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Motivational Interviewing An Evidence-Based Tool for Drug Court

Motivational Interviewing An Evidence-Based Tool for Drug Court. Joe Lunievicz, BA, RYT Director Training Institute, NDRI, Inc. Executive Director, NDRI-USA, Inc. Agenda. What is it? Evidence Base Techniques Used Practice. Exercise in Pairs. Write down on paper:

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Motivational Interviewing An Evidence-Based Tool for Drug Court

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  1. Motivational InterviewingAn Evidence-Based Tool for Drug Court Joe Lunievicz, BA, RYT Director Training Institute, NDRI, Inc. Executive Director, NDRI-USA, Inc.

  2. Agenda What is it? Evidence Base Techniques Used Practice Lunievicz/MI

  3. Exercise in Pairs Write down on paper: What are three things you value in life? What is one five-year goal you have? Discuss with your partner Lunievicz/MI

  4. Participants? What Motivates your participants to move towards graduation?What are their goals?What do they value?How does present behavior get in the way? Lunievicz/MI

  5. Motivational Interviewing A directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is a style of helping that uses a set of specific strategies. Lunievicz/MI

  6. Motivational Interviewing (Cont.) Motivation- or presumed lack of it- is not viewed as a personality problem or character trait, but as a state of readiness for change that can be influenced by a helping relationship. Rollnick & Miller, 1995 Lunievicz/MI

  7. After 30 years of Research … Bill Miller & Steve Rollnick - Stockholm, June 2010 Presentation • 200+ randomized clinical trials – Evidence Base • 10 multisite clinical trails – Evidence Base • 1000+ publications • Dozens of books and videotapes – MI 2 in 2002 • Several coding systems for quality assurance • MIA-STEP to support MI supervisors • Research on MI Training Lunievicz/MI

  8. Evidence Base with… • 100,000 + individuals • Alcohol, crime, drugs, family/relationships, social functioning, trauma/injuries, treatment/recovery • Age 18-25, 26-55, 55+ • Male, female • Caucasian, Asian, Black or African American, Hispanic or Latino • Outpatient, school, community settings • Urban, suburban Lunievicz/MI

  9. Motivational Interviewing • Is a brief intervention • Developed to work with “unmotivated drinkers” • Based on work by Rollnick and Miller 1991 • Useful for clients who are reluctant to change (ambivalence - contemplators) • Draws on client-centered therapy, cognitive therapy & change therapy • Is non-confrontational • Uses specific strategies/skills Motivational Interviewing

  10. MI Basic Principles • Expressing Empathy • Developing Discrepancy • Rolling with Resistance • Supporting Self-Efficacy Lunievicz/MI

  11. MI helps the client… • Enhance intrinsic motivational change • Recognize the need to do something about the potential problem • Resolve ambivalence • Decide to change Motivational Interviewing

  12. The Counselor… • Does not assume an authoritarian position • Avoids conveying the message “I have the answers” • Treats the client as an adult capable of making responsible decisions • Treats the client as the “expert” on his or her own experience Motivational Interviewing

  13. The Counselor Does Not… • Argue with client • Impose a diagnostic label on client • Tell client what they “must” do • Seek to “break down” denial by direct confrontation • Imply clients’ powerlessness Motivational Interviewing

  14. Why use MI in Drug Court? • Better Engagement • More Information • Better Assessments • More Relevant Recommendations • More Successful Outcomes Lunievicz/MI

  15. MI Intervention vs. MI techniques • Full intervention Or • Individual techniques that make up the intervention Lunievicz/MI

  16. Example: Motivational Enhancement Therapy - NIDA • Alcoholics, outpatient tx • 7-8 hour assessment • 4 sessions • 1&2, structured feedback, future plans & motivation for change • 3&4, reinforce progress, encourage reassessment & provide objective assessment of progress • Significant other involved in session 1 & or 2 • Breath alcohol readings • 90 day timeframe Motivational Interviewing

  17. MINT blog post – “Old” • Are you a smoker? • Well, sort of, yes. • How much do you smoke each day? • A pack or two. • The way you’re coughing, I have to tell you, it’s going to get worse if you continue. • Yes, I know but you see it helps with the stress. If you knew what I go through with the truck and long hauls. It’s enough just to get through the day. • But if you carry on like this you might lose even more time at work. • Yeah. I’m cutting back, you see. • Well we’ve got some good aids to quitting if you are interested? • Yes, thanks, sure. I’ll give it some thought. Lunievicz/MI

  18. MINT blog post – “New” • Would you mind if we talked about your smoking? • Well, ok. • How do you really feel about it? • I’m trying to cut back, but I can’t say its easy with my job. You know its stressful driving a truck. • Its not easy for you, yet you’d like to smoke less. • Oh, if I could, definitely. I know it’s not good for my lungs or this cough for a start. • You can feel the effect for yourself and its not pleasant • That’s right. But its such a stress reliever its hard to let go. • It’s difficult to imagine being without smoking. • Yes, that’s exactly right. You got me. • I don’t want to give you a lecture or hassle you about this, but I’m wondering what would be helpful for you? • I just don’t know. • Tell me. Deep down. How important is this for you right now? • I feel sick and I’m tired and this smoking wears me down. Lunievicz/MI

  19. Paraphrasing/Reflection Pairs Can’t respond until you have paraphrased accurately. Argue your point. Lunievicz/MI

  20. MI Strategies • OARS • Open Ended Questions • Affirming • Reflection • Summarizing • Balance sheet • Stages of change • Using the importance Ruler • Exploring goals and values • Elicit Change Talk Lunievicz/MI

  21. Questioning SkillsEffective vs. Ineffective Questions • Ineffective • Too many questions • Accusatory questions: Why? • Multiple questions • Explanatory questions • Closed questions Lunievicz/MI

  22. Questioning SkillsEffective vs. Ineffective Questions • Effective • Have specific objectives in mind • State background for question • Use language of the client • Check out whether client is understanding • Ask openly: Who, What, When, Where & How • Use open-ended questions • Paraphrase; Reflect; Summarize Lunievicz/MI

  23. Open Ended Questions • Who, what, where, when • Tell me about… • How did you… • Redirect: Now tell me about… Lunievicz/MI

  24. Open-ended Examples: • What worries you about your current situation? • Tell me about difficulties have you had with your drug use? • What do you think will happen if you don’t change? • How has your anger interfered with your life? • What would your life be like 5 years from now? Lunievicz/MI

  25. Affirm (but don’t flatter) • Strengths based technique • Verbally supports or validates a participant’s thoughts, emotions, or actions • Demonstrates: Appreciation, Understanding, Support • When you see a strength, notice it Lunievicz/MI

  26. Affirmation Example: 1. Participant arrives on time for his case management appointment. “You’re punctual. That will be a big help in this program.” 2. Participant: “I don’t want to do anything more than I need to. I just want to finish the program and get on with my life.” “Determination is a good characteristic to have in treatment. It will help to keep you focused.” Lunievicz/MI

  27. Reflective Listening • Rationale • Conveys willingness to try to understand • Serves as a perception check • Clarifies feelings • Leads to more exploration • Demonstrates empathy • Common Errors • Not listening closely • Limited feeling vocabulary • Monotone vocal qualities • Premature focus on problem solving Lunievicz/MI

  28. Reflection Expressing Empathy: • “So, what I hear you saying is…” Reflecting Conflict: • “On the one hand…but on the other hand…” • “So what you’re saying is…but you are not able to…” Rolling with resistance: • “You don’t have to do anything you don’t want to.” Lunievicz/MI

  29. Summarizing • The set-up statement • Let me see if I understand correctly… • Reflection, Reflection, Reflection • Open ended Question • What did I miss? • What other concerns do you have? Lunievicz/MI

  30. Practice: Speaker Something about yourself that you Want to change Need to change Should change Have been thinking about changing … but you haven’t changed yet. Lunievicz/MI

  31. Practice: Listener Listen carefully Ask these 4 questions: Why would you want to make this change? How might you go about it in order to succeed? What are the three best reasons for you to do it? On a scale from 0 to 10, how important would you say that it is for you to make this change? Why are you a (?) and not a zero? Give a short summary/reflection of the speaker’s motivations for change. Ask: “So what do you think you’ll do?” and just listen with interest. Lunievicz/MI

  32. Resources: • NREPP SMAHSA’s National Registry of Evidence-based programs and practices • MI – Bill Miller email wrmiller@unm.edu • MI – http://www.motivationalinterviewing.org Lunievicz/MI

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