7/19/2024

An Introduction to
Motivational
Interviewing

William R. Miller, Ph.D.

University of New Mexico

Session 2
The Spirit and Four Tasks of MI

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A definition (2023)
Motivational interviewing is a particular way of talking
with people about change and growth to strengthen
their own motivation and commitment

1991

2002

2013

Motivational interviewing evolves over time 2023

Tell
Today I’m discussing two central aspects of MI:
Four components of the underlying spirit of MI
Four fundamental tasks in MI

I plan to leave time at the end of each session for your questions and
discussion. You can use the “raise hand” tool in Zoom or post
Show Try questions in Chat that is being monitored by NIMHANS staff.

Today: Tell, Show, Discuss

No specific skill practice in breakout rooms
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The dangers of just teaching communication techniques

The Spirit of MI The Spirit of MI

 Limits of expertise: I am not an expert on you

 When what needs to change is the client’s behavior or lifestyle, you
can’t “fix” it. You need their expertise.  A reverence for humankind and its diversity
 As we shall see, trying to fix somebody naturally evokes resistance.  Each person has inherent worth and deserves respect
 MI is a collaboration of expertise: yours and theirs.  Nonjudgmental interest in the person you are serving
 Accepting people as they are
 Ironically, being accepted as you are makes it easier to change

The Spirit of MI The Spirit of MI

 Not primarily a sympathetic feeling  It is not giving someone what they lack
(although that may happen)  It’s not “I have what you need and I will provide it to you”
 Compassion is benevolent intention and commitment to alleviate  Rather “You have what you need, and together we will find it.”
suffering and give top priority to the person’s well-being  Empowerment is helping people to realize and use the strengths,
 The client’s welfare is the reason for the conversation knowledge, wisdom, and resources they already have
 Accepting that people get to make their own choices

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Partnership

MI
Compassion Spirit Acceptance

Empowerment

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Guide me to be a patient companion,

to listen with a heart as open as the sky.
Grant me vision to see through her eyes
and eager ears to hear her story. After initial investigation, a single woman’s child has been
Create a safe and open place where we may walk together. removed from the home by Child Protective Services.
Make me a clear pool in which she may reflect. Protective concerns are related to the woman’s illicit drug use.
Guide me to find in her your beauty and wisdom, She is meeting with a new caseworker.
knowing your desire for her to be in harmony:
healthy, loving, and strong. This first style is from a 20th century U.S. training video called
Let me honor and respect her choosing of her own path, “Successful Intervention with Substance Abusers” to show
and bless her to walk it freely. social workers how to get started by confronting “denial.”
May I know once again that although she and I are different,
yet there is a peaceful place where we are one.

4 Minutes Same situation: After initial investigation, a single woman’s

Attend to what the mother says child has been removed from the home by Child Protective
How motivated is she? Services because of illicit drug use.
Whose plan is it?
Getting started a different way (9 minutes)

This 2013 demonstration (“I Just Want My Daughter Back”)

is one of 19 interviews available for streaming free at:
http://changecompanies.net/mi-videos

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Spirit of MI: “I just want my daughter back”

Attend again to what the mother says

How motivated is she for change?
What is this caseworker doing?

Guiding/Listening Style Telling/Directing Style

Open Defensive
Four Fundamental Engaging
Cooperative Oppositional
Tasks in Focusing
Listening Arguing
Motivational
Engaged Disengaged
Interviewing
Active Passive Evoking
Empowered Powerless Planning
Hopeful Unable to change
Liking Disliking
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Four Fundamental Tasks

Planning

Evoking Can we take a walk together?

A person-centered style
To establish a context of trust and safety
Focusing This does not necessarily require a long time
Listening to understand the person’s perspective
OARS: Open questions, Affirming, Reflecting, Summarizing
Learn these skills first
Engaging
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Where are we going? Why would you go there?

To develop clear mutual goals for the helping relationship To strengthen the person’s own motivations for change
Establishes a direction for movement together Ambivalence and the “internal committee”
MI is directional but not directive The client (not the counselor) voices the reasons for change
The counselor seeks to clarify and summarize motivations

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How will you get there? Asking instead of Telling

To arrive at aggreable goals and plan for change Engaging: Can we take a walk together?
To consult (as needed) as the person carries out the plan Focusing: Where are we going?
To encourage persistence and progress Evoking: Why would you go there?
To help revise the plan (as needed) as challenges arise Planning: How will you get there?

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 Engaging skills (and re-engaging) continue throughout MI

 Engaging necessarily comes first
 Focus may change
 Focusing (identifying change goals) is a prerequisite for Evoking
 Evoking can begin very early
 Planning is logically a later step
 “Testing the water” on planning may indicate a need for
more of the above
Engage Focus Evoke Plan Focus
Engage Evoke
Plan

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Dancing on the stairs

Planning
 Local cultural norms
Evoking  The music in your voice
 How people make and respond to requests
 Autonomy vs. collectivist values
Focusing

Engaging
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[email protected]>

[email protected] [email protected]

 The Engaging Task

 The Skill of Accurate Empathy

Website: https://motivationalinterviewing.org