Transcript Motivational Interviewing

+ Motivational
Interviewing
An Evidence-Based
Tool for Drug Court
Joe Lunievicz, BA, RYT
Director Training Institute, NDRI, Inc.
Executive Director, NDRI-USA, Inc.
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Agenda
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What is it?
Evidence Base
Techniques Used
Practice
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Exercise in Pairs
Write down on paper:
• What are three things
you value in life?
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What is one five-year
goal you have?
Discuss with your partner
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Participants?
What Motivates your participants to
move towards graduation?
What are their goals?
What do they value?
How does present behavior get in
the way?
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Motivational Interviewing
A directive, client-centered
counseling style for eliciting behavior
change by helping clients to explore
and resolve ambivalence. It is a style
of helping that uses a set of specific
strategies.
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Motivational Interviewing
(Cont.)
Motivation- or presumed lack of it- is not
viewed as a personality problem or
character trait, but as a state of readiness
for change that can be influenced by a
helping relationship.
Rollnick & Miller, 1995
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After 30 years of Research …
Bill Miller & Steve Rollnick - Stockholm, June 2010 Presentation
 200+
 10
randomized clinical trials – Evidence Base
multisite clinical trails – Evidence Base
 1000+
publications
 Dozens
of books and videotapes – MI 2 in 2002
 Several
coding systems for quality assurance
 MIA-STEP
 Research
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to support MI supervisors
on MI Training
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Evidence Base with…
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100,000 + individuals
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Alcohol, crime, drugs, family/relationships, social
functioning, trauma/injuries, treatment/recovery
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Age 18-25, 26-55, 55+
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Male, female
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Caucasian, Asian, Black or African American, Hispanic or
Latino
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Outpatient, school, community settings
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Urban, suburban
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Motivational Interviewing
 Is
a brief intervention
 Developed
 Based
to work with “unmotivated drinkers”
on work by Rollnick and Miller 1991
 Useful
for clients who are reluctant to change
(ambivalence - contemplators)
 Draws
on client-centered therapy, cognitive
therapy & change therapy
 Is
non-confrontational
 Uses
specific strategies/skills
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MI Basic Principles
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
Expressing Empathy

Developing Discrepancy
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Rolling with Resistance

Supporting Self-Efficacy
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MI
helps the client…
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Enhance intrinsic motivational change
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Recognize the need to do something about the potential
problem

Resolve ambivalence
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Decide to change
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The Counselor…
 Does
not assume an authoritarian position
 Avoids
conveying the message “I have the
answers”
 Treats
the client as an adult capable of making
responsible decisions
 Treats
the client as the “expert” on his or her
own experience
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The Counselor Does Not…
 Argue
with client
 Impose
 Tell
a diagnostic label on client
client what they “must” do
 Seek
to “break down” denial by direct
confrontation
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Why use MI in Drug Court?
Better
More
Engagement
Information
Better
Assessments
More
Relevant Recommendations
More
Successful Outcomes
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MI Intervention vs.
MI techniques
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Full intervention
Or
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Individual techniques that
make up the intervention
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+ Example: Motivational Enhancement
Therapy - NIDA
 Alcoholics, outpatient
 7-8
4
tx
hour assessment
sessions
1&2, structured feedback, future plans & motivation for
change
 3&4, reinforce progress, encourage reassessment &
provide objective assessment of progress
 Significant other involved in session 1 & or 2
 Breath alcohol readings
 90 day timeframe
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+ MINT blog post – “Old”
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Are you a smoker?
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How much do you smoke each day?
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Yes, I know but you see it helps with the stress. If you knew what I go
through with the truck and long hauls. It’s enough just to get through the
day.
But if you carry on like this you might lose even more time at work.
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A pack or two.
The way you’re coughing, I have to tell you, it’s going to get worse if
you continue.
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Well, sort of, yes.
Yeah. I’m cutting back, you see.
Well we’ve got some good aids to quitting if you are interested?
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Yes, thanks, sure. I’ll give it some thought.
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+ MINT blog post – “New”
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Would you mind if we talked about your smoking?
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How do you really feel about it?
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Yes, that’s exactly right. You got me.
I don’t want to give you a lecture or hassle you about this, but I’m wondering what would be
helpful for you?
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That’s right. But its such a stress reliever its hard to let go.
It’s difficult to imagine being without smoking.
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Oh, if I could, definitely. I know it’s not good for my lungs or this cough for a start.
You can feel the effect for yourself and its not pleasant
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I’m trying to cut back, but I can’t say its easy with my job. You know its stressful driving a truck.
Its not easy for you, yet you’d like to smoke less.
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Well, ok.
I just don’t know.
Tell me. Deep down. How important is this for you right now?
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I feel sick and I’m tired and this smoking wears me down.
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Paraphrasing/Reflection
Pairs
Can’t respond until you have paraphrased
accurately.
Argue your point.
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MI Strategies

OARS
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Open Ended
Questions
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Affirming
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Reflection
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Summarizing
 Balance
 Stages
 Using
of change
the importance
Ruler
 Exploring
goals and
values
 Elicit
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Change Talk
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Questioning Skills
Effective vs. Ineffective Questions
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Ineffective
Too many questions
 Accusatory questions: Why?
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Multiple questions
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Explanatory questions
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Closed questions
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Questioning Skills
Effective vs. Ineffective Questions
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Effective
Have specific objectives in mind
State background for question
Use language of the client
Check out whether client is understanding
Ask openly: Who, What, When, Where &
How
Use open-ended questions
Paraphrase; Reflect; Summarize
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Open Ended Questions
Who, what, where, when
Tell
me about…
How
did you…
Redirect: Now
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tell me about…
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Open-ended Examples:
 What
worries you about your current situation?
 Tell
me about difficulties have you had with your
drug use?
 What
 How
has your anger interfered with your life?
 What
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do you think will happen if you don’t change?
would your life be like 5 years from now?
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Affirm (but don’t flatter)
 Strengths
based technique
 Verbally
supports or validates a
participant’s thoughts, emotions, or actions
 Demonstrates: Appreciation,
Understanding, Support
 When
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you see a strength, notice it
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Affirmation Example:
1. Participant arrives on time for his case
management appointment.
“You’re punctual. That will be a big help in this
program.”
2. Participant: “I don’t want to do anything more than
I need to. I just want to finish the program and get on
with my life.”
“Determination is a good characteristic to have in
treatment. It will help to keep you focused.”
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Reflective Listening
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Rationale
Conveys willingness
to try to understand
 Serves as a
perception check
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Clarifies
feelings
Leads to more
exploration
 Demonstrates
empathy
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Common Errors
Not listening
closely
 Limited feeling
vocabulary
 Monotone vocal
qualities
 Premature focus on
problem solving
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Reflection
Expressing Empathy:
“So, what I hear you saying is…”
Reflecting Conflict:
“On the one hand…but on the other hand…”
“So what you’re saying is…but you are not able
to…”
Rolling with resistance:
“You don’t have to do anything you don’t want to.”
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Summarizing
The
 Let
set-up statement
me see if I understand correctly…
Reflection, Reflection, Reflection
Open
 What
ended Question
did I miss?
 What other concerns do you have?
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Practice: Speaker
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Something about
yourself that you
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Want to change
Need to change
Should change
Have been thinking
about changing
… but you haven’t
changed yet.
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Practice: Listener
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Listen carefully
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Ask these 4 questions:
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Why would you want to make this change?
How might you go about it in order to
succeed?
What are the three best reasons for you to do
it?
On a scale from 0 to 10, how important would
you say that it is for you to make this change?
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Why are you a (?) and not a zero?
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Give a short summary/reflection of the
speaker’s motivations for change.
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Ask: “So what do you think you’ll do?”
and just listen with interest.
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Resources:
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NREPP SMAHSA’s National Registry of Evidence-based
programs and practices
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MI – Bill Miller email [email protected]
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MI – http://www.motivationalinterviewing.org
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