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Motivational Interviewing

Presenation for ARP 660
by

Teresa Grenawalt

on 14 August 2015

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Transcript of Motivational Interviewing

Obstacle 2
Obstacle 3
Start
5 Basic Principles of MI
Motivational Interviewing is a person-centered and directive approach. MI helps clients overcome ambivalence and use their own motivations to make positive change. MI has five basic principles: express empathy, develop discrepancy, avoid argument, roll with resistance, and support self-efficacy. The counselor should be aware of the stages of change and know when to apply each of the basic principles. The counselor will use OARS during all stages of change. Motivational Interviewing is an effective and evidence-based approach.
Remember your OARS
Meet The Creators
Stan
By: Teresa Grenawalt & Dominique Sandifer
Motivational Interviewing
Applications in Case Management
Objectives
By the end of this presentation you will learn…
Overview of Motivational Interviewing (MI)
Change Talk
OARS
States of Change
The Five Basic Principles of MI
Practical Applications of MI
Quiz Preparation
William R Miller
Stephen Rollnick
Motivational Interviewing
Please watch...
Application of OARS
Stages of Change
Pre-Contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Express Empathy
Develop Discrepancy
Avoid Argument
Roll with Resistance
Support Self-efficacy
Summary
Introduction to Motivational Interviewing
Please watch...
Ambivalence
Change Talk
History of MI

Please refer to the reading material:
Case Study of Stan (Corey, pp. 11-15)
Study Guide
Please take a moment to enjoy to this video...
"Rolling with Resistance" is an introduction to Motivational Interviewing.
Feel Free to DANCE!
Motivational Interviewing (MI) is a person-centered and directive approach to counseling.
The goal of MI is to resolve ambivalence and designed to foster client motivation and initiative.
The MI counselor uses the client’s own motivation to direct the “change talk.”
Client motivation can play a significant role in the success of the change process.
MI embodies the principle of self-determination.
MI is a relatively brief intervention.
“MI stresses client self-responsibility and promotes an invitational style for working cooperatively with clients to generate alternative solutions to behavioral problems,” (Corey, 2013).
(Corey, 2013)
Person-Centered Approach of MI:
Focus on client experiences, values, goals and plans.
Promotes client choice and responsibility in implementing change.
Directive Approach of MI:
MI is not to manipulate clients into doing what other expect.
MI is non-confrontational, yet directive.
The counselor directs the “change talk” based on the client’s own motivation.
MI is not just following the client, it is moving the person in the direction of change.
According to Merriam-Webster’s Dictionary:
“Ambivalence (n): simultaneous and contradictory feelings towards an object, person or action.”
A client experiences ambivalence when they are motivated to make a change, but have contradictory feelings about the change.
For example, “the individual wants and needs her job, yet she craves a certain chemical substance and misses social contacts associated with her drug use,” (Olney, Gagne, White, Bennett, & Evans, 2009).
Change Talk : Importance, Confidence, and Readiness
Change talk- Client expressions that emphasize the value of making changes over continuing to make choices that extend to an unsatisfying status quo
4 Categories of change talk
Recognizing disadvantages of the status quo
Recognizing advantages of change
Expressing optimism about change
Expressing intention to change
These connect with 3 essential elements of motivation: importance, confidence, and readiness
Importance: related to client remarks about the disadvantages of status quo
Confidence: related to expressions of optimism about change
Readiness: related to expressions of intent to change
(Wagner & McMahon, 2004).
MI was developed in the early 1980’s in an effort to assist persons with substance use related problems.
MI was developed by William R. Miller and Stephen Rollnick.

(Corey, 2013)
“Dr. William R. Miller is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico, where he joined the faculty in 1976 after receiving his Ph.D. in clinical psychology from the University of Oregon. He served as Director of Clinical Training for UNM's APA-approved doctoral program in clinical psychology and as Co-Director of UNM’s Center on Alcoholism, Substance Abuse and Addictions (CASAA). Dr. Miller’s publications include 40 books and over 400 articles and chapters. Fundamentally interested in the psychology of change, he has focused in particular on the development, testing, and dissemination of behavioral treatments for addictions. He served as principal investigator for numerous research grants and contracts, founded a private practice group, and served as a consultant to many organizations including the United States Senate, the World Health Organization, the National Academy of Sciences, and the National Institutes of Health. In recognition of his research contributions, Dr. Miller is a recipient of the international Jellinek Memorial Award, two career achievement awards from the American Psychological Association, and an Innovators in Combating Substance Abuse award from the Robert Wood Johnson Foundation. He maintains an active interest in pastoral counseling and the integration of spirituality and psychology. The Institute for Scientific Information lists him as one of the world’s most cited scientists.”
“I am a clinical psychologist and Professor of Health Care Communication in the Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Wales, UK.I grew up and graduated in psychology in Cape Town, South Africa, did further training in research in Glasgow (Scotland), and then went to Cardiff (Wales) where I trained as a clinical psychologist and obtained my PhD. I worked as a clinician in the UK National Health Service for 16 years, initially in the addictions field, then in community mental health and primary care settings.In the late 1990s I moved across to the School of Medicine in Cardiff, where I have been working ever since, as a trainer and researcher on the subject of communication & behaviour change. This work has involved studying consultations, developing new interventions, evaluating the efforts of practitioners to change their consulting styles and exploring ways of improving practice in larger service systems. I have written a number of books with colleagues on motivational interviewing and health behaviour change and have published widely in scientific journals. Recent work has included a role in developing a new organisation, Paediatric Aids Treatment in Africa (PATA), the development and evaluation of video rich, web-supported learning programmes, and a training and mentorship role in the UK roll-out of the Nurse Family Partnership project. I was one of the co-founders of the MINT network (Motivational Interviewing Network of Trainers) and its system for training trainers, and I have run workshops in diverse cultures and settings all over the world.”
Now that you have an overview of MI, let’s go a little more in depth. There are 3 key sets of elements, model, and principles to consider in MI. Some of which may be familiar to you.
OARS
Stages of Change
5 Basic Principles of MI
O
pen-ended questions: Open the session with open-ended questions.
A
ffirmation: Follow up with active listening. Use non-verbal cues & paraphrasing to affirm the client’s responses. Affirm and support the client.
R
eflect: Reflect back on the client’s own statements that are reflective of positive change.
S
ummary: Summarize what you heard, emphasizing the client’s motivation for positive change. Acknowledge the other statements too.
O
pen-ended questions:
What brings you in today?
What would you like to change about this behavior?
What does change look like to you?
A
ffirmation:
Non-verbal cues (nod, mhmm’s)
Repeat back key words
Give praise or affirmation for positive statements
R
eflect:
Keep track of statements that support positive change
Listen for what motivates the client to change
Reflect on the positive attributes of the client
S
ummary:
Summarize what you heard
Focus on statements of positive change
Acknowledge the other statements as well
Clients tend to experience 6 stages of change. Clients may not experience each stage sequentially. It is important for the counselor to recognize the stages of change to know how to respond. Let’s explore each stage individually.
For the next phase please refer to the Case Study of Stan.
Client feels a change is not needed
Client may believe the problem is someone else’s
Counselor should raise client awareness
Case Study of Stan:
Stan presented to counseling by the order of a judge. At that point, Stan may have been in the pre-contemplation stage.
Client does not commit to a plan, but considers possible solutions
Counselor tries to lean the client in the direction of committing to a plan but also strengthens the clients self-efficacy
Case Study of Stan:
Stan’s autobiography indicated that Stan wants to change by quitting drinking, but he mentions he is afraid of failure. Here, is in the contemplation stage.
Client is committed to a change but has not taken the necessary steps to do so
Counselor helps the client find evidence for the need to change and affirms the client’s decision
Case Study of Stan:
Suppose Stan commits to change. The next step is for the counselor to affirm Stan’s decision. This is the preparation stage.
Client has begun the plan
Client is pursing the goals
Clients may experience setbacks and the counselor should problem solve and encourage the client
Case Study of Stan:
Next, Stan begins to take steps towards making change. Stan begins avoiding alcohol. Stan is taking action.
Client is considered to be in the maintenance stage after six months of sustained change
Counselor works with client to sustain the change and avoid relapse
Case Study of Stan:
Stan has been abstained from alcohol for 6 months. The counselor should now help Stan identify a plan to avoid relapse. Stan is in the maintenance stage.
Clients are considered to have relapsed when, after 6 months, have not sustained desired change
Counselor assesses the client’s stage of change and uses techniques associated with the assessed stage
Case Study of Stan:
Although Stan and the counselor made a plan to help Stan avoid relapse, Stan had a setback and drank alcohol at a social event. Stan has relapsed. The counselor should now assess which stage Stan will fall into next.
Empathy has to be expressed.
Empathy is not a feeling, it is a behavior.
“Expressing empathy is foundational in creating a safe climate for clients to explore their ambivalence for change,” (Corey, 2013)
Practical Application: Use reflective listening to better understand the client’s world.
The counselor should help the client understand where they’re going and where they want to be.
Help the client realize: “What is the behavior costing me and why do I want to change?”
MI counselors “assume a directive stance by steering the conversation in the direction of considering change without persuading clients to change,” (Corey, 2013).
Practical Application: Pay attention to the client’s reasons for change rather than the reasons not to change (Corey, 2013). Gently point out the contradiction between the client’s beliefs and behaviors and what they say they want. Helpt the client weigh the pros and cons. (Olney, Gagne, White, Bennett, & Evans, 2009).
The counselor should avoid arguing for change and the client arguing not to change.
Practical Application: Assume a respectful view of resistance to change and work through any reluctance with the client
(Governors State University, 2002).
When a client argues against change, the counselor should not try to overwhelm it, push against it, or come up with a counter argument to it.
Use the momentum to redirect. (Governors State University, 2002).
Practical Application: Meet the client’s resistance with
Double-sided reflections: “’On one hand, you would like to work; on the other hand, you want to hang out with your friends.’”
Reframing: “’Just think, although you will eventually lose your Medicare coverage, when you’re working for the state you’re going to have wonderful healthcare benefits.’”
Agreement with a twist: “’So, you are saying you are going to take a week off from work. What’s keeping you from quitting altogether?’” (Olney, Gagne, White, Bennett, & Evans, 2009).
Give hope to the client
It is possible to change
At this stage the client is talking about change and making a plan to change (Governors State University, 2002).
Practical Application: Strengthen the client’s commitment to change and help them make a plan for change. Look at pros and cons. Let the client choose the path they take. (Olney, Gagne, White, Bennett, & Evans, 2009).
According to Corey (2013), MI was intended for problem drinkers, and has expanded to apply to many other clinical problems, such as:
Substance Abuse
Compulsive Gambling
Eating Disorders
Anxiety Disorders
Depression
Suicidality, and
Chronic disease management (like diabetes)
MI can be used to help any client experiencing ambivalence about change (return to work, ending homelessness, choosing a major in college, and stopping certain behaviors, just to name a few).
Discussion
Now that you have a good understanding of Motivational Interviewing, please take a moment to reflect on:
How you might apply MI to a client experiencing any of the conditions on the previous slide.
What other types of situations could you apply MI to as a Case Manager or Para-Professional?
References
Corey, G. (2013). Theory and Practice of Counseling and Psychotherapy.
Belmont, CA: Thomas Higher Education.
Governors State University (Producer). (2002). Motivational interviewing with
Dr. William R. Miller: Brief therapy for addictions video series [Motion picture]. (Available from Psychotherapy.net, 150 Shoreline Hwy, Bldg A Ste 1, Mill Valley CA 94941)
Merriam-Webster Dictionary. Retrieved from
http://www.merriam-webster.com/dictionary/ambivalence
Miller, W. R. (2013). Brief biography. Retrieved from
http://www.williamrmiller.net/index.html
Olney, M. F., Gagne, L., White, M., Bennet, M., & Evans, C. (2009). Effective
counseling methods for rehabilitation counselors: Motivational interviewing and solution-focused therapy. Rehabilitation Education, 13(2), 233-244.
Rollnick, S. (2013). About me. Retrieved from
http://www.stephenrollnick.com/about-me.php
Wagner, C. C., and McMahon, B. T. (2004). Motivational interviewing and
rehabilitation counseling practice. Rehabilitation Counseling Bulletin; 47(3), 152-161.
Full transcript