Motivational Interview Techniques

Solution Preview

RESPONSE;

1. Please discuss motivational interview techniques, since that concept is not readily know by everyone. Describe what those are, and draw on published scholarly sources regarding their effectiveness.

Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

There are many Techniques. In fact, the basic approach to interactions in motivational interviewing is captured by the acronym OARS:

(1) Open-ended questions,
(2) Affirmations,
(3) Reflective listening and
(4) Summaries.

According to Miller et al (1992), the acronym is a nice image, which gives us power to move, yet it is not a powerboat. We don't zip from one place to another, yet with sustained effort OARS can take us a long way.

(1) Open-ended questions

Open-ended questions are those therapist utterances that client's cannot answer with a "yes", "no" or "three times in the last week". Most people begin treatment sessions with an open-ended question - "What brings you here today?" or "Tell me about what's been happening since we last met?" An open-ended question allows the client to create the impetus for forward movement. Although close-ended questions have their place - indeed are necessary and quite valuable at times - the open-ended question creates a forward momentum that we wish to use in helping the client explore change. For example, "So what makes you feel that it might be time for a change?" "Let's say that you decide to change, what makes you think you can change?"Affirmations are statements of recognition about client strengths. We side firmly with Carlo DiClemente that many people who come for our assistance are failed self-changers. That is, they tried to alter their behavior and it didn't work. As a result, clients come to us demoralized or at least suspicious of the assertion that change is possible. This condition means that as therapists, we must help clients feel that change is possible and that they are capable of implementing that change. One method of doing this is to point out client strengths, particularly in areas where they observe only failure. We often explore prior attempts at change. For example, "So you stayed sober for a week after treatment. How were you able to stay sober for that week?" We also use resistance as a source for affirmations. For example, "You didn't want to come today, but you did it anyway. I'm not sure, but it seems like that if you decide something is important enough, you are willing to put up with a lot just to do it." (Material adapted from Ingersoll, Wagner & Gharib, 2000; NIAAA Project MATCH Motivational Enhancement Therapy manual (Miller, Zweben, DiClemente, & Rychtarik, 1992).

EXAMPLES: The "Secret 10 questions?

1. What are your hopes, needs, dreams, expectations? 'Letter from the Future?exercise
2. How confident are you that you will get there doing what you are currently doing? Scale 1- 10? If 8+ - How can you be so sure of this? Question credibility of info they relying on to make this choice; Highlight risks, Raise doubt!; If <8, How come not higher? What doubts do you have? Amplify doubts!
3. What are the benefits & risks associated with your current approach? Client to list side by side
4. If you could change 1 thing about your current situation, what would it be? (What else? Until you get to realistic & specific 1st.step)
5. What would be some of the benefits of making this change? You personally? Your family? ) Twinkle in eye?test)
6. What are some of the negatives about making this change? i.e., what do you stand to lose/risk? (Competence, autonomy, relatedness?)
7. If there was a way that you could make this change without incurring these losses/risks, would you be interested in exploring this with me?
8. What has helped you make change in the past, even when you didn't want to or didn't choose it? Identify resources, strengths
9. If you woke up tomorrow/If I ran into you in the street in 3 months time ? and the change had occurred, what would be different? Specifically! What would you see, hear, feel, think, smell that would tell you this change had occurred? (As vivid as possible, SMART)
10. What would be a good first small & simple step? How confident are you that you will do this by X? 1 ?10? (Aim for +8) (http://74.125.95.132/search?q=cache:A6slsfejqFQJ:www.workcover.com/documents.aspx%3Ffno%3D5630+motivational+interview+techniques+MILLER&cd=5&hl=en&ct=clnk&gl=ca&client=firefox-a)

(2) Affirmations

Affirmations can be wonderful rapport builders. For clients suffering from addictions, affirmations can be a rare commodity. However, they must be congruent and genuine. If the client thinks you are insincere, then rapport can be damaged rather than built.

(3) Reflective listening

Reflective listening is the key to this work. The best motivational advice we can give you is to listen carefully to your clients. They will tell you what has worked and what hasn't. What moved them forward and shifted them backward. Whenever you are in doubt about what to do, listen. But remember this is a directive approach. Unlike Rogerian therapists, you will actively guide the client towards certain materials. You will focus on their change talk and provide less attention to non-change talk. For example, "You are not quite sure you are ready to make a change, but you are quite aware that your drug use has caused concerns in your relationships, effected your work and that your doctor is worried about your health." You will ...