Building Motivational Interviewing Skills Applications of Motivational Interviewing Stephen Rollnick and William R. Miller, Series Editors Since the publication of Miller and Rollnick’s classic Motivational Interviewing, MI has become hugely popular as a tool for facilitating many different kinds of positive behavior change. This highly practical series demonstrates MI approaches for a range of applied contexts and with a variety of populations. Each accessible volume reviews the empirical evidence base and presents easy-to-implement strat- egies, illuminating concrete examples, and clear-cut guidance on integrating MI with other interventions. Motivational Interviewing in the Treatment of Psychological Problems Hal Arkowitz, Henny A. Westra, William R. Miller, and Stephen Rollnick, Editors Motivational Interviewing in Health Care: Helping Patients Change Behavior Stephen Rollnick, William R. Miller, and Christopher C. Butler Building Motivational Interviewing Skills: A Prac ti tion er Workbook David B. Rosengren Building Motivational Interviewing Skills A Prac ti tion er Workbook David B. Rosengren THE GUILFORD PRESS New York London © 2009 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualified professionals. The publisher grants to individual purchasers of this book nonassignable permission to reproduce all materials for which photocopying permission is specifically granted in a footnote. This license is limited to you, the individual purchaser, for personal use or use with individual clients. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, file-sharing sites, Internet or intranet sites, and handouts or slides for lectures, workshops, webinars, or therapy groups, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. Library of Congress Cataloging-in-Publication Data Rosengren, David B. Building motivational interviewing skills : a prac ti tion er workbook / David B. Rosengren. p. cm. — (Applications of motivational interviewing) Includes bibliographical references and index. ISBN 978-1-60623-299-6 (pbk. : alk. paper) 1. Motivational interviewing. 2. Counseling. 3. Interviewing in mental health. I. Title. BF637.I5R67 2009 158′.39—dc22 2009016131 For Nancy Ann About the Author David B. Rosengren, PhD, is a Research Scientist at the University of Washington’s Alcohol and Drug Abuse Institute; a clinical research specialist for the Prevention Research Insti- tute, Lexington, Kentucky; a motivational interviewing (MI) consultant and trainer; and a clinical psychologist in private practice. His primary research and clinical interests are motivation, the process of change, and training methods. Dr. Rosengren has provided MI training since 1993, including serving as a master trainer for the Motivational Interviewing Network of Trainers (MINT). He has authored numerous book chapters and journal articles on MI-related topics. vii Series Editors’ Note During the past decade, the method of motivational interviewing (MI) has spread across the globe at a surprising rate. It is being applied with a wide array of populations in health care, corrections, addiction and mental health treatment, and social services. The demand to learn MI has outpaced the reach of the many hundreds of trainers now teaching it in at least 38 languages. An unfortunate consequence of such rapid dissemination is that misunderstandings of the method easily arise, and the quality of service delivery can suffer. In some ways MI is simple, but mastering it is neither quick nor easy. We have likened the process to that of learning to play a musical instrument or a skillful sport. Reading and lectures can take you a certain distance, but ultimately it is practice that shapes and improves skill in MI. As in music or sport, it helps to receive good feedback and coaching along the way. We also rec- ognize that currently, such expert supervision is not readily available in many areas. How then to help people who want to learn the method of MI? That is the purpose for which this book was written. Over the years the Motivational Interviewing Network of Trainers (MINT) has developed quite an array of useful training methods to help people in learning MI (see www.motivationalinterview.org). David Rosengren has been one of MINT’s most creative and generous contributors in this regard, and in this book he draws together his experience in training thousands of people in MI. He has done an excellent job of balancing content and practice: both clarifying important key concepts in MI and provid- ing helpful aids for developing skill in this method. This book is not meant to replace good feedback and coaching where it is available. To the contrary, it contains a wealth of material that is useful in training, coaching, and learn- ing this method. For those without immediate access to an expert coach, it offers practical methods that can be used by individuals or groups attempting to improve their professional skill. For those fortunate enough to have good MI supervision and coaching available, the clear presentation and methods in this book will also prove useful in the learning process. ix x Series Editors’ Note We are pleased, therefore, with the publication of this next volume in The Guilford Press series Applications of Motivational Interviewing. It is a unique contribution to the series, and we hope that it will help and encourage you as you gain skill in this broadly applicable method for calling forth people’s own motivations for change. WILLIAM R. MILLER , PhD STEPHEN ROLLNICK , PhD Preface Motivational Interviewing (MI), an empirically supported clinical method (e.g., Project MATCH, 1997a, 1998a), has experienced an explosion of interest in treatment, intervention, and research settings. With that steep climb in interest comes a corresponding demand for opportunities to learn MI. There are a variety of methods to meet that demand. Train- ing by expert MI trainers is an important initial tool, but too often does not include either follow-up coaching or ongoing feedback on trainee skills. Prior MI texts have rich contex- tual material, but do not provide opportunities to practice skills. Videos allow opportunities to observe models, but are primarily passive observational tools. Interactive web and DVD materials are starting to appear, but remain in their infancy. Missing in all of these materials is a text that allows the learner to review basic concepts and opportunities to practice skills, alone, with others, and with clients. This workbook fills that void. It provides overviews of concepts and skill areas and is grounded in experiential learning. Through engaging activities and practice opportunities readers will test their knowledge, learn skills, and refine techniques for using MI. For some- one new to MI, this book will provide an introduction to concepts. For a recent workshop attendee, this workbook will provide opportunities to refine skills, deepen understanding, and check progress. For an experienced MI provider, the material here will offer the chance to learn additional techniques and become more adroit in skills. It also provides guidelines for establishing an MI learning group. A companion to Miller and Rollnick’s (2002) second edition of Motivational Interview- ing, this book is built on my 16 years of experience in training prac ti tion ers and MI trainers in the skills of MI, as well as my research studying the acquisition of MI skills. It offers a user-friendly option for that trainee question “Where can I learn more?” xi Acknowledgments It is easy to think of writing as a solitary process, but this conveniently ignores the many hands and heads that make an idea bloom into a manuscript and finally a book. I owe thanks to many. Terri Moyers brought me into this project when it was only a seed and graciously allowed me to cultivate it when her path went elsewhere. Editorial guidance was critical. At The Guilford Press, Kitty Moore started with me and Jim Nageotte finished this meandering; Kitty was a great inspiration and Jim a great guide. Thanks also to the many others at Guilford who brought this book to conclusion. Bill Miller and Steve Rollnick have given much in their work on MI generally and to me particularly. Steve gave me the very helpful advice to make my writing time sacred rather than another burden on an already (too) busy schedule. Bill provided the repeated readings and shepherding that this process needed. It was a bit like having my own graduate seminar with Bill Miller. How great is that? The result is evident: a much better volume where the wisdom is his and the mistakes are mine. Then, of course, there are the many members of MINT who’ve contributed so much to the MI method, training, and research. Editing has reduced all of the names that appeared in early versions, but I am well aware of how this work stands on your shoulders. The richness of ideas, the generosity of spirit, and enthusiasm for your work make me glad to be a part of your ranks and certainly better for it. Your wisdom and friendships are something I hold dear. Even with all of those other things, family and friends made this work possible.