introduction to motivational interviewing
TRANSCRIPT
MOTIVATIONAL INTERVIEWING
SOUTHERN JERSEY FAMILY MEDICAL CENTERS – SANDY BEHAVIORAL
MOTIVATIONAL INTERVIEWING (MI):• AN EFFECTIVE WAY OF TALKING WITH PEOPLE ABOUT CHANGE. • A FORM OF COLLABORATIVE CONVERSATION FOR STRENGTHENING A
PERSON’S OWN MOTIVATION AND COMMITMENT TO CHANGE.• DESIGNED TO STRENGTHEN AN INDIVIDUAL’S MOTIVATION FOR AND
PROGRESS TOWARDS A SPECIFIC GOAL.
WHY DON’T PEOPLE DO WHAT’S BEST FOR
THEM?
SO WHY DON’T PEOPLE CHANGE?• DOESN’T SEEM ALL THAT IMPORTANT• HASSLE• ENJOY CURRENT WAYS• TAKES TIME TO DEVELOP NEW HABITS• REACTANCE• DEMORALIZED• AMBIVALENCE
AMBIVALENCE
• WHEN CHANGE IS HARD IT IS OFTEN DUE TO AMBIVALENCE. AMBIVALENCE IS UNCOMFORTABLE AND LEADS TO PROCRASTINATION. MOST MISTAKE THIS FOR RESISTANCE. AMBIVALENCE IS NOT RESISTANCE.
AMBIVALENCE
AMBIVALENCE
COGNITIVE: KEEP THINGS THE SAME………….TRY SOMETHING NEW
EMOTIONAL:
DREAD/ANGER/GRIEF/SHAME………..EXCITEMENT/CONFIDENCEBEHAVIORAL:
HALTING OR RUSHING……………………CAREFULLY CONSIDERED AND STEADY
STAGES OF CHANGE
MISTAKES PROFESSIONALS MAKE• “THE PROBLEM IS, IF YOU DON’T CHANGE, YOU MAY END UP LOSING YOUR
TOES. AND IF THAT DOESN’T DO IT AND YOU KEEP GOING, WE MAY HAVE TO AMPUTATE AT THE ANKLE. THEN…”• “YOUR KID IS NEVER GOING TO CHANGE IF YOU KEEP LETTING HIM GET AWAY
WITH EVERYTHING”• “I DON’T THINK YOU’RE REALLY READY TO DO ANYTHING DIFFERENTLY YET.
COME BACK WHEN YOU’RE READY TO TAKE THIS SERIOUSLY AND I’LL BE HAPPY TO WORK WITH YOU.”
SKILLS
CORE SKILLS – “OARS”• OPEN ENDED QUESTIONS• AFFIRMATIONS• REFLECTIONS• SUMMARIES• *YOU WILL NOTE THESE ARE BASIC COUNSELING SKILLS
OPEN ENDED QUESTIONS• WHAT WAS THAT LIKE FOR YOU?• WHAT DO THINK ABOUT THAT?• WHAT WOULD YOU LIKE TO DO?• HOW DO YOU SEE THAT?• HOW COULD YOU GO ABOUT ACCOMPLISHING THAT?• HOW MIGHT YOU MAKE THINGS DIFFERENT?• WHAT MIGHT CAUSE YOU SOME SETBACKS?• HOW CAN YOU GET PAST ANY OBSTACLES?
CLOSED ENDED QUESTIONS• SHORT YES/NO QUESTIONS• WERE YOU UNHAPPY ABOUT THAT?• DO YOU THINK HE UNDERSTANDS?• DON’T YOU THINK YOU SHOULD APOLOGIZE?• AREN’T YOU JUST AVOIDING DOING IT?• HOW MANY TIMES A WEEK DO YOU….?
REFLECTIONS
• REFLECTIONS- UNDERSTANDING WHAT THE CLIENT IS THINKING AND FEELING THEN SAYING IT BACK TO CLIENT. NO QUESTIONS HERE!
CLIENT: I DON’T THINK I HAVE PTSD!
COUNSELOR: YOU’RE NOT SURE ABOUT THE DIAGNOSIS OF PTSD?
REFLECTIONSSIMPLE
SLIGHTLY REPHRASE OR CHOOSE ONE WORD THAT SUMMARIZES MEANINGCOMPLEX
MAKE A GUESS ABOUT DEEPER MEANING THAT THE CLIENT HASN’T DIRECTLY STATED…UNDERLYING FEELINGS, VALUES, METAPHORS, ETC.
FOUR PROCESSES OF MI
ENGAGE
• TO ESTABLISH A HELPFUL CONNECTION• TO BUILD RAPPORT• TO OFFER A RELATIONSHIP
FOCUS
• TO DEVELOP A SPECIFIC AGENDA• TO DEVELOP CHANGE GOALS• TO ADD DIRECTION
EVOKE
• FIND THE PERSON’S MOTIVATION FOR SPECIFIC CHANGE• RESPOND TO CHANGE TALK• ELICIT THE PERSON’S RATIONALE FOR AND STRATEGIES FOR CHANGING
PLAN
• OPTIMAL! NOT ALWAYS PART OF MI.• HELP DEVELOP A PLAN• FOR SELF CHANGE• FOR SUPPORTED CHANGE
MI ALWAYS INCLUDES
• EMPATHY• ACCEPTANCE• OPTIMISM• COMPASSION
MI INVOLVES A CHANGE OF ROLE• YOU DON’T HAVE TO MAKE CHANGE HAPPEN• YOU CAN’T ANYWAY
• YOU DON’T HAVE TO COME UP WITH ALL THE ANSWERS• YOU PROBABLY DON’T HAVE THE BEST ONES
• YOU’RE NOT WRESTLING• YOU’RE DANCING
CHANGE TALK (DARN-CAT)• DESIRE (I MIGHT LIKE TO…)• ABILITY (I COULD…)• REASONS (IT WOULD BE SMART TO…)• NEED (I HAVE TO…)
• COMMITMENT (I WILL…)• ACTIVATION (I AM BEGINNING TO…)• TAKING STEPS(I AM…)