Motivational Interviewing: An introduction Jan Larkin Consultant Clinical Psychologist Turning Point (Substance Misuse and Public Health)
Overview of the session Learning objectives Your own behaviour change: Two conversations the spirit of MI What is MI? FRAMES a brief intervention model Information giving: Elicit-Provide-Eicit Giving a steer OARS Putting it all together a health behaviour change intervention
Learning objectives Learning about models of behaviour change for short interactions Having conversations about behaviour change what does it feel like when it s us? Reflecting on an example of Motivational Interviewing practice
Practice 1 (borrowed from Miller, M. & Rollnick, S. 2014) Work with one other person One will be the speaker One will be the therapist Switch roles when I tell you to reverse
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)
Listener Explain why the person should make this change Give at least three specific benefits that would result from this change Tell the person how they could make this change Emphasise how important it is to change Persuade the person to do it If you meet resistance, repeat the above
Persuasion: what goes wrong? When worlds collide The righting reflex Ambivalence
Normal human reactions to the Invalidated righting reflex Not respected / Not understood/ Not heard Angry / uncomfortable / unable to change Resist Arguing / Discounting / Defensive / Oppositional Denying / Delaying / Justifying Withdraw Disengaged / Disliking / Inattentive Passive / Avoid / Leave / Not return
So.. making people feel bad does not help them to change
Practice 2 Speaker: same 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)
Listener Listen carefully with a goal of understanding the dilemma GIVE NO ADVICE Ask these 4 open 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 for you to do it? 4. On a scale of 0 to 10, how important is it for you to make this change? (and why are you at and not 0?) Give a short summary reflection of the speaker s motivation for change? Then ask so what do you think you will do?.. And listen with interest
Normal human responses to a listen / evoke/ empathic style Affirmed Accept Approach Understood / accepted / respected Heard / empowered Open / undefensive Interested / cooperative Talk more / liking Engaged / activated / come back
A change of role.. Not wrestling but dancing: You don t have to make change happen (you can t) You don t have to come up with all the answers (you probably don t have the best ones)
FRAMES brief intervention for people using substances Measures: CAGE, FAST (alcohol) Assess concerns how does alcohol fit in? Elicit and record: typical day s drinking/drug use maximum amount in one day alcohol-related problems (physical/emotional/cognitive)
CAGE Questionnaire Have you ever felt you needed to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about drinking? Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? Two "yes" responses indicate that the possibility of alcoholism should be investigated further.
FRAMES model Feedback (information related to dependence and risk) Responsibility (personal responsibility for change) Advice (to cut down or aim for abstinence, based on risk) Menu of options (e.g. goal-setting, reduction schedule, sobriety sampling) Empathic interviewing (use of reflection, no confronting) Self-Efficacy (what has helped past behaviour change)
Advice and information giving
Menu of options, then.
Brief and Extended Brief Interventions Brief Intervention (5-10 mins) Feedback Responsibility Advice Menu of Options Empathic Listening Extended Brief (10-20 mins) Open-ended Questions Affirmations Reflective listening Summarising Self-Efficacy
What does an EBI look like? Health Behaviour Change Intervention: Mr Richards and Pip Mason What do you notice about Mr Richards reaction as the intervention progresses? What is Pip Mason doing to influence his reactions?
References/Resources CAGE questionnaire http://www.unc.edu/depts/sph/longscan/pages/measures/baseline/cage%20que stionnaire.pdf FAST questionnaire http://www.alcohollearningcentre.org.uk/topics/latest/fast-alcohol-screening- Test-FAST/ Health Behavior Change, 2nd Edition. 2010. Elsevier Press Pip Mason & Christopher Butler Motivational Interviewing: Preparing people for change by William R. Miller and S. Rollnick (2013) 3rd edition. The Guilford Press Motivational Dialogue: Preparing Addiction Professionals for Motivational Interviewing Practice by Gillian Tober and Duncan Raistrick (2007).