4. Goals • Express Understanding and Empathy • Accepting the person for who they are facilitates change • This does not mean you must agree with or endorse their attitude or behavior • Develop Difference • Change is motivated by perceived differences between present behavior and personal values or goals • The person you are talking to discovers and presents their own arguments for change“ • Roll with Resistance: • No arguing • Take what you want and leave the rest • Support Self Efficacy: A person must believe he/she can change before change is possible

5. The MI Process: An Overview Establish Rapport Set the Agenda Assess importance and confidence Explore Importance/Values and Build Confidence Exchange Information Reduce Resistance Open Questions Affirmation Reflective Listening Summarizing Encourage Change Talk Enhance Motivation to Change – Move on to Part 2, Creating a Change Plan

6. Summarize arguments for change/acknowledge reluctance Ask a key question, like “What do you think you will do now?” Provide information and advice Set Goals Consider change options Make a Plan Elicit Commitment to the Plan Support Commitment to the Plan Review and Revise Plan, If Needed Preview of Part 2: Create a Change Plan

7. Categorize these questions as either: Open Closed Does your girlfriend ever ask you if you have other partners? What would make it easier for you to be faithful? Who decides whether or not you will use a condom, you or your partner? What are the reasons that you would want to continue having sex with your boyfriend? What consequences of HIV concern you most? Is this an open or a closed question? What are your views on faithfulness in marriage? Have you ever thought about being abstinent? How would being abstinent before marriage be good for you? Where do you go for information about HIV? Have you ever been tested for HIV? Do you believe you can get HIV, even if you are married? Do you want to stay in this relationship?

8. How would being abstinent before marriage be good for you? What are your views on faithfulness in marriage? Where do you go for information about HIV? What consequences of HIV concern you most? What are the reasons that you would want to continue having sex with your boyfriend? What would make it easier for you to be faithful? Have you ever been tested for HIV? Have you ever thought about being abstinent? Do you want to stay in this relationship? Do you believe you can get HIV, even if you are married? Does your girlfriend ever ask you if you have other partners? Who decides whether or not you will use a condom, you or your partner? Is this an open or a closed question? Correct AnswersOpen Closed

9. Affirmation • An affirmation is a compliment! • Praise positive behaviors. • Support the person as they describe difficult situations. • Examples: • “You seem to be a very giving person. You are always helping your friends.” • “That situation must have been very painful for you, but you managed to get through it.”

10. Communication is hard... • Here are the places it can break down. 1. What the speaker means 2. What the speaker says 3. What the listener hears 4. What the listener thinks the speaker means Speaker Listener

11. Focus all purpose, attention, and energy on understanding what the person is experiencing right now. Hear not only what the are saying but also what they are NOT saying Speaker Listener

12. Simple Reflections • Repeat back what the person said. • This is the same as paraphrasing. • Condense your response so that it is shorter than what they said. • These are statements, not questions. • You can reflect emotions, too. • If you want to move the conversation along, add something – take a chance! • Examples: • “You had a difficult time confronting your wife about her infidelity, and now you don’t know how to approach her.” • “Your mother is really concerned that you will get pregnant before you finish school.”

13. AmplifiedReflections • Strengthen what the person said as you reflect it. • You can make sure you understood. • If their statement was extreme, you can see if they really meant it. • If the amplified reflection was too strong or not correct, the person will tell you. • Examples: • “It wouldn’t matter at all if you got AIDS.” • “It would be impossible for you to be abstinent.”

14. Double-sided Reflection • A double-sided reflection gives both sides of the argument. • You’ve heard arguments for and against change, or you’ve heard two sides of something. • Use “and” or “but” depending on how you want to proceed in the conversation. • “And” is less confrontational – use “and” if you are hearing resistance. • “But” emphasizes the last thing you say – “but” may cause resistance, so use it with caution! • Examples: • “You know your friends will not approve, butyou also know that your parents and your church will approve.” • “Some days it seems as though you will never get out of this trap, andsome days give you hope that things really could change.”

15. Summarizing • Make a summary statement that encompasses everything that was said. • Summarizing can be helpful when you want to move in a new direction. • Examples: • “This has been a really difficult year for you. You have traveled a great deal, and it has not been easy to keep your marriage vows when you are away for so long.” • “You are feeling a lot of pressure to have sex with this man. He offers you money for nice clothes, to pay your school fees, and for other things that you want. Your parents won’t object. You don’t want to do it, but you feel trapped.”

16. Practice: Using the OARS • Divide into groups of 3 • One person (storyteller) talks about a change he/she has been thinking about making. One person (MI listener) practices OARS. 3rd person (the coach) observes, takes notes of both good technique and areas for improvement • After story is complete, the storyteller and the coach provide feedback to the MI listener • Switch roles

17. 4 Kinds of Change Talk • Disadvantages of Maintaining the Behavior • “When I drink, my wife suspects it, becomes angry, and then we argue.” • Advantages of Change • “It would be wonderful not to have my wife get on my case about my drinking.” • “I’d also like my kids to be able to trust that I will be somewhere when I say I will and that I will not embarrass them.” • Optimism about Change • “I think I could do it if I tried, and if I convinced some friends to try it too.” • Intention to Change • “I think I could at least limit myself to drinking once a week”

18. Eliciting Change Talk • Open Questions • What worries you about how things are going? • So, what do you think about ….? • Asking for more detail • Tell me more about the time in your life when you were able to … • How have you made decisions like this in the past? • Ask about extreme situations? • So, what’s the worst that could happen if you don’t make a change? • What would it be like if you were completely successful at changing? • Explore past and future • Ask about goals and values