Introduction to Motivational Interviewing in NAS Interventions

Transcription

1 Introduction to Motivational Interviewing in NAS Interventions Daniel Raymond Tanagra M. Melgarejo Workshop Overview 1

2 Training Objectives By the end of this session you will be able to: Describe the fundamental processes of motivational interviewing as used in NAS interventions. Identify at least three components of the trans theoretical model of stages of change List at least two of the five clinical principles of motivational interviewing Harm Reduction is A set of practical strategies that reduce the negative consequences of drug use and other risk behaviors A spectrum of strategies including safer use, managed use, and abstinence. 2

3 Harm reduction strategies meet people "where they're at. (but don t leave them there) Stages of Change 3

4 Stage 1: Precontemplation Not considering it The worst strategy is persuasion Raise doubt Increase perceptions of risks and problems with current behavior Establish rapport and build trust Stage 2: Contemplation Thinking about it Normalize ambivalence Tip the balance - evoke reasons for change and risks of not changing Assess and support self-efficacy 4

5 Stage 3: Preparation Planning to do it Clarify the goals of the individual Help clients consider barriers and possible solutions in making a plan of action Explore social support Stage 4: Action Doing it Support a realistic view of change through small steps Provide stimulus control, reinforce positive behaviors, and continue emotional support Acknowledge and help them face barriers 5

6 Stage 5: Maintenance Staying with it Help the individual identify and use strategies to prevent relapse Continue emotional support Review long-term goals Develop a fire escape plan The MI Approach 6

7 What is Motivational Interviewing? A client-centered, yet goaldirected counseling method; Used to help people resolve ambivalence about health behavior change; that Helps build intrinsic motivation and stronger commitment to change. (Miller & Rollnick) What is the Goal of MI? To elicit self-motivational statements from the client about change and to direct these statements toward change. 7

8 Why Use MI? Traditional Approaches Authority Confrontation Education Motivational Interviewing Autonomy Collaboration Evocation MI has been proven to be effective! MI assists clients in making informed decisions about change MI is person-centered, so motivation to change is elicited from the individual who is making the change. 5 Key Motivational Areas Concern Competence Self Esteem Desire to Change Knowledge of Problems & Strategies 8

9 Foundations of Motivational Interviewing Clinical Principles & Strategies 5 Clinical Principles Express Empathy Develop Discrepancy Avoid Argumentation Roll with Resistance Support Self-Efficacy 9

10 Expressing Empathy Acceptance facilitates change Skillful reflective listening is fundamental Ambivalence is normal Developing Discrepancy Discrepancy between one s present behavior and important personal goals, values and/or hopes for the future motivates change. The client, not the counselor, should present the arguments for change. Developing awareness of consequences helps individuals examine their behavior 10

11 Avoiding Arguments Arguments are counterproductive Defending breeds defensiveness Resistance is a signal to change strategies Labeling is unnecessary Roll with Resistance Resistance is an interpersonal phenomenon, not an individual quality New perspectives should be invited but not imposed Remember that the client is a primary resource in finding solutions to problems Resistance is a signal to respond differently 11

12 4 TYPES OF RESISTANCE Arguing The client contests the accuracy, expertise, or integrity of the counselor Interrupting The client breaks in and interrupts the counselor in a defensive manner Denying The client expresses unwillingness to recognize problems, cooperate, accept responsibility, or take advice Ignoring The client shows evidence of ignoring or not following the counselor Supporting Self-Efficacy Belief in the possibility of change is an important motivator The client, not the counselor, is responsible for choosing and carrying out personal change There is hope in the range of alternative approaches available 12

13 4 Clinical Strategies Open-Ended Questions Affirmations Reflective Listening Summaries Open-Ended Questions Open-ended questions SHOULD NOT be able to be answered with One-Word!! The client should do most of the talking. Examples: What do you like about drinking? What do you think about using condoms? Tell me more about your daily use. 13

14 Open-Ended Questions Are you worried about your pregnancy? Are you ready to go to treatment? Affirmations Compliments or statements of appreciation. Examples: Great to see you on time today! That s a good idea. That was a BIG step you made last week! You re clearly a really resourceful person to survive through those situations. 14

15 Reflective Listening The essence of reflective listening is that it makes a guess as to what the speaker means. The crucial element is how the counselor responds to what the client says. Reflective listening is a useful tool for responding to resistance. 4 Types of Change Talk 1. Disadvantages of the status quo 2. Advantages of change 3. Optimism for change 4. Intention to change 15

16 Importance Scale How important would you say On a scale from 0 to 5, where 0 is not at all important and 5 is extremely important, where you at? Not at all Important Extremely Important Confidence Scale How confident would you say... On a scale from 0 to 5, where 0 is not at all important and 5 is extremely important, where you at? Not at all Important Extremely Important 16

17 Decisional Balance *comes in handy when clients at earlier stages of change A useful tool to help clients visualize the pros and cons of current behavior and of behavior change Summaries Capture both positive and negative aspects of ambivalence (double-sided reflections) Highlight all self-motivational statements Incorporate information available from outside sources Separate and help clarify different aspects of the individual s situation 17

18 FRAMES Model Feedback Responsibility Advice Menu of options Empathy Self-efficacy Feedback: Give feedback on the risks and negative consequences of substance use. Seek the client's reaction and listen. Responsibility: Emphasize that the individual is responsible for making his or her own decision about his/her drug use. Advice: Give straightforward advice on modifying drug use. 18

19 Menu of options: Give menus of options to choose from, fostering the client s involvement in decision-making. Empathy: Be empathic, respectful, and nonjudgmental. Self-efficacy: Express optimism that the individual can modify his or her substance use if they choose. Self-efficacy is one's ability to produce a desired result or effect. Closing & Evaluations Anonymous Surveys: Put completed surveys in the folder 19

20 HRC thanks you for participating in this workshop! 20