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Motivational Interviewing What Is It? Why Use It? How To

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Motivational Interviewing What Is It? Why Use It? How To Learn It? Agenda What it is and isn t (briefly, more later) Dynamics of change Why use it How it works ... – PowerPoint PPT presentation

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Title: Motivational Interviewing What Is It? Why Use It? How To


1
Motivational Interviewing
  • What Is It?
  • Why Use It?
  • How To Learn It?

2
Agenda
  • What it is and isnt (briefly, more later)
  • Dynamics of change
  • Why use it
  • How it works
  • Applying it in clinical practice
  • How to learn it

3
Motivational InterviewingWhat Is It?
4
Motivational Interviewing
  • A person-centered,
  • goal-oriented
  • method of communication
  • for enhancing intrinsic motivation to change
  • by exploring and resolving ambivalence.

5
Phases of Motivational Interviewing
  • Phase I Snow Shoeing
  • Resolve ambivalence and build motivation
  • Snowshoeing up the mountain

6
Phases of Motivational Interviewing
  • Phase I Snow Shoeing
  • Resolve ambivalence and build motivation
  • Snowshoeing up the mountain
  • Phase II Skiing
  • Strengthen commitment and create a plan
  • Skiing down the mountain

7
What It Is Not
  • Skills training
  • Confrontive denial breaker
  • Simply sitting there listening and reflecting
  • The solution to all client issues and clinician
    headaches

8
Dynamics of Change
You would think that.
9
The Problem With Them Is.
  • They dont see (insight, denial)
  • They dont know
  • They dont know how
  • They dont care

10
So The Answer is..
  • Give them Insightif they just see they will
    change.
  • Give them Knowledge.. if they just know they
    will change.
  • Give them Skills.. if you can just teach them
    how to change, then they will change.
  • Give them Hell.. if you can make them feel bad
    or afraid enough they will change.

11
And Yet.. Sometimes Insight, Knowledge, Skills,
And Feeling Bad Or Fearful Is Still Not Enough
12
What Is Happening?
Issues of
  • Ambivalence
  • Motivation
  • Readiness
  • Confidence

13
Stages of Change
  • Precontemplation
  • Contemplation
  • Determination/Preparation
  • Action
  • Maintenance
  • Prochaska, Norcross, DiClemente

Relapse
14
Stages of Change
  • 80 of substance abusers are in precontemplation
    or contemplation
  • Define success by the movement from one stage to
    the next

15
Motivational InterviewingWhy Bother Learning
And Using It?
16
Evidence Based
17
Miller Hester 1995 Alcohol
  • Top
  • Brief intervention
  • Social skills training
  • Motivational enhancement
  • Community reinforcement approach
  • Behavior contracting
  • Bottom
  • Relaxation training
  • Confrontation
  • Psychotherapy
  • General alcoholism counseling
  • Education

18
Miller Hester 2003 Alcohol (adapted post
COMBINE)
  • Top
  • Brief intervention
  • Motivational enhancement
  • Community reinforcement approach
  • Self-change manual
  • Opiate Antagonists (Naltrexone)
  • BSCT
  • Bottom
  • Relaxation training
  • Confrontation
  • Psychotherapy
  • General alcoholism counseling
  • Education

19
Miller, Zweben Johnson 2006
  • Cognitive-behavioral treatment
  • Community reinforcement approach
  • Motivational interviewing
  • Relapse prevention
  • Social skills training

20
Overview of Treatment Methods
  • Build client motivation, readiness and engagement
  • Cognitive and behavior skills
  • Increasing positive rewards for non-use
  • Involve family and social networks
  • Think outside the skin
  • Appropriate medications

21
Some Specific Benefits
22
Some Benefits of Motivational Interviewing
  • A good preparation for more action-oriented
    treatments
  • Gains rapport and reduces resistance
  • Increases retention and engagement in treatment
  • Resolves ambivalence (prepares for change)
  • Increases client motivation and change talk

23
Some Benefits of Motivational Interviewing
  • Can help increase client confidence
  • Reductions in use
  • Particularly useful with angry clients and those
    in the early stages of change
  • Prevents counselor burnout?

24
Benefits For Using With Methamphetamine Users
  • Helps deal with paranoia and suspicion
  • Effective in dealing with cognitive deficits

25
How It Works
26
Key Assumptions
  • Motivation is interpersonal
  • Resistance is interpersonal
  • Clinician approach and behaviors matter
  • Persuasion is usually not an effective method to
    increase motivation and change

27
MI How it Works
  • Clinician manages important in-session behaviors
    of client using MI spirit, principles and skills

Interaction of clinician and client
Increase Change talk and Decrease Resistance
Leads to
28
Change Talk
Desire Ability Reasons Need Taking Steps
Commitment Strength
Behavior Change
29
Resistance
  • Arguing
  • Interrupting
  • Denying
  • Ignoring

30
MI
Pyramid
Strategies
Principles
Spirit
31
Components of MI Spirit
  • A Autonomy (vs. authority)
  • C Collaboration (vs. confrontation)
  • E Evocation (vs. education)

32
Basic MI Principles
  • D Develop Discrepancy
  • R Roll with Resistance
  • E Express Empathy
  • S Support Self-efficacy

33
Develop Discrepancy
  • Change is motivated by a perceived discrepancy
    between present behavior and important personal
    goals or values
  • The person rather than the counselor should
    present the arguments for change

34
Roll with Resistance
  • Avoid arguing for change
  • Resistance is not directly opposed
  • Resistance is a signal to respond differently
  • The person is a primary resource in finding
    answers and solutions

35
Express Empathy
  • Acceptance facilitates change
  • Skillful reflective listening is fundamental
  • Ambivalence is normal

36
Support Self-Efficacy
  • A persons belief in the possibility of change
    is an important motivator
  • The person, not the counselor, is responsible for
    choosing and carrying out change
  • The counselors own belief in the persons
    ability to change becomes a self-fulfilling
    prophecy (HARP)

37
Strategies
OARS
  • Open Questions
  • Affirming
  • Listen Reflectively
  • Summarizing
  • Dunn/MINT

38
Change Talk
  • Original idea from Bems theory
  • I learn what I believe from what I hear myself
    say.

39
Eliciting Change TalkA Technique For The Road
40
Assessing Importance
  • How important on a scale of 1-10?
  • 1---x--------------y-------------10
  • Why X and not 1?
  • What would have to happen for you to go from X to
    Y?

41
MI What It Looks Like
  • Generally quiet and eliciting
  • Is anything going on here?
  • The Data Says Yes!

42
Using MI In The Clinical Setting
43
Into Practice
  • As a preparation for more action-oriented forms
    of treatment such as
  • CBT
  • 12 Step
  • Matrix Model
  • In individual and group sessions
  • More data about using in individual sessions
  • Reducing resistance and anger upon entry to
    treatment (and throughout)
  • When ambivalence crops up at any point

MI plays well with others
44
A Time Not To Use MI
  • When the client is clearly ready and committed to
    action

45
Learning Motivational Interviewing
46
How To Learn It
  • Workshops typically equivalent of 2-3 days
  • (preferably with follow-up and feedback)
  • Reading MI material
  • Viewing training videos
  • Watching or listening to your own taped sessions
  • Supervision and consultation
  • Peer encouragement

47
Stuck Points in Learning
  • Openness to change behavior and maintaining old
    behaviors
  • Proficiency in reflective listening
  • Eliciting and recognizing change talk
  • Summarizing
  • Transitioning to other therapeutic methods

48
MI Resources
  • Motivational Interviewing (2002) 2nd Edition,
    Miller Rollnick, Guilford Press
  • Complete description of MI and individual
    chapters on various populations, i.e.
    adolescents, corrections clients,
    clients with COD, etc.
  • www.motivationalinterview.org
  • Information, training announcements, videos,
    bibliography

49
Questions, Maybe Answers
50
Contact Information
  • Steve Brazill
  • 316 304-5272
  • sbrazill_at_earthlink.net
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