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Motivational Interviewing with Latino Populations

Motivational Interviewing 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?.

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Motivational Interviewing with Latino Populations

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  1. Motivational Interviewingwith Latino Populations Presenter: James (Diego) Rogers, PsyD, CPRP VP of Clinical Services Community Research Foundation San Diego, CA MINT Member 2004

  2. What is Motivational Interviewing? • A person-centered directive method for enhancing internal motivation for change by exploring and resolving ambivalence. (Miller & Rollnick, 1991; 2002)

  3. What is Motivational Interviewing? • A way of being with a person, not just a set of techniques for doing counseling. (Miller & Rollnick, 1991; 2002)

  4. 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.

  5. MI Spirit • Autonomy (Person-centered) • Collaboration • Compassion • Evocation (Guiding/eliciting style)

  6. Normal Human Reactions to the Righting Reflex (Teach/Direct) Invalidated Resist Withdraw Not respected Arguing Disengaged Not understood Discounting Disliking Not heard Defensive Inattentive Angry Oppositional Passive Ashamed Denying Avoid/leave Uncomfortable Delaying Not return Unable to change Justifying

  7. Normal Human Responses to a Listen/Evoke/Empathic Style Affirmed Accept Approach Understood Open Talk more Accepted Undefensive Liking Respected Interested Engaged Heard Cooperative Activated Comfortable/safe Listening Come back Empowered Hopeful/Able to change

  8. “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.

  9. 4 Principles of MI(2nd Edition) • Express Empathy • Develop Discrepancy • Roll with Resistance • Support Self-efficacy/Elicit Change Talk (Miller & Rollnick, 1991; 2002)

  10. Express Empathy(Use your OARS) • Open-ended questions • Affirmations • Reflections • Summaries

  11. 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

  12. What is Resistance? • Therapy Interfering Behaviors • Interpersonal (It takes two to resist) • A signal of dissonance (empathic failure) • Predictive of (non)change

  13. What is Sustain Talk? • Desire for status quo • Inability to change • Reasons for sustaining status quo • Need for status quo • Commitment to status quo

  14. Sustain Talk and Resistance • Sustain Talkis about the target behavior • I really don’t want to stop smoking • I have to have my pills to make it through the day • Resistanceis 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

  15. How to Roll w/ Resistance(Sustain Talk) • Simple/Double-sided Reflections • Shifting Focus • Agreement with a Twist • Emphasizing Personal Choice • Reframing

  16. Change Talk & Sustain Talk Opposite sides of the same coin

  17. 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 . .)

  18. Mobilizing Change TalkReflects resolution of ambivalence • COMMITMENT (intention, decision, promise) • ACTIVATION (willing, ready, preparing) • TAKING STEPS

  19. 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

  20. 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

  21. Linguistic Translations • Motivational Interviewing (MI) = La Entrevista Motivacional (EM) • MI Spirit = Espíritu de EM • OARS = PARS

  22. 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

  23. 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)

  24. 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

  25. 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).

  26. 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)

  27. 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)

  28. Motivational Interviewing Web Site www.motivationalinterview.org

  29. Thanks for your participation!!

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