motivational interviewing in drug courts ron jackson, msw, licsw school of social work university of...
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Motivational Interviewing in Motivational Interviewing in Drug CourtsDrug Courts
Ron Jackson, MSW, LICSWRon Jackson, MSW, LICSW
School of Social WorkSchool of Social Work
University of WashingtonUniversity of Washington
Seattle, WASeattle, WA
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MI is a fancy way of selling people on their need to change behavior.
A. True
B. False
50%50%
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Motivational InterviewingMotivational Interviewing
Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
Miller & Rollnick, 2012
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Motivational InterviewingMotivational InterviewingTheoretical FoundationTheoretical Foundation
Client-centered approach – RogersClient-centered approach – RogersEmpathic Reflections
Self-Perception Theory – BemSelf-Perception Theory – Bem “We come to know what we believe by listening to
ourselves talk.” Self-Efficacy – BandSelf-Efficacy – Bandura
Power to Change Focus on Intrinsic Motivation – BrehmFocus on Intrinsic Motivation – Brehm
External pressure can lead to resistance to change Respect for client/patient autonomy – Medical EthicsRespect for client/patient autonomy – Medical Ethics Transtheoretical Model “Stages of Change” – Transtheoretical Model “Stages of Change” –
Prochaska & DiClementeProchaska & DiClemente
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STAGES OF CHANGESTAGES OF CHANGEPROCHASKA & DiCLEMENTEPROCHASKA & DiCLEMENTE
PRECONTEMPLATION
CONTEMPLATION
PREPARATION
ACTION
MAINTENANCE
TERMINATION
RELAPSE is viewed as a loss of motivation and movement back down the spiral of change.
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Spirit of MISpirit of MI
• Partnership• Acceptance• Compassion• Evocation
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The The SpiritSpirit of Motivational Interviewing (MI) of Motivational Interviewing (MI)
Therapeutic relationship is a collaborative partnership, rather than separate ‘expert’ & ‘recipient’ roles. Motivation for change is elicited from the client, not imposed.
It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence. The counseling style is an eliciting one.
Direct persuasion is infrequently effective in resolving ambivalence. Instead, the counselor supports a client’s autonomy while helping to explore the prospect of change.
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Process StructureProcess Structure
Engagement
OARS
Focusing – Strategic Direction
Evoking Motivation – Change Talk
Planning
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FOUR PROCESSES OF MIFOUR PROCESSES OF MI
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Four Principles ofFour Principles ofMotivational InterviewingMotivational Interviewing
R – Resist the righting reflex
U – Understand client’s motivation
L – Listen to the client
E – Empower the client
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Four Elements of Four Elements of Motivational InterviewingMotivational Interviewing
Express empathy
Develop discrepancy – Gap
Roll with resistance
Support self-efficacy – Can Do
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Supporting Self-EfficacySupporting Self-Efficacy
Encourages hope or the possibility of change. Our expectations about the likelihood of client
change has a powerful effect on the outcome. We want to enhance our client’s confidence in
their capacity to change. The client is responsible for choosing and carrying out change.
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Four Goals ofFour Goals ofMotivational InterviewingMotivational Interviewing
Increase problem awareness
Resolve ambivalence
Increase the value of change
Increase confidence
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O.A.R.S.O.A.R.S.Tools for Moving in the MI SessionTools for Moving in the MI Session
Open-ended questions
Affirmations
Reflective listening
SummariesMotivational Interviewing is not a series of techniques for doing therapy but instead is a way of being with patients.
William Miller, Ph.D.
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Question Answer or Assessment Premature Focus Labeling Chat Trap Blaming Expert
MI TRAPSMI TRAPS
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CHANGE TALK ANDCHANGE TALK ANDSUSTAIN TALKSUSTAIN TALK
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Desire for status quo (don’t want to change)Inability to change (can’t change)Reasons for sustaining the status quoNeed for the status quo (have to stay)Commitment to status quo (not going to
change)
EXAMPLES OF SUSTAIN TALKEXAMPLES OF SUSTAIN TALK
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Change StatementsChange Statements
Problem recognition
Statements of concernProblems with the status quo
Desire to change
OptimismAbility to change
Benefits of change
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Preparatory Change Talk Preparatory Change Talk
DARN
Desire
Ability
Reasons
Need
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Mobilizing Change Talk Mobilizing Change Talk
CAT
Commitment
Activation
Taking steps
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Recognize EvokeRespond
CHANGE TALKCHANGE TALK
Desire
Ability
Reason
Need
CAT
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Desire AbilityReasonsNeed
(preparatory)
CHANGE TALKCHANGE TALK
Activation
Taking Steps
(mobilizing)
Behavior
Change
Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology.Vol 71(5) Oct 2003, 862-878.
Commitment
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Readiness to Change
Importance
Confidence Readiness
From Chris Dunn & Stephen Rollnick, Lifestyle Change.
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Exploring ImportanceExploring Importance
Assess: “On a scale of 1-10, how important is it to you now to…(change)?”
Explore: “Why did you give it a ___ and not a ___ (lower number)?”
“What would have to happen to raise that score?”
“How can I help you with that?”
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Exploring ConfidenceExploring Confidence
Assess: “On a scale of 1-10, how confident are you now that could make that change, if you decided to make it?”
Explore: “Why did you give it a ___ and not a ___ (lower number)?”
“What would have to happen to raise your confidence?”
“How can I help you with that?”
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PartnershipAutonomyCompassionEvocation
MI Spirit
DD - Developing
DiscrepanciesEE -Expressing
EmpathySS -Supporting
Self EfficacyRR - Rolling with
Resistance
O-OEQAffirmationsReflectionsSummariesE-P-E Elicit-Provide-Elicit
EngagingFocusEvokingPlanning
Heart-Set
Mind-Set
Being
Working
Doing
Going
Principles
Skills
Path
MI Package
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Resources: BooksResources: Books Motivational Interviewing (3rd Ed.), Miller,
W.R. & Rollnick, S., Guilford Press, 2013. Motivational Interviewing in Health Care,
Rollnick, S, Miller, W.R., & Butler, C. C., Guilford Press, 2008.
Lifestyle Change, Dunn, C. & Rollnick, S., Mosby, 2003.
Building Motivational Interviewing Skills Rosengren, David , Guilford, 2009.
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BOOKS FOR LEARNING BOOKS FOR LEARNING MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING
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Resources: WebsitesResources: Websites
www.motivationalinterview.org – excellent source of MI resource material.
www.msleaders.org/ms-leaders/ce/motivational.asp – Overview & video demonstrations of brief interventions contrasting MI consistent & inconsistent styles. Requires broadband connection.