1	Motivational Interviewing
2	How do people change? People motivate themselves to change by exploring and resolving their ambivalence to change.
3	A good clinician facilitates this process of exploring ambivalence by: Expressing empathy Develop discrepancy between the way things are and the way they want them to be Rolling with resistance
4	Techniques for exploring ambivalence Elaboration – ask for lots of detail use open ended questions Summarize with uncertainty Scaling – 1-10 importance of change 1-10 confidence they can change
5	Techniques (continued) What’s the worst case scenario if you: Stayed the same Tried to change and failed Tried to change and made some changes Looking back How did you deal with it before What was life like before this problem
6	Techniques (continued) Looking forward – What would life be like if you didn’t have this problem? Looking for exceptions – Look for strengths. When the problem is manageable what do you do to make it manageable? What is it like when the problem isn’t as stressing?
7	Techniques (continued) Exploring goals – what’s the most important in your life? Do pros & cons for change
8	The process of the interview Approach the interview like two people sitting side by side looking at a photo album – asking questions and commenting The client must feel that you care but that you respect their right to choose how and when they will change.
9	Process (continued) Therapists often feel that this is not enough – “I know what’s right for you and I want you to follow my direction”. This is called “the Righting Reflex”. Remember for “every action there is an equal and opposite reaction”.
10	Process (continued) Offer a menu of options instead. Ask permission before you offer the menu of options.
11	Motivational Interviewing is Directive Use “reflective listening” – selectively emphasizing some of the client’s ideas while ignoring others. Move the client towards change with reflection. Skillful counselors use 2 reflections for every question (open-ended) asked.
12	How to make the interview go badly Confront Act like an expert Label Blame Focus too soon Take sides on client’s ambivalence
13	How do you know if the interview is not going well? Argument Interruption Denial Playing stupid
14	How to make the interview go well Respond to resistance with non-resistance – recognize the client’s disagreement Amplify the reflection – reflect back what the client has said in an amplified or exaggerated way Reflect back both sides of the ambivalence
15	"Shift focus away from “..." Shift focus away from “stumbling block” Agreeing with a twist – Client: nobody can tell me how to raise my kids Therapist: you’re right – you are in the best position to know what is right for your kids. You need to be a full partner in this process.
16	"Coming alongside – if client..." Coming alongside – if client is resistant to change, the counselor recommends that the client should continue on as before, without changing or should even increase the behavior in question Make the client the therapist – “I’ll take the side of the resisting change and you try to convince me to change”.
17	Let’s look at ambivalence “I want to, but I don’t want to”. High functioning, people with a lot of support and resources can afford to make change quickly. Why – because if some unexpected, negative consequence of change occurs, they can use their resources to correct it.
18	Ambivalence for the people in lower socio-economic groups Low functioning, isolated, people with few resources need to approach change very cautiously – if they have an unexpected, negative consequence, the repercussions can be immense. Respect your clients’ ambivalence.
19	When we speak, we learn what we think.