86 lines
3.6 KiB
Markdown
86 lines
3.6 KiB
Markdown
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## Motivational Interviewing (MI)
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**Core principle:** People are more likely to change when they talk themselves into it than when someone else tries to convince them. Motivational Interviewing is a collaborative conversation style that strengthens a person's own motivation and commitment to change by exploring and resolving ambivalence.
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### The Spirit of MI
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Four elements that define the approach:
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- **Partnership** — Working with, not on, the person. They are the expert on their own life.
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- **Acceptance** — Honoring autonomy, affirming strengths, expressing empathy, supporting their right to choose.
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- **Compassion** — Prioritizing the person's welfare and best interests.
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- **Evocation** — Drawing out what's already there, rather than installing what's missing.
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### OARS: Core Skills
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**Open Questions**
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- Questions that invite reflection and elaboration
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- "What concerns you about this?" vs. "Are you concerned?"
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- "How would you like things to be different?"
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**Affirmations**
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- Genuine recognition of strengths, effort, and values
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- Not praise ("Good job!") but reflection of character ("That took courage")
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- "You care deeply about your kids—that comes through clearly"
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**Reflections**
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- The most important MI skill—listening and giving back what you hear
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- Simple: repeating or rephrasing ("You're frustrated")
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- Complex: reflecting meaning, feeling, or what's unsaid ("Part of you really wants this, and part of you is scared of what it would mean")
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**Summaries**
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- Collecting what's been said, linking ideas together
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- Especially useful for gathering change talk into one place
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- "So on one hand... and on the other hand... and what matters most to you is..."
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### Change Talk vs. Sustain Talk
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**Change Talk** — Language that moves toward change:
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- Desire: "I want to..."
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- Ability: "I could..."
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- Reasons: "I'd be healthier if..."
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- Need: "I have to..."
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- Commitment: "I will..."
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- Taking steps: "I actually started..."
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**Sustain Talk** — Language that favors the status quo:
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- "I can't see myself doing that"
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- "It's not that bad"
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- "I've tried before and it didn't work"
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The goal is not to eliminate sustain talk but to gently tip the balance toward change talk.
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### Key Concepts
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**Ambivalence** — Wanting and not wanting to change at the same time. This is normal, not resistance. MI works with ambivalence rather than against it.
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**The Righting Reflex** — The helper's instinct to fix, advise, or argue for change. Paradoxically, this often increases resistance. MI resists the righting reflex.
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**Readiness Rulers** — "On a scale of 0-10, how important is this change to you?" followed by "Why a 5 and not a 2?" (elicits change talk, not deficit).
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### Key Questions
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- "What would you like to be different?"
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- "What's the best thing about the current situation? And the not-so-good things?"
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- "If you did decide to make a change, what would be your first step?"
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- "You rated importance at a 7—tell me about that."
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- "Where does this leave you?"
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### When to Use MI
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- Ambivalence about change (health, relationships, habits, career)
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- Addictive behaviors or harm reduction
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- Health behavior change (exercise, medication adherence, diet)
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- When advice-giving or persuasion has failed or backfired
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- Early stages of change (pre-contemplation, contemplation)
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- Any situation where autonomy and self-direction matter
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### MI Exercises
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- Decisional balance: exploring pros and cons of change and status quo
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- Readiness ruler with follow-up (why not lower?)
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- "A day in the life" of the changed future
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- Values card sort connecting values to desired change
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- Noticing and reinforcing change talk in conversation
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