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Motivational Interviewing: Third Edition: a State-Of-The-Science Introduction

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Motivational Interviewing: Third Edition: a State-Of-The-Science Introduction Motivational Interviewing: Third Edition: A State-of-the-Science Introduction Presented by: William B. Webb, Ph.D., L.I.C.S.W., M.A.C. Director, OASIS Behavioral Health Services 689 Central Ave. P.O. Box 219 Barboursville, WV 25504-0219 Phone: (304) 733-3331 Email: [email protected] Website: www.PsychOasis.com 1 MOTIVATIONAL INTERVIEWING : A Comprehensive Introduction to Concepts, Principles and Strategies TRAINING AGENDA (Tentative) Times 9:00 - 10:15 Session - 1 10:15 – 10:30 BREAK 10:30 – 11:45 Session - 2 12:15 – 1:00 LUNCH 1:00 – 2:15 Session - 3 2:15 – 2:30 BREAK 2:30 – 4:00 Session - 4 2 Principles of Motivational Interviewing Pre-Post Quiz 0 1 2 3 4 5 6 7 8 910 None Moderate Very High Use this scale to rate your understanding of motivational interviewing methodology How would you rate your understanding of these basic principles of motivational interviewing? Pre Post Assessing the stages of change Methods for setting an agenda Establishing the “spirit” for motivating change Expressing empathy Developing discrepancy Rolling with resistance Supporting self-efficacy Avoiding triggering resistance Techniques for resolving ambivalence Communication traps to avoid Techniques to reduce resistance Identifying types of “change talk” Evoking “change talk” Assessing commitment to change Responding to “change talk” Use of effective focusing techniques Practical application of the decisional balance technique Ways of strengthening commitment to change Negotiating a written change plan 3 TOTAL SCORES Initial Training A workshop is only the beginning of learning MI. Learning Goals: 1. To understand the underlying spirit and approach of MI. 2. To recognize the reflective listening responses and differentiate them from other counseling responses. 3. To be able to provide at least 50% reflective listening responses during a conversation. 4. To recognize change talk and be able to differentiate commitment language from other types of change talk. 5. To list and demonstrate several different strategies for eliciting client change talk. A workshop without follow-up is unlikely to make a significant difference in practice. Research indicates that personal feedback and performance coaching are necessary to effectively integrate MI skills. 4 Recommended Skill-Development Format How to Integrate this Training Study •Workshops •Readings •Tapes •Videos •Website •Review Research Practice •Training •Audio/Video critiques •Coaching •Feedback Extend •In-vivo application •Further training •Mint •List serve 5 •Measure effectiveness The Transtheoretical Model of Stages of Change Prochaska, DiClemente, and Norcross (1994) 6 Stages of Change Model Precontemplation Increase Awareness Contemplation Motivate & increase self-efficacy Relapse Assist in coping Preparation Negotiate plan Maintenance Reaffirm commitment Active problem solving Action Implement Plan F/U Termination 7 The Spiral of Change 8 As the degree of mismatch increases between yourself and the client in readiness for change, the likelihood of resistance increases proportionately. Your Viewpoint Other person Differing viewpoints on readiness for change. 9 Movement Along the Motivational Continuum ? ? ? 1 10 Not Ready Unsure Very Ready People come in within a certain range of motivation. What you say influences where they end up. 10 The Transtheoretical Model of Change: A Six-Step Process Stage 1 - Precontemplation “What, me have a problem? No way!” Stage II – Contemplation “Maybe I need to change something, but I’m not sure what to do” Stage III – Preparation “Yes, there’s a problem and I’m going to change it” 11 Stage IV –Action “I’m doing something about my problem.” Stage V – Maintenance “I’m an old pro now.” Stage VI – Termination “I’m not even tempted anymore” Ancillary Stage VII – Relapse/Recycling “Whoops! I slipped back into my old habit!” 12 The Stages of Change Model Precontemplation Contemplation Progress Preparation Relapse Action Maintenance 13 Processes of Change in Correlation to Stages of Change Precontemplation Contemplation Preparation Action Maintenance 1. Consciousness Raising→→→→→→→→→→ 2. Social Liberation→→→→→→→→→→→→→ 3. Emotional Arousal→→→→→→→→→ 4. Self Re-evaluation→→→→→→→→→ 5. Commitment→→→→→→→→→→→→→→→→ 6. Reward→→→→→→→→→→→→ 7. Countering→→→→→→→→→→ 8. Environmental Control→→→→→ 9. Helping Relationships→ 14 Readiness Levels Not Ready Unsure Ready Trying 1…..2….. 3…..4…..5 6…..7…..8 9…..10 Pre-contemplation Contemplation Preparation Action 15 Stages of Change – Therapist Tasks Stage Tasks Precontemplation Raise doubt – Increase awareness of risks of current behavior Contemplation Tip the decisional balance – Evoke reasons for change; risks of status quo; strengthen self-efficacy Preparation Assist in developing a change plan Action Help client implement the plan; use problem solving and support self- efficacy Maintenance Develop relapse prevention strategies; resolve associated problems Relapse Recycle through earlier stages; alter action plan; avoid demoralization 16 Stages of Change – Patient Tasks Stage Tasks Precontemplation Become aware and concerned - Not interested Contemplation Risk/Reward analysis and decision - Considering making Preparation Creating an action plan - Planning Action Implement plan and revise as needed - Initiate change Maintenance Consolidate change into lifestyle - Sustain change 17 Summary: Stages of Change •About the process of change •Compatible with different tx. models •Change occurs all the time •Many people change without help •People fluctuate among SOC •Emphasizes positive reasons for change •People require more motivation in early stages •Combined with MI, it helps people decide on their own plan of action 18 “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” - Charles Darwin (1809-1882) 19 Motivational Interviewing: An Overview Miller and Rollnick (2002, 2 nd Ed.) 20 Principles of Person-Centered Change 1. Our services exist to benefit others. 2. Change is fundamentally self-change. 3. People are experts on themselves. 4. We don’t make change happen. 5. We don’t have to come up with all the solutions 6. People have their own resources to effect change 7. Change requires a collaboration of experience. 8. Start where the client is: “Seek first to understand.” (Covey) 9. A conversation about change is not a power trip. 10. Motivation is evoked, not installed. 11. It’s not a change-goal until the client adopts it. 21 MI and Change • What is Motivational Interviewing? • What is it for? • Why would I want to learn this? • How would I use it? “Things do not change; we change.” – Henry David Thoreau “MI is about arranging conversations so that people talk themselves into change.” – MI-3, p.4 22 “Motivation is a fire from within. If someone else tries to light that fire under you, chances are it will burn very briefly.” - Stephen R. Covey, (1932-Present) 23 Why Do People Change? • People change voluntarily only when: – They become interested in or concerned about the need for change. – They become convinced that the change is in their best interests or will benefit them more than cost them. – They organize a plan of action that they are committed to implementing. – They take the steps necessary to make and sustain the change. 24 Sources of Motivation: External Pressure + Internal Motivation Externally motivated subjects had long term outcomes only when they also had high levels of internal motivation (Deci, 2000) 25 Self Determination Theory: SDT Internal motivation is enhanced by: •Autonomy - Freedom to choose • Competence - Self efficacy • Relatedness - Relationships heal BREHM’S REACTANCE THEORY = whenever a particular behavior is threatened, the desirability of that behavior increases. Ex: “You can not use drugs while on probation!” 1. (Brehm 1981) 2. (Miller, Rollnick 2002) 3. (Hubble Duncan and Miller, 1999) 26 New Findings on Motivation: • Motivation predicts action • Motivation is changeable • Motivation is behavior specific • Motivation is interactive • Internal motivation lasts longer than external 27 Key Concepts about Motivation “Motivation is the application of energy to act in pursuit of some perceived (goal).” - Keller, 2012 “Most people trust themselves more than others. People learn about their own attitudes by hearing themselves talk.” - Bem, 1972 “Change is an inside job, that flows from internal motivation.” - Weinstein, 200228 Key Concepts about Motivation “MI is not done ‘to’ or ‘on’ someone, it is done ‘for’ and ‘with’ a person.” - MI-3, p. 15 “A motivational conversation entails capturing change-talk and using it in a manner that moves one in the direction of their goals.” - Webb, 2015 “You are a midwife, assisting in someone else’s birth. Facilitate what is happening rather than what you think ought to happen.” - Tao Te Ching29 Probability of Behavior Change Clinician talks about why change is important. Client nods head. Client thinks about why change is personally important Client talks about why change is personally important Client makes verbal commitment to change 30 Low High Motivational Interviewing (MI) is a directive, client-centered approach that enhances motivation for change, by helping individuals clarify and resolve their ambivalence about change, and by eliciting change language. It is based on the principles of collaboration, evocation, and antonymy; while supporting self- efficacy. This approach has shown good outcome in clinical research with diverse client populations. It is especially effective in working with resistant
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