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Principles and Practice of Motivational Interviewing An Introduction

Principles and Practice of Motivational Interviewing An Introduction. Jonathan Fader, PhD Palmetto Health Columbia, SC November 8, 2012. Disclosures. I have no relevant disclosures related to this activity. Jonathan Fader, PhD. Honoring Each Other ’ s Participation.

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Principles and Practice of Motivational Interviewing An Introduction

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  1. Principles and Practice of Motivational InterviewingAn Introduction Jonathan Fader, PhD Palmetto Health Columbia, SC November 8, 2012

  2. Disclosures I have no relevant disclosures related to this activity. Jonathan Fader, PhD

  3. Honoring Each Other’s Participation • Respect for effort makes for a good training • We can honor fellow participants by: • High Five, Handshake or Pound • Hug • ET hug • Bow • ASL applause • Real Play • Respect for varying viewpoints www.jonathanfader.com

  4. Training Objectives Become familiar with theory of Motivational Interviewing Learn Basic Motivational Interviewing technique Be able to apply that technique to working with your clients www.jonathanfader.com

  5. Warm-Up • Find a partner in the room • Decide who is going to speak and who is going to listen • Listener: Ask your partner ,“What could you do to lead a more fulfilling life?” • Speaker: speak for 90 seconds to your listeners about how you can be helped. • This is not a ‘role-play’: this is a ‘real-play’. • Listener is to hold complete silence, to use your • non-verbal interviewing skills • Begin! www.jonathanfader.com

  6. Warm-Up Continued • Offer your listener one piece of positive feedback. What’s one thing you saw them doing or not doing that made it easy for you tell your story? • What are some examples of positive feedback you just offered your listener? • Please extend gratitude and thank your listener for listening • What was challenging and/or easy about listening in silence? www.jonathanfader.com

  7. Outline • Background on behavior change theories • Review theory of Motivational Interviewing • Introduce Motivational Interviewing Technique • Videos • Practice Motivational Interviewing technique • Wrap up discussion and questions www.jonathanfader.com

  8. Important Theorists “Look children, this is all I’m going to say about drugs…Stay away from them…There’s a time and a place for everything…and it’s called college.” Chef Parker & Stone, South Park www.jonathanfader.com

  9. Mechanisms For Change Transtheoretical Model (Prochaska & DiClemente, 1986) Change as a continuous variable Stages of change Individuals can continuously cycle through stages www.jonathanfader.com

  10. Mechanisms For Change Precontemplation Contemplation Relapse Preparation Maintenance Action www.jonathanfader.com

  11. Michael Jackson Said It Best I Said You Wanna Be Startin' Somethin'You Got To Be Startin' Somethin'I Said You Wanna Be Startin' Somethin'You Got To Be Startin' Somethin'It's Too High To Get Over (Yeah, Yeah)Too Low To Get Under (Yeah, Yeah)You're Stuck In The Middle (Yeah, Yeah)And The Pain Is Thunder (Yeah, Yeah)It's Too High To Get Over (Yeah, Yeah)Too Low To Get Under (Yeah, Yeah)You're Stuck In The Middle (Yeah, Yeah)And The Pain Is Thunder (Yeah, Yeah) www.jonathanfader.com

  12. Stages of Change in Problem Behavior: Intervention Strategies Precontemplation Stage Contemplation Stage Action Stage Maintenance Relapse Stage MOTIVATIONAL ENHANCEMENT STRATEGIES RELAPSE PREVENTION & MANAGEMENT TREATMENT www.jonathanfader.com

  13. What is Motivational Interviewing? www.jonathanfader.com

  14. VIDEO- What isn’tMI? What happens when we tell people what to do? www.jonathanfader.com

  15. Brief Interventions Motivational Enhancement Therapy (Motivational Interviewing) Miller and Rollnick, 2009 MI is a collaborative, person-centered form of guiding to elicit and strengthen motivation for change www.jonathanfader.com

  16. Five Principles of MI Express Empathy www.jonathanfader.com

  17. Five Principles of MI Develop Discrepancy www.jonathanfader.com

  18. Five Principles of MI Avoid Argumentation www.jonathanfader.com

  19. www.jonathanfader.com

  20. Five Principles of MI Roll with Resistance www.jonathanfader.com

  21. www.jonathanfader.com

  22. Five Principles of MI Support Self-Efficacy www.jonathanfader.com

  23. www.jonathanfader.com

  24. Five Principles of MI Video What to look for in the video Three examples of actions or words that you observe that look like MI to you www.jonathanfader.com

  25. What Is Resistance? www.jonathanfader.com

  26. I don't exercise. If God had wanted me to bend over, he would have put diamonds on the floor. - Joan Rivers www.jonathanfader.com

  27. Argument Challenging Discounting Hostility Denial Blaming Disagreeing Excusing Reluctance Minimizing Pessimism Unwillingness to change Claiming immunity Types of Resistance: Exercise Split up into pairs. Write down on a note card a resistance statement that a client you work with would say. These cards will be collected by the trainer afterwards www.jonathanfader.com

  28. Motivational Interventions The “Hook” A person’s behavior-related issue or problem that, if addressed, can promote change www.jonathanfader.com

  29. The “Hook” • Relationships • Financial • Legal • Health • What else?? Negative Consequences www.jonathanfader.com

  30. Case # 1 Juan is a 50 year old unemployed man who is an aspiring artist. He was diagnosed with type 2 DM when we was 45. He complains that he and his girlfriend are always fighting because since he was diagnosed with DM she is always trying to limit his diet. He tells you that he’s tried to cut back on eating high fat foods before but that he always starts to eat them when one of his paintings gets passed over for an art gallery. www.jonathanfader.com

  31. Case #1 Juan’s Possible Hooks • Impact on relationship with girlfriend • Importance of his artwork www.jonathanfader.com

  32. Motivational Interviewing Techniques Open-ended Questions Reflective Listening Affirm Summarize Elicit Change Talk Core Components Being Behaving Express Empathy Avoid Argumentation Roll with Resistance Develop Discrepancy Support Self-efficacy Spirit Collaboration Evocation Autonomy www.jonathanfader.com Miller and Rollnick, 2002

  33. OARS Open-Ended Questions Affirmations Reflective Listening Summaries www.jonathanfader.com

  34. OARS – CLOSED Ended Questions • Did you have more than one alcoholic beverage this week? www.jonathanfader.com

  35. OARS – CLOSED Ended Questions www.jonathanfader.com

  36. OARS Open-Ended Questions What are the words that usually begin CLOSED ended questions? Is Are Do What are the words that usually begin OPEN ended questions? What How Why www.jonathanfader.com

  37. Eliciting Negative Consequences Motivationally • What difficulties have you had from not taking breaks at work? • What do see happening if you continue to eat as you are? • In what ways do you think other people have been affected • you not taking your medication? • What do you think will happen if you don’t make a change? • What is there about your mood that you or other • people might see as reasons for concern? • Modified From Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. Motivational Enhancement Therapy Manual, National Institute on Alcohol Abuse and Alcoholism, Project MATCH Monograph Series, Volume 2.

  38. Examples of Key Questions • What do you think you will do? • What does this mean about your eating habits? • It must be uncomfortable for you now, seeing all this…What's the next step? • What do you think has to change? • What could you do? What are your options? • It sounds like things can't stay the way they are now. What are you going to do? • Of the things we have mentioned here, which for you are the most important reasons for a change? www.jonathanfader.com

  39. They speak of my drinking, but never of my thirst. -Scottish Proverb www.jonathanfader.com

  40. What are the reasons you don’t want to take your medicine? What do you get out of eating high fat foods? What do you like about fighting? How does {problem behavior} help? What are your reasons for not wanting to these exercises? Addressing the Positives www.jonathanfader.com

  41. Reasons not to Change! www.jonathanfader.com

  42. “To alcohol, the cause of, and solution to, all of life's problems" - Homer Simpson

  43. Motivational Interviewing Strategies Reflection: The key to developing discrepancy www.jonathanfader.com

  44. Motivational Interviewing Strategies • Reflection: The key to developing discrepancy • Simple Reflection • Amplified Reflection • Double-Sided Reflection www.jonathanfader.com

  45. Motivational Interviewing Strategies • Reflection: The key to developing discrepancy • Simple Reflection • I can’t start exercising, none of my family or friends do! • It’s difficult for you to think about starting to be more physically active because you are surrounded by people who don’t exercise. www.jonathanfader.com

  46. Motivational Interviewing Strategies • Reflection: The key to developing discrepancy • Amplified Reflection • My Dad is exaggerating. I’m not that overweight! • It seems to you that he has no reason at all to worry about you. www.jonathanfader.com

  47. Motivational Interviewing Strategies • Reflection: The key to developing discrepancy • Double-Sided Reflection Client: So I’m trying to eat right most days… I know I gotta bring my weight down so I don’t get sick… it’s just such a hassle. Clinician: So on one hand paying attention to what you are eating is a lot of work, but on the other hand, you have to do it so that you stay healthy… Client: Yeah… I know that my weight is pretty high and thinking about what might happen if it stays that way, kind of freaks me out. Clinician: Seeing that your weight was high scared you. www.jonathanfader.com

  48. Important Theorists “Named must be your fear before banish it you can.” Yoda

  49. Exercise: Practicing Rolling with Resistance • Facilitator will play the client with statements suggesting resistance representing types of resistance described previously (From the cards you turned in!!) • You, as the group, are our counselors • Please respond to these statements with reflections www.jonathanfader.com

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