Helping People to Change: A Speed Date with Motivational Interviewing
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1 Helping People to Change: A Speed Date with Motivational Interviewing NHCHC: CMS Innovation Grant Scott R. Petersen, LCSW, CAC-III Colorado Coalition for the Homeless spetersen@coloradocoalition.org November 27, 2012
2 Why a Speed Date? Only 90 minutes a very brief encounter with MI! Maybe - you ll like the look of it Maybe - you ll arrange a second date to find out more It could be - the beginning of a beautiful relationship! And - no strings - if you re happy with what you already have that s fine!
3 STRATEGIES FOR LEARNING NEW SKILLS (MILLER, ET AL., 2006) Reading, verbal instruction, observation Practice with feedback Ongoing coaching and supervision of practice
4 Stages of Change Model (Prochaska & DiClemente, 1983)
5 Stages of Change Pre-Contemplation not yet considering changing Contemplation starting to think about it Preparation gathering information, thinking about when & how Action making the change Maintenance sustaining the change Relapse can occur at any time
6 How Many Are Ready To Change? How Many Are Ready To Change? Action 15% Precontemplation 15% Preparation 15% Contemplation 55%
7 STAGES OF CHANGE & WORKER TASKS PRECONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE RELAPSE Engage; Build Relationship; Raise doubt - Increase the patient s perception of risks and problems with current behavior Tip the decisional balance - Evoke reasons for change, risks of not changing; Strengthen selfefficacy for behavior change Help to determine the best course of action to take in seeking change; MENU; Develop a plan Help implement the plan; Use skills; Problem solve; Support self-efficacy Help identify and use strategies to prevent lapse/relapse; Resolve associated problems Help recycle through the stages of contemplation, preparation, and action, without becoming stuck or demoralized because of relapse
8 MI in Action: A Few Examples sbc&playnext=1&list=pl73b3ac8e7fac52 9A&feature=results_video
9 About Motivational Interviewing (MI) An approach developed by psychologists, originally used in the addictions field (Miller, 1985; Miller & Rollnick 1991, 2002, 2012) An approach derived from Client-Centred Counseling (Rogers, 1950) Recognizes that the more you confront and persuade, the more the person will resist (Reactance Theory, Brehm, 1968) If the person hears him/herself say the reasons for change it is much more powerful (Self-Perception Theory, Bem, 1967, 1972) Counseling style to elicit internal motivation Gentle & active and sometimes directive listening Respect for persons values & autonomy Over 1000 publications (
10 People are generally better persuaded by the reasons they themselves discover than by those that enter the minds of others. Pascal
11 What is Motivational Interviewing? A person-centered counseling style for addressing the common problem of ambivalence about change. (Miller & Rollnick, 2012)
12 MOTIVATIONAL INTERVIEWING: SPIRIT and TECHNIQUE We believe that each person possesses a powerful potential for change. The counselor s task is to release that potential and to facilitate the natural change processes that are already inherent in the individual (Miller & Rollnick, 2002, p. 41). People possess substantial personal expertise and wisdom regarding themselves and tend to develop in a positive direction if given proper conditions of support (Miller & Moyers, 2006, p. 5).
13 What is Unique to MI? Strategic-directive use of clientcentered counseling skills (OARS) Intentional, differential evoking and reinforcement of change talk Sequencing of preparatory change talk (desire, ability, reasons, need) and commitment language
14 Three Communication Styles (Rollnick, Miller, & Butler, 2008)
15 Styles and Skills (Rollnick, Miller, & Butler, 2008) Informing Asking Listening 10 0 Directing Guiding Following
16 Three Styles Following (WHY CHANGE/WHY NOT CHANGE?) Build Rapport Obtain the Basic Story Set a Shared Agenda Guiding (IF I CHANGE ) Elicit Change Talk -Importance/Confidence -Values Clarification Seek Commitment to Change Directing (HOW DO I CHANGE?) Build a Menu With Options Set Goals Discuss Next Steps and Monitoring Plan Action Reflections
17 Guiding Skills (aka MI) Open-ended questions Affirmations Reflective Listening Develop discrepancy Highlight ambivalence Summaries Eliciting change talk Reinforcing change talk
18 Providing Information Use of permission Offer choices Chunk Check Chunk Elicit Provide Elicit (MI sandwich)
19 Motivational Interviewing (MI) Elements (Rosengren, 2009) MI Spirit OARS MI Change Talk MI Principles
20 The Spirit of MI If you treat an individual as she is, she will stay as she is, but if you treat her as if she were what she ought to be and could be, she will become what she ought to be and could be. -Goethe Compassion is the wish to see others free from suffering. -The Dalai Lama
21 The Spirit of MI, continued (Miller & Rollnick, 2012) Partnership Acceptance Absolute Worth Accurate Empathy Autonomy Support Affirmation Compassion Evocation
22 Motivational Interviewing: Spirit vs. Technique Internal monitoring for urge to: Persuade Confront Warn Coercion vs. Collaboration Education vs. Evocation Authority vs. Autonomy
23 MI: Four Basic Principles Express Empathy Develop Discrepancy Roll with Resistance Support Self-Efficacy Also RULE (Rosengren, 2009)
24 On Empathy
25 Four Processes in MI (Miller & Rollnick, 2012) Engaging Focusing Evoking Planning
26 Four Basic Strategies: OARS Open-Ended Questions Affirm Reflective Listening Summarize
27 Assessing Readiness - Importance On a scale 0f 1-10 how Important is it to you to make this change? Questions to evoke change talk. Why are you a 5 and not a 3? What needs to happen for you to get to a 7?
28 Assessing Readiness - Confidence On a scale 0f 1-10 how confident are you that you can succeed in making this change? Questions to evoke change talk. Why are you a 5 and not a 3? What needs to happen for you to get to a 7?
29 Decisional Balance Worksheet Current Behavior Good things Change Less good things
30 Decisional Balance Worksheet Good things Not so good things Current Behavior Short Term Long Term Short Term Long Term Change Short Term Long Term Short Term Long Term
31 Thinking About Drinking Here is an example of someone exploring their ambivalence about alcohol use. Everyone s decisional balance will look a little different. Good things about my drinking: More relaxed Good things about changing my drinking: More control over my life Will not have to think about my problems for a while More comfortable with drinking friends Less good things about my drinking: Disapproval from family and friends Increased chance of legal and job trouble Costs too much money Support from family and friends Less legal trouble & better health Less good things about changing my drinking: More stress or anxiety Feel more depressed Increased boredom
32 Key Points The reasons for not changing are seldom to do with lack of knowledge. People find their own reasons for changing. The approach of the worker is a critical factor toward the outcome for the person with whom we are working. Giving advice and information when the person is not ready may increase resistance. A respectful, empathic, collaborative, eliciting approach is more likely to lead to change Motivational Interviewing is such an approach.
33 A Few Additional Resources Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in healthcare: Helping patients change behavior. New York, NY: Guilford. Rosengren, D. B. (2009). Building motivational interviewing skills: A practitioner workbook. New York, NY: Guilford. HCH Clinicians Network Healing Hands: Eliciting Behavioral Change: Tools for HCH Clinicians: A Comprehensive Approach to Substance Abuse and Homelessness: MI Home Page: For additional training:
34 Motivational Interviewing Self-Check: My Clients Would Say That I Believe that they know what is best for themselves Help them to recognize their own strengths Am interested in helping them solve their problems in their own way Am curious about their thoughts and feelings Help guide them to make good decisions for themselves Help them to look at all sides of their situations or concerns Help them feel empowered by my interactions with them Adapted from K. Kraybill (2011)
35 On Hope Often people who have suffered many losses relinquish hope as a means of survival. People who believe they are likely to change do so. People whose counselors believe that they are likely to change do so. Those who are told that they are not expected to improve indeed do not (Miller & Rollnick, 2002).
36 Thank You! A Speed Date with Motivational Interviewing! Scott R. Petersen, LCSW, CAC-III spetersen@coloradocoalition.org Member of the International Motivational Interviewing Network of Trainers (MINT) with special thanks to Jacqui Radford
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