Transcript Document
Rolling with Resistance :
Using a Motivational
Interviewing Approach
Presented by
Danette Heckathorn, M.S.,
L.P.C.
7/16/2015
1
Motivational Interviewing
A Humanistic approach to counseling
developed by Miller and Rollnick (1991,
2002).
Motivational interviewing (MI) is not a theory.
It is a tool to be used in conjunction with
other theories.
7/16/2015
2
Agenda
Motivation
What this training will do for you
Stages of Change Model
Major goals of motivational interviewing
How to address negative behavior
Rolling with Resistance
Practice
7/16/2015
3
Motivation
What motivates?
Is motivation enough?
7/16/2015
4
What will this training do for
you?
You will learn ways to use motivational
interviewing as a tool to roll with client
resistance.
This training will give you a taste of MI and
introduce you to some resources, but it
cannot substitute for a 4-Day comprehensive
MI training.
7/16/2015
5
Cycle of Change
Precontemplation
Maintenance
Action
7/16/2015
Contemplation
Preparation
6
Stages of Change (Prochaska et.
al., 1994)
Precontemplation – either unaware of
problems related to negative health behavior
or lack the desire to change their negative
behavior, and they do not report any
intention to change their negative habit
within the next 6 months.
7/16/2015
7
Contemplation
Individuals recognize that some aspect of
their negative behavior is a problem, and
they plan to take action in the next 6
months. They are often seen as
ambivalent because the perceived costs
and benefits of the negative behavior are
equivalent (Rollnick et. al., 1991).
7/16/2015
8
Preparation
Commitment to change has been made and
they plan to take action in the near future.
Action
Begin to actively change behaviors and
environmental conditions to overcome
problem.
Maintenance
Changes have become a regular part of the
individual’s lifestyle.
7/16/2015
9
Why Determine Stage of
Change?
Identifying a clients stage of change will
help you determine the best approach to
take with them.
Change is the responsibility of the client
but the caregiver is responsible for
enhancing motivation to change.
7/16/2015
10
Ways to Determine Their Stage
of Change
I noticed (behavior) is this something
that is creating a problem for you or
something you would like to change?
People differ in how ready they are to
change their (behavior) habits. What
about you?
7/16/2015
11
Precontemplative Client
“I don’t have any problems with
(behavior)”
They may come across defensive
•
•
•
•
Reluctant
Resigned
Rationalizing
Rebellious
No intention to change
7/16/2015
12
Comtemplative Client
“I have been thinking about changing
(behavior)”
• They have identified the behavior may be
problematic
• More troubled about the behavior
• Ambivalent but may be weighing pros and
cons
• Decisional balance exercise useful
7/16/2015
13
Preparation Stage and Client
“How can I change (behavior)?”
•
•
•
•
More committed
Ready to start
Sharing plans for change
Change becomes a priority
7/16/2015
14
Action Stage and Client
“Here I go”
• They decide on a change strategy and try it
out
• Actively modify behavior including thoughts,
feelings, and the environment
• Treatment and/or self-help
• Persistence and completion or drop-out
7/16/2015
15
Maintenance Stage and Client
“I think this will work and I am going to
continue”
• Trying to keep the ball rolling
• Preventing relapse – learning new coping
skills
• Watching out for triggers
• Acknowledging self for changes made and
taking credit
• Moving toward more balance
7/16/2015
16
Practice Identifying Stage of
Change
Quick Exercise
We will come back to the stages of
change after discussing motivational
interviewing
7/16/2015
17
Motivational Interviewing
Defined as “...a client-centered directive
method for enhancing intrinsic motivation
to change by exploring and resolving
ambivalence” (Miller & Rollnick, 2002, p.
25)
Let’s break it down
7/16/2015
18
Four Main Principles of MI
Express empathy
Develop discrepancy
Roll with resistance
Support self-efficacy
7/16/2015
19
Strategies Used in MI
Eliciting Change Talk – motivational
statements from the client
OARS Method
•
•
•
•
Open-Ended Questions
Affirming the client
Reflective listening
Summarizing
7/16/2015
20
Change Talk
Client identifies that behavior might be
problematic
Client expresses concern about a
behavior
Client expresses a desire to change the
behavior
7/16/2015
21
Reflective Listening
What is it?
How do you do it?
Levels of reflective listening
Optimal reflective listening
Let’s Practice…
7/16/2015
22
Affirming the Client
The idea here is to enhance self-efficacy
Self-efficacy is our belief in our own ability to
achieve a goal or accomplish a task
Strengthen the relationship
Enhance self-esteem
7/16/2015
23
Summarizing
A technique to be used throughout the
meeting
• Strategically repeat a client’s self-motivational
statements
Include reluctance/resistance
Reflect optimism for change
7/16/2015
24
Knowing When a Client is Ready
to Change
What do you expect to hear when a
client is ready to change?
What do you not expect to hear?
What will the client look like?
What other indications might the client
make?
7/16/2015
25
How to Elicit Change Talk
Open-ended questions (handout)
Ruler (handout)
Pros/Cons exercise
Looking forward
Looking back
Goals and values
Change Planning
What changes?
Why change?
Goals – SMART
Steps to take?
First steps – concrete
Help
I will know it is working if
Potential obstacles
7/16/2015
27
Resistance to Change
4 Categories
• Arguing
• Interrupting
• Denying
• Ignoring
7/16/2015
28
NO NO’s for Dealing with
Resistance
Arguing, disagreeing and
challenging
Judging, criticizing, blaming
Warning of negative
consequences
Seeking to persuade with logic
Analyzing
Confronting with authority
Sarcasm
7/16/2015
29
How to Respond to Resistance
Simple reflection
Amplified reflection
Double-sided reflection
Agreement with a twist
Shifting focus
Reframing
Rolling with resistance
7/16/2015
30
Simple Reflection
Stating what you here the client saying
It is sometimes helpful for the client just
to hear their own words
7/16/2015
31
Amplified Reflection
Reflect with modification
Client: I just don’t think that I have a
problem with gambling.
Caregiver: There is no cause for
concern for you.
Client: I don’t know how changing
my eating habits could help me.
Caregiver: You feel your eating
habits are perfectly reasonable.
7/16/2015
32
Double-Sided Reflections
Reflect back the statement but also use
the other side of the client’s ambivalence
• Client: I can’t quit eating sweets. I look
forward to having a nice desert each day.
• Caregiver: It sounds like you are going to
miss eating deserts, but you also don’t want
to take diabetic medication. What do you think
would be the best way to resolve this
situation?
7/16/2015
33
Agreement with a Twist and
Shifting Focus
Add a slant or twist to the
meaning when you reflect
back to the client
Defuse resistance by
shifting focus
Client: I can’t imagine quitting
drinking. All of my friends
drink!
Caregiver: It sounds like you’ll
really miss the social
interaction. And at the same
time, it might provide an
opportunity to expand your
social network like you were
wanting.
Client: I can’t imagine quitting
drinking. All of my friends
drink!
Caregiver: It’s hard to imagine
giving up a lifestyle that you’re
accustomed to. I’m wondering,
what can you imagine?
7/16/2015
34
Reframing
Placing something in a more positive
light – (what are the benefits?)
• Client – It is really going to be hard for me to
quit eating sweets.
• Caregiver: While it will be hard to quit eating
sweets, you are determined to do it because it
will allow you to control your diabetes without
taking medication.
7/16/2015
35
Rolling with Resistance
This is where you just want to validate
what the client is telling you by letting
them know you have heard their problem
and understand their ambivalence
It can be one of the most difficult
techniques
7/16/2015
36
MI – The BASICS
1) Don’t ignore the behavior – even if you
simply say “Hey, (name) I noticed (behavior).
2) Try to determine where they are with regards
to stage of change.
3) Let’s Practice…
7/16/2015
37
Summary
The Basics of MI
Can be used to address any negative
behavior
7/16/2015
38
Feedback and/or Questions
[email protected]
or
(479) 601-2164
Thank you.