motivational interviewing - monmouth university...motivational interviewing an evidence based...

Motivational InterviewingAn Evidence Based Approach For Addressing Ambivalence

Kimberly Pillsbury, MA, LPC, LCADC, ACS, [email protected]

Presenter

Presentation Notes

Good Afternoon, I will be sharing what I know about MI with you in the next hour and my experiences with implementing into daily practice. First of all let me say that I think it is really awesome that so many of you are here. A decade ago when I first started learning about MI there were only a small handful of people in the room and now we have a room full.

Learning Objectives

Understand MI as a Counseling Approach

Identify the 4 Processes of MI

Review the 4 Basic Skills of MI (OARS)

Explore Ways to Incorporate into your Counseling Approach

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Presenter

Presentation Notes

Today we are going to look at what MI is, the 4 processes of MI and we will discuss the basic skills of MI then end with ways to incorporate it into your counseling approach. How many of you are currently using MI? How many of you have heard of it but don’t know too much about it? The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy. Miller and Rollnick later elaborated on these fundamental concepts and approaches in 1991, then 2002, and now the 3rd edition in 2013. MI is not and was never intended to be a stand alone theory, it is intended to be used with other approaches.

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What Is Motivational Interviewing Motivational interviewing is a collaborative,

goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.

(Motivational Interviewing: Helping People Change. William R Miller, PhD, Stephen Rollnick, PhD. Guilford Press, Sep 2012.)

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Presenter

Presentation Notes

William Miller and Stephen Rollnick The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy. Miller and Rollnick later elaborated on these fundamental concepts and approaches in 1991, then 2002, and now the 3rd edition in 2013. MI is not and was never intended to be a stand alone theory, it is intended to be used with other approaches. MI is used by physcians, coaches, dentist, clergy. Heck even my hair dresser. No lie I walked in to Modern Technique. Insurance Companies, Verizon.

http://www.guilfordpress.co.uk/books/details/9781609182274/

http://thisnessofathat.blogspot.com/2012/04/its-like-your-health-bad-habits-make-it.html

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MI Defined

Client Centered Directed Guidance Toward Change Autonomy

Presenter

Presentation Notes

Directing in not directive style such as advice giving. Rather it is working with the client to strengthen their motivation for and commitment to make a particular change.

How is MI important for the people we work with?

Increases likelihood of following protocol

Increases quality of care provided

Increases follow through

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Myths of MI

MI is just Carl Rogers with an

attitude

Autotomy means we don’t have goals for

our clients

Best results if use MI as sole

therapeutic approach

It is a way to trick our clients

Reflective listening is MI and it is EASY

Presenter

Presentation Notes

Carl Rogers- continuum of Directing- Guiding- Following. MI uses Client centered methods to evoke/elicit change talk and MI adds a directional component. MI was designed to strengthen motivation for commitment to make a particular change.

What MI Is NOT

https://www.youtube.com/watch?v=Ow0lr63y4Mw

https://www.youtube.com/watch?v=Ow0lr63y4Mw

Transtheoretical Model of Change (Prochaska & DiClemente, 1986)

Presenter

Presentation Notes

MI uses

Ambivalence

The hallmark of the Contemplation Stage of Change

A normal part of the change process

Wanting and not wanting something

Change talk and Sustain Talk

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Presenter

Presentation Notes

Mixed Feelings. I want to and I don’t want to change NORMAL Human Experience. When you hear BUT- Again how language is helpful and important. Ambivalence with attending conference. Clients getting stuck with ambivalence distract and Status Quo MI works to explore ambivalence

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MI SpiritA Way of Being

Partnership

1Acceptance

2Compassion

3Evocation

4

MI Spirit

CompassionateBEING

GenuineBEING

EmpatheticBEING

CuriousBeing

Engaging The Client

• Verbally• Reflect back what

client is saying• Normalize, validate

client’s experience and feelings

• Affirm their strengths• Non Verbally

• Body language (eye contact, open posture)

EXPRESS EMPATHY

Henry Nouwen stated “Anyone who willingly enters into the pain of a stranger is truly a remarkable person” (2005)

Empathy vs. Sympathy

Focusing And Evoking

Focus on particular agenda

Direction toward goal Change Plan

Elicit the client’s own motivation for change

Planning/Quiet Curiosity When your client begins thinking and talking more

about when and how to change rather than whether they want to or why they need to change.

What does it look like Seeking advice, more information.

(SMART) Specific

Measurable

Attainable

Relevant

Timely

Righting Reflex “A natural and instinctive response of

trained care provers is to fix the problem, make things right, to use knowledge acquired from training and experience to help the individual seeking care to overcome their problems.” (Miller & Rollnick , 2012)

Persuading-resistance trap

Rescuing Client

Overload with info

Directing rather than guiding

Pursuing Problems and weaknesses

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The 5 Principals of MI

EmpathyExpress

DiscrepancyDevelop

ArgumentationAvoid

With ResistanceRoll

Self-EfficacySupport

MI’s New Look At Resistance Sustain Talk- Relates to target behavior or

change “I have more energy to do what I need to

do and be a fun mom for my kids when I use cocaine”

“Drinking makes me feel normal.”

Discord- Is about the relationship “You’re not an addict so you don’t get it.” “This isn’t the 1800’s things are different from

when you were my age.” “You have no idea what I go through”

Change and Commitment Talk

Keep Your EARS Open For Change Talk

Elaboration:What? Why?

How? Tell me…

Affirm: As you affirm, it

encourages more change

talk

Reflect: allows the client to hear

their own words/ideas

about change

Summarize the change talk

Implementing Techniques into Practice

OARS Open-ended questions

Mindful of direction of question (positive or negative)

Affirmations From I to You

Reflections Simple, complex, double sided, metaphor

Summaries- Provide to the client as a Bouquet of flowers Collecting,

Linking

transitional

Presenter

Presentation Notes

Positive direction- Negative direction- MI was originally developed to strengthen a client’s commitment toward a particular change. The choice is ultimately the client’s but wording of questions and reflections are often intended to influence a particular direction. However, there are situations when

Open Ended Questions Closed questions limit information we can gather from

client

Elicit Negative Consequences In what ways does your drinking affect other people in

your life?

What will happen if you don’t make a change?

Elicit Positive too What do you like about getting high/drunk?

In what ways has your anxiety been helpful to you?

Affirmations

Reinforces change talk

Promotes empowerment/self-efficacy

Acknowledges client’s struggles

Increases self awareness of strengths and struggles

Use YOU rather than I

“I am proud of you”

“You worked hard to make this happen.”

Reflections

Simple- Stay close what the client states

Amplified- You want the client to correct you

Double Sided- Acknowledging both sides of ambivalence.

Complex- Evoking deeper meaning, creating awareness.

Summaries

Reflections that collect what a person said and present them to a client as a “bouquet of flowers.” (Miller and Rollnick)

Linking Summaries: clarify ambivalence and reflect on previously discussed items. “I am confused….

Transitional Summaries Used toward the end of a session or when moving on to a

new topic.

Tools To Help Decisional Balance

Values Clarification

Importance Ruler

Query Extremes Open-ended questions that lead to extreme positive or

extreme negative

Value Exploration

Looking Back

Looking Forward

Summary: An MI PrayerGuide me to be a patient companion,

to listen with a heart as open as the sky.

Grant me vision to see through her eyes

and eager ears to hear her story.

Create a safe and open mesa on which we may walk together.

Make me a clear pool in which we may reflect.

Guide me to find in her your beauty and wisdom,

knowing your desire for her to be in harmony:

healthy, loving, and strong.

Let me honor and respect her choosing of her own path,

and bless her to walk it freely.

May I know once again that although she and I are different,

yet there is a peaceful place where we are one.

William Rollnick, 2012

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motivational interviewing - monmouth university...motivational interviewing an evidence based...

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