The Use of Motivational Interviewing working with Women Clients

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welcome
WELCOME
The Use of Motivational Interviewing working with
Women Clients
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COMMON FACTORS

• 40--CLIENT TRAITS
• Strengths, Resources, Client Perceptions
• 30--THERAPEUTIC RELATIONSHIP
• Empathy, Acceptance, Mutual Affirmation,
  Encouragement, Respect Warmth
• 15--HOPE-EXPECTANCY
• Belief in possibility of change
• 15--TECHNIQUES/ORIENTATION

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Womens Treatment

• Elements for Engagement/Retention
• Available Child Care Transportation
• Relationship-Based
• Family/Couples Counseling
• Domestic Violence Services
• Employment Services

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Stages of Change
Termination
recovery
relapse
Action
Maintenance
Preparation
Contemplation
Precontemplation
Stages of Change Prochaska et al, 1991
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Why Enhance Motivation?

• Inspire Motivation
• Assist Individuals Readiness for Change
• Keep People in Treatment

• Improve Individuals Experiences in Treatment
• Improve Outcomes
• Increase Return Rate

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Motivation and change
Motivation Change

• KEY TO CHANGE
• MULTIDIMENSIONAL
• CAN BE MODIFIED
• DYNAMIC FLUCTUATES
• INFLUENCED BY OTHERS
• STYLE OF CLINICIAN INFLUENCES
• IS ELICITED ENHANCED

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Motivational Interviewing

• Directive
• Client-centered
• Counseling style
• Elicits behavior change

• Client ambivalence
• Communication style
• Autonomy respected

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MI Principles

• Express Empathy
• Develop Discrepancy
• Roll with Resistance
• Support Self-efficacy

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Motivational Interviewing
PHASE I BUILDING MOTIVATION PHASE II
STRENGTHENING COMMITMENT TO CHANGE
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Phase One StrategiesBuilding Motivation

• Open-ended Questions
• Affirmation
• Reflective Listening
• Summary
• Eliciting Change Talk

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Open vs Closed Questions

• Open-
• Requires more than a yes or no response
• Eliciting more person centered
• Aides individual cognitions
• Closed-
• Quick, easier, efficient
• Less person centered
• Less engaging

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Affirmations

• Client Focused
• Build on Client Strengths
• Highlight Client Success
• Express Empathy

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What is Reflective Listening?

• Hearing meaning behind the clients words
• Building Hypothesis vs. Making Assumptions
• Creating a non-judgmental, accepting environment
• Genuineness

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REFLECTIVE LISTENING

• Levels of depth --
• Level One Repeat
• Level Two Rephrase
• Level Three Paraphrase

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Reflections Options

• Some Starting Points
• It sounds like you . . . .
• Youre feeling . . . .
• It seems to you that . . . .
• So you . . . .

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Summarizing

• Special form of reflection
• Provider chooses what to include and emphasize
• Includes concerns about change, problem
  recognition, optimism about change, ambivalence
  about change
• Client knows you are listening
• Invite client to respond to your summary

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• Change Talk Categories
• Self-Motivational Statement

• Problem Recognition
• Statements of Concern
• Intention to Change
• Optimistic about Change

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Phase TwoStrengthening Commitment

• Recognizing Readiness
• Transitional Summary
• Key Questions
• Information Advise
• Negotiating a Plan

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RAW GRAPH
Readiness

• 
  

Willing
Motivation
CONFIDENCE
Able
RAW GRAPH
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Motivation Exercise

• Listener
• Ask What is something you are motivated to
  change?
• Use active listening, open-ended statements or
  questions
• Speaker- respond

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Termination
A
R
Action
Recycle
S
Relapse
Maintenance
O
Change Plan
Preparation
CHANGE TALK
information advice
OARS
OARS
Contemplation
Summary Key Questions
Readiness?
OARS
OARS
Precontemplation
MI-SOC ROADMAP TOMLIN/RICHARDSON-2000 SPIRAL OF
CHANGE DEVELOPED BY PROCHASKA, et al, 94 OARS IS
A TERM DEVELOPED BY MILLER et al, 00