MOTIVATIONAL INTERVIEWING

MOTIVATIONAL INTERVIEWING October 28, 2014

AGENDA • Motivational Interviewing (MI) Overview and Skills • Classroom Check-up (CCU) • Practice

INTRODUCTIONS • Introduce yourself (name tags) • Current Role - Clinician, Teacher, etc. • Experience/training with Motivational Interviewing, Classroom Check-up and Family Check-up

DISCUSSION QUESTION How much control do you have over whether teachers implement your recommendations?

ACTIVITY • Think of someone who had an important influence in your life, a favorite teacher, mentor, family member, etc. • What personal qualities do you remember about them?

Personal Qualities • Helpful • Nonjudgmental • Inspirational • Self-assuredness • Rationale • High expectations • Listener • Nurturing • Encouraging • Credible • Curious, probe • Ask reflective questions • Dynamic • Believed in your potential • Model • Walk the talk • Tenacious • Well-respected

SMALL GROUP DISCUSSION • Have you ever lied/exaggerated . . . . . . to your dentist about how much you floss? . . . to your physician about how much you drink/ smoke/exercise? . . . to your teacher/professor about whether you did the readings for a class? • Why? • What could your dentist/physician/teacher have done to make it more likely that you would be more truthful?

Objectives • The Spirit of MI • Apply motivational interviewing theory and techniques to coaching • Discuss historical and conceptual foundations • Identify key parts of effective, brief interventions • Implement strategies for promoting teacher motivation • Practice

The Spirit of MI • Client-centered • Not just a set of techniques • Carl Rogers - unconditional positive regard, empathy • Collaborative • Evocative • Listening more than telling • Respectful • Honoring a person’s autonomy, resources • Stages of learning MI • See handouts: • Eight Stages in Learning Motivational Interviewing (p. 1 & 2) • Levels/Types of Training in Motivational Interviewing (p. 3)

HISTORICAL FOUNDATIONS What is motivation, and what makes people want to change? • We have great strategies for helping people change who have already made a decision that they want to change. • Unfortunately, most people don’t come to us ready to change. • Most of us are ambivalent about change. • Ambivalence is normal. • We need strategies to help people resolve their ambivalence.

Traditional Assumptions About Motivation • Clients are motivated to change • If not, it’s hopeless • Clients must want to change • Motivation is dichotomous • Motivation comes from within • Motivation precedes behavior

New Assumptions About Motivation • Motivation is a state of readiness to change. • Motivation fluctuates and can be influenced. • Motivation involves interpersonal contact. • The coach’s style is a powerful determinant of the client’s motivation. • Ambivalence is a normal part of considering and making change and is not pathological. • Each person has a potential for change.

How People Change • Studied change as it naturally occurs • Desire to change is not dichotomous • Stage of change predicted outcomes • Redefined the problem (not resistance) • Argued that different change strategies may be most effective at different points Prochaska, DiClemente, & Norcross, 1992

Spiral Model of Change Prochaska, DiClemente, & Norcross, 1992 Termination Action Maintenance Preparation Contemplation Action Preparation Contemplation Precontemplation

HOW DO PEOPLE CHANGE? • Often consultants try to persuade teachers to change by giving them facts, information, and logical arguments. • Logic and factual information alone are not enough to get people to adopt new behaviors and routines! • Research has shown increases in resistance when consultants use teaching (giving instructions or suggestions, providing rationale) and confrontation as opposed to when they used supportive comments (empathizing, paraphrasing, affirming).

Motivational Interviewing • Developed by William Miller and Stephen Rollnick in 1980s • Initially focused on problem drinkers in outpatient settings • Used more recently in a variety of settings to promote health behavior change

DEFINITION OF MI • A directive, client-centered approach • Enhances motivation for change by helping the client clarify and resolve ambivalence about behavior change.

MI GOALS • To create and amplify discrepancy between present behavior and broader goals • To create cognitive dissonance between where one is and where one wants to be

Ingredients of Effective Brief Interventions • Personalized Feedback • Responsibility • Advice • Menu of options • Empathy • Support Self-Efficacy

General Principles of MI • Develop Discrepancy • Express Empathy • Roll with Resistance • Support Self-Efficacy

Ready, Willing, and Able • Willing: The importance of change • Able: Confidence to change • Ready: Priority to change Miller & Rollnick, 2002

Specific Motivational Interviewing Strategies Negative Practice Use Your OARS Evoking Change Talk Responding to Change Talk Responding to Resistance

NEGATIVE PRACTICE Roadblocks to Listening: What are some ways you can tell someone is not listening when you are talking?

Roadblocks to Listening • Ordering, directing, commanding • Warning or threatening • Giving advice, suggestions, solutions • Persuading with logic, arguing, or lecturing • Moralizing, preaching, telling what should do • Disagreeing, judging, criticizing, blaming • Agreeing, approving, praising • Shaming, ridiculing, labeling • Interpreting or analyzing • Reassuring, sympathizing, or consoling • Questioning or probing • Withdrawing, distracting, humoring, or changing subject

#1: NEGATIVE PRACTICE WITH ROADBLOCKS TO LISTENING Speaker role: Identify a real change that you are considering, something you are thinking about changing in your own life, but have not definitely decided (and feel comfortable discussing in role play). It will be something you feel two ways about. It might be a change that would be good for you, that you should make for some reason, but have been putting off. Tell the counselor about this change you are considering.

#2: A Taste of MI • Listener role: Don’t try to persuade or fix anything. Don’t offer advice. Instead ask these four questions one at a time and listen carefully to what the person says: 1. Why would you want to make this change? 2. If you did decide to make this change, how might you go about it in order to succeed? 3. What are the three best reasons for you to do it? 4. How important would you say it is for you to make this change, on a scale from 0 to 10, where 0 is not at all important, and 10 is extremely important? [Follow-up question: And why are you at _____ rather than a lower number of 0?] • After you have listened carefully to the answers to these questions, provide a short summary of what you heard regarding the person’s motivations for change. Then ask one more question: 5. So what do you think you’ll do? and listen with interest to the answer.

OARS • OARS • Open-ended questions • Affirmations • Reflections • Summarize

OARS • Open-ended questions (can’t be answered in a single word): • “What are your concerns about…? • “Why do you want to make these changes…?” • “How have you handled these problems in the past?” • Affirmations (specific & genuine): • “You’re really putting a lot of thought and time into this.” • “I see how hard you are working” • “You did an amazing job with praise this week!”

OARS • Reflective statements (strategy of paraphrasing comments while giving special attention to the implied feelings): • “You’re really frustrated by how things are going.” • “You’re having fun in your class.” • “You just really want the best for these kids.”

OARS • Summaries (2 to 3 sentences to draw connections): “Let me make sure I am understanding all of the big ideas so far. You are feeling pretty worn out from all of the chaos in your classroom this year and taking on new classroom strategies just seems like another burden right now. At the same time part of you is hopeful that spending time on it now could eventually give you more time.”

CHANGE TALK • Counseling in a way that invites the person to make arguments for change • Language that conveys a person’s desire, ability, reasons, need, or commitment to change • Ask about/listen for: DARN • Desire: want, prefer, wish • Ability: able, can, could, possible • Reasons: Why do it? What would be good? • Need: important, have to, need to, got to

LISTEN FOR CHANGE TALK Statements that indicate a need or willingness to change a behavior • Concerns about the status quo • “I’m worried that . . .” • “If I don’t do something soon . . .” • Advantages of changing • “Things would be better if I . . .” • Optimism about changing • “I know I can do this . . .” • Intention to change • “I’m going to do this because . . .” • Goal-setting • “I’d like to improve my . . .”

Methods for Evoking Change Talk • Asking evocative questions • Using Importance and Confidence Rulers • Elaboration • See handout: • 10 Strategies for Evoking Change Talk (p. 7)

QUESTIONS THAT EVOKE CHANGE TALK • Disadvantages of Status Quo • What worries you about your ____? • Advantages of Change • How would you like things to be different? • Optimism About Change • What makes you think you could do it? • Intention to Change • What would you be willing to do? See handout: Questions that Evoke Change Talk (p. 8)

IS IT CHANGE TALK? • I’m worried that if I don’t get control of this class soon that I’m not going to make it through the year. • It just seems like we’re wasting a lot of time this year waiting for students to settle down. • Yeah, I know it’s important to have a fast pace, but you know this year I have the low group and I worry that they won’t be able to keep up. • I would like to be better at setting limits with students.

Responding to Change Talk • Elaborating change talk • Reflecting change talk • Summarizing change talk • Affirming change talk

Change Questionnaire • Notice the language • See handout: Change Questionnaire (p. 4) • Tool to gauge readiness to change • How would teachers respond?

Commitment Talk • Special instance of change talk • Intention to change • See handout: Commitment Language (p. 9) • Commitment talk towards end of session is the best predictor of whether people will change

EFFECTIVE QUESTIONS “People are much more likely to do things THEY say they will do versus things that they are told to do.” “When the amount of change talk increases over the session or if it is more pronounced at the end of the session = better outcomes!” “Commitment language especially during the last 5 minutes of the meeting is the most predictive of CHANGE!!!”

IMPORTANCE & CONFIDENCE RULERS • How important would you say it is for you to _________? On a scale from 0 to 10, where 0 is not at all important and 10 is extremely important, where would you say you are? 0 2 4 6 8 10 Not at all Extremely Important Important • Why are you at a ____ and not zero? • What would it take for you to go from ___ to [a higher number]? • And how confident would you say you are, that if you decided to _________, you could do it? On the same scale from 0-10, where would you say you are? 0 2 4 6 8 10 Not at all Extremely Important Important • Why are you at a ____ and not zero? • What would it take for you to go from ___ to [a higher number]?

RESISTANCE • Humans have a natural tendency to avoid persuasion and do not like to be told what to do. • When we hear reasons why we should change, our minds automatically contemplate the reasons against change. • Rule of thumb: If you hear yourself (consultant) arguing for change, do something different. You want the teacher to make the arguments in favor of change.

GOOD LISTENING • Teacher should be making 9 out of every 10 statements • You can not get to the good stuff (values, change talk) without listening • People will not listen to you if you are not listening to them!!!

MI CLINICIAN SELF-ASSESSMENT REPORT • See Handout • Ongoing feedback, supervision • Taping Sessions

Responding to Resistance • Definition • Simple reflection • Amplified reflection • Double-sided reflection • Shifting focus • Reframing • Agreeing with a twist • Emphasize personal choice and control • Coming along side See Miller & Rollnick

Rolling with Resistance • Reflective Listening: Simple Reflections. When in doubt, use a simple reflection to acknowledge the person’s perspective or feeling. This invites further exploration, saps the energy of resistance, and avoids the trap of taking sides. • TEACHER:I don’t get why we have to do this. I have been teaching for years and the kids just get worse and worse. • CONSULTANT:It’s frustrating to put a lot of effort into doing this if people aren’t going to stick with it.

Practice • Teacher: This child has me crazy. It is simply easier to send him to the office.

Rolling with Resistance • Amplified Reflections. Miller and Rollnick describe these as exaggerated reflections and note to be effective must be delivered in a matter-of-fact manner without hint of sarcasm. For instance: • TEACHER: Those studies about effective classroom management really don’t prove anything. • CONSULTANT: You really don’t believe research tells us anything about how to manage classrooms.

Practice • Teacher: The kids in my class just don’t have parents that discipline them at home. The parents are the ones you should be talking to, not me.

Rolling with Resistance • Double-sided Reflections. These responses are excellent ways to respond to ambivalence. It involves including a summary of both sides of the ambivalence in a single response. Note that the preceding teacher statement does not necessarily need to include both sides of the ambivalence. That is, you may be reflecting the immediate response and drawing on prior teacher responses to put together these double-sided reflections. • TEACHER: This intervention is just not going to work. • CONSULTANT: I can see your predicament. On the one hand, you’re really worried about how things are going in your class (prior content), but on the other hand, you’re not sure how our work together can help.

MOTIVATIONAL INTERVIEWING