Motivational Interviewing: Rolling with Resistance Todd C. Campbell, Ph.D., CSAC, ICS

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1 Motivational Interviewing: Rolling with Resistance Todd C. Campbell, Ph.D., CSAC, ICS Psychologist May 22, 2012

2 Learning Objectiveses At the end of this one-hour presentation, you will be able to: 1. Summarize the core principles of Motivational Interviewing (MI). 2 Describe one MI strategy to bypass resistance 2. Describe one MI strategy to bypass resistance and denial in a client.

3 Stages in the Process of Change Permanent Exit Pre-contemplation

4 Self-Efficacy Self-reflection is a second human quality and is expressed in the concept of self-efficacy. Self-efficacy is the belief in one s capabilities to organize and execute the sources of action required to manage prospective situations. (Bandura, 1986)

5 Self-Efficacy Important: Self-Efficacy is in respect to specific behavior

6 Stages of Change Important: Stage of Change is in respect to specific behavior

7 Traditional adto a View of Motivation ato Static TRAIT or disposition that a person either has or does not have (e.g. addictive personality) Reflected in the degree to which client agrees with perspective of the counselor Agreement on goals of treatment t t

8 Motivational o a Psychology ogy Borrowed elements from studies of cognitive elements that influence motivation Cognitive Dissonance (Festinger, 1957) Self-perception (Bem, 1965) Self efficacy (Bandura, 1977) Decision-making theory (Janis & Mann, 1977) Alcohol / Drug Expectancy (Brown, 1980)

9 Motivation o Motivation is a key to change. Motivation is multidimensional. Motivation is dynamic and fluctuating. Motivation is influenced by social interactions. Motivation can be modified. d Our task is to elicit and enhance motivation.

10 Definition to of Motivation ato Motivation: A state of readiness to change. It may fluctuate t over time and situations.

11 Definition to of Motivation ato Motivation: A probability that a client will engage in a particular behavior

12 Principles cpesof Motivational ato a Interviewing: e G.R.A.C.E.S. Generate a Gap Roll with Resistance Avoid Argumentation Can Do Express Empathy Support Self-Efficacy

13 Principles cpesof Motivational ato a Interviewing: e G Generate a Gap Develop a discrepancy between individual s id current behaviors and his/her stated values and interests. Let client present arguments for change. Acknowledge both the positives and negatives of behavioral change.

14 Principles cpesof Motivational ato a Interviewing: e Roll with Resistance Seek to clarify, understand. d Invite consideration of new perspectives. Reinforce person s role as a problem-solver.

15 Principles cpesof Motivational ato a Interviewing: e Avoid Argumentation ti Keep on your client s side. Arguing for change often promotes resistance, thus causing the client to defend d the behavior you want them to change.

16 Principles cpesof Motivational ato a Interviewing: e C Can Do Increase individual s id perception of self as a capable person. Affirm positive statements t t and behaviors. Offer options, instill hope. Encourage consideration of role models, past successes.

17 Principles cpesof Motivational ato a Interviewing: e E Express Empathy Create a free and friendly space to explore difficult issues. Use reflective listening. i An accepting attitude facilitates change, pressure to change thwarts it (paradox).

18 Principles cpesof Motivational ato a Interviewing: e S Support Self-Efficacy Efficacy is the belief that t a person can make a specific change. Robust predictor of outcomes with a variety of clinical problems. I i h f i i i li Interviewers may search for optimism in client s previous successes.

19 Support Self-Efficacy Belief in the possibility of change is an important motivator The client is responsible for choosing and carrying out personal change There is hope in the range of alternative approaches available

20 Affirm Finding something positive about client s behavior Making that finding verbally explicit Genuineness is critical What if I can t find anything positive about my clients?

21 Reflect ect Various levels of reflection Best to start with simplest and move forward as rapport builds Good follow up to open-ended question

22 Reflective ect e Listening Reflective e listening is the key to this kind of work. The best motivational advice we can give is to listen carefully to your clients. They will tell you what has worked and what hasn t. What moved them forward and shifted them backward. Whenever you are in doubt about what to do, listen. - Miller & Rollnick, 1991

23 Types of Resistance sta Arguing Challenging, Discounting, Hostility Interrupting Talking over, Cutting off Denying Blaming, Disagreeing, Excusing, Claiming impunity, Minimizing Pessimism, Reluctance, Unwillingness to change Ignoring Inattention, Non-answer, No response, Sidetracking

24 Beware eof Common o Traps Premature Focus Trap Confront/Denial Trap Labeling Trap Blaming Trap Question-Answer Trap Expert Trap

25 mismatching g Assume that the person is in ACTION Interpret AMBIVALENCE as denial Ignore BARRIERS Don t assess READINESS Give MORE help than person wants Ignore client s PREFERENCE

26 Recommended e Resources Books: Miller, W.R. & Rollnick, S. (2002). Motivational Interviewing : Preparing People for Change (2 nd ed.). New York: Guilford Press. Miller, W.R. & Rollnick, S. (Coming Soon). Motivational Interviewing : Helping People Change (3 rd ed.). New York: Guilford Press. Naar-King, S. & Suarez, M. (2011). Motivational Interviewing with Adolescents and Young Adults. New York: Guilford Press. Wbi Websites:

27 Thank you Todd C. Campbell, Ph.D., CSAC, ICS Extension: rogershospital.org

These core elements are included in three increasingly detailed levels of definition:

These core elements are included in three increasingly detailed levels of definition: A Definition of Motivational Interviewing The definition of Motivational Interviewing (MI) has evolved and been refined since the original publications on its utility as an approach to behavior change.