An Introduction to Motivational Interviewing
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1 AN INTRODUCTION TO MOTIVATIONAL INTERVIEWING For Non-Clinicians Kate Speck, PhD WHAT YOU WILL LEARN IN THIS SERIES This Webinar will review the basics of Motivational Interviewing and will provide an overview of the primary concepts. The discussion will cover definitions of Motivational Interviewing, the importance of creating collaborative environments to enhance the change process, a description of the Motivational Interviewing micro skills, the importance of the Stages of Change in the area of consumer readiness and a description of the goals of Motivational Interviewing. We will cover the essential components of the Spirit of Motivational Interviewing. Goal: To increase the knowledge of non-clinical professionals on the use of Motivational Interviewing in behavior change processes. You will learn: The basics of Motivational Interviewing and its importance in creating a climate for change The critical steps in evoking change talk with your clients The processes that promote successful change with those you serve An evidence based style to engage and retain your clients A way to handle client ambivalence and resistance MAJOR GOALS OF MI APPROACH Create a set of conditions that enhances the person s own motivation and commitment for change Help person focus on his/her situation in a nonjudgmental way Explore and resolve ambivalence Assist a person to move through the stages toward a successful sustained change PPC
2 ESSENTIALS OF MI Motivation to change is elicited from the client, and not imposed from outside. It is the client s task, not the counselor s to resolve ambivalence. Direct persuasion is not an effective method for resolving ambivalence. The patient is supported in identifying and resolving ambivalence Patient values and autonomy respected ESSENTIALS OF MI The practitioner is directive in helping resolve ambivalence. Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction. Change talk recognized & responded to Resistance is treated constructively WHO IS ATTENDING TODAY? PPC
3 THREE ESSENTIAL ELEMENTS IN ANY DEFINITION OF MI MI is a particular kind of conversation about change (counseling, therapy, consultation, method of communication) MI is collaborative (person-centered, partnership, honors autonomy, not expert-recipient) MI is evocative, seeks to call forth the person s own motivation and commitment YOU WOULD THINK... that having had previous education a person would be persuaded to participate, complete the goals and objectives of a program, change their diet, exercise more, and begin to use the recipes that are healthful That being on welfare, having to use food stamps, being in job training programs, and being recommended for education would be enough to convince a person to become responsible 8 YOU WOULD THINK... that the very real threats of blindness, amputations and other complications from diabetes would be enough to motivate weight loss and glycemic control.. that time spent incarcerated and the dehumanizing aspects of being in prison would dissuade people from reoffending.. 9 PPC
4 DEFINITIONS OF MI Three levels of definition (of increasing specificity) 1. A layperson s definition (What s it for?) 2. A pragmatic practitioner s definition (Why would I use it?) 3. A technical therapeutic definition (How does it work?) 1. A LAYPERSON S DEFINITION ( WHAT S IT FOR?) Motivational interviewing is a collaborative conversation to strengthen a person s own motivation for and commitment to change. Motivational interviewing is a person-centered counseling method for addressing the common problem of ambivalence about change. 3. A TECHNICAL THERAPEUTIC DEFINITION (HOW DOES IT WORK?) Motivational Interviewing is a collaborative, goaloriented method of communication with particular attention to the language of change. It is designed to strengthen an individual s motivation for and movement toward a specific goal by eliciting and exploring the person s own arguments for change. PPC
5 WHAT IS MOTIVATIONAL INTERVIEWING? (MI) a method of communication rather than a set of techniques. It is not a bag of tricks for getting people to do what they don t want to do; rather, it is a fundamental way of being with and for people a facilitative approach to communication that evokes change (Miller & Rollnick, 2002) WHAT IS IT GOOD FOR? 2 elements of Motivational Interviewing are evidence based: Engagement Retention Motivational Interviewing ties in with the NIDA Principles of Effective Treatment; engaging and retaining clients in the process enhances their experience of change and leads to successful outcomes 14 RESOLVING AMBIVALENCE The Righting Reflex PPC
6 MI SPIRIT An openness to a way of thinking and working that is collaborative rather than prescriptive, and that honors and respects the students autonomy and self direction. Belief that people inherently move in direction of positive growth in right climate MI Pyramid Strategies Principles Spirit 18 PPC
7 THE SPIRIT OF MOTIVATIONAL INTERVIEWING Autonomy Collaboration Evocation Compassion THE SPIRIT OF MOTIVATIONAL INTERVIEWING SYNERGY QUESTION 2 Please rate your current confidence to use Motivational Interviewing with the consumers you serve: Low Moderate High PPC
8 Motivation should not be thought of as a personality trait rather as a state of readiness or eagerness to change, which may fluctuate from one time or situation to another This state is one that can be influenced Miller & Rollnick (1991) MOTIVATIONAL INTERVIEWING Empathetic, patient-focused directive counseling style Seeks to create conditions for positive behavioral change Well-suited for brief clinical encounters Evidence-based (>200 clinical trials, both adults and adolescents) (grounded in theory, verifiable, generalizable, delivered by wide range of health care practitioners) FOUR FOUNDATIONAL PROCESSES Planning Evoking Focusing Engaging PPC
9 The Spirit of MI vs. Its Mirror Image COLLABORATION VS. CONFRONTATION EVOCATION VS. EDUCATING AUTONOMY VS. AUTHORITY MOTIVATIONAL INTERVIEWING SPIRIT Providing low-key feedback Rolling with resistance (e.g., avoiding arguments, shifting focus). Using a supportive, warm, non-judgmental, collaborative approach? 26 SPIRIT. Conveyance of empathic sensitivity through words and tone of voice. Demonstrate genuine concern and an awareness of the client s experiences. Follow the client s lead in the discussion instead of structuring the discussion according to the clinician s agenda? 27 PPC
10 TWO ASSUMPTIONS: 1. Motivation: due to interpersonal interaction (not just innate character trait) Confrontation leads to resistance Empathy and understanding lead to change 2. Ambivalence to change: normal and natural Competing positive and negative feelings Decision balance: pros and cons MOTIVATIONAL INTERVIEWING: BASIC SKILLS Unconditional Acceptance - the counsellor accepts the client as a person regardless of his or her values, life-style or actual problems; he is respectful towards the client Empathy - understanding another person s emotions and feelings from that persons frame of reference; the counsellor is warm, caring and interested in the client Enhancing Self-efficacy in clients - the counsellor fosters hope and optimism in the clients capacities to change QUESTION 3 How included do you feel with the Motivational Interviewing in your agency? There is no current plan for an MI initiative Low inclusion Moderately Very included PPC
11 THANK YOU EVERYONE! Next session - Dealing with the common issue of AMBIVALENCE PPC
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