Transcript Using Motivational Interviewing to Enhance Engagement

Using Motivational Interviewing
To Enhance Engagement
PCCYFS
Thursday, April 14
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 clients
• 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
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 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/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”)
Identifying “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
• Empathy facilitates change
Miller & Rollnick’s
“Spirit of MI”
•Motivation to change is elicited from the client
and not imposed from without
•It is the clients task, not the counselor’s , to
articulate and resolve their ambivalence
•The therapeutic relationship is more like a
partnership or companionship than expert/recipient
roles
Rollnick and Miller 2006
Approach
• Direct persuasion is not an
effective method for resolving
ambivalence
• The counseling style is generally
a quiet and eliciting one
Approach, continued
•The counselor is directive in helping the
client to examine and resolve ambivalence
•Readiness to change is a not a client trait,
but fluctuating product of interpersonal
interaction
Three Key Components
• Collaborate (Partner)
• Evocation (Draw Out)
• Autonomy (Stand on own)
Identifying “Change Talk”
• Disadvantages of status quo
• Advantages of change
• Optimism
• Intention to change
What is Unique about MI?
• MI is Directive
• Client-Centered= focused on client’s interest and
concerns
• Do not teach new skill, alter thought patterns
or look to the past
• MI is a method of communication
• 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
Wheel of Change
• Motivational Interviewing and the Transtheoretical model to change – developed
separately but synchronously.
• Trans-theoretical model of change is used to
breakdown the concept of readiness to
change into stages.
• Use the Wheel of Change to assess what MI
strategies to use for forward movement.
Prochaska, Di Clemente and Norcross, 1992
Wheel of Change
Prochaska, Di Clemente and Norcross, 1992
Stages of Change
Phase I – Address
Ambivalence
• Pre-Contemplation
• Contemplating
Phase II Address
Change/Changing Action
• Preparation
• Action
• Maintenance
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?”
Traps
• Question-Answer
– prevents discussion from getting to a deeper level
• Taking Sides
– encourages client to argue more for their current
perspective
• Expert
– change is more effective when it comes from within,
not without
• Labeling
• Premature Focus
– increases defensiveness, decreases chances for longterm success
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
• Express empathy- reference
listening, reflective listening
• 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 his/her ability
Elements of a Change Plan
•
•
•
•
•
•
Goals
Reasons
Steps
Support
Obstacles
Signs of Progress
How to Use Skill (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, Ingersoll, C. (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.