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Rolling with Resistance : Using a Motivational Interviewing

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Rolling with Resistance : Using a Motivational Interviewing Approach Presented by Danette Heckathorn, M.S., L.P.C. * * Open ended questions Disadvantages ... – PowerPoint PPT presentation

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Title: Rolling with Resistance : Using a Motivational Interviewing


1
Rolling with Resistance Using a Motivational
Interviewing Approach
  • Presented by
  • Danette Heckathorn, M.S., L.P.C.

2
Motivational Interviewing
  • A Humanistic approach to counseling developed by
    Miller and Rollnick (1991, 2002).
  • Motivational interviewing (MI) is not a theory.
    It is a tool to be used in conjunction with other
    theories.

3
Agenda
  • Motivation
  • What this training will do for you
  • Stages of Change Model
  • Major goals of motivational interviewing
  • How to address negative behavior
  • Rolling with Resistance
  • Practice

4
Motivation
  • What motivates?
  • Is motivation enough?

5
What will this training do for you?
  • You will learn ways to use motivational
    interviewing as a tool to roll with client
    resistance.
  • This training will give you a taste of MI and
    introduce you to some resources, but it cannot
    substitute for a 4-Day comprehensive MI training.

6
Cycle of Change
7
Stages of Change (Prochaska et. al., 1994)
  • Precontemplation either unaware of problems
    related to negative health behavior or lack the
    desire to change their negative behavior, and
    they do not report any intention to change their
    negative habit within the next 6 months.

8
Contemplation
  • Individuals recognize that some aspect of their
    negative behavior is a problem, and they plan to
    take action in the next 6 months. They are often
    seen as ambivalent because the perceived costs
    and benefits of the negative behavior are
    equivalent (Rollnick et. al., 1991).

9
Preparation
  • Commitment to change has been made and they plan
    to take action in the near future.

Action
  • Begin to actively change behaviors and
    environmental conditions to overcome problem.

Maintenance
  • Changes have become a regular part of the
    individuals lifestyle.

10
Why Determine Stage of Change?
  • Identifying a clients stage of change will help
    you determine the best approach to take with
    them.
  • Change is the responsibility of the client but
    the caregiver is responsible for enhancing
    motivation to change.

11
Ways to Determine Their Stage of Change
  • I noticed (behavior) is this something that is
    creating a problem for you or something you would
    like to change?
  • People differ in how ready they are to change
    their (behavior) habits. What about you?

12
Precontemplative Client
  • I dont have any problems with (behavior)
  • They may come across defensive
  • Reluctant
  • Resigned
  • Rationalizing
  • Rebellious
  • No intention to change

13
Comtemplative Client
  • I have been thinking about changing (behavior)
  • They have identified the behavior may be
    problematic
  • More troubled about the behavior
  • Ambivalent but may be weighing pros and cons
  • Decisional balance exercise useful

14
Preparation Stage and Client
  • How can I change (behavior)?
  • More committed
  • Ready to start
  • Sharing plans for change
  • Change becomes a priority

15
Action Stage and Client
  • Here I go
  • They decide on a change strategy and try it out
  • Actively modify behavior including thoughts,
    feelings, and the environment
  • Treatment and/or self-help
  • Persistence and completion or drop-out

16
Maintenance Stage and Client
  • I think this will work and I am going to
    continue
  • Trying to keep the ball rolling
  • Preventing relapse learning new coping skills
  • Watching out for triggers
  • Acknowledging self for changes made and taking
    credit
  • Moving toward more balance

17
Practice Identifying Stage of Change
  • Quick Exercise
  • We will come back to the stages of change after
    discussing motivational interviewing

18
Motivational Interviewing
  • Defined as ...a client-centered directive method
    for enhancing intrinsic motivation to change by
    exploring and resolving ambivalence (Miller
    Rollnick, 2002, p. 25)
  • Lets break it down

19
Four Main Principles of MI
  • Express empathy
  • Develop discrepancy
  • Roll with resistance
  • Support self-efficacy

20
Strategies Used in MI
  • Eliciting Change Talk motivational statements
    from the client
  • OARS Method
  • Open-Ended Questions
  • Affirming the client
  • Reflective listening
  • Summarizing

21
Change Talk
  • Client identifies that behavior might be
    problematic
  • Client expresses concern about a behavior
  • Client expresses a desire to change the behavior

22
Reflective Listening
  • What is it?
  • How do you do it?
  • Levels of reflective listening
  • Optimal reflective listening
  • Lets Practice

23
Affirming the Client
  • The idea here is to enhance self-efficacy
  • Self-efficacy is our belief in our own ability to
    achieve a goal or accomplish a task
  • Strengthen the relationship
  • Enhance self-esteem

24
Summarizing
  • A technique to be used throughout the meeting
  • Strategically repeat a clients self-motivational
    statements
  • Include reluctance/resistance
  • Reflect optimism for change

25
Knowing When a Client is Ready to Change
  • What do you expect to hear when a client is ready
    to change?
  • What do you not expect to hear?
  • What will the client look like?
  • What other indications might the client make?

26
How to Elicit Change Talk
  • Open-ended questions (handout)
  • Ruler (handout)
  • Pros/Cons exercise
  • Looking forward
  • Looking back
  • Goals and values

27
Change Planning
  • What changes?
  • Why change?
  • Goals SMART
  • Steps to take?
  • First steps concrete
  • Help
  • I will know it is working if
  • Potential obstacles

28
Resistance to Change
  • 4 Categories
  • Arguing
  • Interrupting
  • Denying
  • Ignoring

29
NO NOs for Dealing with Resistance
  • Arguing, disagreeing and challenging
  • Judging, criticizing, blaming
  • Warning of negative consequences
  • Seeking to persuade with logic
  • Analyzing
  • Confronting with authority
  • Sarcasm

30
How to Respond to Resistance
  • Simple reflection
  • Amplified reflection
  • Double-sided reflection
  • Agreement with a twist
  • Shifting focus
  • Reframing
  • Rolling with resistance

31
Simple Reflection
  • Stating what you here the client saying
  • It is sometimes helpful for the client just to
    hear their own words

32
Amplified Reflection
  • Reflect with modification
  • Client I just dont think that I have a problem
    with gambling.
  • Caregiver There is no cause for concern for you.
  • Client I dont know how changing my eating
    habits could help me.
  • Caregiver You feel your eating habits are
    perfectly reasonable.

33
Double-Sided Reflections
  • Reflect back the statement but also use the other
    side of the clients ambivalence
  • Client I cant quit eating sweets. I look
    forward to having a nice desert each day.
  • Caregiver It sounds like you are going to miss
    eating deserts, but you also dont want to take
    diabetic medication. What do you think would be
    the best way to resolve this situation?

34
Agreement with a Twist and Shifting Focus
  • Defuse resistance by shifting focus
  • Add a slant or twist to the meaning when you
    reflect back to the client
  • Client I cant imagine quitting drinking. All
    of my friends drink!
  • Caregiver Its hard to imagine giving up a
    lifestyle that youre accustomed to. Im
    wondering, what can you imagine?
  • Client I cant imagine quitting drinking. All of
    my friends drink!
  • Caregiver It sounds like youll really miss the
    social interaction. And at the same time, it
    might provide an opportunity to expand your
    social network like you were wanting.

35
Reframing
  • Placing something in a more positive light
    (what are the benefits?)
  • Client It is really going to be hard for me to
    quit eating sweets.
  • Caregiver While it will be hard to quit eating
    sweets, you are determined to do it because it
    will allow you to control your diabetes without
    taking medication.

36
Rolling with Resistance
  • This is where you just want to validate what the
    client is telling you by letting them know you
    have heard their problem and understand their
    ambivalence
  • It can be one of the most difficult techniques

37
MI The BASICS
  • Dont ignore the behavior even if you simply
    say Hey, (name) I noticed (behavior).
  • Try to determine where they are with regards to
    stage of change.
  • Lets Practice

38
Summary
  • The Basics of MI
  • Can be used to address any negative behavior

39
Feedback and/or Questionsdheckat_at_uark.eduor
(479) 601-2164
  • Thank you.
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