Motivational Interviewing

Using Motivational Interviewing with Juvenile OffendersJoan Leary, LPCjleary@uab.eduMay 7, 2014National TASC Conference

Experts in AudienceYEARS IN FIELDPOPULATION I WORK WITHWhat do I know about MI? 010Glean from todays workshop?

DO I CONSIDER MYSELF AMENABLE OR RESISTANT TO CHANGE?Juvenile Arrest Rates

Frustrations with Juvenile Offenders?Failure to complyBack talk_______________Disrespect/defiance_______________Tired of arguing and convincingNo follow throughKnow it allsBurn-outPaperwork

How do we talk to kids?Why dont you do.. I told you to do this! Youre a loser. What you did got you here. If you knew best you wouldnt be in this predicament.6ApproachHarsh verbal discipline increases the likelihood that teens will misbehave and exhibit symptoms of depression.

Teens are more likely to exhibit problem behaviors such as anger, aggression, vandalism and misconduct. Wang et al.

MIis adapted to each individual and the specific behavioral problems that the individual presents it is a collaborative effort between the therapist/PO/case manager and the individual to identify and forge a path to behavioral change using the clients own motivationsWHO, What, When, Where?

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

30 yrs later- MI has Exploded!

DefinitionA person centered, goal directed method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

Motivational InterviewingEncourages positive behavior change in offendersEvidence based practice

What is Motivation?Process that initiates, guides and maintains goal-oriented behaviors, which cannot be forcedThe reason or reasons one has for acting or behaving in a particular wayCannot be given to someoneAbout the choices we make/dont makeVariable with different times/situations

Motivation is NOT a Personality Problem or traitMotivation is a STATE of readiness or eagerness to changeIt may fluctuate from one time to another or situationIt CAN be influenced

Client MotivationREADY: right time to make a changeWILLING: person themself makes a decisionABLE: confidence to change

How?Do you motivate a client to change a pattern of destructive behavior?Do you help someone to stop offending and committing anti-social acts?Do you motivate a client to keep appointments, participate in programs etc?

The Nature of Our InteractionsWhen your objective is to change a persons behavior, what style works best? ConfrontationDemonstrating our power over someoneLecturingDemandingCheer-leadingPleadingBegging BribingShaming

18More Effective ApproachHelping the person to appreciate the value in changing themselves.

Sparking Intrinsic motivation

An Effective StyleIs NOTConfrontationalBlamingHostileDemandingCommandingWishy-washyNon-DirectNon-specificUnclearTouchy-feelySympatheticParentingFriendISEmpathicGenuineHonestSupportiveTrustworthySolution-focusedFairConsistentContingency BasedInterestedNon-argumentativeNon-judgmentalRespectfulHelping Change OccurInterviewing style is a significant factor in dropout, retention, adherence and outcomes.

Individuals who believe they can and will change (self-efficacy) do change.

Officers/practitioners who believe their clients can and will change, influence them positively to do so.

21 Enhance Intrinsic MotivationStaff should relate to offenders in interpersonally sensitive and constructive ways to enhance intrinsic motivation in offenders.Research strongly suggests that motivational interviewing techniques, rather than persuasion tactics, effectively enhance motivation for initiating and maintaining behavior changes.Listening Matters

What doesnt work! - Famous programs based on flawed theories/modelsScared Straight deterrence theory; make them fear prison.Nearly every study over the past 25 years has found dismal results, many even showing higher recidivism rates for Scared Straight participants. Has been characterized as criminal justice malpractice.Drug Abuse Resistance Education (DARE) didactic model; kids dont know drugs are bad for them.Most studies have found neutral effects for DARE. More recent versions of DARE, based upon cognitive-behavioral principles, have been more promisingSheriff Joe Arpaios (Maricopa County Jail, Arizona) Tent Cities and Chain Gangs more deterrence theory; make them hate prison.By the jails own admission, its recidivism rate exceeds 60 percent.NIJ

Ambivalence

is a normal part of considering and making change and is

NOT pathological.

Smoking cessation

Weight lossAlcohol useDrugsNutritionExerciseTherapyBalanceWorkHIVTeensWhere is MI Used?PreventionCondom useART TherapyMD apptsMedication complianceStressHealthcareCorrections29Why Use MI in Corrections?Helps to get offender to be honest/open in assessment processHelps create a more engaging environment with less defensiveness from offenderElicits more accurate information which aids in determiningSupervision levels -PlacementsTypes of treatmentParadigm ShiftGone are the days of;Shouting insults at offendersDenial bustingAlcoholics are liarsAbusing addicts because it was good for themConfrontation and polarization

20 yrs ago a punitive, moralistic and arrogant stance was common in U.S. treatment

Hierarchical EnvironmentCorrections staff often use;Coercive powerAuthorityDynamics which increase defensiveness and resistance

MIMore collaborativeMore respectfulSupportiveDirective

Simpler Definitions1. Its a way of using questions and statements strategically to help people think and talk in a positive direction.

Simpler Definitions2. Its a way of helping people find their OWN reasons for change.

Spirit of Motivational InterviewingCollaborationEvocationAutonomy

5 MI Principles1. Express empathy2. Develop discrepancy3. Avoid argumentation4. Roll with resistance5. Support self efficacy4 Fundamental Processes in MI

1. Engaging The Relational Foundation2. Focusing The Strategic Focus3. Evoking The Transition to MI 4. Planning The Bridge to Change

Changes attributed to oneself are more likely to endure. Davison, Tsujimoto & Glaros, 1973

Rolling with ResistanceDiscordLike Verbal Martial ArtsResistance is not challengedUse the clients energy to take you where you want to goDecreases the clients tendency to play devils advocate

Roll with Resistance/DiscordOpposing resistance can reinforce itCounselor/interviewer rolls or flows with itReluctance & ambivalence are acknowledged as normal & understandableInterviewer invites client to consider new information or ways of thinking about things

Our desire to fix people and set them on a better courseRighting Reflex

Righting reflexArgument for the changeChange is important because..You should changeDrinking is serious you need to quit.Your baby is going to be impaired due to your drug use.DHR will take your kids away..Argument against the changeI dont want/need to changeYou dont know meNo I shouldntI dont have a problemYes, but

CounselorClientSustain Talk

Who are you to tell me what to do? Im not going to do it and no one can make me.Status quoWe blame client for being difficultOne side of ambivalence

Learning is not a one-way "push" model.

http://headrush.typepad.com/creating_passionate_users/2006/01/crash_course_in.html

ASKratherthanTELLConfrontationA confrontational and directive approach may = more client resistanceMay lead to poorer client outcomes1993, Miller study found, the more a client was confronted the more alcohol the client drankConfrontational counseling included; challenging, disputing, refuting and sarcasmASSESS OffenderURICAProchaska and DiClementes Stages of ChangeMost change happens slowlyOffenders may make small incremental positive steps toward changeStages of Change

From DOCMotivational Interviewing principle isListening to offenders and following up on positive aspects of their speechAwareness that corrections professionals can help INCREASE an offenders motivationPositive behavior changes are possible which reduce likelihood of re-offending

GoalThe interviewer/case manager/PO must have a GOAL in mind; a GOAL of Directed change

Not just talking/chatting with offender but have an intention in helping the offender set and achieve positive life changes

Win/WinSecure compliance/impose sanctions+Increase readiness to change/establish a helping relationship=Behavior Change=Better outcomesParticipantsHow might an increased motivation for change from the offender

BENEFIT YOU in your job??

Considerations1) offender be more involved in making life changes2) we wont force change on the offender3) we will have less burn-out4) more sustained change likely when a person makes their own decisionMotivational Interviewing is;NOT about forcing changeIs about encouraging the use of self-perceptionUsing open-ended questions to generate a DESIRE for change

541..2..3..4..5..6..7..8..9..10How important is it for you to make a change? How confident are you that you are going to be able to change? Scaling RulerMIUse your acute listening skillsCareful listeningListening for meaningBuilding upon cues heard from client

MAKING REFLECTIVE STATEMENTS:repeat rephrase paraphrase or make reflective summary statements of what the client said Group ExercisePick one speaker and one listener (switch roles)Pick a topic you would like to change (something you are ambivalent about)

ListenerGive no adviceAsk these questions1) Why would you like to make this change?2) How might you go about it, in order to succeed?3) What are the best reasons to do it?4) On a scale of 1-10, how important is it to you?5) why are you at __ and not __?

RolesDo we often give advice?Do we tell the clients what to do?Do we make suggestions?Do we make threats?

Benefits When Using MIClients feelHeardLike they are really being listened toUnderstoodMore like being openMore safeMore empoweredMore free to be honestMIIs built on internal desire for changeWe cant force change to happen!We dont have all the answers/all of the timeEx; we tell offenders they cant leave the county, when in actuality they can do whatever they please, but if they make the wrong choices they may experience consequences.MI Interviewing Relationship w/Offender Is more like a DANCE

NOT a Wrestling match

You as a GUIDEA guide to motivate offender to changeYou will point out pitfalls of poor decisions

But the offender ultimatelyMakes his/her own decisions

MIChanges the processInstead of telling the offender what to do,

We listen for the offender to express a need for change, and then we capitalize on it.

3 aspects of a successful MI interview1) collaborativeNot authoritativeIs a partnershipTeam approach

Example, Not- I have what you need. But- You have what you need and Im going to help you find/access it.2.) Evocative statements are part of a successful MI interview

It promotes self-discoveryOffenders see problems through their own eyes

3.) AutonomyWhat can we do?1. How can we help facilitate change?2. What kinds of things can we say to get client buy-in?3. What do we say that might encourage client momentum towards change?

We Use MI TechniquesOpen ended questionsListen reflectivelyDevelop discrepancy/dissonanceSupport self-efficacyRoll with resistance; deflectionAvoid argument, lecture, shaming, threats or sympathizing

Video Cliphttp://nicic.gov/MotivationalInterviewingTraps to Avoid

Traps to AvoidQuestion-Answer TrapStifles client elaborationReduces collaborative effort

2.Taking Sides TrapThe most important trap to avoidArguing one side elicits the otherTraps to AvoidExpert TrapThe client is the expert on themselvesOpinions will come later

Labeling TrapPressure to label can lead to wrestlingData does not support need to accept labelTraps to AvoidPre-mature Focus TrapMay elicit dissonanceStart where client is

Blaming TrapRender blame irrelevant in the counseling context. [Counseling is not about deciding who is at fault. Thats what judges do, but not good counselors.Eliciting & Responding toChange TalkChange Talk is the river on which we row.

What is Change Talk?Clients are more convinced by arguments they have presented to themselves more so than arguments presented by others.

In MET we strive to elicit their own arguments for change and the value in such change.Change Talk Model (2.0)DesireAbilityReasonNeedCommitment}DARN-CDesire to change:I want a better life.I would like to be happier.I want to stop using.Ability to change:I could do it if I decided to.When I put my mind to something, I dont quit until Im done.If I could give up drinking, I could quit weed too.DARN-CReasons to change:I would get to see my family.They would send me home.I would have some money.Id feel a lot better.Need to change:I got to get out of jail.I need to stop hurting other people.I have to go to group.DARN-CDesire: Why would you want to make this change? Ability: How would you do it if you decided? Reason: What are the three best reasons? Need: How important is it? and why? Commitment: What do you think youll do?

Benefits/ProsCosts/ConsMaking a Change

Not Making a Change

Decisional BalanceChange Plan Worksheet

1. The changes I want to make (or continue making) are:

2. The reasons why I want to make these changes are:

3. The steps I plan to take in changing are:

4. The ways other people can help me are:

5. I will know that my plan is working if:

6. Some things that could interfere with my plan are:

7. What I will do if the plan isnt working:

Resources

Impact: Motivational Interviewing, Innovation Means Prisons and Communities Together, EUNAADAC.orgNIC, Motivational Interviewing in Corrections: A comprehensive Guide to Implementing MI in CorrectionsSAMHSA Gains Center, 2011 Motivational InterviewingWilliam Miller, Motivational Interviewing, 3rd Editionwww.offenderchange.org/programs/motivational-interviewingwww.buildmotivation.comhttp://aspe.hhs.gov/hsp/08/boys/FactSheets/