Facilitating Change through Motivational Interviewing: An Interdisciplinary Narrative

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1 Facilitating Change through Motivational Interviewing: An Interdisciplinary Narrative Steven P. Wells, Ph.D., L.C.S.W. Darcy L. Stowe, M.S., CCC-SLP, LSLS Cert AVT Lindsay Hanna, M.S., CCC-SLP, LSLS Cert AVT

2 A Beginning Definition of Motivational Interviewing (MI) : A collaborative conversation style for strengthening a person s own motivation and commitment to change. 2

3 Spirit of Motivational Interviewing : How a Helper Maximizes Being Helpful Partnership Compassion Acceptance Absolute Worth Accurate empathy Autonomy support Affirmation Evocation of Speaker Voice 3

4 Maintaining the Spirit Means Being Open to... Suspending the authoritarian role. Working with clients rather than prescribing. Bringing forth client voice rather than installing our own values and ideas. Honoring client self-direction, capacity, strength, and experience. 4

5 5

6 People Change When They Find They Are: Ready Is it the right Time? Able Do I have what it takes? Willing Is it important enough? 6

7 Maintenance The Spiral of Change: The Trans- Theoretical Model Preparation Ambivalence Ambivalence Action Struggle With Change MI Most Useful Here Pre-Contemplation Contemplation 7

8 But, people are most often Ambivalent about difficult change. They need to hear that Ambivalence is Not a Dirty Word! The natural tendency for a person to both want and not want to make change. 8

9 The Technical Definition of Motivational Interviewing (MI) : Motivational Interviewing is collaborative, goaloriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person s own reasons for change witan an atmosphere of acceptance and compassion. 9

10 Four Fundamental Processes of MI Planning for change. Evoking talk about change. Focusing on the topic of change. Engaging for building a collaboration. 10

11 Core Communication Skills (OARS+): 1. Ask Open questions 2. Offer Affirmation 3. Use Reflection Often 4. Add Summarization 5. + Informing and Advising Building Engagement 11

12 Evoking: Change Talk and Sustain Talk.....Opposites Sides of a Coin (The Process of Ambivalence) 12

13 Change Talk comes in two varieties, known as DARN CAT Preparatory Change Talk Mobilizing Change Talk Desire Ability Reasons Need Commitment Activation Taking Steps 13

14 We can Respond to Change Talk or Elicit Change Talk How we respond to Change Talk likely impacts whether or not people choose change. 14

15 When Change Talk Is Expressed, Respond by..... Reflecting Elaborating Summarizing Affirming When Change Talk Is Absent, Elicit the... Disadvantages of the Status Quo Advantages of change Optimism for change Intention to change:

16 When More Directness is Needed or Requested Elicit Provide Elicit for Feedback Model 1. Elicit What the Person Wants to Know and What They Do Know 2. Provide Feedback Neutrally Just the information stay away from personal interpretation. Talk about what many clients experience. Avoiding you language. 3. Elicit What the Person Thinks About the Information What do you make of that? What does this mean to you? 16

17 Effectively Using MI in AVT

18 Initial Diagnosis Responding to Change Talk Eliciting Change Talk Responding to Resistance

19 When you need to hear some hard things, it s really good that it s coming from someone that you already trust. -Parent

20 Coaching Relationship What the parent brings to the table What the practitioner brings to the table

21 Time takes it all, whether you want it to or not. (Stephen King, the Green Mile)

22 Critical Conversations Initial diagnosis of hearing loss Beyond diagnosis Responding to change talk Eliciting change talk Responding to resistance

24 Eliciting Change Talk Ask about disadvantages of the Status Quo Ask about advantages of change Ask about optimism for change Ask about intention to change

25 Eliciting Change Talk: Starting the Conversation What are your concerns about, how do you think he is doing? I hear you have some serious concerns, we would love to hear those concerns. Where do you want your child to be in 5 years? How would you like him/her to get there? Would you permit me to tell you how we can help your child?

26 Eliciting Change Talk: Moving the Conversation Along We find that other families/children experience Here s what people who experience this have reported what do you think about that? We find that kids do this NOT If you do this, then your child will. Then ask, What do you think? Other parents have found it helpful to, what do you think about that? Is there one thing you could hear to help move you forward? This is surprising to you, what is the most surprising? What would you have to know to decide a CI/HA would be helpful for your child?

27 Eliciting Change Talk: Concluding the Conversation I really admire that you are willing to move forward even though you have doubts (acknowledge and affirm for making steps)

29 Responding to Resistance Simple Reflection Emphasizing Personal Choice and Control Reframing Double-Sided Reflection Amplified Reflection Agreement with a Twist

30 Responding to Resistance Elicit Provide Elicit for Feedback

31 Responding to Resistance What I hear you saying is you never, ever want to hear about a CI again. Yes Here s my card, call me if you change your mind. It sounds like you know your mind.

32 Pulling it all together

33 We don t change a person change comes from within.

34 References Arkowitz, H., Westra, H. A., Miller, W. R., & Rollnick, S. (2008). Motivational Interviewing in the Treatment of Psychological Problems. New York: The Guildford Press. Miller, W. R. & Rollnick, S. (2012). Motivational Interviewing: Preparing People for Change (3 rd ed.). New York: The Guilford Press. (ISBN ) Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992) In search of how people change: Applications to Addictive Behaviors. American Psychologist, 47, No. 9, Prochaska, J.O. & Norcross, J. C. (2010). Systems of Psychotherapy: A Transtheoretical Analysis. Belmont, CA: Brooks/Cole Cengage Learning. Rosengren, D. B. (2009) Building Motivational Interviewing Skills. New York: The Guildford Press. Wells, S.P. & Stowe, D.L. (2013). Facilitating Change through Motivational Interviewing. Volta Voices, Volume 20, Issue 5,

Alison Bell alisonbell2@bigpond.com Medicine in Addictions Conference

Alison Bell alisonbell2@bigpond.com Medicine in Addictions Conference 2013 Motivational Interviewing Are we Dancing or Wrestling? Definition of Motivational Interviewing Motivational interviewing is a