“MI Preparation Prayer”

1. Using Motivational Interviewing To Enhance EngagementPCCYFSThursday, April 148:30 - 10:00Dave VactorChristy Pfleger

2. “MI Preparation Prayer” Guide me to be a patient companion To listen with a heart as open as the sky Grant me vision to see through her eyes And eager ears to hear her story Create a safe and open mesa on which we may walk together Make me a clear pool in which she may reflect Guide me to find in her your beauty and wisdom Knowing your desire for her to be in harmony-healthy, loving, strong Let me honor and respect her choosing of her own path And bless her to walk it freely May I know once again that although she and I are different Yet there is a peaceful place where we are one -Bill Miller, co-founder of MI Rollnick and Miller 1995

3. Purpose • Provide an overview of the process of change and basic MI skills • Explore how to use MI skills to effectively engage clients • Learn strategies to help clients tap into their motivation for change

4. So What Exactly is MI? Definition: • A perspective that views a client as the most influential agent of change and aims to empower the client to actively engage in the process of change. • A method or approach, not a technique, that is not based on a singular theory. • “A directive, client-centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence.”-Rollnick and Miller, 1995 Rollnick and Miller 2006

5. History • MI was developed in 1983 by Bill Miller for use with substance abuse clients. • Empirical data has been collected for use of MI treatment with: drug and alcohol abuse, smoking cessation, psychiatric disorders, HIV related risk behaviors, diet and exercise. • Note: These effects did not diminish over time.

6. Beliefs Essential to the MI process • Person-Centered (closely linked to Rogerian Theory) • Resistance to change and ambivalence are natural human processes • Lack of motivation=unresolved ambivalence • Negative feelings/experiences can inhibit change • Change occurs when it is connected to something of importance and value • The client needs to show you the reason for change in order to proceed successfully (“change talk”)

7. Identifying “Change Talk” • What people say and how they talk about change is important.

8. Defensiveness = Change Confrontation = Change

9. Confidence and Self-Efficacy • When people and service providers believe that change can happen, it is more likely it will happen. • Self-efficacy= hope • Empathy facilitates change

10. Miller & Rollnick’s • Motivation to change is elicited from the client and not imposed from without • It is the clients task, not the counselor’s , to articulate and resolve their ambivalence • The therapeutic relationship is more like a partnership or companionship than expert/recipient roles “Spirit of MI” Rollnick and Miller 2006

11. Direct persuasion is not an effective method for resolving ambivalence The counseling style is generally a quiet and eliciting one Approach

12. The counselor is directive in helping the client to examine and resolve ambivalence Approach, continued • Readiness to change is a not a client trait, but fluctuating product of interpersonal interaction

13. Three Key Components • Collaborate (Partner) • Evocation (Draw Out) • Autonomy (Stand on own)

14. Identifying “Change Talk” • Disadvantages of status quo • Advantages of change • Optimism • Intention to change

15. What is Unique about MI? • MI is Directive • Client-Centered= focused on client’s interest and concerns • Do not teach new skill, alter thought patterns or look to the past • MI is a method of communication • Not something we do to, but we are with and for clients • Change is not forced or imposed (i.e., through punishment, pressure, financial gain) • The client is the expert

16. Wheel of Change • Motivational Interviewing and the Trans-theoretical model to change – developed separately but synchronously. • Trans-theoretical model of change is used to breakdown the concept of readiness to change into stages. • Use the Wheel of Change to assess what MI strategies to use for forward movement. Prochaska, Di Clemente and Norcross, 1992

17. Wheel of Change Prochaska, Di Clemente and Norcross, 1992

18. Stages of Change

19. Phase I – Address Ambivalence • Pre-Contemplation • Contemplating

20. Phase II Address Change/Changing Action • Preparation • Action • Maintenance

21. Using MI with the Stages of Change • Each stage contains certain helping behaviors that are particularly constructive • Assist in measuring/gauging • Readiness • Confidence • Motivation

22. Instead of asking “Why isn't this person motivated?” ask “What is this person motivated by?”

23. Traps • Question-Answer • prevents discussion from getting to a deeper level • Taking Sides • encourages client to argue more for their current perspective • Expert • change is more effective when it comes from within, not without • Labeling • Premature Focus • increases defensiveness, decreases chances for long-term success

24. Resistance Behaviors • Arguing • Interrupting • Denying • Ignoring • Overt compliance/Covert defiance

25. Skills • Get Permission • Drawing from past successes • Scaling • Imagine ideal future and change needed to get there • Extremes-worst and best possible outcomes of change • Scaling Mandated Clients: • Acknowledge mandate • Provide choices • Empathize with lack of choice

26. Principles • Express Empathy • Develop Discrepancies • Roll with Resistance • Support Self-Efficacy

27. How to Make it Work • Express empathy- reference listening, reflective listening • Develop discrepancies – bring client on board with the importance for change, by highlighting differences • Between current behavior and personal values • Have the person argue for change

28. Rolling with Resistance • Accept it • Respect it • Flow with it • “Roll with it” rather than oppose it

29. Supporting Self-Efficacy • Empowering the client to be the change agent • Have confidence in his/her ability

30. Elements of a Change Plan • Goals • Reasons • Steps • Support • Obstacles • Signs of Progress

31. How to Use Skill (OARS) • Ask open ended questions • Affirm • Reflective Listening • Summarizing

32. References Baer, J.S., Garrett .S.B., Beadnell, B,Wells E.A, & Peterson P.L., (2007). Brief Motivational Intervention With Homeless Adolescents: Evaluating Effects on Substance Use and Service Utilization, Psychology of Addictive Behaviors, 21, 582-586. Burke B.L., Arkowitz. H & Menchola. M., (2003). The Efficacy of Motivational Interviewing: A Meta-Analysis of Controlled Clinical Trials Journal of Consulting and Clinical Psychology, 21, 843-861. Miller, W. R., & Rollnick, S.,(1995). What is motivational interviewing? Behavioral and Cognitive Psychotherapy, 23, 325-334. Miller, W. R., & Rollnick, S., (2002). Motivational interviewing: Preparing people for change (2nd ed.) New York: Guilford Press.

33. Petrocellim, J.V., (2002). Process and change: counseling with the transtheoretical model of change, Journal of Counseling and Development, 80, 22-28. Russell .C.R., Motivational Interviewing training for new trainers., (2002). The Motivational Interviewing Network of Trainers. Wagner,C, Ingersoll, C. (2008). Beyond cognition: broadening the emotional, base of motivational Interviewing Journal of Psychotherapy. Integration and American Psychological Association 18, 191–206. Wiles, M.,(2005). Motivational interviewing: overcoming client resistance to change. Cross Country Education Inc. Zuckoff, A., & Daley, D. C., (1999). Improving Treatment Compliance: Counseling & Systems Strategies for Substance Abuse & Dual Disorders.