Motivational Interviewing. Calvin Miller, CADC, MAATP

Transcription

1 Motivational Interviewing Calvin Miller, CADC, MAATP

2 Why use Motivational Interviewing? Respectful approach Considers the where the client is at in the Stages of Change. Considers the client s resources. Non-judgmental

3 Stages of Change Prochaska & DiClemente

4 Ambivalence To change or not to change?

5 The importance of Empathy in MI

6 Empathy vs. warmth Tries to understand the client s world but is not very warm or personable.

7 Empathy vs. acceptance Willingness to enter client s world but has value judgments about it and therefore does not accept it.

8 Genuineness vs. empathy Very friendly and down-to-earth but still does not attempt to enter the client s world.

9 The importance of Spirit in MI

10 High spirit collaboration Counselor is not the expert Willing to negotiate with the client. Open to ideas from the client. Avoid persuasion. Explore and support what the client wants to do. Client is partner.

11 Low spirit collaboration Confronts clients Only counselor s point of view is right Rigid in their ideas and plans Try to persuade the client to change. See the client as less than themselves, whom are in need of their help. Their pearls of wisdom are doing to be shared with the client, no matter what.

12 High spirit evocation Elicits the client s ideas about change. Curious and patient Stay focused on whatever behavior change the client is willing to do.

13 Low spirit evocation Counselor ignores the client s offering up of their own ideas for change. Counselor devalues the client s ideas for change. Insist on educating or being logical with the client. Do not pursue the eliciting of self-motivational statements from the client.

14 High Autonomy/Self-efficacy in MI Accept that the clients may not choose to change. Are invested in behavior change but don t push it, in order to maintain therapeutic alliance. Reinforce that ultimately any behavior change is within the realm of the client.

15 Low autonomy These counselors may struggle with clients choosing not the change. May demonstrate urgency in the session (example: Death, jail or institutions).

16 How is Spirit of MI different from other counselor characteristics? Not sympathy No emphasis on expertise (on the part of the counselor) Education of client not considered effective (not to be confused with Giving Information) Does not focus on skill-building Does not analyze unconscious motivations

17 OARS: The Basic Skills of MI Open-ended questions Affirmations Reflective listening Summarize

18 Open-ended Questions What brings you into today? What can you tell me about that? Could you tell me more about that? In what ways.? What have you noticed?

19 Questions Closed questions: will result in yes or no response. Open Question: allows for a wide range of information from the client.

20 Affirmations Two weeks of no drinking is great! Tell me how you did it. Cutting down from 20 bags to 12 bags is very good. I am impressed with your desire to quit smoking. It took a lot for you to come in today. I appreciate it.

21 Reflective Listening It should be a statement, with the inflection turning down at the end. So, you mean that It sounds like you You re wondering if.

22 Summarize The pros The cons An invitation to continue ( What else? ) Include problem recognition, concern, reasons for change and optimism for change.

23 Basic Principles of MI

24 Express Empathy Create a safe environment. Form an alliance. Acceptance works better than judgment. Not over-identification with user. Entering the user s internal world.

25 Develop Discrepancy Where I see myself, and where I want to be. Client (not counselor) presents argument for change. Discrepancy between the client s values, not the counselor.

26 Developing Discrepancy Ask the client: What did you think you did well in the? What would you like to change next time? Where do you see yourself currently, and where would you like to be? Client must provide argument for change, not the counselor.

27 Avoid Argumentation Keeps client s resistance levels low. Resistance: counselor problem. What I am doing wrong with this client? Change your strategy fast! Don t diagnose your client (tempting as it may be ) Don t label your client.

28 Roll with Resistance Go with the flow. Change your strategy in order to keep rolling. Dancing vs. wrestling Think about what lesson you (as counselor) are supposed to learn with this particular client. Patience? Humility? Maybe they are right and you are wrong? Reframing.

29 Support Self-efficacy It is ultimately ALWAYS the client s choice, even death. Impart hope. Pain can be a good motivator but there must be something to work towards. High pain/high hope is always the best motivator. Pathological optimism on the part of the counselor.

30 Eliciting Change Talk 1. Problem Recognition (pros and cons, negative consequences, difficulties or need for change.) 2. Concern: Client voices their concern. 3. Determination: Willingness, desire, commitment, decision to change. 4. Optimism for Change: Hopefulness in their ability to change.

31 Getting Moving: OARS Let s practice.

32 Exercise Work in groups of 3 One speaker and two counselors Counselor #1 will go first Counselor #2 listen carefully but don t speak yet

33 Speaker s topic Something about yourself that you - want to change - need to change - should change - have been thinking about changing but you haven t changed yet (i.e. something you are ambivalent about)

34 Counselor #1 Listen carefully with the goal of understanding the dilemma Give no advice Ask these five open questions:

35 5 Questions 1. Why would you want to make this change? 2. How might you go about it, in order to succeed? 3. What are the three best reasons to do it? 4. On a scale from 0 to 10, how important would you say it is to make this change? 5. And why are you at and not zero?

36 Counselor #2 Listen very carefully. Give a short summary/reflection of the speaker s motivations for change - Desire for change - Ability to change - Reasons for change - Need for change Then ask: So what do you think you will do? and just listen with interest.

37 Ready, Counselor #1 10 minutes Go!

38 Counselor #2 5 minutes Go!

39 Round table and Dodge Ball

40 Resources Motivational Interviewing: Preparing People for Change, 2 nd Edition, Miller and Rollnick Where I can be reached: cmiller235@aol.com