WELCOME

The Use of Motivational Interviewing working with

Women Clients’

COMMON FACTORS

40%--CLIENT TRAITS– Strengths, Resources, Client Perceptions

30%--THERAPEUTIC RELATIONSHIP– Empathy, Acceptance, Mutual Affirmation,

Encouragement, Respect & Warmth 15%--HOPE-EXPECTANCY

– Belief in possibility of change 15%--TECHNIQUES/ORIENTATION

Women’s Treatment

Elements for Engagement/RetentionAvailable Child Care &

TransportationRelationship-BasedFamily/Couples CounselingDomestic Violence ServicesEmployment Services

TerminationTermination

MaintenanceMaintenanceActioActionn

PreparationPreparationContemplatiContemplationon

PrecontemplationPrecontemplationStages of ChangeProchaska et al, 1991

Why Enhance Motivation?

Inspire Motivation Assist Individuals

Readiness for Change

Keep People in Treatment

Improve Individuals Experiences in Treatment

Improve Outcomes Increase Return Rate

KEY TO CHANGE

MULTIDIMENSIONAL

CAN BE MODIFIED

DYNAMIC & FLUCTUATES

INFLUENCED BY OTHERS

STYLE OF CLINICIAN INFLUENCES

IS ELICITED & ENHANCED

Directive Client-centered Counseling style Elicits behavior

change

Client ambivalence

Communication style

Autonomy respected

Express Empathy

Develop Discrepancy

Roll with Resistance

Support Self-efficacy

Motivational Interviewing

PHASE I: BUILDING

MOTIVATION

PHASE II: STRENGTHENING

COMMITMENT TO CHANGE

Phase One StrategiesBuilding Motivation

Open-ended Questions

Affirmation

Reflective Listening

Summary

Eliciting Change Talk

Open-– Requires more than a yes or no response– Eliciting – more person centered– Aides individual cognitions

Closed-– Quick, easier, & efficient– Less person centered– Less engaging

Affirmations

Client Focused Build on Client StrengthsHighlight Client SuccessExpress Empathy

What is Reflective Listening?

•Hearing meaning behind the client’s words•Building Hypothesis vs. Making Assumptions•Creating a non-judgmental, accepting environment•Genuineness

REFLECTIVE LISTENING

Levels of depth --Level One: RepeatLevel Two:

RephraseLevel Three:

Paraphrase

Reflections Options

Some Starting Points It sounds like you . . . .

You’re feeling . . . .

It seems to you that . . . .

So you . . . .

Summarizing

Special form of reflection Provider chooses what to include and

emphasize Includes: concerns about change, problem

recognition, optimism about change, ambivalence about change

Client knows you are listening Invite client to respond to your summary

Change Talk CategoriesSelf-Motivational Statement

Problem Recognition

Statements of Concern

Intention to Change

Optimistic about Change

Phase TwoStrengthening Commitment

Recognizing ReadinessTransitional SummaryKey Questions Information & AdviseNegotiating a Plan

Motivation Exercise

•Listener –

Ask – What is something you are motivated to change?

Use active listening, open-ended statements or questions

• Speaker- respond

Maintenance

Termination

Action

Preparation

Contemplation

Precontemplation

MI-SOC ROADMAP TOMLIN/RICHARDSON-2000

SPIRAL OF CHANGE DEVELOPED BY PROCHASKA, et al, ‘94OARS IS A TERM DEVELOPED BY MILLER et al, ‘00

OARS

OARS OARS

CHANGE CHANGE TALKTALK

Summary & Key Questions

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