Motivational Interviewing: to Engage Students in their Learning and Counseling Goals

1. Motivational Interviewing: to Engage Students in their Learning and Counseling Goals Sara Burd Behavioral Health Coordinator Reading Public Schools

2. What This Workshop Will Do For You • You will learn ways to use motivational interviewing as a tool to roll with student resistance. • This training will give you a taste of MI and introduce you to some strategies and resources.

3. What is Motivational Interviewing? Directive, person centered counseling style that aims to help people explore and resolve their ambivalence about behavior change Source: Michael Wiles and Cross Country Education, Inc. 2005

4. Spirit of MI • Motivation to change is elicited from the person, not externally • It is the person’s task, not the counselor’s or teacher’s, to articulate and resolve ambivalence • Direct persuasion is not an effective method for resolving ambivalence • The adult’s style is generally a quiet and eliciting one • The adult is directive only in helping the person to examine and resolve ambivalence • Readiness to change is a fluctuating product of interpersonal interaction. • The relationship is more like a partnership or collaboration than expert/recipient role.

5. Characteristics of MI • Guiding, more than directing • Dancing, rather than wrestling • Listening, as much as telling • Collaborative conversation • Evokes from a person what he/she already has • Honoring of a person’s autonomy

6. What Do We Know About Motivation? • It is fundamental to change • It fluctuates • It can be modified • It is influenced by external factors and social interactions • It is very sensitive to interpersonal style • There are internal and external sources • We want to increase the probability of the person engaging in change behavior • Motivating is an inherent part of our job

7. What is Ambivalence • I want to, but I don’t want to • Natural phase in the process of change • Normal aspect of human nature, not pathological • Ambivalence is key issue to resolve for change to occur • It is our friend

8. PRINCIPLES

9. Principles of MI • Express empathy • Develop discrepancy • Roll with resistance • Support self-efficacy

10. Express Empathy • Acceptance facilitates change • Skillful reflective listening is fundamental to expressing empathy • Ambivalence is normal

11. Develop Discrepancy This is accomplished by thorough goal and value exploration: • Help the student identify their own goals/values • Identify small steps toward the goal- focus on the feasible steps • List pros and cons ( payoff matrix) • Difference between the person’s core values and life goals and their behavior • Use the ICR scale ( Importance, Confidence, Readiness) • Difference between where the person is now and where he/she would like to be in the future • Best if the individual makes the argument for change. • No discrepancy = No ambivalence…Ambivalence makes change possible.

12. Resistance • It is normal • 4 types: arguing; denying; ignoring; interrupting • The more one talks about non-change behaviors, the more a person is likely to do them. • May mean the adult is ahead of the person in the change process • Resistance often stems from fear of change • Resistance is a signal to change strategies

13. Roll with Resistance: DO NOT… • Argue, disagree and challenge • Judge, criticize, blame • Warn of negative consequences • Seek to persuade with logic • Analyze • Confront with authority • Use Sarcasm

14. How to respond to resistance • Simple reflection: State what the student says • Amplified reflection: Reflect with modification (Student: I don’t know how changing my eating habits could help me. Adult:You feel your eating habits are perfectly reasonable. ) • Double-sided reflection: Reflect back the statement but also use the other side of the client’s ambivalence • Agreement with a twist • Shifting focus • Reframing: Placing something in a more positive light – (what are the benefits?) • 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

15. Support Self-Efficacy • Express optimism that change is possible • Review examples of past successes to stop using • Use reflective listening, summaries, affirmations • Validate frustrations while remaining optimistic about the prospect of change

16. Let’s Try… Developing Discrepancy: • Have students identify their own goals/values • Identify small steps toward the goal- focus on the feasible steps • List pros and cons ( payoff matrix) • Difference between the person’s core values and life goals and their behavior • Difference between where the person is now and where he/she would like to be in the future Trina dreams of becoming a marine biologist. Trina never arrives to her first morning class (Biology) on time. She has increasingly fallen behind in her work for that class. Trina has been reminded to arrive on time and has served detentions for her chronic tardiness. She is still unable to arrive on time.

17. Let’s Try… • Rolling with Resistance: • Simple reflection • Amplified reflection • Double-sided reflection • Agreement with a twist • Shifting focus • Reframing Sawyer speaks out loud in class a lot. Sawyer often interrupts others, speaks off topic and very loudly. As Sawyer’s teacher you have asked him countless times to remain silent or wait for the appropriate time to speak. Sawyers peers have also started to plead with him to stop interrupting. Sawyer argues with you and his peers defending his right to speak in school and have his own opinion.

18. STAGES OF CHANGE

19. Cycle of Change

20. Precontemplation Student is 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. • I don’t have any problems with (behavior)” • They may come across defensive • Reluctant • Resigned • Rationalizing • Rebellious • No intention to change

21. 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. • 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

22. Preparation • Commitment to change has been made and they plan to take action in the near future • How can I change (behavior)?” • More committed • Ready to start • Sharing plans for change • Change becomes a priority

23. Action • Begin to actively change behaviors and environmental conditions to overcome problem. • “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

24. Maintenance • Changes have become a regular part of the individual’s lifestyle • “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

25. Why Use Stage of Change Model? • Identifying a clients stage of change will help you determine the best approach to take with them. • If using strategies for a more advanced stage of change with a student who is at an earlier stage of change, resistance is almost guaranteed. • Change is the responsibility of the client but the caregiver is responsible for enhancing motivation to change.

26. Ways to Determine 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?”

27. Let’s Try… Identifying stage of change: Precontemplative, Contemplative, Preparation, Action, Maintenance Raj knows that his social interactions with peers tends to isolate him. Raj likes to talk very fast, and only about himself without ever listening to others. Raj thinks its okay to talk about himself, but he wishes that others would seek him out at lunch and recess or in group projects.

28. Let’s Try… Identifying stage of change: Precontemplative, Contemplative, Preparation, Action, Maintenance Kristoff never hands in homework. He believes that it is irrelevant to a true education and that he learns best without doing his homework.

29. Let’s Try… Identifying stage of change: Precontemplative, Contemplative, Preparation, Action, Maintenance Lucille is very shy and doesn’t like to speak out loud in class. Lucille’s class participation grade has suffered and as a dedicated student she is willing to endure some discomfort in order to raise her grade. Lucille has decided to challenge herself to speak once a day in each class for a week.

30. STRATEGIES

31. Strategies of MI • Eliciting Change Talk – motivational statements from the client • OARS Method • Open-Ended Questions • Affirming the client • Reflective listening • Summarizing

32. What is Change Talk • Student identifies that behavior might be problematic • Student expresses concern about a behavior • Student expresses a desire to change the behavior • DARN-CAT: Desire, Ability, Reason, Need, Commitment, Activation, Taking Steps

33. Eliciting Change Talk • Asking Evocative Questions • Using Readiness Rulers ( ICR Scale) • Exploring the Decisional Balance (pros and cons) • Good Things/ Not So Good Things • As for examples, elaboration • Looking Back/Looking Forward • Query extremes • Come alongside ( side with the negative)

34. Open-Ended Questions • Open questions gather broad responses • Facilitate dialogue • Require more than a yes no response • Usually go from general to specific • Convey that our agenda is about the student • Usually start with words like “how”, “what”, “tell me about” or “describe”.

35. Affirming the Student • 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 • Must be sincere • Acknowledges the difficulties the student faces • Validates the students experience and feelings • Emphasizes past experiences that demonstrate strength and success to prevent discouragement

36. Reflective Listening • Begins with a way of thinking • It includes an interest in what the person has to say and a desire to truly understand how the person sees things. • Allows individual to feel heard • Allows you to confirm perceptions

37. Reflective Listening Examples • Repeating- simplest • Rephrasing- substitute synonyms • Paraphrasing- major restatement • Reflection of feeling- deepest • “It sounds like . . .” • “It seems as if . . .” • “What I hear you saying . . .” • “I get a sense that . . .” • “It feels as though . . .” • “Help me to understand. On the one hand you . . . and on the other hand . .”

38. Summarizing • A technique to be used throughout the meeting • Strategically repeat a client’s self-motivational statements • Include reluctance/resistance • Can link together a students feelings of ambivalence and promote perception of discrepancy • Reflect optimism for change

39. Let’s Try… • Eliciting Change Talk: • Asking Evocative Questions • Using Readiness Rulers • Exploring the Decisional Balance (Payoff matrix-benefits/costs) • Good Things/ Not So Good Things • As for examples, elaboration • Looking Back/Looking Forward • Query extremes • Come alongside ( side with the negative) Gabriel is a student in your class who tends to sleep through instruction.

40. Let’s Try… • OARS Method • Open-Ended Questions • Affirming the client • Reflective listening: Repeating-Rephrasing-Paraphrasing - Reflection of feeling • Summarizing Shay expresses affection very physically at school. She has noticed that her friends are distancing themselves and that the boys are teasing her. She is venting with you about how badly this makes her feel and damages her self-esteem.

41. Let’s Put It All Together • Practice the 4 Principles of MI • Express empathy • Develop discrepancy • Roll with resistance • Support self-efficacy • Identify the Stage of Change • Precontemplative, Contemplative, Preparation, Action, Maintenance • Use the OARS Method (and strategies) • Open-Ended Questions • Affirming the client • Reflective listening • Summarizing

42. Greta stays after class to talk with you about her poor test grades. Greta is a strong student, but never studies and as a result has a very low grade for the course. She wants to know why you deducted 5 points from one of her answers and is argumentative. Greta clearly believes the problem is poor grading from you and feels the need to fight until it is changed.

43. Marcus makes odd noises during class. He has been talking with you over the past few weeks about how uncomfortable he feels in school. Marcus has identified that his discomfort comes from how his peers and teachers treat him; they tend to look at him funny or avoid and ignore him altogether. Marcus says he makes the noises because he doesn’t know any other way to get people to acknowledge him.

44. Questions?

45. Thanks!

46. Resources Garfinkle, Buddy & Schneeloch, Nancy Bridgeway Rehabilitation Services, Elizabeth, New JerseyMotivational Interviewing in Action: Integrating MI Across Your Agency Heckathorn, Danette M.S., L.P.C. Rolling with Resistance : Using a Motivational Interviewing Approach icanhelp Program Training www.icanhelp.me Prochaska et. al., 1994, Stages of Change Model S. Rollnick, W. Miller and C. Butler, Motivational Interviewing in Health Care, 2008.