MI Quick Tips
Three Definitions of Motivational Interviewing
A Beginning Definition
Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment for change.
A Practitioner's Definition
Motivational Interviewing is a person-centred counselling style for addressing the common problem of ambivalence about change.
A Technical Definition
Motivational Interviewing is a collaborative, goal-oriented style of communication with 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.
Motivational Interviewing Quick Tips
PRINCIPLES OF MI: RULE
The underlying “spirit” (or philosophy) of MI is even more important than the skills. While you are an expert in health care, your client is an expert in his or her own life.
RESIST the “righting reflex”. The urge to “fix” the client. Arguing for change can have a paradoxical effect.
COMPASSION
UNDERSTAND your client. The client’s reasons for change are most important because these will most likely trigger behaviour change.
ACCEPTANCE
LISTEN to your client. MI involves as much listening as informing.
PARTNERSHIP
EMPOWER your client. Convey hope around the possibility of change and support patients’ choice and autonomy re: change goals.
EVOCATION
FOUNDATIONAL SKILLS IN MOTIVATIONAL INTERVIEWING: OARS
OARS are the foundational tools that you will use throughout the four processes. Hover over each letter to discover it's meaning.
OPEN-ENDED QUESTIONS
Open-ended questions encourage elaboration
AFFIRMATIONS:
Promote optimism and acknowledge the client’s expertise, efforts and experience of the client. Praising is different as it implies that the clinician is in a one-up position and focuses on how the clinician feels rather than the strengths of the client.
RELECTIONS:
The skill of accurate empathy:
- simple reflections
- complex reflections
SUMMARIES:
The best are targeted and succinct, and include elements that keep the client moving forward. The goal is to help the client organize his or her experience.
CHANGE AND SUSTAIN TALK
PREPARATORY CHANGE TALK (DARN)
Hover over each letter to discover it's meaning.
(wishes, hopes, wants)
(optimism)
(benefits of change)
(problems with the status quo)
MOBILIZING CHANGE TALK (CAT)
Commitment indicates that the client is likely to act on making changes.
(“I will . . . ,” “I plan to . . .”)
Activiation signals that the client is leaning toward action but has not made a commitment yet.
(steps that the client is already taking in support of a goal)
Taking Steps indicates that the client has already taken steps toward change.
(same as Activation; e.g., “I made an appointment to see my doctor about medication for quitting smoking.”)
HOW TO ELICIT? ASK .....
“Why do you want to make this change?”
“If you decided to make a change, how might you be able to do it?”
“How would things be different if you changed?”
“How would things be better if you changed?”
When you hear change talk you know you are doing it right.
COMMITMENT LANGUAGE PREDICTS CHANGE
“What do you intend to do?”
“What are you ready or willing to do?”
“What have you already done?”
“What is your next step?"
“I know I should use my medication ............
CHANGE TALK
...but ...
............I always misplace my asthma inhaler.”
SUSTAIN TALK
READINESS RULER
Readiness rulers are a tool designed to elicit change talk. Use them to explore the importance clients attach to changing, and their confidence and readiness to change (on a scale of 1 to 10). “On a scale of 1 through 10, how important is it for you to quit smoking?” “On the same scale, how confident are you feeling about your ability to quit?”
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Ask: “Why are you at __ [lower #] and not a __ [higher #]?” “What would it take to go from [client’s chosen #] to__ [one number #]?”
AGENDA MAPPING
Create a “bubble sheet” and invite the client to identify all the possible areas for change. You may choose to pre-populate some of the circles. After inviting the client to share his or her priorities, ask: “Given these possible areas to focus, what would you like to talk about in our time together today?”
Click to download an Agenda Mapping Worksheet
Miller. W. R. and Rollnick, S. 2013. Motivational Interviewing: Helping People Change. New York: Guilford Press.