“MI Preparation Prayer”
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Transcript “MI Preparation Prayer”
Using Motivational Interviewing To
Enhance Engagement
PCCYFS Annual Spring
Conference
Thursday, April 14, 2011
8:30 - 10:00
Dave Vactor
Christy Pfleger
“MI Preparation Prayer”
Guide me to be a patient companion
To listen with a heart as open as the sky
Grant me vision to see through her eyes
And eager ears to hear her story
Create a safe and open mesa on which we may walk
together
Make me a clear pool in which she may reflect
Guide me to find in her your beauty and wisdom
Knowing your desire for her to be in harmony-healthy,
loving, strong
Let me honor and respect her choosing of her own
path
And bless her to walk it freely
May I know once again that although she and I are
different
Yet there is a peaceful place where we are one
-Bill Miller, co-founder of MI, Rollnick and Miller 1995
Purpose
Provide an overview of the
process of change and basic MI
skills
Explore how to use MI skills to
effectively engage families
Learn strategies to help clients tap
into their motivation for change
So What Exactly is MI?
Definition:
a perspective that views a client as the most
influential agent of change and aims to empower
the client to actively engage in the process of
change.
a method or approach, not a technique, that is not
based on a singular theory.
“A directive, client-centered counseling style for
eliciting behavior change by helping clients
explore and resolve ambivalence.”-Rollnick and
Miller, 1995
Rollnick and Miller 2006
Benefits of using MI
Address and move past ambivalence
Motivate towards change
Helping the decision making process
Address and decrease resistant
behaviors
History
MI was developed in 1983 by Bill Miller for use
with substance abuse clients.
Empirical data has been collected for use
of MI treatment with: drug and alcohol
abuse, smoking cessation, psychiatric
disorders, HIV related risk behaviors, diet
and exercise.
Note: These effects did not diminish
significantly over time.
Beliefs Essential to the MI
process
Person-Centered (closely linked to Rogerian
Theory)
Resistance to change and ambivalence are
natural human processes
• Lack of motivation=unresolved
ambivalence
• Negative feelings and experiences can
inhibit change
• Change occurs when it is connected to
something of importance and value
The client needs to show you the reason for
change in order to proceed successfully
(“change talk”)
“Change Talk”
What people say and how they talk about
change is important.
Defensiveness =
Confrontation =
Change
Change
Confidence and Self-Efficacy
When people and service providers
believe that change can happen, it is
more likely it will happen
Self-efficacy=hope that change can
occur
Empathy facilitates change
Positive reinforcement increases likelihood of
trying new behaviors
Sets up the collaborative relationship
“Friendly consultant” role
Approach
Direct
persuasion is not an
effective method for
resolving ambivalence
Increases resistance behaviors,
decreases willingness for change
The
style is generally a
quiet and eliciting one
Focus is on drawing out from the
client, and providing guidance through
questions, scaling, etc.
60/40
Approach, continued
o The counselor is directive in
helping the client to examine and
resolve ambivalence
o Readiness to change is a not a client
trait, but fluctuating product of
interpersonal interaction
• Resistance and denial are a product of the
client’s interactions with the world around
him, not a personality trait
Three Key Components
Collaborate
Empathy, respect
Evocation
(Draw Out)
Guided questions, reflection
Autonomy
(Partner)
(Client stands on own)
Implements and sustains change
Identifying “Change
Talk”
Disadvantages
Advantages
of status quo
of change
Optimism
Intention
to change
What is Unique about MI?
MI is Directive
Client-Centered= focused on client’s interest
and concerns
•
MI is a method of communication
•
Do not teach new skill, alter thought patterns
or look to the past
Not something we do to, but we are with and
for clients
Change is not forced or imposed (i.e.,
through punishment, pressure, financial
gain)
The client is the expert to their situation
Wheel of Change
Motivational Interviewing and the
Trans-theoretical model to change
were developed separately but
synchronously.
•
Trans-theoretical model of change is
used to breakdown the concept of
readiness to change into stages.
The Wheel of Change was created
to to assess what MI strategies to
use for forward movement.
Prochaska, Di Clemente and Norcross, 1992
Wheel of Change
Based on self-help change, but applies to
all types of change.
Tool to help us understand where clients
are in their cycle of change.
Assists in engaging clients to help them
want to change.
Relapse is viewed as an inevitable stage
of change.
Wheel of Change
Prochaska, Di Clemente and Norcross, 1992
Stages of Change
Pre-Contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Stage 1: Pre-Contemplation
Characteristics:
No intention of changing anytime soon
Unaware that a problem exists “ignorance is bliss”
Discouraged, Rationalization, Denial, Minimization
Persons close to them are aware of problems
If a pre-contemplative person is in treatment
- normally a result of coercion by someone in their
environment. (e.g. spouse, employer, legal, agency)
Pre-Contemplation
Techniques/Strategies:
Avoid giving advice
Validate lack of readiness
Clarify: decision is theirs
Encourage self-exploration, not action
Engage by acknowledging thoughts,
fears, feelings, concerns
Information and feedback
Explain and personalize the risks
Stage 2: Contemplation
Characteristics:
Ambivalence: “Sitting on the fence”
Reasons for concern more evident
Justification for lack of concern
Beginning recognition of problem
Evaluating pro’s and con’s
Contemplation
Techniques/Strategies:
Avoid giving advice
Create awareness of defenses
Identify relationships that help not enable
Increase perception of risks &
consequences
Engage by acknowledging thoughts,
fears, feelings, concerns
Identify and promote new positive
outcome expectations
Stage 3: Preparation
Characteristics:
Intention to change, but no specific goals
Attempts to change: “Testing the waters”
Reduction in poor choices, negative behavior
Changes have a minimal impact on their life
Temporary exit and return to precontemplation
Preparation
Techniques/Strategies:
Identify and assist in problem
solving i.e. obstacles, barriers
Help identify positive social support
Validate client’s underlying skills for
behavior change
Encourage small initial steps
Articulate choices in client’s words
Stage 4: Action
Characteristics:
Changes in environment to achieve
goals
Doing things to make change
Experience of success (may remain
here)
Client gain sense of hope
Combat feelings of loss, isolation,
despair
Action
Techniques/Strategies:
Cheering on/Encouraging
Reflecting on goals
Bolster self-efficacy
Pointing out long-term benefits
Maintain focus on accomplishments
and social supports
Stage 5: Maintenance
Characteristics:
Continued commitment to sustain
change
Post 6 months to 5 years
Working to prevent relapse
New skills drawn out are practiced
Maintenance
Techniques/Strategies:
Identify and
Reflecting on goals
Bolster self-efficacy
Pointing out long-term benefits
Maintain focus on accomplishments
and social supports
Stage 5: Relapse
Characteristics:
Oops
Step backward
Slip=minor
Off the wagon=major
Challenge is to start again
Use relapse as opportunity to grow
Relapse
Techniques/Strategies:
Help prepare for expected relapse
Avoid demorilzation
Don’t give up
Clarify consequences
Liken to experience of loss
-Shock, Denial, Anger, Bargaining, Acceptance, Moving on
Using MI with the
Stages of Change
Each
stage contains certain
helping behaviors that are
particularly constructive
Assist in measuring/gauging
•
•
•
Readiness
Confidence
Motivation
Instead of asking “Why isn't this
person motivated?” ask “What is
this person motivated by?”
Resistance Behaviors
Arguing
Interrupting
Denying
Ignoring
Overt compliance/Covert defiance
Skills
Get Permission
Drawing from past successes
Scaling
Imagine ideal future and change needed
to get there
Extremes-worst and best possible
outcomes of change
Scaling
Mandated Clients:
Acknowledge mandate
Provide choices
Empathize with lack of choice
Principles
Express
Empathy
Develop
Discrepancies
Roll
with Resistance
Support
Self-Efficacy
How to Make it Work
o
Express empathy- reference
listening, reflective listening
o
Develop discrepancies – bring
client on board with the
importance for change by:
•
•
highlighting differences between current
behavior and personal values
Have the person argue for change
Rolling with Resistance
Accept
it
Respect it
Flow with it
“Roll with it” rather than
oppose it
Supporting Self-Efficacy
Empowering
the client to be
the change agent
Have confidence in client’s
ability
Be a cheerleader!!
Punctuate positives and strengths
Convey understanding
Elements of a Change Plan/
Case Plan
Goals
Reasons
Steps
Support
Obstacles
Signs of Progress
MI Skills (OARS)
Ask Open ended questions
Affirm
Reflective Listening
Summarizing
References
Baer, J.S., Garrett .S.B., Beadnell, B,Wells E.A, & Peterson
P.L., (2007). Brief Motivational Intervention With Homeless
Adolescents: Evaluating Effects on Substance Use and
Service Utilization, Psychology of Addictive Behaviors, 21,
582-586.
Burke B.L., Arkowitz. H & Menchola. M., (2003). The Efficacy
of Motivational Interviewing: A Meta-Analysis of Controlled
Clinical Trials Journal of Consulting and Clinical Psychology,
21, 843-861.
Miller, W. R., & Rollnick, S.,(1995). What is motivational
interviewing? Behavioral and Cognitive Psychotherapy, 23,
325-334.
Miller, W. R., & Rollnick, S., (2002). Motivational interviewing:
Preparing people for change (2nd ed.) New York: Guilford
Press.
Petrocellim, J.V., (2002). Process and change: counseling
with the transtheoretical model of change, Journal of
Counseling and Development, 80, 22-28.
Russell .C.R., Motivational Interviewing training for new
trainers., (2002). The Motivational Interviewing Network of
Trainers.
Wagner,C, .C,. Ingersoll. (2008). Beyond cognition:
broadening the emotional, base of motivational
Interviewing Journal of Psychotherapy. Integration and
American Psychological Association 18, 191–206.
Wiles, M. (2005). Motivational interviewing: overcoming client
resistance to change. Cross Country Education Inc.
Zuckoff, A., & Daley, D. C., (1999). Improving Treatment
Compliance: Counseling & Systems Strategies for
Substance Abuse & Dual Disorders.