Using Motivational Interviewing (MI) with Latino Populations
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Transcript Using Motivational Interviewing (MI) with Latino Populations
Presenter:
James (Diego) Rogers, PsyD, CPRP
VP of Clinical Services
Community Research Foundation
San Diego, CA
MINT Member 2004
What is
Motivational Interviewing?
A person-centered directive method
for enhancing internal motivation for
change by exploring and resolving
ambivalence.
(Miller & Rollnick, 1991; 2002)
What is
Motivational Interviewing?
A way of being with a person, not
just a set of techniques for doing
counseling.
(Miller & Rollnick, 1991; 2002)
Broader than
Behavior Change
Decision- to make a choice
Forgiveness, leaving or staying
Attitude- to become a different person
To be more compassionate, assertive etc.
Resolution- acceptance
Complicated grief
Finding peace regarding a decision
Tolerance for anxiety, uncertainty etc.
MI Spirit
Autonomy (Person-centered)
Collaboration
Compassion
Evocation (Guiding/eliciting style)
Normal Human Reactions to the
Righting Reflex (Teach/Direct)
Invalidated
Resist
Withdraw
Not respected
Not understood
Not heard
Angry
Ashamed
Uncomfortable
Unable to change
Arguing
Discounting
Defensive
Oppositional
Denying
Delaying
Justifying
Disengaged
Disliking
Inattentive
Passive
Avoid/leave
Not return
Normal Human Responses to a
Listen/Evoke/Empathic Style
Affirmed
Accept
Understood
Open
Accepted
Undefensive
Respected
Interested
Heard
Cooperative
Comfortable/safe
Listening
Empowered
Hopeful/Able to change
Approach
Talk more
Liking
Engaged
Activated
Come back
“Change Talk”
The goal of MI is for the provider to
guide the client to discuss/argue for
his/her own reasons for change in a
compassionate way that respects the
client’s autonomy.
4 Principles of MI
(2nd Edition)
Express Empathy
Develop Discrepancy
Roll with Resistance
Support Self-efficacy/Elicit
Change Talk
(Miller & Rollnick, 1991; 2002)
Express Empathy
(Use your OARS)
Open-ended questions
Affirmations
Reflections
Summaries
Develop Discrepancy
Empathize with the ambivalence
Explore gains/losses of all options
Imagine extreme outcomes
Look forward & backward
Amplify ambivalence with reflections &
affirmations
Values sorting
What is Resistance?
Therapy Interfering Behaviors
Interpersonal (It takes two to resist)
A signal of dissonance (empathic
failure)
Predictive of (non)change
What is Sustain Talk?
Desire for status quo
Inability to change
Reasons for sustaining status quo
Need for status quo
Commitment to status quo
Sustain Talk and Resistance
Sustain Talk is about the target behavior
I really don’t want to stop smoking
I have to have my pills to make it through the day
Resistance is about your relationship
You can’t make me quit
You don’t understand how hard it is for me
Both are highly responsive to counselor style
How to Roll w/ Resistance
(Sustain Talk)
Simple/Double-sided Reflections
Shifting Focus
Agreement with a Twist
Emphasizing Personal Choice
Reframing
Opposite sides of the same coin
Preparatory Change Talk
DESIRE to change
(want, like, wish . . )
ABILITY to change
(can, could . . )
REASONS to change
(if . . then)
NEED to change (need, have to, got to . .)
Mobilizing Change Talk
Reflects resolution of ambivalence
COMMITMENT (intention, decision,
promise)
ACTIVATION (willing, ready, preparing)
TAKING STEPS
Responding to Change Talk
(All EARS)
Elaboration- Asking for elaboration, more
detail, in what ways, an example, etc.
Affirming- commenting positively on the
person’s statement
Reflecting- continuing the paragraph, etc.
Summarizing- collecting bouquets of
change talk
Culturally Competent Adaptations
Balancing act between maintaining fidelity to an
evidence-based practice…
While adapting and tailoring the practice to increase
engagement, receptivity, efficacy, and value to the
recipent(s) (Cultural Responsiveness).
Linguistic Translations
Incorporating Social Contexts
Incorporating Cultural Values
Linguistic Translations
Motivational Interviewing (MI) = La Entrevista
Motivacional (EM)
MI Spirit = Espíritu de EM
OARS = PARS
Incorporating Social Contexts
Immigration/migration experiences/status (including
political/historical contexts)
Contexts of Migration (Falicov, 1998)
Receptivity of the host community/dominant culture
Language barriers
Experiences of Group Antagonism
Acculturation process/Level of Acculturation
Ethnic Identity
Socio-economic Status
Social Context
A Cultural Adaptation of MI to Address Heavy
Drinking Among Hispanics (Lee, Lopez, Colby,
Caetano, Borrelli, & Rohsenow, 2011).
Social Context of Immigration (OARS)
Changing Family Dynamics (immigration & drinking)
Social Support (familismo y amistades/compadres_
Alcohol Health Literacy (E-P-E)
Incorporating Latino Cultural
Variables
Assess for value adherence (using OARS/PARS):
Familismo (family orientation)
Personalismo (relationships with people not agencies)
Respeto (mutual respect and deference)
Confianza (trust and intimacy in the relationship)
Controlarse (self-containment or control)
Agüantarse/Luchar (ability to withstand stress & difficult
times)
Poner de su parte (doing one’s part)
Religión
Latino Cultural Variables
Engaging Latinos Through the Integration of
Cultural Values and MI Principles (Añez, Silva,
Paris Jr., Bedregal, 2008).
Mental Health treatments were four times more
effective when culturally modified for a specific group
and when attentive to cultural context and values
(Griner and Smith, 2006).
General Research Findings on
MI and Latinos
Still generally limited in number of studies, sample
sizes, and populations.
Studies that do exist show that adopting the MI Spirit
and incorporating social contexts and cultural values
yielded favorable results in the therapeutic
relationship:
Personalismo
Respeto
Confianza (buena gente, simpatico)
General Research Findings on
MI and Latinos
Studies also show that incorporating social contexts
and cultural values with the MI principles/techniques
yielded favorable results (High Engagement & Client
Satisfaction):
Clients enjoyed talking about their cultural values and
striving for change toward those values (OARS).
Clients enjoyed talking about the change plan goals
and action plans (Agenda Setting and Change Talk).
Clients enjoyed have an ability to demonstrate
“poniendo de mi parte” (Change Talk)
Clients enjoyed having their opinion “respected” even
when given advice (E-P-E)
Motivational Interviewing
Web Site
www.motivationalinterview.org