Psychotherapy.

net Academy

Role-Plays
After watching the video, break participants into groups of two and
have them role-play two different sessions so they can get a feel for
the difference between the MI approach and a more confrontational
approach. This is also an opportunity to practice 1) fully exploring
ambivalence, 2) using MI tools for eliciting change talk, and 3) fostering
a next step.
In both sessions, clients will role-play someone who is faced with a
dilemma and ambivalent about making a particular decision. Clients
should choose a specific life change they are considering, where there
is no obvious preferred outcome, such as moving or changing jobs.
Students can play themselves, a client they have worked with, or
someone they know personally; they can also base their character on
Jim in the video, or completely make it up.
First, have counselors embody a non-MI approach: that is, one
characterized by confrontation, persuasion, explanation, and authority.
They should try to convince the clients to make a particular decision,
offering advice and opinions, and giving clients reasons for why they
should do what the counselor thinks is best. Both the counselor and
client should avoid the tendency to overact; try to make this as realistic
as possible. Then have the dyad debrief the experience: how did clients
and counselors feel during this exchange?
Next, have counselors practice both the technique and spirit of
Motivational Interviewing, remembering that the counselors role is
not to try to influence the client in a particular direction, but to remain
neutral and help them thoroughly explore the dilemma and come to
their own conclusion. Experiment with the techniques of Motivational
Interviewing, such as Open Questions, Affirmations, Reflections, and
Summaries.
The MI counselor should focus first on establishing a therapeutic
relationship characterized by acceptance, respect, and partnership
with the client, remembering the importance of honoring the clients
autonomy. Counselors should pay particular attention to the righting
reflex in themselvesthe tendency to want to give advice or lecture
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RESOLVING AMBIVALENCE IN MOTIVATIONAL INTERVIEWING: ROLE PLAYS

the clientand, as much as possible, to offer a reflection instead of

following that impulse. Counselors may need to exert extra care
to conduct the conversation in a way that does not sway toward
personal preference. Particular focus should be placed at first on
using a following conversational style and mostly utilizing reflections
as clients sort out the dilemma for themselves. This allows clients to
set the direction for the conversation and reinforces their autonomy.
Then, shift to a more directing style, eliciting change talk by using the
decisional balance tool. To do this, ask clients to talk about the pros
and cons of making the change they are considering, responding with
reflections. Then, invite clients to envision what the outcome of both
decisions might be in the future. Finally, end by asking clients what
they think the next step might be for them in terms of making the
decision.
After both sessions are complete, have participants switch roles, so
that each gets to try out being the counselor and the client.
After the role-plays, have the groups come together to discuss their
experiences. First, have the clients talk about what each session was
like for them. What differences did they notice between the two
approaches? Do they feel they got to fully explore their ambivalence?
Do they feel clearer about a particular decision after either of the
sessions? Did they experience the counselor as remaining neutral?
Was the decisional balance tool helpful? How about envisioning the
future and naming a next step? What do they think are the benefits
and risks of an MI approach and a non-MI approach? Then have
the counselors talk about their experiences. Which approach felt
more natural for them? What do they like and dislike about the MI
approach? Do they have the sense that they helped the client resolve
their ambivalence? How was it to work with the clients ambivalence
did they feel impatient, frustrated, tempted to give their opinion? Did
it take a lot of effort to remain neutral? What did they like and dislike
about the decisional balance tool and directing the client to envision
the future and name a next step? Did any of these techniques seem to
elicit change talk? Were they more comfortable following or directing?
Which approach seemed more effective for resolving ambivalence?
Finally, open up a general discussion of the strengths and the
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 Psychotherapy.net Academy

challenges in employing a Motivational Interviewing approach.

Alternatively, you may have the exercise done in a triad, with one
counselor, one client and one observer, and each party sharing during
the debriefing. Observers can pay particular attention to the righting
reflex in themselves and note when counselors follow this impulse
and when they stay neutral. Observers can also stay attuned to the
therapeutic relationship and notice what seems to be helpful and
unhelpful in terms of resolving ambivalence. When and why might
they have done something differently from the counselor?
A third alternative is to do these role-plays in front of the whole group
with one counselor and one client; the entire group can observe, acting
as the advising team to the counselor. Before the end of each session,
have the counselor take a break, get feedback from the observation
team, and bring it back into the session with the client. Other
observers might jump in if the counselor gets stuck. Follow up with
a discussion on what participants learned about using Motivational
Interviewing to resolve ambivalence.