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Motivational Interviewing: Rapport Building and Client Engagement

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Motivational Interviewing: Rapport Building and Client Engagement Minnesota Coalition for the Homeless Conference: October 14th 2013 Bradley Dreis, MS, LPCC, CRC, NCC – PowerPoint PPT presentation

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Title: Motivational Interviewing: Rapport Building and Client Engagement


1
Motivational Interviewing Rapport Building and
Client Engagement
  • Minnesota Coalition for the Homeless Conference
    October 14th 2013
  • Bradley Dreis, MS, LPCC, CRC, NCC
  • Thomas Jaeger, Families Achieving Success Today
    (FAST)

2
Introduction
  • Bradley Dreis
  • E-mail BDreis_at_GoodwillEasterSeals.org
  • LPCC (Licensed Professional Clinical Counselor)
  • CRC (Certified Rehabilitation Counselor)
  • NCC (National Certified Counselor)
  • History
  • Psychotherapist at Goodwill/Easter Seals Working
    Well Mental Health Clinic
  • Mental Health Motivational Interviewing
    consultant to the FAST program
  • Motivational Interviewing trainer for
    Goodwill/Easter Seals of MN
  • Vocational Evaluator
  • Case Manager

3
Introduction
  • Thomas Jaeger
  • E-mail Tjaeger_at_GoodwillEasterSeals.org
  • SACIT (substance abuse Counselor in training)
  • BS Vocational Rehab UW Stout
  • Concentration in Psych-Rehab
  • History
  • Employment Support Consultant to the FAST program
  • Motivational Interviewing coach for Goodwill
    Easter seals
  • Transitional living skills counselor and Client
    Advocate Catholic Charities
  • Chemical Dependency counselor residential
    treatment facility

4
Introduction
  • A few considerations before we begin
  • Motivational Interviewing will be referred to as
    MI throughout the remainder of this
    presentation.
  • MI isnt meant to be delivered in short one-hour
    segments, so it is assumed that we have all had
    at least some previous MI training.
  • Todays goal is to provide a few new
    ideas/strategies to assist you and your clients
    with making positive changes.

5
Introduction
  • A Show of Hands How familiar are you with MI?
  • 1. No familiarity
  • 2. Brief surface-level introduction
  • 3. Intensive training over multiple days
  • 4. Intensive training(s) and broad familiarity
    with periodic use
  • 5. Extensive familiarity Use it often Maybe
    even train others

6
Founders of MI
  • William R. Miller, PhD
  • Wrote first MI article in 1983
  • Began work in chemical dependency field
  • Emeritus Distinguished Professor of Psychology
    and Psychiatry at the University of New Mexico
  • Stephen Rollnick, PhD
  • Clinical psychologist
  • Professor of Health Care Communication in the
    School of Medicine, at Cardiff University, Wales,
    United Kingdom

7
Definitions Key Concepts
  • Brief Refresher of MI Definitions and Concepts to
    Assist with Remainder of Presentation
  • Motivational Interviewing (Lay definition)
  • Motivational Interviewing is a collaborative
    conversation style for strengthening a persons
    own motivation and commitment to change. (Miller
    Rollnick, 2013)

8
Definitions Key Concepts
  • Change Talk
  • Any client speech that favors movement toward a
    particular change goal.
  • Sustain Talk
  • Any client speech that favors status quo rather
    than movement toward a change goal.

9
Definitions Key Concepts
  • Self-Perception Theory
  • "Individuals come to know their own attitudes,
    emotions and internal states by inferring them
    from observations of their own behavior and
    circumstances in which they occur. (Bem, 1972)
  • OrThe more somebody verbalizes a position
    (either positive or negative), the more s/he will
    commit to it.

10
Definitions Key Concepts
  • Reactance Theory
  • The natural human tendency to reassert ones
    freedom when it appears to be threatened. even
    if it hurts them.

11
Definitions Key Concepts
  • OARS
  • An acronym for four basic client-centered
    communication skills.
  • O Open questions
  • A Affirmations
  • R Reflections
  • S Summary

12
Definitions Key Concepts
  • Spirit
  • The underlying set of mind and heart within which
    MI is practiced.
  • Partnership
  • Acceptance
  • Compassion
  • Evocation

13
Definitions Key Concepts
  • Deceptive Simplicity
  • Many MI concepts appear easy at first glance, but
    take practice to master and perform
    intentionally.

14
Rapport Building Client Engagement
  • Practical MI Strategies/Techniques for Rapport
    Building Client Engagement

VS
15
Rapport Building Client Engagement
  • 1. Nobody is in a Power Position.
  • Clients input is crucial (Instant engagement!)
  • Clients are individuals, not populations
  • Trouble occurs when we start thinking I know my
    typical client population because we then make
    assumptions.
  • Clients are perceptive of our assumptions and
    will deem us to be just another professional in
    much the same manner.

16
Rapport Building Client Engagement
  • 1. Nobody is in a Power Position. continued
  • Taking a few minutes to better understand a
    clients situation can go a long way with
    building rapport and maintaining engagement.
  • Example of an initial introduction to an
    appointment
  • A Hello. Did you bring your ID? We should
    probably get started on updating your plan right
    away. Its due today and I only have a half hour
    to get it all done.
  • B Hello. How was your weekend? Well need to
    update your plan today, so Im interested to know
    if there have been any changes since we last
    met.

17
Rapport Building Client Engagement
  • 1. Nobody is in a Power Position. continued
  • Both people are working collaboratively towards a
    goal. Both people are responsible for doing their
    part to attain the goal.
  • The practitioner is the expert regarding
    professional knowledge. The client is the
    expert regarding their own life and behaviors.
  • Both need to work together for maximum benefit.
  • Recognizing that we arent expected to be the
    expert and fully responsible for a clients
    success can be incredibly freeing. This
    decreases staff burnout.

18
Rapport Building Client Engagement
  • 2. Act like you have 30 minutes with a client and
    it will take all day. Act like you have all day
    with a client and it will take 30 minutes.
  • Q What if I need to meet certain outcome
    numbers and I dont get much time with my
    clients?
  • A Its important to recognize that some clients
    are going to need additional time. This cant be
    forced. Some may not even be appropriate for your
    program.

19
Rapport Building Client Engagement
  • 2. Act like you have 30 minutes with a client and
    it will take all day. Act like you have all day
    with a client and it will take 30 minutes.
    continued
  • We want to fish WITH clients, not be relied
    upon by them.
  • Walking with others instead of solving their
    problems for them shows that we believe in their
    ability to be independent and resourceful.

20
Rapport Building Client Engagement
  • 3. Judge if ambivalence is present.
  • Use OARS to explore ambivalence while listening
    for change talk.
  • Always end with Positive Change Talk.
  • Even 1 will work!!!
  • If no ambivalence, then no MI.

21
Rapport Building Client Engagement
  • 4. What if there is no ambivalence?
  • Use the Hypothetical Question with a focus on
    potential change talk.
  • Use Open-Ended questions to explore and maybe
    start a new way of thinking.
  • Keep in mind that this may be the first time that
    the client is actively thinking through a
    problem. This may cause some initial resistance.

22
Rapport Building Client Engagement
  • 5. There are always givens that can be counted
    upon to encourage change talk.
  • Examples
  • The client showed up and is complying with the
    program.
  • MI works with both mandated and non-mandated
    clients.
  • The client has established goals. even if very
    little progress is being made.
  • Have you recognized any givens with your
    clients that are sure to elicit change talk?

23
Rapport Building Client Engagement
  • 6. Ambivalence means that 2 sides of change
    exist. We want clients to advocate for the side
    of positive change.
  • Things to watch for
  • The Righting Reflex
  • Self-Reactance Theory
  • Staff Smoking costs so much. You cant afford
    it.
  • Client Sure I can. I can buy a cheaper brand. I
    could also skip one AA meeting per week and buy a
    pack with the saved bus fare.
  • Staff Smoking causes cancer. It will kill you!
  • Client I dont think so. My Grandfather lived
    90 years and smoked every day!

24
Rapport Building Client Engagement
  • 7. Affirmations are HUGE!
  • We may be one of the only people in a clients
    life that is in a position to compliment them.
  • There are lots of givens that can be used with
    affirmations.
  • Ex. Arrived on time, Appearance, Completed
    homework, etc. others?

25
Rapport Building Client Engagement
  • 7. Affirmations are HUGE! continued
  • Leading off a meeting with an affirmation is a
    great way to start positive communication and
    encourage engagement and rapport.
  • Did you bring your activity log? I hope so
    because its due by 500 today. Do you need
    another bus pass?
  • OR
  • You arrived on time for the third meeting in a
    row! I know its been hard to coordinate your
    sons new childcare schedule. You have really
    done an excellent job prioritizing your
    responsibilities.

26
Rapport Building Client Engagement
  • 8. Arguments should never occur when following
    the Spirit of MI. (but we do like emotional
    resistance!)
  • Arguments are 100 ineffective
  • Which person would you rather work with?
  • Which one is more passionate?
  • Which one cares more about the situation/circumsta
    nce?

27
Rapport Building Client Engagement
  • 8. Arguments should never occur when following
    the Spirit of MI. (but we do like emotional
    resistance!) continued
  • We want to Roll With Resistance
  • We dont want to waste or discourage their
    passion!
  • Remember that resistance isnt about us, its
    about their situation or circumstances
  • We can often agree with their frustration, even
    when their statements are initially directed at
    us.
  • It is possible to show empathy without condoning
    or agreeing with client behaviors.
  • Ex. Yea, it is annoying to be asked to fill out
    more paperwork. A lot of these forms do ask
    similar questions. I certainly understand your
    frustration.

28
Rapport Building Client Engagement
  • 9. What can I do when a client just isnt making
    progress and is sitting on my case load for an
    extended period of time?
  • Often, a client says that they are motivated and
    appears to follow through with requirements, but
    they never actually make progress.
  • Is the client truly motivated to change, or do
    they feel that they are accomplishing something
    by merely participating in the process of
    change?
  • Ex. A job searcher that seems to sabotage
    interviews because they consider the job
    placement process as work without the
    responsibilities of an actual job.

29
Rapport Building Client Engagement
  • 9. What can I do when a client just isnt making
    progress and is sitting on my case load for an
    extended period of time? continued
  • It may help to assume that the client has low
    motivation or doesnt feel that the change is of
    high importance.
  • Hypothetical and Open-Ended questions can help to
    explore ambivalence and potentially evoke change
    talk.

30
Rapport Building Client Engagement
  • 10. Its OK to give advice, but make sure that it
    is the clients decision to pursue the advice.
  • We are professionals, but we shouldnt be
    expected to have ALL of the answers.
  • Ex. I specialize in mental health treatment, but
    am not an expert on solving housing issues even
    though unstable housing is often correlated with
    increased symptoms.

31
Rapport Building Client Engagement
  • 10. Its OK to give advice, but make sure that it
    is the clients decision to pursue the advice.
    continued
  • Use EPE (Elicit, Provide, Elicit) to provide
    information while still maintaining the Spirit of
    MI.
  • We all often look to blame others for negative
    outcomes, even if others are trying to help us.

32
Rapport Building Client Engagement
  • 10. Its OK to give advice, but make sure that it
    is the clients decision to pursue the advice.
    continued
  • Which of these clients will likely
  • follow through with the advice?
  • blame the practitioner for an unfavorable result?
  • feel more engaged in the change process?
  • You should tell your boss that you didnt mean
    to yell at her. Maybe then she will give you back
    your job?
  • OR
  • Do you mind if I share a suggestion that has
    worked for a few of my past clients? Some of them
    have successfully saved their job by apologizing
    for mistakes.

33
Audience Findings with MI Strategies
  • Have you had success with building rapport and
    keeping clients engaged using MI strategies?

34
Feedback/Questions
35
Further Resources
  • http//www.motivationalinterview.org/

36
References
  • Miller, W.R., Rollnick, S. (2013) Motivational
    Interviewing (3rd ed.). New York, NY The
    Guilford Press.
  • Bem, D. J., Self Perception Theory. In L.
    Berkowitz (ed). Advances in Experimental Social
    Psychology, Vol 6, 1972.
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