Motivational Interviewing in Drug Courts

1. Motivational Interviewing in Drug Courts Ron Jackson, MSW, LICSW School of Social Work University of Washington Seattle, WA

2. MI is a fancy way of selling people on their need to change behavior. • True • False

3. Motivational Interviewing Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change. Miller & Rollnick, 2012

4. Motivational InterviewingTheoretical Foundation Client-centered approach – Rogers Empathic Reflections Self-Perception Theory – Bem “We come to know what we believe by listening to ourselves talk.” Self-Efficacy – Bandura Power to Change Focus on Intrinsic Motivation – Brehm External pressure can lead to resistance to change Respect for client/patient autonomy – Medical Ethics Transtheoretical Model “Stages of Change” – Prochaska & DiClemente

5. STAGES OF CHANGEPROCHASKA & DiCLEMENTE TERMINATION MAINTENANCE ACTION PREPARATION CONTEMPLATION PRECONTEMPLATION RELAPSE is viewed as a loss of motivation and movement back down the spiral of change.

6. Spirit of MI • Partnership • Acceptance • Compassion • Evocation

7. The Spirit of Motivational Interviewing (MI) Therapeutic relationship is a collaborative partnership, rather than separate ‘expert’ & ‘recipient’ roles. Motivation for change is elicited from the client, not imposed. It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence. The counseling style is an eliciting one. Direct persuasion is infrequently effective in resolving ambivalence. Instead, the counselor supports a client’s autonomy while helping to explore the prospect of change.

8. Process Structure • Engagement • OARS • Focusing – Strategic Direction • Evoking Motivation – Change Talk • Planning

9. FOUR PROCESSES OF MI

10. Four Principles ofMotivational Interviewing R – Resist the righting reflex U – Understand client’s motivation L – Listen to the client E – Empower the client

11. Four Elements of Motivational Interviewing Express empathy Develop discrepancy – Gap Roll with resistance Support self-efficacy – Can Do

12. Supporting Self-Efficacy Encourages hope or the possibility of change. Our expectations about the likelihood of client change has a powerful effect on the outcome. We want to enhance our client’s confidence in their capacity to change. The client is responsible for choosing and carrying out change.

13. Four Goals ofMotivational Interviewing Increase problem awareness Resolve ambivalence Increase the value of change Increase confidence

14. O.A.R.S.Tools for Moving in the MI Session Open-ended questions Affirmations Reflective listening Summaries Motivational Interviewing is not a series of techniques for doing therapy but instead is a way of being with patients. William Miller, Ph.D.

15. MI TRAPS Question Answer or Assessment Premature Focus Labeling Chat Trap Blaming Expert

16. CHANGE TALK ANDSUSTAIN TALK

17. EXAMPLES OF SUSTAIN TALK Desire for status quo (don’t want to change) Inability to change (can’t change) Reasons for sustaining the status quo Need for the status quo (have to stay) Commitment to status quo (not going to change)

18. Change Statements Problem recognition Statements of concern Problems with the status quo Desire to change Optimism Ability to change Benefits of change

19. Preparatory Change Talk DARN Desire Ability Reasons Need

20. Mobilizing Change Talk CAT Commitment Activation Taking steps

21. CHANGE TALK Desire Ability Reason Need CAT Recognize Evoke Respond

22. CHANGE TALK Activation Taking Steps (mobilizing) Behavior Change Commitment Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology.Vol 71(5) Oct 2003, 862-878. Desire Ability Reasons Need (preparatory)

23. Readiness to Change From Chris Dunn & Stephen Rollnick, Lifestyle Change.

24. Exploring Importance Assess: “On a scale of 1-10, how important is it to you now to…(change)?” Explore: “Why did you give it a ___ and not a ___ (lower number)?” “What would have to happen to raise that score?” “How can I help you with that?”

25. Exploring Confidence Assess: “On a scale of 1-10, how confident are you now that could make that change, if you decided to make it?” Explore: “Why did you give it a ___ and not a ___ (lower number)?” “What would have to happen to raise your confidence?” “How can I help you with that?”

26. Principles Mind-Set DD - Developing Discrepancies EE - Expressing Empathy SS - Supporting Self Efficacy RR - Rolling with Resistance Partnership Autonomy Compassion Evocation MI Spirit Heart-Set Being Doing Working Going O-OEQ Affirmations Reflections Summaries E-P-E Elicit-Provide-Elicit Engaging Focus Evoking Planning Skills Path MI Package

27. Resources: Books Motivational Interviewing (3rd Ed.), Miller, W.R. & Rollnick, S., Guilford Press, 2013. Motivational Interviewing in Health Care, Rollnick, S, Miller, W.R., & Butler, C. C., Guilford Press, 2008. Lifestyle Change, Dunn, C. & Rollnick, S., Mosby, 2003. Building Motivational Interviewing Skills Rosengren, David , Guilford, 2009.

28. BOOKS FOR LEARNING MOTIVATIONAL INTERVIEWING 28

29. Resources: Websites www.motivationalinterview.org – excellent source of MI resource material. www.msleaders.org/ms-leaders/ce/motivational.asp – Overview & video demonstrations of brief interventions contrasting MI consistent & inconsistent styles. Requires broadband connection.