|
MI NordicMotivational Interviewing - Motiverande samtal |
A Taste of MI
'''Abstract''': In a structured exercise, participants can experience the basic approach and “feel” of motivational interviewing, even without understanding the skills and principles involved.
'''Overview''': This can be done early in training, even before explaining what MI is. This is particularly effective following the Persuasion Exercise described above, precisely because it provides an experiential contrast.
'''Guidelines''': Have people work in pairs: One speaker, one listener. Time permitting, they can switch roles.
Speaker role: Identify a change that you are considering, something you are thinking about changing in your life, but have not definitely decided. It will be something you feel two ways about. It might be a change that would be "good for you," that you "should" make for some reason, but have been putting off. Tell the counselor about this change you are considering.
Listener role: Don’t try to persuade or fix anything. Don’t offer advice. Instead ask these four questions one at a time, and listen carefully to what the person says:
* Why would you want to make this change?
* If you did decide to make this change, how might you go about it in order to succeed?
* What are the three best reasons for you to do it?
* How important would you say it is for you to make this change, on a scale from 0 to 10,
where 0 is not at all important, and 10 is extremely important? [Follow-up question:
And why are you at _____ rather than a lower number of 0?]
After you have listened carefully to the answers to these questions, give back a short summary of what you heard, of the person’s motivations for change. Then ask one more question:
* So what do you think you’ll do? and listen with interest to the answer.
'''Notes''': In debriefing, ask first about the Speakers’ experience in this conversation. What was happening? Write bullet-point responses on the board or paper. Some common responses across cultures are: understood, want to talk more, liking the listener, open, accepted, respected, engaged, able to change, safe, empowered, hopeful, comfortable, interested, want to come back, cooperative.
If the Persuasion Exercise was done first, you now have two lists of Speaker reactions. Put them side by side and ask, “Which clients would you rather work with?” The point, of course, is that they are the same people responding in different ways to these two counseling styles.
Contributed by: Bill Miller.
| Bilaga | Storlek |
|---|---|
| MIAMI 2006 - MINT Forum.ppt | 100.5 kB |
| Bill's Introduction to MI thru 3 Exercises.doc | 25.5 kB |
- logga in eller registrera dig för att kunna kommentera
Added the slides and Bill's instructions under the prior name, "Intro to MI in Three Exercises" for MINTies to download.
Thanks to David Rosengren
Here is the mail from Bill where he describe how he combined this exercise with [Negative Practice]
First, I had people get into groups of four, and stay with the same group through the day. The one rule was not to be in the same group as your boss or supervisor. The first exercise was the role play that I described. The speaker: Role play a client presentinf ro treatment, where there is a clear behavior change goal. You are ambivalent and somewhat resistant to change. (My reasoning in doing this as a role play rather than real play is that with such a large audience, there's no way to detect or address adverse effects of this "counseling" on real life issues.) The counselor instructions were as I listed: (1) Explain why the client should make this change. (2) Give at least three specific benefits that would result from making the change. (3) Tell the client how to change. (4) Emphasize how important it is for the client to change, and (5) Tell the client to do it. I emphasized on the slide, "P.S. This is NOT motivational interviewing!" There was raucous laughter throughout the exercise, which I let run for about 10 minutes. Then I had a roving microphone to get reactions from the speakers only. They were the predictable ones, and I listed them on a sheet of flipchart paper: Angry, resistant, decided not to change, want out of here, feel attacked and want to attack back, not listening, etc. As usual there were a couple of speakers who said they found it helpful, which I acknowledged and then asked for other responses.
Next (with didactic in between) we did real play. Speaker: Talk about something about yourself that you want to change / need to change / should change / have been thinking about changing etc., but haven't changed yet. i.e. something you're ambivalent about.
Counselor #1: Listen carefully with a goal of understanding the dilemma. Give no advice. Ask these four questions:
Why would you want to make this change?
How might you go about it, in order to succees?
What are the three best reasons to do it?
On a scale from 0 to 10, how important would you say it is for you to make this change? . . and why are you at ___ and now zero?
No instruction yet about reflective listening. Just these open questions geared toward desire, ability, reasons, and need. So that engages two of the four people, and I told them that there would be a Counselor #2 whom I would give instructions later. "So listen carefully, Counselor #2, because there will be a test." (audience groans)
I gave them 15 20 minutes for this exercise. Then I stopped the process and told Counselor #2:
Give a short summary/reflection of the speaker's motivations for change. Summarize what they said about Desire for change, Ability to change, Reasons for change, Need for change. Then ask, "So what do you think you'll do?" and just listen with interest.
Obviously what I'm having Counselor #2 do is a recapitulation and key question. Then we again heard from the speakers via roving microphone. Lots of informative statements. "Just hearing and responding to those questions was powerful." "Usually I get stuck in thinking about this, but I just kept going." There were a number of public statements (in front of 400) about what change the person was going to make.
That's all I had time for in this context. It was interesting to try to give people a taste of MI without doing the reflection exercises. With a little more time (like tomorrow, when I start a 2 day training, I would certainly include the exercise to shape up reflection. Previoiusly I have done the reflective listening training first and then got into directive open questions, summaries etc. the other parts of OARS. It worked pretty well, I think, to use this sequence of three exercises to illustrate the method and its potential impact, even before and without getting into the shaping of reflection, which in a way follows nicely from this opening.