ACT and Motivational Interviewing

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ACT and Motivational Interviewing

• Intersection of ACT Core Processes and MI
  principles

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Kristin Dempsey, MS, MFT

• Workforce Development Director San Mateo County
  BHRS Adjunct Faculty Dominican University of
  California
• Trainer, Psychotherapist, Consultant

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Goals for this Workshop

• Explore the client-centered nature of both
  approaches, as well as how each theory addresses
  change and action within a collaborative,
  client-centered model.
• Examine how integration of models can provide a
  more powerful source of intervention as strengths
  of each technique is strategically combined and
  implemented.

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Goals for this Workshop

• Identify which interventions in the perspective
  practices can be best combined for the greatest
  therapeutic impact.
• Develop increased ability to creatively make
  connections between models be open to weaving
  together the approaches based on client needs,
  readiness and confidence to change, and
  participation in committed action.

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This is just the beginning

• The examples here of the complimentary nature of
  ACT and MI principles and procedures are not
  intended to be an exhaustive list.
• In fact, this is a place for you to be
  inspired.the challenge is thus
• What additional connections can you identify
  between the principles for both approaches, and
  how do these connections help reinforce the goal
  of behavior change toward valued action?

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Lets start with commonalities in spirit

• ACT
• Therapeutic stance therapist sits in the same
  boat as our clients
• Avoids convincing and arguing with clients
• Therapists recognize their similarities to
  clients
• Values the clients experience and perspective
• Collaborates with client

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Lets start with commonalities in spirit

• Motivational Interviewing
• Empathic, collaborative approach
• Handled resistance skillfully (instead of
  head-on)
• Therapeutic style is one of calm and caring
  concern
• Appreciate the experiences and opinions of the
  client
• Demonstrates a genuine concern and an awareness
  of clients experiences

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Lets start with commonalities in spirit

• Motivational Interviewing
• Avoids advising or directing the client in an
  unsolicited fashion.
• Decision making is shared
• Clinician uses clients reactions to what the
  clinician has said to guide the direction of the
  session
• Clinician avoids arguing with client

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What do you know about motivational interviewing?

• Starting with the Basics

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Motivational Interviewing Essential Definition
of the Method 2009 Version

• Motivational Interviewing is a collaborative,
  person-centered form of guiding to elicit and
  strengthen motivation for change.
• Miller and Rollnick, 2009, page 130

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What do you know about Motivational Interviewing?
Principles

• Explore Empathy
• Develop Discrepancy
• Roll with Resistance
• Support Self Efficacy

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What do you know about Motivational Interviewing?
- OARS

• OARS can be used in service of achieving the
  principles. Most often seen as a way to develop
  empathic connection
• Open-ended questions
• Affirmations
• Reflections
• Summaries

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Stages of Change
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Phase I

• Motivational Interviewing departs from more
  general client-centered counseling into being
  more consciously directive.
• The counselor listens for, evokes and reinforces
  certain kinds of client statements (change talk),
  while responding to sustain talk in a way that
  does not strengthen it.

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Phase II

• This is when the client is actively motivated and
  committed toward change.
• The counselor is negotiating change strategies
  with the client.

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Motivational Interviewing 3rd Edition

• The essential components of MI
• Engagement
• Guidance
• Evocation
• Change Plan

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ACT and MI Partnership

• At Phase II, ACT can not only be used as the
  intervention to help negotiate behavior change,
  but ACT can help with the transition from
  pre-action to actively engaging change, by
  reinforcing motivational principles via thought
  defusion, acceptance skills, and addressing
  experiential avoidance.

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If change were so easy..How ACT can support the
MI principles and movement toward change

• Client is motivated to leave a job which she
  finds demeaning and abusive. When asked to rate
  her desire to leave on a 1-10 scale, she insists
  she is a 9but she doesnt feel confident in her
  ability to make the move. When asked what might
  be in the way of her making a change, she states
  she cant get over her family rule that you can
  never give up what you started with out being
  considered a loser. She felt much more able to
  consider finding a new job after practicing
  letting go defusing the thoughts through
  visualization. Her confidence regarding leaving
  her work rose after practicing defusion, and
  continued to rise independently of the therapy
  session.

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If Change Were so Easy.

• Client was able to speak at length regarding
  various reasons and needs for change
  specifically improving reading skills and going
  back to work following a long period in a
  residential drug treatment program.
• Despite his strong stated interest he always
  found more important things to do than to sign up
  for the adult school. After some exploration, he
  was able to firmly and

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If it were so easy, continued

• Consistently state that he did not have any
  obvious resistance to going back to school.
• The ACT (this is also MI consistent) intervention
  used was to review again with client his values
  and be curious around how not signing up for
  adult school was or wasnt contributing to his
  goal.
• It was these conversations, which got him
  revisiting his values for himself and his family
  that moved him toward adult school.

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Empathy and Mindfulness
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Developing Discrepancy and Observing
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Rolling with Resistance and Defusion
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Supporting Self-Efficacy
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Consider this.

• Mary Ann is a 53 year old client you meet at the
  pain management clinic. She has spotty
  attendance at the clinic, but states she comes
  because she doesnt think the Vicodin is helping
  her any longer. Shes been on Vicodin for 12
  years following an on the job accident at the
  assembly plant where she worked. She has had
  some success in cutting back, and says her valued
  goal is to stop using altogether.

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Mary Ann, Continued

• When you explore further her valued goal of being
  abstinent from opiates, she says she cannot bear
  being clean, as when she is, she cannot get over
  her anger around the loss of her physical health
  and her livelihood. As she talks, she becomes
  more agitated, and starts to intensely focus on
  the unfairness of her injury.

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Looking through a double lens

• The client has some motivation and some action in
  her life, yet she is also blocked when it comes
  to her target behavior and taking the next step.

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Thinking it through

• What stage of change is the client in .
• REMEMBER, FOR WHICH BEHAVIOR!
• Name two ways you could assess her motivation for
  each target behavior area.
• What are the core processes you see as needing
  the most attention?
• How do issues in these core process areas help or
  hinder clients move to Phase II (toward valued
  action).

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Given this dual assessment

• What ACT-consistent intervention could you use to
  create some space in her thought/behavior
  process, and possibly move her toward acting on
  her valued goal (i.e. committed action)?

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Bruce

• Bruce, 22 years old, has been in four treatment
  programs. He has been a chronic user of
  marijuana, and recently picked up an Adderall
  habit while attending community college. He sees
  you in your office as he is about ready to flunk
  out of school due to non-attendance. His dad,
  with whom he lives, has given him an ultimatum to
  clean up or leave. Bruce says his dad is
  frustrated

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Bruce, continued

• because Bruce has spent so many years in
  programs and has not gotten anywhere.
• Since the ultimatum 3 weeks ago, Bruce has not
  used. This has not been easy for him, and he
  admits to white knuckling it all this time. He
  doesnt want to lose his housing, says he feels
  bad for his family, and is tired of not owning
  my life as the result of his use.

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Bruce, continued

• Bruce says he wants to quit, but he hates
  thinking about stopping drugs because if he does,
  it proves that he is a junkie-addict. He then
  goes on to rant about the addicts in treatment
  programs, how hes not one of them, and his
  powerful desire/need to separate himself from
  those f_____ing losers.

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Motivational Interviewing Literature

• Miller, WR and Rollnick, S. Motivational
  Interviewing Preparing People for Change, 2nd
  ed. Guilford Press, 2002.
• Prochaska, J., et al. Changing for Good. Collins
  1995.
• Rollnick, S., et al. Health Behavior Change A
  Guide for Practitioners, 8th ed. Churchill
  Livingstone.
• Velasquez, M., et al.. Group Treatment for
  Substance Abuse. Guilford Press, 2001.

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Motivational Interviewing and Acceptance and
Commitment Therapy

• I hope this presentation will initiate a common
  dialogue for all of us to consider the vast
  possibilities of the power of these two
  well-designed and compatible interventions.
  Please send feedback to me at dempseykristin_at_gmail
  .com