![● Double-sided reflection: On the one hand [reasons against change], but on
the other hand [reasons for change].
TYPES OF REFLECTIONS, CONT’D](https://image.slidesharecdn.com/mi101lectureslides-kline-220720070951-c237171e/85/MI-101-lecture-slides-Kline-pdf-14-320.jpg)
MI 101 lecture slides - Kline.pdf
- 1. Motivational Interviewing 101 Emily Kline, PhD
- 2. Behavior change is in all of medicine
- 3. Why do people use drugs?
- 4. We’re all doing our best ● Change is hard ● When people in positions of authority tell us we need to make big changes, we are likely to feel ashamed, defensive, and/or hopeless ● Motivational Interviewing is about being sensitive to this dynamic and avoiding power struggles & shame so that people can actually make the changes they need to make
- 5. What is “Motivational Interviewing”? ● “MI” is a communication style widely used by health professionals to talk about making healthy changes – research shows it works! ● Developed with the goal of increasing motivation for treatment among people with substance use disorders ● MI is based on the idea that the best way to influence another person’s behavior is by respecting their independence and creating space for them to explore their own motivation for change.
- 6. What isn’t motivational interviewing?
- 7. What happened here? ● How is this like being in clinic? ● Why doesn’t it work to tell people there’s a nail in their head?
- 8. The Righting Reflex ● The impulse to help others by ○ FIXING their problem ○ GIVING them advice ○ MINIMIZING their issue
- 9. In order to consider a healthy choice or a change, people need to feel: “My stepdad never assumes… he tries to see my point of view” “I know I can get to work on time” “No one can make me take medicine – I’ll decide for myself”
- 10. Tool #1: Reflections Convey empathy and careful listening
- 11. WHAT IS A REFLECTION? • A Statement, Not a question • Specific – not generic • Repeat back what you heard the person say, or guess at the feelings beneath • Helps the person: • Feel understood and accepted, • Hear their words think a little deeper about what they meant.
- 12. Reflections Don’t Judge ● Reflections are different from praise – they don’t evaluate whether someone met expectations ● Reflections don’t indicate whether you agree/disagree
- 13. TYPES OF REFLECTIONS Simple: repeat back what you heard Complex: reflect the “gist” or overall meaning Feeling: name the emotion you’re hearing
- 14. ● Double-sided reflection: On the one hand [reasons against change], but on the other hand [reasons for change]. TYPES OF REFLECTIONS, CONT’D
- 15. All my friends do it. It’s not a big deal. ● Simple: You feel like it’s not a big deal. ● Complex: Smoking seems normal to you. ● Feeling: People’s concerns about can be annoying. REFLECTION EXAMPLE 1
- 16. REFLECTION EXAMPLE 2 I think it’s fine to have a few drinks to relax. My wife says I get carried away. ● Double-sided: On the one hand, it’s a nice way to relax, but on the other, it’s causing some problems in your marriage.
- 17. Reflections Practice I can’t believe they sent me here. I’m not a drug addict. I stopped shooting up all on my own, I couldn’t live like that anymore. I’ve tried to quit smoking like a thousand times.
- 18. Tool #2: Asking Curious Questions Get curious about another’s perspective and values
- 19. Question Examples OPEN ENDED QUESTIONS get people talking ● Hmm. Tell me more about that. ● What do you think she means by that? ● What do you see as the pros and cons? I think it’s fine to have a few drinks to relax. My wife says I get carried away.
- 20. Open vs. Closed Questions Instead of this (Closed) ● Are you feeling better today? ● Did you take your medications? ● Are you going to go to your therapy appointment today? Try THIS (Open) ● What did you do today? ● What’s going on with your medications? ● How has therapy been lately? ● What do you see as the pro’s and con’s of meeting with your therapist today?
- 21. Questions Practice I can’t believe they sent me here. I’m not a drug addict. I stopped shooting up all on my own, I couldn’t live like that anymore. I’ve tried to quit smoking like a thousand times.
- 23. Before jumping into “expert” role ● Can I share some information with you about the research on THC and addiction? ● I have some ideas that I think would help you. Would you like to hear them? ● Our clinic treats many patients with similar struggles. Do you want to hear more about the services we offer?
- 24. When people feel Understood, confident, and in control… ● They will usually want to hear your advice
- 25. 5 Step Cheat Sheet 1. Make an observation (you’re primary care doctor referred you to me to talk about your drug use) & wait for patient’s response 2. Use reflections to show that you’re listening and learn more about their substance use habits and attitudes (on the one hand…, on the other…) 3. Ask open-ended questions to fill in the gaps (What medications have you already tried? What got in the way last time you wanted to quit?) 4. Seek permission before giving advice (I’ve got some ideas, can I share?) 5. Collaborate on a plan (So what do you think about trying suboxone/CBT/supervised detox?)
- 26. Want to learn more?
- 27. Resource #1: The MI “Bible”
- 28. Resource #2: My E-Course ● FREE at: https://handholdma.org/what- can-i-do/the-school-of-hard- talks-online-lessons-from- motivational-interviewing-for- everyday-families ● (Or just google “School of Hard Talks Online”) ● Seven interactive 10-minute e- lessons + take home points
- 29. Resource #3: Instagram ● Follow @learnaboutMILO to see my students and I demonstrate MI skills, see MI skill flashcards, and learn the results of our research studies
- 30. Resource #4: My Book ● Available for pre-order ● To be released in April 2023!
- 31. Resource #4: Stay in touch Emily.Kline@bmc.org
- 32. Thank You!