Motivational Interviewing

1. Motivational Interviewing What Is It? Why Use It? How To Learn It?

2. Agenda • What it is and isn’t (briefly, more later) • Dynamics of change • Why use it • How it works • Applying it in clinical practice • How to learn it

3. Motivational InterviewingWhat Is It?

4. Motivational Interviewing A person-centered, goal-oriented method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

5. Phases of Motivational Interviewing Phase I: Snow Shoeing • Resolve ambivalence and build motivation • Snowshoeing up the mountain

6. Phases of Motivational Interviewing Phase I: Snow Shoeing • Resolve ambivalence and build motivation • Snowshoeing up the mountain Phase II: Skiing • Strengthen commitment and create a plan • Skiing down the mountain

7. What It Is Not • Skills training • Confrontive denial breaker • Simply sitting there listening and reflecting • The solution to all client issues and clinician headaches

8. Dynamics of Change You would think that…….

9. The Problem With Them Is…. • They don’t see (insight, denial) • They don’t know • They don’t know how • They don’t care

10. So The Answer is….. • Give them Insight……if they just seethey will change. • Give them Knowledge….. if they just knowthey will change. • Give them Skills….. if you can just teach them howto change, then they will change. • Give them Hell….. if you can make them feel bad or afraid enough they will change.

11. And Yet….. Sometimes Insight, Knowledge, Skills, And Feeling Bad Or Fearful Is Still Not Enough

12. What Is Happening? • Ambivalence • Motivation • Readiness • Confidence Issues of……

13. Stages of Change • Precontemplation • Contemplation • Determination/Preparation • Action • Maintenance Prochaska, Norcross, DiClemente Relapse

14. Stages of Change • 80% of substance abusers are in precontemplation or contemplation • Define success by the movement from one stage to the next

15. Motivational InterviewingWhy Bother Learning And Using It?

16. Evidence Based

17. Top Brief intervention Social skills training Motivational enhancement Community reinforcement approach Behavior contracting Bottom Relaxation training Confrontation Psychotherapy General alcoholism counseling Education Miller & Hester 1995: Alcohol

18. Top Brief intervention Motivational enhancement Community reinforcement approach Self-change manual Opiate Antagonists (Naltrexone) BSCT Bottom Relaxation training Confrontation Psychotherapy General alcoholism counseling Education Miller & Hester 2003: Alcohol (adapted post COMBINE)

19. Miller, Zweben & Johnson 2006 • Cognitive-behavioral treatment • Community reinforcement approach • Motivational interviewing • Relapse prevention • Social skills training

20. Overview of Treatment Methods • Build client motivation, readiness and engagement • Cognitive and behavior skills • Increasing positive rewards for non-use • Involve family and social networks • Think outside the skin • Appropriate medications

21. Some Specific Benefits

22. Some Benefits of Motivational Interviewing • A good preparation for more action-oriented treatments • Gains rapport and reduces resistance • Increases retention and engagement in treatment • Resolves ambivalence (prepares for change) • Increases client motivation and change talk

23. Some Benefits of Motivational Interviewing • Can help increase client confidence • Reductions in use • Particularly useful with angry clients and those in the early stages of change • Prevents counselor burnout?

24. Benefits For Using With Methamphetamine Users • Helps deal with paranoia and suspicion • Effective in dealing with cognitive deficits

25. How It Works

26. Key Assumptions • Motivation is interpersonal • Resistance is interpersonal • Clinician approach and behaviors matter • Persuasion is usually not an effective method to increase motivation and change

27. MI: How it Works Clinician manages important in-session behaviors of client using MI spirit, principles and skills Interaction of clinician and client Increase Change talk and Decrease Resistance Leads to

28. Change Talk Desire Ability Reasons Need Taking Steps Commitment Strength Behavior Change

29. Resistance • Arguing • Interrupting • Denying • Ignoring

30. MI Pyramid Strategies Principles Spirit

31. Components of MI Spirit A= Autonomy (vs. authority) C = Collaboration (vs. confrontation) E= Evocation (vs. education)

32. Basic MI Principles • D= Develop Discrepancy • R = Roll with Resistance • E= Express Empathy • S= Support Self-efficacy

33. Develop Discrepancy • Change is motivated by a perceived discrepancy between present behavior and important personal goals or values • The person rather than the counselor should present the arguments for change

34. Roll with Resistance • Avoid arguing for change • Resistance is not directly opposed • Resistance is a signal to respond differently • The person is a primary resource in finding answers and solutions

35. Express Empathy • Acceptance facilitates change • Skillful reflective listening is fundamental • Ambivalence is normal

36. Support Self-Efficacy • A person’s belief in the possibility of change is an important motivator • The person, not the counselor, is responsible for choosing and carrying out change • The counselor’s own belief in the person’s ability to change becomes a self-fulfilling prophecy (HARP)

37. Strategies • Open Questions • Affirming • Listen Reflectively • Summarizing Dunn/MINT OARS

38. Change Talk Original idea from Bem’s theory “I learn what I believe from what I hear myself say.”

39. Eliciting Change Talk:A Technique For The Road

40. Assessing Importance • How important on a scale of 1-10? 1---x--------------y-------------10 • Why X and not 1? • What would have to happen for you to go from X to Y?

41. MI: What It Looks Like Generally quiet and eliciting Is anything going on here? The Data Says Yes!

42. Using MI In The Clinical Setting

43. Into Practice • As a preparation for more action-oriented forms of treatment such as: • CBT • 12 Step • Matrix Model • In individual and group sessions • More data about using in individual sessions • Reducing resistance and anger upon entry to treatment (and throughout) • When ambivalence crops up at any point MI plays well with others

44. A Time Not To Use MI • When the client is clearly ready and committed to action

45. Learning Motivational Interviewing

46. How To Learn It • Workshops: typically equivalent of 2-3 days • (preferably with follow-up and feedback) • Reading MI material • Viewing training videos • Watching or listening to your own taped sessions • Supervision and consultation • Peer encouragement

47. Stuck Points in Learning • Openness to change behavior and maintaining old behaviors • Proficiency in reflective listening • Eliciting and recognizing change talk • Summarizing • Transitioning to other therapeutic methods

48. MI Resources • Motivational Interviewing (2002) 2nd Edition, Miller & Rollnick, Guilford Press • Complete description of MI and individual chapters on various populations, i.e. adolescents, corrections clients, clients with COD, etc. • www.motivationalinterview.org • Information, training announcements, videos, bibliography

49. Questions, Maybe Answers

50. Contact Information Steve Brazill 316 304-5272 sbrazill@earthlink.net