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Using the principles of motivational interviewing to promote ethical rehabilitation services

Mikyta D. Daugherty, PhD Licensed Clinical Psychologist MINT Motivational Interviewing Trainer Shifting Perspectives, Inc. Using the principles of motivational interviewing to promote ethical rehabilitation services.

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Using the principles of motivational interviewing to promote ethical rehabilitation services

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  1. Mikyta D. Daugherty, PhD Licensed Clinical Psychologist MINT Motivational Interviewing Trainer Shifting Perspectives, Inc. Using the principles of motivational interviewing to promote ethical rehabilitation services

  2. www.shiftingperspectivesinc.com

  3. What are the ethical standards of Rehabilitation Counseling ?How can the MI spirit and method help to promote them?

  4. What does your code say? • Code of Professional Ethics for Certified Rehabilitation Counselors (CRCs) • Code of Professional Ethics for Licensed Rehabilitation Counselor

  5. Code of Professional Ethics for Licensed Rehabilitation Counselors • “…Committed to facilitating the personal, social, and economic independence of individuals with disabilities.” • “recognize that their actions (or inaction) can either aid or hinder clients in achieving their rehabilitation objectives, and they accept this responsibility as part of their professional obligations”

  6. Code of Professional Ethics for Certified Rehabilitation Counselors (CRCs) • committed to facilitating the personal, social, and economic independence of individuals with disabilities. • recognize diversity and embrace a cultural approach in support of the worth, dignity, potential, and uniqueness of individuals with disabilities within their social and cultural context

  7. Common issues addressed • Confidentiality and Privileged communication • Informed consent • Responsibility to client • Counselor competence • Client to counselor relationship

  8. Code of Professional Ethics for Licensed Rehabilitation Counselor • CLIENT-COUNSELOR RELATIONSHIP • At all times, licensed rehabilitation counselors shall endeavor to place their clients’ interests above their own. • counselors will be continually cognizant of their own needs and values as well as of their potential influence • counselors and their clients will work together to devise an integrated, individualized rehabilitation plan ….. remembering that clients have the right to make their own choices

  9. Code of Professional Ethics for Certified Rehabilitation Counselors (CRCs) • Section A: The Counseling Relationship • counselors and clients work jointly in devising and revising integrated, individual, and mutually agreed upon rehabilitation and counseling plans • counselors respect the rights of clients to make decisions on their own behalf • counselors are aware of their values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with rehabilitation counseling goal

  10. COMPETENCE. RESPONSIBILITY. ADVOCACY. What do you know about MI that may help to increase adherence to these tenets?

  11. What is Motivational Interviewing? • An egalitarian, empathetic “way of being” • manifested through specific techniques and strategies, such as reflective listening, shared decision making, and agenda setting • to assist individuals in working through their ambivalence about behavior change. www.shiftingperspectivesinc.com

  12. The “Spirit” of Motivational Interviewing Collaboration Evocation Autonomy Compassion www.shiftingperspectivesinc.com

  13. Compassion. Indifference. www.shiftingperspectivesinc.com

  14. Traits clients find most and least important from rehabilitation counselors • Top 3 traits • Consumer first attitude and advocacy (28.5%) • Nuturing and promotion of counselor relationship (20%) • Knowledge about disability and rehabilitation (14%) • Bottom 3 • Disability experience in personal life (4%) • Educational Background (2.5%) • Maturity and professional experience (1.5%) (McCarthy, H. & Leierer, S.J. (2001) Consumer concepts of ideal characteristics and minimum qualification for rehabilitation counselors. Rehabilitation Counseling Bulletin,45, 12-23.

  15. The art of MI connects: Possible behavior changes With what the client cares about • Goals • Aspirations • Dreams • Values • Concerns

  16. Explore assumptions What makes people change?What makes people stay the same? www.shiftingperspectivesinc.com

  17. REAL PLAY COMMON BRIEF INTERVENTION STYLE www.shiftingperspectivesinc.com

  18. Exercise #1: The Speaker • TOPIC: Something about yourself that you • want to change • need to change • should or ought to change • have been thinking about changing but you haven’t changed yet i.e. – something you’re ambivalent about www.shiftingperspectivesinc.com

  19. Helper: Find out what change the person is considering making, and then: • Explain why the person shouldmake this change • Give at least three specific benefits that would result from making the change • Tell the person how they could make the change • Emphasize how important it is to change • Persuade the person to do it. • If you meet resistance, repeat the above. P.S. This is NOT motivational interviewing www.shiftingperspectivesinc.com

  20. www.shiftingperspectivesinc.com

  21. 4 Common Assumptions about Change • Insight Induction - if you can make people see, then they will change • Knowledge Induction - if people know enough, then they will change • Skill Induction - if you teach people how to change, then they will do it • Distress Induction - if you can make people feel bad or afraid enough, they will change www.shiftingperspectivesinc.com

  22. Don’t you see… Let me explain… Four Corresponding Helping Roles If you don’t… Have you tried… www.shiftingperspectivesinc.com

  23. www.shiftingperspectivesinc.com

  24. Where’s the problem? I can fix it. The righting reflex

  25. Persuasion:What Goes Wrong? www.shiftingperspectivesinc.com

  26. Persuasion does not help to increase motivation when….. OR when the person is….. www.shiftingperspectivesinc.com

  27. Ambivalence The dilemma of change • People are almost always ambivalent about change – ambivalence is normal • Lack of motivation can be viewed as unresolved ambivalence. AMBIVALENCE is the key issue to be resolved for change to occur. www.shiftingperspectivesinc.com

  28. When Worlds Collide  www.shiftingperspectivesinc.com

  29. The dilemma…. Direct persuasion is not an effective method for resolving ambivalence What do you say, if you’re not making suggestions, educating, or warning? www.shiftingperspectivesinc.com

  30. A taste of MI www.shiftingperspectivesinc.com

  31. Taste of MI Work in groups of 3 One speaker and two helpers Helper #1 will go first Helper #2 – listen carefully but don’t speak yet M.D.Daugherty, PhD 5.26.11

  32. Speaker’s Topic Something about yourself that you want to change need to change should change have been thinking about changing but you haven’t changed yet i.e. – something you’re ambivalent about M.D.Daugherty, PhD 5.26.11

  33. Helper #1 Listen carefully with a goal of understanding the dilemma Give no advice Ask these six open questions: Why would you want to make this change? What are the three best reasons to do it? What do you think would be some of the consequences of not making this change? “If you decided to make this change, what would you to do be successful?” “How would you feel about yourself if you did make the change?” On a scale from 0 to 10, how important would you say it is for you to make this change? And why did you choose ## and not a lower number? M.D.Daugherty, PhD 5.26.11

  34. Helper #2 Give a short summary/reflection of the speaker’s motivations for change including: Why they want to make the change and the best reasons for doing it Consequences of not making change How would they go about changing and how they would feel if successful Reason why it is important to do Then ask: “So, what do you think you’ll do?” Exercise continue - M.D.Daugherty, PhD 5.26.11

  35. Normal Human Responses to a Listen/Evoke/Empathic Style Affirmed Accept Approach Understood Open Talk more Accepted Undefensive Liking Respected Interested Engaged Heard Cooperative Activated Comfortable/safe Listening Come back Empowered Hopeful/Able to change www.shiftingperspectivesinc.com

  36. Normal Human Reactions to the Righting Reflex (Teach/Direct) Invalidated Resist Withdraw Not respected Arguing Disengaged Not understood Discounting Disliking Not heard Defensive Inattentive Angry Oppositional Passive Ashamed Denying Avoid/leave Uncomfortable Delaying Not return Unable to change Justifying www.shiftingperspectivesinc.com

  37. Motivational Interviewing Style in Action Therapist elicits behavior change Respects autonomy of the patient Tolerates patient’s ambivalence Helps patient explore consequences of choices being considered www.shiftingperspectivesinc.com

  38. Shift in Method • Common Methods • Rely heavily on counselor insight • Emphasize information exchange • Counselor does most of the talking • Motivational Interviewing • Rely heavily on counselor reflective listening and positive affirmation • Emphasize client’s reaction to information • Counselor prioritizes elicitation of “change talk” or client arguments for change www.shiftingperspectivesinc.com

  39. Motivational Interviewing • Requires clients themselves to do much of the psychological work • Helps clients think about and verbally express their own reasons for and against change and how their current behavior or health status affects their ability to achieve their life goals or fulfill core values • Encourages clients to make fully informed and deeply contemplated life choices, even if the decision is not to change • Makes no direct attempt to dismantle denial, confront irrational or maladaptive beliefs, or convince or persuade www.shiftingperspectivesinc.com

  40. Therapeutic empathy PERSON-CENTERED STYLE www.shiftingperspectivesinc.com

  41. Express compassion: How do you demonstrate understanding?

  42. Express Empathy • Empathy is not: • Having had the same experience or problem • Identification with the client • Let me tell you my story • Empathy is: • The ability to accurately understand the client’s meaning • The ability to reflect that accurate understanding back to the client M.D.Daugherty, PhD 5.26.11

  43. "Empathy is listening to people and showing them what you hear - in a way that helps them understand what they are saying and makes it easier for them to act on this understanding." www.shiftingperspectivesinc.com

  44. Skill of Reflective Listening

  45. Empathy Scale Primary Empathy Advanced Empathy ReflectImpliedFeelings and Meaning ReflectExpressedFeelings ReflectImpliedFeelings Non- Empathy RephraseSummarize Recognize Ambivalent Feelings www.shiftingperspectivesinc.com

  46. Therapeutic impact of EMPATHY • Promotes self-reflection, values clarification and new perspectives. • Related with constructive results and more functional behaviors in clients. • Clients learn to listen to and observe themselves. (Watson, 2002). www.shiftingperspectivesinc.com

  47. Traps to Avoid Question-Answer Trap Trap of Taking Sides Expert Trap Labeling Trap Premature Focus Trap Blaming Trap M.D.Daugherty, PhD 5.26.11

  48. Why are these “roadblocks”? • They get in the speaker’s way. In order to keep moving, the speaker has to go around them • They insert the listener’s “stuff” • They communicate: • One-up role: Listen to me! I’m the expert. • Put-down (subtle, or not-so-subtle) • Roadblocks are not wrong. There’s a time and place for them, but they are not good listening. M.D.Daugherty, PhD 5.26.11

  49. Actively elicit client arguments for change

  50. Eliciting ability change talk What gives you the courage to go after what you want? What do you already do well that will help you make this happen? What would be the first thing you’d do in order to succeed? M.D.Daugherty, PhD 5.26.11

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