This is a six session learning module to provide MSW students with an overview of Motivational Interviewing. The units cover MI principles, skills, the change process and handling resistance.
Motivational Interviewing, MI, AROSE, OARS, DEARS, change talk
Welcome to the introduction to Motivational Interviewing (MI). This course is intended to provide Social Work students with an opportunity to learn the history of MI, the basic principles, skills, and clinical application. These lessons are divided up into six weeks and adapted from The Motivational Interviewing Training Manual that the University of Southern California uses in their MSW program Virtual Field Placement course. The manual was developed in a project funded by NIMH, IP-RISP PA#PAR 00-096 (2007; revised 2018) with John Brekke, Ph.D. as the principal investigator.
I became aware of Motivational Interviewing after graduating with my Master's in Social Work in the 1990s. This was then used for those suffering from addictions but has now spread to many other types of behavior-related issues like diabetes, heart disease, smoking, weight loss, etc. In essence, if one has difficulty making a change in themselves or their lifestyle, Motivational Interviewing is a good starting point. One of the hallmarks of people in a change process is ambivalence. This means that part of them wants to change and part of them doesn't. Just like a pendulum, the degree to which a change is desired fluctuates day to day, depending on their feelings, life circumstances, and seeing that change is possible.
I have been teaching the Virtual Field Placement course to MSW students since 2014, which includes using manuals for the evidence-based interventions (EBI) of Motivational Interviewing, Cognitive Behavioral Therapy, and Problem Solving Therapy. During the 15 week semester, the MI course is taught first and consists of asynchronous videos in conjunction with an intensive two-hour class meeting virtually twice weekly. During these two-hour class periods, students are exposed to the EBI content, complete in-class exercises and role-plays. They are then able to apply these skills during the weekly one-hour simulated client session played by an actor for 13 of the 15 week semester. This actor was trained to follow a loosely developed script, aimed at offering students the opportunity to use their newly-acquired training.
This MI training was adapted to this e-learning module to afford it to be used asynchronously with students learning content while practicing specific exercises with their peers, family members, or clients. It is intended to be an introduction to Motivational Interviewing that can lead students to engage in advanced training, supervision, and practice.
Hall, K., Staiger, P., Simpson, A., Best, D., and Lubman, D. (2016) researched skill acquisition of Motivational Interviewing training. They note that "mastering MI requires a complex set of skills that are used flexibly, responding to moment-to-moment changes in what the client says." Hall et al., (2016) continue, "The complexity of MI may not lie simply in the acquisition of new skills or therapeutic practices (open-ended questioning, summarizing, reflective listening, affirmation), but in the suppression of previous practice behaviors (giving advice, directing, confronting, talking instead of listening) that are inconsistent with the spirit of MI." They set out to answer the question, "So what is the most effective training method for achieving competence in MI?" (p. 1145)
After conducting a systematic review of 20 studies, Hall et al., (2016) found that "The results of this review are consistent with Miller and his colleagues' assertions that MI is simple, but not easy to learn." Hall et al., (2016) continue:
adoption of skills is rarely maintained by practitioners without extended contact through follow-up consultation or supervision. Miller draws similarities in learning MI to that of other complex skills, such as playing a musical instrument or a sport. He states: "real skill and comfort in the method can only be achieved through disciplined practice with feedback and coaching from a knowledgeable guide.
(p. 1144)
This learning module is intended to provide Masters in Social Work students with the basic vocabulary and philosophy of Motivational Interviewing. To fully learn MI, one needs the continuous practice of these skills, ongoing education, training, and direct feedback in supervision. We hope this will give you the motivation to continue on a journey of exploration.
The Learning Module consists of six lessons:
Each lesson is to be completed within a week's time and includes reading, videos, comment, and update. Students may work ahead if desired.
Here is the rubric being used in this course:
This learning module is intended to be an introduction to Motivational Interviewing that can be woven into the overall MSW curriculum. Students may have been trained in MI in the past, so not everyone approaches this learning module from the same position. However, it takes years to fully master MI and generally requires consistent education, training, and supervision. Students will have the opportunity to complete a pre-course survey so that you will know their prior experience and confidence in using this model. We will also ask students to complete a similar survey at the end of the six units.
Much of the content of this learning module is derived from the attached workbook:
Suggested Reading:
Corcoran, J. (2016). Motivational Interviewing: A Workbook for Social Workers. Oxford University Press, Incorporated.
Rollnick, S., & Miller, W. (2013). Motivational interviewing helping people change (3rd ed.). Guilford Press.
Welcome to Week 1!
Please complete the pre-course survey before beginning this unit. This survey is to assess your general knowledge of Motivational Interviewing. At the end of this learning module, there will be another similar survey to assess your knowledge after you complete these 6 weeks of coursework.
https://www.surveymonkey.com/r/P9L9TJG
In this first week, we will begin with an overview of MI.
In the video below, "founders and experts in Motivational Interviewing William Miller, Theresa Moyers, and Stephen Rollnick explain how Motivational Interviewing allows you to engage with your clients in a practical way to help them find and build their own motivation for change":
(Video Length: 1:00)
Video 1. Psychwire. (2019 June 18) What is Motivational Interviewing?. [Video]. https://www.youtube.com/watch?v=reTb-x6UOmY&list=PLffBXI4nwQ4gdfX3L2nIoziobaRdwCWSy
In the next video, William Miller, co-creator of MI expands further on Motivational Interviewing:
(Video Length: 4:01)
Video 2. PsychotherapyNet. (2009 April 6). Motivational Interviewing (MI) with William Miller. [Video]. https://www.youtube.com/watch?v=cj1BDPBE6Wk
Using the link below, please select the following short videos to continue your introduction to MI:
1. What is Motivational Interviewing? Miller, Moyers, and Rollnick answer the question.
2. What is MI? Stephen Rollnick explains.
3. Motivational Interviewing for Addiction
4. The MI Approach to Addiction
5. Lifting the burden. William Miller talks about the change of role in MI.
We will begin to cover and practice the skills of Motivational Interviewing in Week 2. Some say that we need to have an appreciation of the spirit of MI as depicted in this video:
(Video Length: 6:13)
Video 3. Bill Matulich. (2019, June 11). Spirit of Motivational Interviewing. [video]. https://www.youtube.com/watch?v=APPoKvTPhog
The following article discusses Motivational Interviewing and the social work principle of self-determination:
Comment: Write at least 100 words as a reflection from what you have learned about Motivational Interviewing using these prompts:
Upload this in the LMS for review.
Update: Using the Markland et al., 2005 article and at least one other, write at least 200 words about the compatibility of MI with social work values. Include at least one media element in your update.
Upload this in the LMS for review.
Please complete this survey once you have gone through all of the Week 1 material:
Learning MI is a process that needs continuous exposure to concepts, practice, and feedback. In the video below, Dr. William R. Miller discussed the origins of MI and the importance of developing these skills over time. We encourage you to refresh your knowledge of MI as you engage your students in this study.
(Video Length: 25:27)
Video 17. Columbia U School of Social Work. (2017 September 22). Motivational Interviewing: A Dialogue with the Practice's Co-founder William R. Miller. [Video] https://www.youtube.com/watch?v=DSHh6V9yNzg
The foundation for Motivational Interviewing is contained in this text which you may already have: Rollnick, S., & Miller, W. (2013). Motivational interviewing helping people change (3rd ed.). Guilford Press.
Your students are being asked to complete a pre-course survey to assess their knowledge of MI. A similar one will be completed at the end of this course. Please utilize these surveys as part of a formative assessment for both student's learning and course design feedback.
Welcome to Week 2!
In this lesson, the principles of Motivational Interviewing will be presented.
To begin, expert Dr. Theresa Moyers discussed the four processes of MI, which are engaging, focusing, evoking, and planning. MI, like other client-centered therapy models, has the main goal of establishing a therapeutic relationship. As you complete this lesson, ask yourself how this method is similar or different to other types of therapy approaches you have learned.
(Video Length: 1:57)
Video 4. Psychwire. (2019, June 18). The Four Processes of Motivational Interviewing. [Video]. https://www.youtube.com/watch?v=4Hrz9tLUlUw
As Motivational Interviewing was being developed, the basic principles of this approach were becoming evident as Dr. William Miller worked with clients. These principles emerged organically and eventually became a formal part of this model. Here are these five basic principles referred to as DEARS as noted in the Motivational Interviewing Training Manual (Brekke, J. et al. 2018):
DEARS - 5 Basic Principles of Motivational Interviewing
Develop Discrepancy
The goal here is to create and amplify, in the client’s mind, a discrepancy between present behavior and broader goals. This can be triggered by an awareness of the costs of a behavior. When a behavior is seen as conflicting with important personal goals, change is likely to occur. A goal of MI is to develop discrepancy—make use of it, amplify it, increase it until it overrides attachment to the current behavior. When MI is done well, it is not the counselor but the client who gives voice to concerns. (e.g. “This problem is more serious than I realized.”)
Express Empathy
The attitude under this principle might be called “acceptance.” Empathic warmth and reflective listening is employed from the beginning and throughout the process of motivational interviewing. The counselor’s role is to understand the client’s feelings and perspective without judging, criticizing, or blaming. An empathic therapist seeks to respond to a client’s perspective as understandable, comprehensible, and valid. Ambivalence is accepted as a normal part of human experience and change—not as a pathological trait or defensiveness.
Avoid Argumentation
Direct argumentation tends to evoke reactance from people; that is, it results in clients asserting their freedom to do as they please. The least desirable situation from the viewpoint of this principle is one in which the counselor is arguing that the client has a problem and needs to change, while the client is defending an opposite viewpoint.
Roll with Resistance
Reluctance and ambivalence are not challenged but are acknowledged by the counselor as being natural and understandable. The counselor does not impose new views or goals. Rather the client is invited to consider new information and is offered new perspectives. “Take what you want and leave the rest” is the permissive kind of advice that pervades this approach. It’s an approach that’s hard to fight against.
Support Self-efficacy
Self-efficacy refers to a person’s belief in his or her ability to carry out and succeed with a specific task. It is a key element in motivation for change, and a good predictor of treatment outcome with addictive behaviors. The counselor’s own expectations about a person’s chances for recovery can have a powerful impact on the outcome. It is the client who is responsible for choosing and carrying out personal change.
Brekke, J. et al., (2018 revision). Motivational interviewing training manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018). (p. 8)
In part 1 of a 2 part video series, Motivational interviewing techniques are shown and discussed by expert Mike Stratton ACSW. As you watch Video 5, make note of at least one example of each of the DEARS principles. This will be used for your weekly update.
Here is a worksheet to use while you view the video:
(Video Length: 9:42)
Video 5. Michigan Department of Community Health. (2009 August 7) Developing Discrepancy Part I. [Video]. https://www.youtube.com/watch?v=EJ6A7C3pcHE
In part 2, the same vignette continues as Mike Stratton ACSW works with the client. As you watch Video 6, identify at least one example of each of the DEARS principles. This will be used in your weekly update.
Here is a worksheet to use while you view the video:
(Video Length: 10:00)
Video 6. Michigan Department of Community Health. (2009 August 6) Developing Discrepancy Part II. [Video]. https://www.youtube.com/watch?v=K7m9vCFa6H8
Comment: Write at least 100 words as a reflection from what you have learned about Motivational Interviewing using these prompts:
What do I now know about MI?
What do I want to know about MI?
What thoughts and feelings did you have while watching the videos?
Upload this in the LMS for review.
Update: Refer to the following prompts for analyzing Videos 5 and 6. Give at least one example of each DEARS skill from each video:
(Minimum 200 words)
Upload this in the LMS for review.
Please complete this survey once you have gone through all of the Week 2 material:
In week 2, students are exposed to the basic principles of MI. These are provided through excerpts from the Motivational Interviewing Training Manual and short videos. Students are being challenged to observe the principles in action and be able to articulate them in an update. It is very common for students to grasp the concepts but have difficulty identifying the principles being used by themselves and others. Feedback from you will be very important to both encourage and examine their learning needs.
Welcome to Week 3!
In this lesson, the basic skills of Motivational Interviewing will be presented.
Motivational Interviewing uses several acronyms in their training. OARS is one that is used to remind providers of the basic engaging skills. OARS stands for:
O - open-ended questions
A - affirmations
R - reflection
S - summaries
In the following video, MI Expert Theresa Moyers briefly explains the basic skills:
(Video Length: 1:37)
Video 7. Psychwire. (2019 June 18). What Does the Acronym OARS Mean in Motivational Interviewing? [Video] https://www.youtube.com/watch?v=8JI0IL9wRjo
These skills are further elaborated on in the Motivational Interviewing Training Manual (Brekke, J. et al., 2018) with another acronym AROSE:
Basic Skills of Motivational Interviewing
Affirmations
These are statements that encourage, reinforce, and acknowledge appropriate attempts made by the client. Though this strategy is the easiest, it is often the most neglected. Examples include: “I’m glad you came in today.” “Good work.” “You’re doing great.”
Reflective Listening
This includes showing interest in what the client has to say, and respect for the client’s inner wisdom. It is critical to attempt to understand the gist, the real meaning of what client is communicating. Types of reflective statements include simple (rephrase, paraphrase), reflection of feeling, and double-sided reflection. Reflective statements often begin with “So you feel…” “It sounds like you…” You’re wondering if…” “On the one hand…” (Please see handouts for more examples.)
Open-ended Questions
This is a style that is quiet and curious. The questions cannot easily be answered with a “yes” or “no” or other brief reply. This encourages the client to do most of the talking. They usually begin with “What” “How” “Tell me about…” Avoid the question “Why?” as it tends to put people on the defensive.
Summarizing
This is a special application of reflective listening which links together discussed material, demonstrates careful listening, and prepares the client to move on. A transitional summary usually has three parts: 1) a recap of the pros, 2) a recap of the cons, 3) an invitation to continue…”what else?” A major summary is one that comes at the end of the meeting and may be more formal. It may begin with a statement indicating that the service coordinator is about to summarize. For example: “Let me see if I understand you so far.” “Okay, here’s what I’ve heard so far. Listen and tell me if I’ve missed anything important.”
Eliciting Change Talk
This skill directs clients to discuss their ambivalence about changing a particular behavior. It involves several strategies, including 1) Asking evocative questions, 2) Exploring pros and cons, 3) Asking for elaboration, 4) Imagining extremes, 5) Looking forward, and 6) Looking back. (Please see handouts for more examples.)
Brekke, J. et al., (2018 revision). Motivational Interviewing Training Manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018). (p. 9)
Summarizing is a skill that is often used throughout the MI session as noted in the Motivational Interviewing Training Manual (Brekke, J. et al., 2018):
Summarizing
Summarizing is a special application of reflective listening which links together discussed material, demonstrates careful listening, and prepares the client to move on.
A transitional summary usually has three parts: 1) The pros, 2) the cons, 3) and an invitation to continue. These summaries can be especially helpful in expressing a client’s ambivalence around an issue. It is one way to allow the person to examine the positives and negatives simultaneously, acknowledging both are present. The following linking phrases can be useful:
“On the one hand…”
“On the other hand…”
“At the same time…”
“What else?”A major summary is one that comes at the end of a meeting or a significant point in the session and may be more formal. The following phrases can be useful:
“Let me see if I understand what you’ve told me so far…”
“Okay, here’s what I’ve heard so far. Listen and tell me if I’ve missed anything important…”
Special attention should be given to include all the client’s statements that suggest recognition that there is a problem, express concern about a problem, reasons for change, and optimism for change.For example:
“So far you’ve mentioned to me that work in the past has been really frustrating for you because people were always pushing you to take on more responsibilities. You also said that people would get on your case because you couldn’t do the overtime and still have time for your family. But now you’re thinking that you’d like to work again. You remember how it feels to work hard and contribute financially to the family. And you’re thinking it will give you a sense of purpose that you haven’t had for a while. Did I get that right?”
Brekke, J. et al., (2018 revision). Motivational Interviewing Training Manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018). (p. 16)
The next video is an example of a patient being interviewed by a health psychologist about her alcohol consumption. This patient was referred to the psychologist by her primary care physician because of the elevated alcohol use.
As you watch this video, please make note of the specific skills being demonstrated and your thoughts/feelings during the interview. You will be asked to incorporate those in your update at the end of the unit.
Here is a worksheet to use while you view the video:
(Video Length: 13:44)
Video 8. SBIRT IPE. (2014 December 11). 3 Motivational interviewing Core Skills in Action. [Video]. https://www.youtube.com/watch?v=Gf_guzP_u2M
This next video depicts a pediatrician using OARS (part of Motivational Interviewing) to encourage a mom to stop smoking.
Again, as you watch this video, please make note of the specific skills being demonstrated and your thoughts/feelings during the interview. You will be asked to incorporate those in your update at the end of the unit.
Here is a worksheet to use while you view the video:
(Video Length: 6:33)
Video 9. University of Florida Dept of Psychiatry with captions added by Beth Glicker. (2018 June 14). Motivational Interviewing OARS Annotated. [Video].
Comment: Write at least 100 words as a reflection from what you have learned about Motivational Interviewing using these prompts:
Upload this in the LMS for review.
Update: Write at least 200 words describing the skills you observed in videos 8 and 9. Be as specific as possible for each of the videos.
As you watched Video 8, identify at least one example of each of the AROSE skills:
As you watched Video 9, identify at least one example of each of the AROSE skills:
Upload this in the LMS for review.
Please complete this survey once you have gone through all of the Week 3 material:
In week 3, students are exposed to the basic skills of MI. These are provided through excerpts from the Motivational Interviewing Training Manual and short videos. Students are being challenged to observe the skills in action and be able to articulate them in an update. It is very common for students to grasp the concepts but have difficulty identifying the skills in themselves and others. Feedback from you will be very important to both encourage and examine their learning needs.
Welcome to Week 4.
In this unit, the basic skills will be covered in more detail.
Reflective listening is one of the cornerstones of Motivational Interviewing and also one of the hardest to learn. Along with the use of open-ended questions, reflective listening sets the stage for engaging the client in their own change process. Therapists often feel like they have to be the ones to "do something" to help the client make the desired or required changes. However, it is creating the therapeutic environment that allows the client to determine their own course of action. Here are the types of reflective statements from the Motivational Interviewing Training Manual (Brekke, J. et al., 2018):
Types of Reflective Statements
Simple Reflection:
Stay close to what the client is saying by taking some part of what the person says and rephrase in your own words.
Client: I really want to leave my board and care. Everybody’s smoking weed and they’re not getting kicked out.
Response #1 Counselor: You want to move. People are getting loaded and getting away with it.
Response #2 Counselor: Your board and care is not a good place for you right now. People can get away with anything, and you’d like there to be more consequences.
Reflection of feeling:
This is the deepest form of reflection. It is a paraphrase that emphasizes the emotional dimension of the message.
Client: I really want to leave my board and care. Everybody’s smoking weed and they’re not getting kicked out.
Response #1 Counselor: You’re disappointed. The board and care is not the safe and supportive place you’d hoped it would be.
Response #2 Counselor: It makes you angry that people can just do anything they please.
Double-sided reflection
This acknowledges and amplifies the ambivalence.
Client: Everyone said my life would be so much better off crack. Sure, I’m not on the street, but there’s nothing to do, nothing to get up for.
Response #1 Counselor: On the one hand you’re grateful to have a roof over your head. On the other hand, you’re wondering, “Is this all there is?
Response #2 Counselor: You feel misled. It’s a relief to not be homeless. At the same time, smoking crack was an activity you looked forward to.
Brekke, J. et al., (2018 revision). Motivational Interviewing Training Manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018). (p. 12)
Open-ended questions
The initial goal of establishing rapport with the client requires creating an atmosphere of safety and trust. If the client feels judged, challenged, or intimidated at the beginning of the relationship, then they will be more likely to terminate early or shift into a "compliant" position. The use of open-ended questions along with reflective listening helps create this non-judgemental atmosphere. Here are sample questions from the Motivational Interviewing Training Manual (Brekke, J. et al., 2018). As you read each one, make a note if they are open-ended or closed-ended questions. If they are closed-ended, how would you make them open?:
Is this an Open or Closed Question?
1) What do you like about not working?
2) Where did you go to school?
3) What do you want to do about your drinking: quit, cut down, or stay the same?
4) Are you willing to attend the group?
5) What can I do for you today?
6) What are you getting out of this relationship?
7) Have you ever thought about walking as a simple form of relaxation?
8) What does having a meaningful life mean to you?
9) In the past, how have you managed stressful events?
10) Will you make an effort to look for work this week?
11) In what ways is your anger a problem for you?
12) Do you care about your family?
13) What are the most important reasons why you want to manage your emotions?
14) What do you want to set as your quit date?
15) What’s going on with your job lately?
16) What do you see yourself doing when you get out of school?
17) What do you want to be when you grow up?
18) What do you think will happen if you lose the friends you have now?
19) Did you have a good life before you started smoking weed?
20) What is a close-ended question?
Brekke, J. et al., (2018 revision). Motivational interviewing training manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018). (p. 11)
In the following video, Alan Lyme, LISW, MAC, a member of MINT (Motivational Interviewing Network of Trainers) since 2004, is an Internationally Certified Clinical Supervisor, a Master Addictions Counselor, and a Leadership Challenge Workshop Certified Master in Training demonstrates a "bad example" of working with someone who has been excessively using alcohol.
Please note: as you watch this video, identify what the interviewer was doing wrong and the impact this was having on the client that you could observe, both verbally and non-verbally. These observations will be needed for your update at the end of the unit.
You may use the attached template to make notes:
(Video Length: 3:14)
Video 10. TheIRETAchannel. (2013 July 11). Motivational Interviewing: A Bad Example. Alan Lyme, LISW, MAC. [Video]. https://www.youtube.com/watch?v=_VlvanBFkvI
In the next video, Alan Lyme, LISW, MAC, demonstrates a "good example" of using Motivational Interviewing with the same client. Please note: as you watch this video, identify what the interviewer was doing well and the impact this was having on the client that you could observe, both verbally and non-verbally. These observations will be needed for your update at the end of the unit.
You may use the attached template to make notes:
Video 11. TheIRETAchannel. (2013 July 18). Motivational Interviewing - Good Example. Alan Lyme, LISW, MAC. [Video]. https://www.youtube.com/watch?v=67I6g1I7Zao
Comment: Write at least 100 words as a reflection from what you have learned about Motivational Interviewing using these prompts:
What do I now know about MI?
What do I want to know about MI?
What thoughts and feelings did you have while watching the videos?
Update: Write at least 200 words describing your observations in videos 10 and 11:
As you watched Video 10, identify what the interviewer was doing wrong and the impact this was having on the client that you observed, both verbally and non-verbally. What were your thoughts and feelings?
As you watched Video 11, identify what the interviewer was doing well and the impact this was having on the client that you observed, both verbally and non-verbally. What were your thoughts and feelings?
Please complete this survey once you have gone through all of the Week 4 material:
In week 4, we take a "deeper dive" into the basic skills of MI. These are provided through excerpts from the Motivational Interviewing Training Manual and short videos. Students are being challenged to observe the skills in action and be able to articulate them in an update. It is very common for students to grasp the concepts but have difficulty identifying the skills in themselves and others. Feedback from you will be very important to both encourage and examine their learning needs.
Welcome to week 5!
This unit will focus on the change process in human behavior and how MI can be used.
The following video explains the Transtheoretical model or "Stages of Change" as it is more commonly known that was developed by researchers Prochaska and DiClimente in the 1980s. This model is one of the philosophical underpinnings for Motivational Interviewing.
(Video Length: 2:36)
Video 12. Dovetail Qld. (2018 September 26). The Stages of Change Model. [Video]. https://www.youtube.com/watch?v=ayjXMix-nMw
In the next video, Motivational Interviewing co-founder William Miller talks about how the therapists role changes in Motivational Interviewing:
(Video Length: 2:07)
Video 13. Psychwire. (2019 June 18). Lifting the Burden in Motivational Interviewing. [Video]. https://www.youtube.com/watch?v=SsNgZ47o2I4
Please review the following from the Motivational Interviewing Handbook (Brekke, J. et al., 2018) which may assist as you view Dr. Miller's video below about change talk:
Eliciting Change Talk What is Change Talk?
Change talk is any statement coming from the client that expresses at least one of the following:
- Desire to change
- Ability to change
- Reason to change
- Need to change
- Commitment to change
How can we elicit change talk?
Ask evocative questions.
In what ways has this been a problem for you?
What’s the downside to not working?
In what ways has this bothered you?
What do you think will happen if you don’t make a change?Explore pros and cons.
What are some of the good things about using crack?
What are some of the not-so-good things?
What worries you about your drug use?
What worries you about quitting?Ask for elaboration.
Can you tell me more about this?
When was the last time this happened?
Can you give me an example?Imagining extremes
If you were to make the decision to go back to work, what’s the worst that could happen?
What’s the best thing that could happen?
Looking forward
What would you like your life to look like in three years? What would be the advantages of making a change?
Looking backward
Before you began drinking, what was your life like?
Going back to your childhood, or a time in your life before this became a problem for you, tell me a story about what you wanted, hoped, or expected your life to be like.
Brekke, J. et al., (2018 revision). Motivational interviewing training manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018). (p. 17)
In the video below, Dr. William Miller, co-founder of Motivational Interviewing discusses change talk:
(Video Length: 12:44)
Video 14. Pernille Erichsen. (2018 August 5). Bill Miller - On Change Talk. [Video]. https://www.youtube.com/watch?v=YIhMsTdZMVM
Change is something that we may want but resist. As discussed earlier in this learning module, we may have ambivalence and resistance toward this change. The Decisional Balance Exercise was developed by William Miller and Stephen Rollnick as a way of exploring the aspects of making a change in a non-judgemental way. Both sides of the argument are given equitable treatment which helps the client view their situation in a new way. Here is the exercise, as taken from the Motivational Interviewing Training Manual (Brekke, J. et al., 2018):
Decisional Balance Exercise (generic) Adapted from © 2000 by Miller and Rollnick
DECIDING NOT TO CHANGE
A. What are the good things about deciding not to change?
_____________________________________________________________
B. What are the not-so-good things about staying the same? about staying the same? (not working, staying in the same home, etc.) (not working, staying in the same home, etc.)
_____________________________________________________________
DECIDING TO CHANGE
C. What are some of the not-so-good things about deciding to change?
_____________________________________________________________
D. What are some of the good things about making the change? about making the change? (Getting a job, moving, etc.) (Getting a job, moving, etc.)
_____________________________________________________________
On a scale of 1-10, how important is it for you to make this change? (Get a job, move) not important very important __________.
On a scale of 1-10, how confident are you that you can make this change? (Get a job, move) not confident very confident __________.
(Please compare the numbers and inquire about the difference between importance and confidence, if any).
Brekke, J. et al., (2018 revision). Motivational interviewing training manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018). (p. 29)
Activity:
Comment: How effective do you think using this worksheet was for each of you in motivating you to change? Write at least 100 words.
Update: Upload both videos and complete the following written dialogue for 5-10 minutes of the session where you used MI skills:
Please complete this survey once you have gone through all of the Week 5 material:
When we are in conversation with someone struggling with a situation, it is tempting to give direct advice, especially by students in the helping profession. It is easy to think that we are the experts and therefore we are supposed to give advice. The role of the instructor in MI training is to blend the social work principle of self-determination with motivational interviewing. Students are to prepare recordings of their work using the Decisional Balance Exercise. Giving them feedback that encompasses the spirit of MI along with the principles and skills will help further their learning process.
The following video gives you an expanded version of Dr. Miller's thoughts on MI and the change process.
(Video Length: 59:31)
Video 18. Columbia University. (2009 October 22). Dr. William Miller, "Motivational Interviewing: Facilitating Change Across Boundaries". [Video]. https://www.youtube.com/watch?v=6EeCirPyq2w
Welcome to Week 6!
This week's lesson will cover how to deal with resistance and the opportunity to "put it all together". It is important to remember that even we know that we might need to make a change, we will still resist. This is natural. Sometimes, we think if we can only say it repeatedly, then that person will understand they need to change and move into the action stage. However, the more we insist, the more they resist. We need to remember that we are all ambivalent about making changes and as social workers, we want the client to be the one arguing for change.
The method ‘Rolling with Resistance’ is a key principle of Motivational Interviewing developed by Rollnick and Miller (2013). The following video shows a dentist talking with a mother about the health of her child baby teeth and was inspired by Motivational Interviewing:
(Video Length: 2:58)
Video 15. Leeds School of Dentistry. (2019 October 23). Rolling with Resistance: Re-Framing. [Video]. https://www.youtube.com/watch?v=KBjmGCHx5BE
The next video shows a dentist talking with a father about how his son's teeth are being negatively impacted by drinking cola from a bottle:
(Video Length: 3:23)
Video 16. Leeds School of Dentistry. (2019 October 29). Rolling with Resistance: Shifting the Focus. [Video]. https://www.youtube.com/watch?v=GJYruT30gZI
Several strategies for dealing with resistance have been developed as demonstrated in these videos. In the Motivational Interviewing Training Manual (Brekke, J. et al., 2018) these strategies are:
Strategies for Rolling with Resistance
- Reflective listening
- Simple reflection
- Reflection of feeling
- Double-sided reflection
Shifting focus
“Let’s not worry about whether or not you’re an alcoholic. Let’s focus on this for awhile.”
Reframing
Take something the client does not like about him/herself and reframe it as a strength.
“Maybe it’s a good thing that it takes you a long time to make a decision. It shows that you are thoughtfully considering all sides of the issue.”Emphasize personal choice and control.
“I agree. No one can or should be able to make you do anything against your will.”
Side with the negative.
Take the negative side of the argument.
“It may be that you find it’s just too difficult to change.
Brekke, J. et al., (2018 revision). Motivational interviewing training manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018). (p. 15)
Comment: Please complete these sentence stems in as many ways as possible using the attached worksheet below:
I learned _________
I relearned _________
I gained ______________
I appreciated __________
It is challenging to ______________
One thing that surprised me was ___________
I could use motivational interviewing to ___________
I am more confident now that I can _______________
Here is a document to record and upload your responses:
Update: Please write at least 200 words or more about Motivational Interviewing in a practice area of your choice which includes at least one peer-reviewed article and one media element.
Please complete this survey once you have gone through all of the Week 6 material:
Please complete the post-module survey: https://www.surveymonkey.com/r/P9XJWLL
By week 6, you have been able to see the progress your students have made in this learning module. Students have to complete sentence stems about their learning process. It would be helpful to provide a recap to the class about their responses and also distilling the feedback by unit to see what can be improved for next time.
Students are asked to complete the post-module survey. Please compare their responses from Unit 1 to Unit 6 and provide specific feedback on their progress.
Work 1
For your final project in this course, you are asked to create your own learning module. This will be an introduction to motivational interviewing.
The lesson needs to include:
1. Goals and Learning Objectives
2. At least two peer-reviewed articles
3. At least three multi-media items which include:
5. The Rubric by which each student will be evaluated.
6. A post-unit survey for feedback on unit design.
Please upload this on the LMS when complete.
Work 1 was based on the concept of learning by teaching. There is much research about this method, but here is an article that you can review:
Printed Sources:
Brekke, J. et al., (2018 revision). Motivational interviewing training manual. The University of Southern California. Project funded by NIMH, IP-RISP PA # PAR 00-096 (2007; revised 2018).
Corcoran, J. (2016). Motivational interviewing: A workbook for social workers. Oxford University Press, Incorporated.
Hall, K., Staiger, P., Simpson, A., Best, D., & Lubman, D. (2016). After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing? Addiction (Abingdon, England), 111(7), 1144–1150. https://doi.org/10.1111/add.13014
MARKLAND, D., RYAN, R., TOBIN, V., & ROLLNICK, S. (2005). Motivational interviewing and self-determination theory. Journal of Social and Clinical Psychology, 24(6), 811–831. https://doi.org/10.1521/jscp.2005.24.6.811
Rollnick, S., & Miller, W. (2013). Motivational interviewing helping people change (3rd ed.). Guilford Press.
Rod D. Roscoe. (2014). Self-monitoring and knowledge-building in learning by teaching. Instructional Science, 42(3), 327–351. https://doi.org/10.1007/s11251-013-9283-4
Multi-Media Sources:
https://psychwire.com/motivational-interviewing/resources?gclid=Cj0KCQjwse-DBhC7ARIsAI8YcWIxsW0zwebigxuE-2ICO7YpFsUXrmpCq5iKH4iNvg5GJAOZ4wiArqcaAkOWEALw_wcB
Video 1. Psychwire. (2019 June 18) What is Motivational Interviewing?. [Video]. https://www.youtube.com/watch?v=reTb-x6UOmY&list=PLffBXI4nwQ4gdfX3L2nIoziobaRdwCWSy
Video 2. PsychotherapyNet. (2009 April 6). Motivational Interviewing (MI) with William Miller. [Video]. https://www.youtube.com/watch?v=cj1BDPBE6Wk
Video 3. Bill Matulich. (2019, June 11). Spirit of Motivational Interviewing. [video]. https://www.youtube.com/watch?v=APPoKvTPhog
Video 4. Psychwire. (2019, June 18). The Four Processes of Motivational Interviewing. [Video]. https://www.youtube.com/watch?v=4Hrz9tLUlUw
Video 5. Michigan Department of Community Health. (2009 August 7) Developing Discrepancy Part I. [Video]. https://www.youtube.com/watch?v=EJ6A7C3pcHE
Video 6. Michigan Department of Community Health. (2009 August 6) Developing Discrepancy Part II. [Video]. https://www.youtube.com/watch?v=K7m9vCFa6H8
Video 7. Psychwire. (2019 June 18). What Does the Acronym OARS Mean in Motivational Interviewing? [Video] https://www.youtube.com/watch?v=8JI0IL9wRjo
Video 8. SBIRT IPE. (2014 December 11). 3 Motivational interviewing Core Skills in Action. [Video]. https://www.youtube.com/watch?v=Gf_guzP_u2M
Video 9. University of Florida Dept of Psychiatry with captions added by Beth Glicker. (2018 June 14). Motivational Interviewing OARS Annotated. [Video]. https://www.youtube.com/watch?v=6UBTxPcAFKM
Video 10. TheIRETAchannel. (2013 July 11). Motivational Interviewing: A Bad Example. Alan Lyme, LISW, MAC. [Video]. https://www.youtube.com/watch?v=_VlvanBFkvI
Video 11. TheIRETAchannel. (2013 July 18). Motivational Interviewing - Good Example. Alan Lyme, LISW, MAC. [Video]. https://www.youtube.com/watch?v=67I6g1I7Zao
Video 12. Dovetail Qld. (2018 September 26). The Stages of Change Model. [Video]. https://www.youtube.com/watch?v=ayjXMix-nMw
Video 13. Psychwire. (2019 June 18). Lifting the Burden in Motivational Interviewing. [Video]. https://www.youtube.com/watch?v=SsNgZ47o2I4
Video 14. Pernille Erichsen. (2018 August 5). Bill Miller - On Change Talk. [Video]. https://www.youtube.com/watch?v=YIhMsTdZMVM
Video 15. Leeds School of Dentistry. (2019 October 23). Rolling with Resistance: Re-Framing. [Video]. https://www.youtube.com/watch?v=KBjmGCHx5BE
Video 16. Leeds School of Dentistry. (2019 October 29). Rolling with Resistance: Shifting the Focus. [Video]. https://www.youtube.com/watch?v=GJYruT30gZI
Video 17. Columbia U School of Social Work. (2017 September 22). Motivational Interviewing: A Dialogue with the Practice's Co-founder William R. Miller. [Video] https://www.youtube.com/watch?v=DSHh6V9yNzg
Video 18. Columbia University. (2009 October 22). Dr. William Miller, "Motivational Interviewing: Facilitating Change Across Boundaries". [Video] https://www.youtube.com/watch?v=6EeCirPyq2w
Pre-module survey: https://www.surveymonkey.com/r/P9L9TJG
Post-module survey: https://www.surveymonkey.com/r/P9XJWLL