Motivational Interviewing: to Engage Students in their Learning and Counseling GoalsSara BurdBehavioral Health CoordinatorReading Public Schools

What This Workshop Will Do For You

You will learn ways to use motivational interviewing as a tool to roll with student resistance.

This training will give you a taste of MI and introduce you to some strategies and resources.

What is Motivational Interviewing? Directive, person centered

counseling style that aims to help people explore and resolve their ambivalence about behavior change

Source: Michael Wiles and Cross Country Education, Inc. 2005

Spirit of MIMotivation to change is elicited from the person, not

externallyIt is the person’s task, not the counselor’s or teacher’s,

to articulate and resolve ambivalenceDirect persuasion is not an effective method for

resolving ambivalenceThe adult’s style is generally a quiet and eliciting oneThe adult is directive only in helping the person to

examine and resolve ambivalenceReadiness to change is a fluctuating product of

interpersonal interaction.The relationship is more like a partnership or

collaboration than expert/recipient role.

Characteristics of MIGuiding, more than directingDancing, rather than wrestlingListening, as much as tellingCollaborative conversationEvokes from a person what

he/she already hasHonoring of a person’s autonomy

What Do We Know About Motivation?It is fundamental to changeIt fluctuatesIt can be modifiedIt is influenced by external factors and social

interactionsIt is very sensitive to interpersonal styleThere are internal and external sourcesWe want to increase the probability of the

person engaging in change behaviorMotivating is an inherent part of our job

What is Ambivalence I want to, but I don’t want to Natural phase in the process of

change Normal aspect of human nature,

not pathological Ambivalence is key issue to

resolve for change to occur It is our friend

PRINCIPLES

Principles of MIExpress empathyDevelop discrepancyRoll with resistanceSupport self-efficacy

Express EmpathyAcceptance facilitates changeSkillful reflective listening is

fundamental to expressing empathy

Ambivalence is normal

Develop DiscrepancyThis is accomplished by thorough goal and value exploration:Help the student identify their own goals/values Identify small steps toward the goal- focus on the

feasible stepsList pros and cons ( payoff matrix)Difference between the person’s core values and life

goals and their behaviorUse the ICR scale ( Importance, Confidence,

Readiness)Difference between where the person is now and

where he/she would like to be in the futureBest if the individual makes the argument for change. No discrepancy = No ambivalence…Ambivalence

makes change possible.

ResistanceIt is normal4 types: arguing; denying; ignoring;

interruptingThe more one talks about non-change

behaviors, the more a person is likely to do them.

May mean the adult is ahead of the person in the change process

Resistance often stems from fear of change

Resistance is a signal to change strategies

Roll with Resistance: DO NOT…

Argue, disagree and challengeJudge, criticize, blameWarn of negative consequencesSeek to persuade with logicAnalyzeConfront with authorityUse Sarcasm

How to respond to resistance

Simple reflection: State what the student saysAmplified reflection: Reflect with modification (Student:

I don’t know how changing my eating habits could help me. Adult: You feel your eating habits are perfectly reasonable. )

Double-sided reflection: Reflect back the statement but also use the other side of the client’s ambivalence

Agreement with a twistShifting focusReframing: Placing something in a more positive light –

(what are the benefits?)Rolling with resistance :This is where you just want to

validate what the client is telling you by letting them know you have heard their problem and understand their ambivalence

Support Self-EfficacyExpress optimism that change is

possibleReview examples of past

successes to stop usingUse reflective listening,

summaries, affirmationsValidate frustrations while

remaining optimistic about the prospect of change

Let’s Try…Developing Discrepancy:

◦ Have students identify their own goals/values◦ Identify small steps toward the goal- focus on the

feasible steps◦ List pros and cons ( payoff matrix)◦ Difference between the person’s core values and life

goals and their behavior◦ Difference between where the person is now and where

he/she would like to be in the future

Trina dreams of becoming a marine biologist. Trina never arrives to her first morning class (Biology) on time. She has increasingly fallen behind in her work for that class. Trina has been reminded to arrive on time and has served detentions for her chronic tardiness. She is still unable to arrive on time.

Let’s Try…Rolling with Resistance:

◦ Simple reflection◦ Amplified reflection◦ Double-sided reflection◦ Agreement with a twist◦ Shifting focus◦ Reframing

Sawyer speaks out loud in class a lot. Sawyer often interrupts others, speaks off topic and very loudly. As Sawyer’s teacher you have asked him countless times to remain silent or wait for the appropriate time to speak. Sawyers peers have also started to plead with him to stop interrupting. Sawyer argues with you and his peers defending his right to speak in school and have his own opinion.

STAGES OF CHANGE

Cycle of Change

Precontemplation

Contemplation

PreparationAction

Maintenance

PrecontemplationStudent is either unaware of problems related to negative health behavior or lack the desire to change their negative behavior, and they do not report any intention to change their negative habit within the next 6 months.

I don’t have any problems with (behavior)”They may come across defensive

◦ Reluctant◦ Resigned◦ Rationalizing◦ Rebellious

No intention to change

ContemplationIndividuals recognize that some aspect of

their negative behavior is a problem, and they plan to take action in the next 6 months. They are often seen as ambivalent because the perceived costs and benefits of the negative behavior are equivalent.

I have been thinking about changing (behavior)”◦They have identified the behavior may be

problematic◦More troubled about the behavior◦Ambivalent but may be weighing pros and cons◦Decisional balance exercise useful

PreparationCommitment to change has been

made and they plan to take action in the near future

How can I change (behavior)?”◦More committed◦Ready to start◦Sharing plans for change◦Change becomes a priority

ActionBegin to actively change behaviors

and environmental conditions to overcome problem.

“Here I go”◦They decide on a change strategy and

try it out◦Actively modify behavior including

thoughts, feelings, and the environment◦Treatment and/or self-help◦Persistence and completion or drop-out

MaintenanceChanges have become a regular part

of the individual’s lifestyle“I think this will work and I am going

to continue”◦Trying to keep the ball rolling◦Preventing relapse – learning new coping

skills◦Watching out for triggers◦Acknowledging self for changes made

and taking credit◦Moving toward more balance

Why Use Stage of Change Model?Identifying a clients stage of change

will help you determine the best approach to take with them.

If using strategies for a more advanced stage of change with a student who is at an earlier stage of change, resistance is almost guaranteed.

Change is the responsibility of the client but the caregiver is responsible for enhancing motivation to change.

Ways to Determine Stage of Change

“I noticed (behavior) is this something that is creating a problem for you or something you would like to change?”

“People differ in how ready they are to change their (behavior) habits. What about you?”

Let’s Try…Identifying stage of change:

Precontemplative, Contemplative, Preparation, Action, Maintenance

Raj knows that his social interactions with peers tends to isolate him. Raj likes to talk very fast, and only about himself without ever listening to others. Raj thinks its okay to talk about himself, but he wishes that others would seek him out at lunch and recess or in group projects.

Let’s Try…

Identifying stage of change: Precontemplative,

Contemplative, Preparation, Action, Maintenance

Kristoff never hands in homework. He believes that it is irrelevant to a true education and that he learns best without doing his homework.

Let’s Try…Identifying stage of change:

Precontemplative, Contemplative, Preparation, Action, Maintenance

Lucille is very shy and doesn’t like to speak out loud in class. Lucille’s class participation grade has suffered and as a dedicated student she is willing to endure some discomfort in order to raise her grade. Lucille has decided to challenge herself to speak once a day in each class for a week.

STRATEGIES

Strategies of MIEliciting Change Talk –

motivational statements from the client

OARS Method◦Open-Ended Questions◦Affirming the client◦Reflective listening◦Summarizing

What is Change TalkStudent identifies that behavior

might be problematicStudent expresses concern about a

behaviorStudent expresses a desire to

change the behaviorDARN-CAT: Desire, Ability, Reason,

Need, Commitment, Activation, Taking Steps

Eliciting Change TalkAsking Evocative Questions Using Readiness Rulers ( ICR Scale)Exploring the Decisional Balance

(pros and cons)Good Things/ Not So Good Things As for examples, elaborationLooking Back/Looking Forward Query extremesCome alongside ( side with the

negative)

Open-Ended QuestionsOpen questions gather broad

responsesFacilitate dialogueRequire more than a yes no

responseUsually go from general to

specificConvey that our agenda is about

the studentUsually start with words like

“how”, “what”, “tell me about” or “describe”.

Affirming the StudentThe idea here is to enhance self-efficacy (Self-

efficacy is our belief in our own ability to achieve a goal or accomplish a task)

Strengthen the relationshipEnhance self-esteemMust be sincereAcknowledges the difficulties the student

facesValidates the students experience and feelingsEmphasizes past experiences that

demonstrate strength and success to prevent discouragement

Reflective ListeningBegins with a way of thinkingIt includes an interest in what the person has to say and a desire to truly understand how the person sees things.

Allows individual to feel heardAllows you to confirm perceptions

Reflective Listening Examples

Repeating- simplestRephrasing-

substitute synonymsParaphrasing- major

restatementReflection of feeling-

deepest

“It sounds like . . .”

“It seems as if . . .”“What I hear you

saying . . .”“I get a sense

that . . .”“It feels as

though . . .”“Help me to

understand. On the one hand you . . . and on the other hand . .”

SummarizingA technique to be used throughout

the meeting◦Strategically repeat a client’s self-

motivational statementsInclude reluctance/resistanceCan link together a students

feelings of ambivalence and promote perception of discrepancy

Reflect optimism for change

Let’s Try…Eliciting Change Talk:

◦ Asking Evocative Questions ◦ Using Readiness Rulers◦ Exploring the Decisional Balance (Payoff matrix-

benefits/costs)◦ Good Things/ Not So Good Things ◦ As for examples, elaboration◦ Looking Back/Looking Forward ◦ Query extremes◦ Come alongside ( side with the negative)

Gabriel is a student in your class who tends to sleep through instruction.

Let’s Try…

OARS Method◦Open-Ended Questions◦Affirming the client◦Reflective listening: Repeating-Rephrasing-

Paraphrasing - Reflection of feeling◦Summarizing

Shay expresses affection very physically at school. She has noticed that her friends are distancing themselves and that the boys are teasing her. She is venting with you about how badly this makes her feel and damages her self-esteem.

Let’s Put It All TogetherPractice the 4 Principles of MI

◦ Express empathy◦ Develop discrepancy◦ Roll with resistance◦ Support self-efficacy

Identify the Stage of Change◦ Precontemplative, Contemplative, Preparation,

Action, MaintenanceUse the OARS Method (and strategies)

◦ Open-Ended Questions◦ Affirming the client◦ Reflective listening◦ Summarizing

Greta stays after class to talk with you about her poor test grades. Greta is a strong student, but never studies and as a result has a very low grade for the course. She wants to know why you deducted 5 points from one of her answers and is argumentative. Greta clearly believes the problem is poor grading from you and feels the need to fight until it is changed.

Marcus makes odd noises during class. He has been talking with you over the past few weeks about how uncomfortable he feels in school. Marcus has identified that his discomfort comes from how his peers and teachers treat him; they tend to look at him funny or avoid and ignore him altogether. Marcus says he makes the noises because he doesn’t know any other way to get people to acknowledge him.

Questions?

Thanks!

ResourcesGarfinkle, Buddy & Schneeloch, Nancy Bridgeway Rehabilitation Services, Elizabeth, New Jersey Motivational Interviewing in Action: Integrating MI Across Your Agency

Heckathorn, Danette M.S., L.P.C. Rolling with Resistance : Using a Motivational Interviewing Approach

icanhelp Program Training www.icanhelp.me

Prochaska et. al., 1994, Stages of Change Model

S. Rollnick, W. Miller and C. Butler, Motivational Interviewing in Health Care, 2008.