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ACT and Motivational Interviewing

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ACT and Motivational Interviewing Intersection of ACT Core Processes and MI principles Motivational Interviewing and Acceptance and Commitment Therapy I hope this ... – PowerPoint PPT presentation

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Title: ACT and Motivational Interviewing


1
ACT and Motivational Interviewing
  • Intersection of ACT Core Processes and MI
    principles

2
Kristin Dempsey, MS, MFT
  • Workforce Development Director San Mateo County
    BHRS Adjunct Faculty Dominican University of
    California
  • Trainer, Psychotherapist, Consultant

3
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.

4
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.

5
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?

6
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

7
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

8
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

9
What do you know about motivational interviewing?
  • Starting with the Basics

10
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

11
What do you know about Motivational Interviewing?
Principles
  • Explore Empathy
  • Develop Discrepancy
  • Roll with Resistance
  • Support Self Efficacy

12
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

13
Stages of Change
14
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.

15
Phase II
  • This is when the client is actively motivated and
    committed toward change.
  • The counselor is negotiating change strategies
    with the client.

16
Motivational Interviewing 3rd Edition
  • The essential components of MI
  • Engagement
  • Guidance
  • Evocation
  • Change Plan

17
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.

18
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.

19
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

20
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.

21
Empathy and Mindfulness
22
Developing Discrepancy and Observing
23
Rolling with Resistance and Defusion
24
Supporting Self-Efficacy
25
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.

26
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.

27
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.

28
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).

29
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)?

30
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

31
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.

32
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.

33
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.

34
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
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