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Download CCSP Motivational Interviewing: Skills Building Webinar ... Motivational Interviewing: Skills Building Webinar and Workshop Denise Barnes, MA, LPC Member of the Motivational Interviewer

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  • CCSP Motivational Interviewing:

    Skills Building Webinar and Workshop

    Denise Barnes, MA, LPC

    Member of the Motivational

    Interviewer Network of Trainers

  • Motivational Interviewing (MI)

    Why is MI a hot topic these days?

    It can be hard to change

    If you force change, you get push back

    MI helps understand ambivalence

    This can make navigation easier

    It often helps client understand themselves

  • Learning Objectives At the conclusion of the webinar and

    workshop, you will be able to:

    Describe motivational interviewing (MI).

    Identify the four key MI principles and SPIRIT.

    Understand how conversation can facilitate change

    Demonstrate the four MI Skills (OARS)

    Demonstrate basic strategies that will enhance patient readiness to change.

  • What is MI?

  • Motivational Interviewing

    in a Nutshell

    Motivational interviewing is a client-

    centered, guiding communication

    style for enhancing a persons

    intrinsic motivation for change.

  • Motivational Interviewing

    Developed by William Miller

    (University of New Mexico),

    Stephen Rollnick (University of

    Wales College of Medicine), and

    their colleagues over the past two

    decades.

  • MI Spirit - A key foundation

  • MI Spirit

    Autonomy

    Honoring and supporting clients personal responsibility for change

    Collaboration

    Meeting of the clients and professionals hopes

    Sharing power and respecting dual expertise

    Evocation

    Drawing out clients concerns, wishes, hopes, strengths, goals, values, and intention

    Compassion

    Demonstrating genuine concern for the wellbeing of your client

  • MI Spirit from a long time ago

    Out beyond ideas of wrongdoing and

    rightdoing, there is a field.

    Ill meet you there.

    Rumi, 13th Century poet

  • Characteristics of an MI Practitioner

    Able to listen with heart and mind

    Genuinely warm and caring

    Respectful of client autonomy

    Collaborative (doesnt need to always be in charge or take the expert role)

    Appreciate the complexity of your clients lives and the difficulty of behavior change

  • Basketball Perception Test

  • What are the Four Processes of MI

  • Four Processes of MI

    1. Engaging

    2. Focusing

    3. Evoking

    4. Planning

  • Engaging

    Engaging is laying the relational foundation.

    Engaging is that beginning process where

    you let them know the agenda and how

    things works. If an ongoing session, this

    might be where you summarize last work

    and check in about the current focus.

    You can try adding MI spirit in.

  • Focusing

    Focusing involves steering the course of the

    conversation in a strategic and

    collaborative - manner.

  • Evoking

    Evoking is drawing out the client views,

    beliefs and values what is important to

    them.

    The clients change talk , their words that

    express interest in changing, are what you

    spotlight in your responses.

  • Planning

    Planning in an MI framework is negotiating

    goals and plans that name the necessary

    actions and commitment needed.

  • A Final Note on the Processes

    Using all the principles together defines MI

    Using only one or two of them will not

    necessarily be MI

    For the best outcome, work toward using

    all of these principles with clients

    It does take practice, but with MI spirit and

    intention, you cant go wrong

  • Not the MI Way

  • Group Discussion

    1 2 3 4 5 6 7 8 9 10 Not Somewhat Highly

    at all motivated motivated

    motivated

  • Group Discussion

    How motivated was this patient at the beginning of the session?

    How motivated was she at the end?

    What happened in between?

    What specifically did the health care provider do to increase or decrease motivation?

  • The MI Way

  • Group Discussion

    1 2 3 4 5 6 7 8 9 10 Not Somewhat Highly

    at all motivated motivated

    motivated

  • Group Discussion

    How motivated was this patient at the beginning of the session?

    How motivated was she at the end?

    What happened in between?

    What specifically did the health care provider do to increase or decrease motivation?

  • What is Motivation Anyway?

  • Motivation Is:

    An ever changing state (not trait)

    Fundamental to change

    Fluctuates in response to the influence of others, especially helping professionals and peers

    Strongly influenced by the interpersonal style of helping professionals

  • Stages of Change a process

    Precontem-plation

    (start here)

    Contemplation

    Preparation

    Action

    Maintenance

    Relapse is common

    Adapted from DiClemente & Prochaska, 1982

  • Banksy The Dog

    Demonstrates

    The Six Stages of Change

  • 1) Pre-contemplation

  • Perhaps more exercise would do me good

    2) Contemplation

  • To get ready I went shopping for the right work out gear!

    3) Preparation

  • Lets play ball Im ready to go!!!

    4) Action

  • Look at me Im still ready for more!!!

    5) Maintenance

  • 6) Relapse

  • Stages of Change a process

    Precontem-plation

    (start here)

    Contemplation

    Preparation

    Action

    Maintenance

    Relapse is common

    Adapted from DiClemente & Prochaska, 1982

  • Why Dont People Want To Change?

  • Ambivalence is a normal

    part of the process of change.

    Successfully addressing

    ambivalence is a crucial MI

    skill.

  • The Two Sides of Ambivalence MI model: A schematic

    Ambivalence

    ResistanceChange Talk

    Importance Confidence

    Resistance

    Advantages of Status quo

    Disadvantages of change

    Pessimism about change

    Yes, but

    Change Talk

    Disadvantages of Status quo

    Advantages of change

    Optimism about change

    I want to do something different

    Change Talk = Importance & Confidence

  • Resistance & Change Talk

    Yellow Toadflax

    (Butter 'n Eggs)

    (WEEDS! )

    Yellow

    Daffodils

    Two Sides of Ambivalence:

    =sustain talk

  • It is not the professional, but the

    client who has to make an

    argument for change.

  • MI for pre-contemplation

    Lets practice

    Write out any change talk

  • Analyze the Situation

    Amy is your client.

    What is her Stage of Change

    What are your goals based on

    SOC?

    What small seeds of change talk, if

    any, did you hear?

    How might you engage Amy and

    elicit change talk?

  • How Best to Enhance Motivation?

    ROLL WITH RESISTANCE:

    Avoid getting stuck in a tug-of-war

    Dont drive into the ditch

    MI is more like dancing than wrestling

    Reflect, Reflect, Reflect..

  • Argument Trap

  • How Best to Enhance Motivation?

    Facilitate Change Talk DARN-C

    Disadvantages of not getting screened for cancer

    Advantages of being screened

    Reasons for screening

    Need to be screened

    Commitment to be screened

  • Four MI Skills

    Open ended Questions

    Reflective Listening

    Affirmations

    Summary

  • Can You Recognize Change Talk?

    LETS TAKE THE

    CHANGE TALK QUIZ!

    (Next 2 slides attached as worksheets

    too, so you can bring to training.)

  • Change

    Talk

    Quiz

    CHANGE TALK QUIZ

    1) Ive been doing better on my blood sugars but I dont know what my AIC is. Sometimes I cheat on my diet, so I know its not as good as it could be.

    2) I dont need to stop drinking soda. I need to cut down for sure, but I dont

    need to stop.

    3) This heart-healthy diet is too hard. I cant figure out all these different kinds of oils and fats. Its all grease to me.

    4) What about exercise? Well, I used to swim every week and I liked it.

    5) Yeah, I know I need to get a pap smear but Ive got a lot of other more

    important things to think about right now.

    6) You might be good at helping some people, but not me. I need to help myself.

    7) Yeah, yeah, yeah I know smoking is bad for my health. I feel it

    sometimes when I run to catch the bus. I cant breathe like I used to. But cigarettes can be my best friend sometimes, like when I get in from a hard day. Theres nothing that settles me down like a cigarette.

    8) Colonoscopies may detect cancer early but just the thought of getting one

    makes me sick. Id much rather try another test, instead, or just take my chances.

    9) If I had a symptom, Id be screened; but I feel fine. Im not the kind to go

    looking for trouble.

    10) I like sweets but Im not crazy about the weight gain.

  • Coding

    Sheet

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