Amy Shanahan, MS, CADC Director of Clinical Care Services Western Psychiatric Institute & Clinic of UPMC

Transcription

1 Motivational Interviewing Introduction Amy Shanahan, MS, CADC Director of Clinical Care Services Western Psychiatric Institute & Clinic of UPMC Jeff Geibel, PhD Senior Program Director Addiction Medicine Service Dual Diagnosis Program Western Psychiatric Institute & Clinic of UPMC

2 Motivational Interviewing

3 Historical Background William R. Miller, PhD Steve Rollnick o Wrote first MI article in 1983 o Collaborated and wrote the first MI book Influenced by Carl Rogers person-centered counseling o Congruence genuineness & honesty o Empathy feeling what the person is feeling o Respect acceptance and unconditional positive regard

4 MI Studies 160 n = 150 Obesity Dental 140 Asthma Violence 120 Family n = 93 Health Prom Psychiatric Diabetes Cardiac HIV 60 n = 54 Smoking/Tob Adh/Retention n = Eating Disorders Offenders 20 Gambling n = 6 Dual Dx 0 AOD

5 Important Findings MI can be delivered effectively by health care practitioners; professional role does NOT appear to affect its efficacy MI achieves it effects in ONE to FOUR sessions Requires a minimum dose of about 20 minutes. More sessions = Greater efficacy Feedback and coaching + MI workshop = significant improvement in clients responses.

6 Confrontation vs. Empathy Miller, Benefield, & Tonigan (1993) reported drinking outcomes at 12 months were strongly predicted by counselor style: o The more the counselor confronted, the more the client drank o Random assignment to counseling styles also strongly predicted the degree of client resistance (higher with confrontation) o Expressed motivation for change (higher with MI)

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8 Confrontation vs. Empathy It matters what the clinician does Confrontation undermines change Given a brief motivational intervention, clients went ahead and changed on their own without any treatment Clinician s empathy predicts client change

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11 MI Spirit - confrontation - authority - self-interest - education Partnership/Collaboration Acceptance Compassion Evocation

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13 OARS Skills Open-ended questions Affirmation Reflective Listening (Heart of MI!!!!) Summary 13

14 Open-Ended Questions Are you doing OK? o What has been good in your day so far? o Where would you like to start today? Are you married? o Tell me about the important relationships in your life? o What does your home situation look like? How much do you exercise on a typical occasion? o What does a typical exercise session look like for you? o Tell me about the physical activities you enjoy the most? Did you have a good day? o What did you talk about at lunch today? o What is something interesting or funny that happened today?

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16 Affirmations A person you see is here for the 3 rd time this year. He continues to use substances despite his efforts to cut down; one time completing detoxification treatment. While on the unit he has been swearing, disrespectful to some staff and keeps asking to go home. 1. Strengths: 1. He has made attempts to cut down several times. 2. Despite potential embarrassment, he is here and accepting some medical attention. 2. Affirmation: 1. You are courageous and have taken some steps to consider changing. 2. You are strong minded and know what you need to do.

17 Roadblocks to Listening Directing Warning/threatening Giving advice Lecturing/arguing Preaching Judging Praising Shaming Interpreting/analyzing Reassuring/consoling Questioning/Probing Distracting/changing the subject Handout Roadblocks worksheet

18 Active Listening

19 Reflections Simple Repeating (repeats an element of what the client said) o Rephrasing (uses new words) Complex o o Paraphrasing (makes a guess to unspoken meaning) Reflection of feeling (a paraphrase that emphasizes the emotion through feeling statements) o Metaphors and similes (Kind of like ; It s as though ) o Double-sided o Amplified o Continuing the sentence/paragraph

20 Reflections I m not sure I ll be able to fit going to treatment appointments with my busy schedule. 1. What is your first reaction to this statement? 2. Using the SPIRIT of MI, provide a simple reflective statement in response.

21 Practice Reflections I m not sure I ll be able to fit going to treatment appointments in with my busy schedule. Provide an example of a complex reflection. o o o o o o What might this person really be saying? What might be the underlying feeling? Example of a metaphor? Might this person feel two ways about this? What double-sided reflection might you consider? Amplified? Continuing the paragraph?

22 Summaries Longer reflections that capture what the person is sharing and can be used to: o Summarize key points. o Shift back to the topic. o End a session. Example: Over the past year you ve made attempts to change your substance use patterns, are here because of health complications and you are wondering how you might be able to juggle treatment so you don t have to come back here again.

23 MI in Summary MI is a Collaborative Conversation that, Respects autonomy, Focuses on ambivalence and, Involves a Spirit and, Tools to engage people in a discussion about change. OARS are the tools we can use.

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