Motivational Interviewing (Brief)
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1 Motivational Interviewing (Brief) Stephen R. Andrew LCSW LADC CCS CGP Health Education & Training Institute 25 Middle Street Portland, Maine
2 Biography Stephen R. Andrew, LCSW, LADC, CCS, CGP Storyteller, Trainer, Author. Chief Energizing Officer of Health Education Training Institute. Stephen is the former substance abuse counselor for a public school system, the former Executive Director of an adolescent prevention/ treatment agency, and founder of a recovery camp for adults. He is the co-founder of the Men s Resource Center of Southern Maine the mission is to support boys, men and fathers and oppose violence. Stephen maintains a compassion-focused private practice in Portland, Maine and facilitates a variety of groups for men, co-ed, couples and caregivers. He also presents workshops internationally for health-care, criminal justice, social service agencies, substance abuse treatment agencies on motivational interviewing, adolescents and adults & addiction, dual diagnosis, men s issues and group work. Stephen with his two friends authored: Game Plan: a Man s Guide to Emotional Fitness. He is a member of M.I.N.T. (Motivational Interviewing Network of Trainers) since Stephen lives with his sweet wife, Hilary, and is a proud father of a sixteen year old boy, Sebastian in Portland Maine USA.
3 Guidelines for the Training Ask lots of questions.. Be critical of everything what is being said Be mindful of each other. Be kind... Attitudes: What the Heck!! Jump into the experience.. Make Mistakes, OOPS! Confidentiality, make the training your experience Please resist the fixing impulse
4 The nature of the conversation is critical What we say - and how we say it and how it lands largely determines what the client/patient says and what happens next What we say matters!
5 What does motivate people? Change agent (e.g., supervisor, teacher, coach, counselor, relative, clergy person) who had a major positive influence What were their characteristics? List behaviors What did they do?
6 DEFINITION: MOTIVATIONAL INTERVIEWING DEFINITION & SPIRIT Motivational interviewing is a collaborative, personcentered, evidence-based, guiding method of communication for enhancing and strengthening intrinsic motivation for change. SPIRIT: Collaboration; autonomy; empathy; evocation; compassion...
7 Definition of Listening Presence, Interest & Curiosity... Focusing all of one s purpose, attention, and energy on understanding what the person s message means to the them.. Empathy Focus: What is the person experiencing now? Hearing what person is NOT saying..
8 Presence...LISTEN well... " Undivided Attention. " Listen with your soft eyes, ears and your heart... Silence... " Deep Interest in...empathic reflection... " heard & believed. " respectful & compassion. " Reflect...YOU... " Dash of... Curiosity... open?
9 Motivational Interviewing Assumes motivation is fluid and can be positively influenced. Motivation influenced in the context of a relationship. Principle task to guide conversation towards eliciting motivation for change. Goal to influence change in the direction of health. Do you believe that people have a self - determination towards health?
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11 POWER & CONTROL TO LOVE AND TO BE LOVED CAPABLE CONNECTION
12 UNDERLYING ASSUMPTIONS the spirit " Autonomy/Choice " Less is better " Elicit versus Impart " Hope (Michelangelo Belief) " Ambivalence is normal " Non-judgmental " Change talk " Righting reflex " Compassion
13 Evocation of persons own resources Goals Aspirations Dreams Values Concerns Unlock the genius within We do not meet people where they are at...we meet people where they dream.
14 Process of a Conversation the structure Develop Discrepancy/ Amplify Ambivalence OARS Change Talk/ Change Theory Express Empathy Change Plan Target/purpose 10 Commitment Language
15 Processes 1. ENGAGE.. Express Accurate Empathy (radical acceptance, compassion-understands the person s competent world view) 2. HEIGHTEN AMBIVALENCE.. Develop the Discrepancy. (Change is motivated by perceived conflict present behavior and desired intentions,dreams) 3. EMPOWERMENT.. Support Self-Efficacy (worker believes in and listens for change talk and/or commitment language) Stay focused on the target issue...
16 To hold the right position is to let go of the relationship Express Accurate Empathy Amplify Ambivalence Avoid Arguments, the Right position Support Self-efficacy-EMPOWER Roll Resistance/ Status Qou-REFLECT
17 OARS the skills O: open-ended questions, A: affirm, notice the strengths of the person, see the motivation in what they do hear their values, affirm specific behaviors, R: reflection, use empathy, simple and complex, S: summarize (begin, transition and end)...
18 Change Talk: DARN desire, ability, reason, need ACT Action, Commitment, Taking Steps...
19 Levels of Empathic Reflection REPEAT (simple reflections) (restate what the person has said) REPHRASE (synonym) Complex Reflections PARAPHRASE, infer meaning, amplify concepts & values, double-sided, continue paragraph, metaphor, affective SUMMARIZE (gather & reflect the person utterances)
20 Motivational Interviewing literature 1991, 2002, 2013 Motivational Interviewing 3rd edition Miller & Rollnick 2008 Motivational Interviewing in Health Care Rollnick, Miller & Butler
21 Thank You! One thing you liked... One thing you relearned... One thing you learned... One thing you are willing to try... Stephen R. Andrew LCSW LADC CCS CGP
22 Bibliography Motivational Interviewing in Healthcare: William R. Miller, Stephen Rollnick, Christopher C. Butler, The Guilford Press. New York, New York Compassion. Roger Lewin.. Jason Aronson, Inc. Northvale New Jersey Motivational Interviewing: Helping People Change, Third Edition. William R. Miller, Stephen Rollnick. The Guilford Press. New York, New York The Power of Empathy. Arthur Ciaramicoli, Ph.D., Kathleen Ketcham. Dutton Book Company. New York, New York Game Plan: A Man s Guide to Achieving Emotional Fitness. Lyme A., Powell, D., Andrew S.,Central Recovery Press, Las Vegas NV Spirit Wind CD/Tapes Series. Stephen R. Andrew LCSW LADC CCS CGP
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Group Treatment for Substance Abuse: Addressing Motivation and Processes of Change Carlo C. DiClemente, Ph.D. ABPP University of Maryland Baltimore County www.umbc.edu/psyc/habits Disclosures Dr. DiClemente