Active Listening and Motivational Interviewing

Purpose

Minimize resistance to change

Elicit “change talk”Explore and resolve ambivalence

Nurture hope and confidence

Wrestling vs dancing

Stages of Change

The stages describe a person’s motivational readiness or progress towards modifying the problem behaviour

Precontemplation: not considering behavior change in the next 6 months; may not be aware a problem exists

Contemplation: seriously considering behavior change in the next 6 months

Stages of Change cont’d

Preparation: planning behavior change in the next 30 days

Action: the first 6 months of behavior change

Maintenance: behavior changed for more than 6 months

Relapse: transition to an earlier stage

Change Talk

Listen for indications of readiness to change in the client’s language. Phrases

to listen for include:

“I want to…”“I can…”“There are good reasons to…”“I really need to…”“I started…”

When you hear change talk: reflect, reinforce and ask for more!

Questions that will encourage change talk

• “What step could you take immediately that would make the greatest difference in your life?”

• “If nothing changes, what might happen?”

• “Suppose that you did succeed and are looking back on it now: What is most likely to have worked? How did it happen?”

• “If you don’t feel ready for change, what would need to happen for you to think about changing?”

Conversational Barriers

ConfrontingPersuadingNaggingInterruptingOrderingJudging

PressuringCriticizingDirectingTalking down toShamingScolding

Don’t try to fix things, ‘set someone right’, or get them to ‘face up to reality’!

Active Listening: OARS

Open-ended questions Example?

Affirms the client Positive or complimentary statements

Reflective listening State what you heard the client say

Summaries Summarize the client’s conversation

More on Reflective Listening

Reflections have the effect of encouraging the other person

to elaborate, amplify, confirm or correct

Good reflective statement openings: “So you feel…” “You’re wondering if…” “It sounds like you…” “So you…”

Types of reflection: Repeating (repeat part of what the speaker said, use synonyms) Rephrasing (use new words) Paraphrasing (make a guess as to unspoken or hidden meaning) Reflect feelings (type of paraphrase that speaks to emotional meaning)

The 10 Minute Interview

1)Create focus “What change would give you the greatest return?”

2)Build motivation “How important is it for you to make this change?”

“What will happen if you don’t make this change?”

3)Summarize the big picture “So you want to X because Y. Z will happen if you don’t make this change.”

4)Ask transition questions “What happens next?”