Mental Health for Families in Supportive Housing Parents Mental Health and Its Impact on Children: A Look at Adult Mental Health Issues in the Context of Family Life in Supportive Housing Session #1, February 2006 Produced by the Family Housing Fund in cooperation with Supportive Housing Provider Group, University of Minnesota, Hart-Shegos and Associates Presenter: Dr. Carl Isenhart, Psychologist/Coordinator, Additive Disorders Section, VA Medical Center, Minneapolis MN Motivational Interviewing: Basic Principles and their Application to Clinical Settings Motivational Interviewing what can we do to help the person understand the problems and take steps toward resolution. Goals: Develop a strong working alliance (therapeutic relationship) a. Best predictor of success is a strong working relationship between therapists and client Create an atmosphere in which the patient can engage in change talk a. More change talk a client engages in the more likely change will occur in all types of therapy 1. Main components of Change Talk DARN Language the more the client talks about these factors, the more change will occur. Commitment Language Desires Ability Reasons Need 2. Therapist s Style and Outcome a. Working alliance predicts outcomes i. Rogerian style associated with positive outcomes b. Empathy (reflective listening) c. Affirming d. Client-center (client s goals, strategies, timeframe) 3. Therapist s reflective listening skills most therapists think they are more empathic, reflective listeners than they really are. a. Zero correlation between observed (actual) and perceived style b. Typically relatively small percentage of reflective listening c. Typically more questions, especially closed-end Session 1 February 2006 Page 1 of 4
Mental Health for Families in Supportive Housing 4. Whose goal--client vs Therapist a. Therapist s goals i. Understand it ii. Fix it iii. Diagnose it b. Client needs i. To be listened to ii. To be understood 5. Motivational Interviewing Defined a. Person centered b. Directive c. Method of communication d. For enhancing intrinsic motivation to change by exploring and resolving ambivalence 6. Motivational Interviewing Spirit a. People are ambivalent toward their unhealthy behavior i. Fix it or leave will damage the therapist/client trust factor right off the bat b. Natural and normal step in the process c. Anticipatory regret the therapist anticipates that the client will regret changing to behavior i. People have a natural tendency to strive for healthy behavior 7. Motivational Interviewing Collaboration a. Negotiate goals, strategies, timeframe b. Avoid authoritarian stance c. Accept difference between ideal plan and what the clients are willing to endorse 8. Motivational Interviewing Evocative a. Draw out the client s own desire and reasons for change i. Shows respect for the client s needs ii. Engages the client 9. Motivational Interviewing Autonomy a. Accept client s right to make a decision, even if that decision is not to change b. Emphasize client s freedom of choice Session 1 February 2006 Page 2 of 4
Mental Health for Families in Supportive Housing 10. Motivational Interviewing Carl s Goal (Duck analogy) a. Use MI principles and strategies to allow the client to say what I want to tell him/her b. Duck analogy duck sitting on water looks like nothing is happening, but a lot is going on under the surface 11. Motivational Interviewing--Principles a. Express empathy i. Demonstrates acceptance of person as is as versus you re not ok b. Develop discrepancy i. Gap between current behavior and goals, values, and priorities ii. Change is motivated by a perceived discrepancy between present behavior and important personal goals or values c. Roll with resistance i. Avoid arguing for change ii. Readiness to change is a fluctuating product of interpersonal interaction d. Support self-efficacy i. Person s believe in the responsibility of change is an important motivator ii. Counselor s own belief in the person s ability to change becomes a self-fulfilling prophecy 12. Motivational Interviewing Traps to avoid a. Question-Answer trap b. Confrontation-Denial c. Premature focus d. Expert trap e. Cheerleader f. Righting Reflex (balance) 13. Motivational Interviewing Tools a. Reflective Listening b. Summary c. Affirm d. Open-ended Questions 14. Motivational Interviewing Handling Resistance a. Reflection b. Double-sided reflection Session 1 February 2006 Page 3 of 4
Mental Health for Families in Supportive Housing i. Reflecting the client s ambivalence c. Shifting Focus d. Agreement with a twist i. Reflection followed by a reframe e. Ask client what s/he wants f. Emphasize personal control and choice 15. Motivational Interviewing How It All Fits Together a. MI b. DARN language i. Desire I want to, hope to ii. Ability I can, I could iii. Reasons go reasons to; it is important for me to iv. Need I need to, have to c. Commitment Language i. Increased commitment language within MI sessions is associated with more behavior change at follow up d. Taking Steps i. Specific steps to change 16. Motivational Interviewing Eliciting DARN & Commitment Language a. Pros and cons of changing i. There are a lot of self-changers out there who do this process on their own b. Pros and cons of staying the same c. Elaboration d. Forward and backward looking 17. Motivational Interviewing--Responding to DARN & Commitment Language a. Elaborating in what way b. Reflecting c. Summarizing d. Affirming Other Resources: William Miller & Stephen Rollnick, Motivational Interviewing: Preparing People for Change (2 nd Ed), Website: www.motivationalinterview.org Website: Center on Alcoholism, Substance Abuse and Additions, www.cassas.unmn.edu Email: cisenhart@mn.rr.com Session 1 February 2006 Page 4 of 4
Parents Mental Health and Its Impact on Children: A Look at Adult Mental Health Issues in the Context of Family Life in Supportive Housing Session #1, February 2006 Produced by the Family Housing Fund in cooperation with Supportive Housing Provider Group, University of Minnesota, Hart-Shegos and Associates Presenter: Dr. Carl Isenhart, Psychologist/Coordinator, Additive Disorders Section, VA Medical Center, Minneapolis MN Motivational Interviewing: Basic Principles and their Application to Clinical Settings Outline Motivational Interviewing what can we do to help the person understand the problems and take steps toward resolution. Objectives Develop a strong working alliance (therapeutic relationship) Create an atmosphere in which the patient can engage in change talk 1. Main components of Change Talk DARN Language the more the client talks about these factors, the more change will occur. 2. Therapist s style will predict outcome. 3. Most therapists think they are more empathic, reflective listeners when they are really something else. 4. Differences between a client s goals and the therapist s goals. 5. What is motivational interviewing? 6. Spirit--What are the client s natural tendencies toward the interviewing process? 7. Collaboration--A therapist must do three things to conduct a successful interview. These are 8. Evocative--By drawing out the client s own desire and reasons for change, we are doing what? 9. Autonomy--During an interview, the therapist must accept a client s right to make a decision. The therapist must also emphasize a client s freedom of choice. Session 1 February 2006 Page 1 of 2
10. Carl s Goal --Use motivational interviewing principles and strategies to allow the client to say what I want to tell him/her. 11. Principles of Motivational Interviewing a. Express empathy b. Develop discrepancy c. Roll with resistance d. Support self-efficacy 12. Traps to be avoided in motivational interviewing 13. Tools the therapist should use during motivational interviewing 14. How should you handle resistance? 15. How all the steps in motivational interviewing fit together a review 16. Eliciting DARN and commitment language 17. Responding to DARN and commitment language Other Resources: William Miller & Stephen Rollnick, Motivational Interviewing: Preparing People for Change (2 nd Ed), Website: www.motivationalinterview.org Website: Center on Alcoholism, Substance Abuse and Additions, www.cassas.unmn.edu Email: cisenhart@mn.rr.com Session 1 February 2006 Page 2 of 2
Family Mental Health for Families in Supportive Housing Adolescence: Reframing Youth Risk Taking Test/Review 1. What are the two goals identified for motivational interviewing in this series? 2. Name the four components of change talk. 3. How does a therapist style indicate the outcome for the interview? 4. Identify the differences between the therapist s goals and the client s needs. 5. What is motivational interview? 6. What three things must a therapist be prepared for in the interview process that will enhance collaboration? 7. Name the four principles of motivational interviewing and explain briefly. Session 1 February 2006 Page 1 of 2
Family Mental Health for Families in Supportive Housing 8. What are the most effective tools a therapist can use in the interviewing process? 9. Name four out of six ways to handle resistance in an interview. 10. How would you elicit DARN and commitment language in an interview? Session 1 February 2006 Page 2 of 2