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 clients. This two (2) day training is designed to provide a broad overview of the entire system of Motivational Interviewing. However, the specific focus for this introductory session will be on conveying the spirit and major principles of the model. Recent research has demonstrated that retention and proficiency of practical application of MI is significantly enhanced by follow up sessions, which include a review of work samples and MI coaching.
Objectives of this training: • To increase participants’ knowledge of Motivational Interviewing. • To exhibit the appropriate application of stages of change model to the Motivational Interviewing approach. • To demonstrate via lecture, video, and group activities the spirit, principles, and skill set for the application of Motivational Interviewing. • To provide in vivo practice of MI listening skills and methods for recognizing and dealing with change talk. 31 Motivational Interviewing
• Layperson’s Definition: – Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
• Practitioner’s Definition: – Motivational Interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change.
32 What MI is NOT
• Just being nice • Rogerian therapy • A “technique” • A panacea • Comprehensive Theory of Change • Transtheoretical Model (TTM) • Decisional balance • Assessment feedback NOT required • A way of manipulating people
33 How to Learn MI: 8 Skills
1. Openness to underlying assumption and spirit of MI. 2. Proficiency in client centered interpersonal skills, especially accurate empathy. 3. Recognize change talk and commitment language. 4. Minimize resistance in responding to sustain talk. 5. Skill in eliciting and responding to change talk. 6. Formulate an effective change plan. 7. Enlist commitment to the plan. 8. Blending MI with other therapies. (Explore and resolve ambivalence – ongoing)
34 Where people get stuck in MI
1. Underlying Assumptions 2. Reflective Listening 3. Recognizing Change Talk 4. Evoking Change Talk 5. Collecting Bouquets (Summarizing) 6. Responding to Resistance 7. Evoking and Strengthening Commitment 8. Transfer to Other Therapeutic Methods
35 A Motivational Interviewing Parable
A traveler in ancient Greece had lost his way and, seeking to find it, asked a man by the roadside who turned out to be Socrates. “How can I reach Mt. Olympus?” asked the traveler. To this inquiry Socrates is said to have gently replied “Just make sure that every step you take goes in that direction.”
Source: Discover the Power Within You By: Jeff Butterworth (Chapter 3) 36 Spirit of MI: Four Vital Aspects The practice of MI Spirit is a developmental process
PARTNERSHIP
COMPASSION MI Spirit ACCEPTANCE
1. Partnership 2. Acceptance EVOCATION 3. Compassion 37 4. Evocation The Spirit of Motivational Interviewing
Collaboration Confrontation
Evocation VS. Education
Autonomy Authority
MI is a mind and heart set.
38 Four Aspects of Acceptance
Absolute Worth
Affirmation Acceptance Autonomy
Accurate Empathy 39 40 Continuum of Communication Styles
Directing ↔ Guiding ↔ Following
↑ MI ↑
41 Verbs Associated with Each Communication Style
Directing Style Guiding Style Following Style Administer Accompany Allow Authorize Arouse Attend Command Assist Be Responsive Conduct Awaken Be with Decide Collaborate Comprehend Determine Elicit Go along with Govern Encourage Grasp Lead Enlighten Have faith in Manage Inspire Listen Order Kindle Observe Preside Look after Shadow Rule Motivate Stay with Steer Offer Stick to Run Point Take in Take charge Show Take interest in Take Command Support Understand 42 Tell Take along Value The Processes of MI
1. Engaging: The relational foundation 2. Focusing: The strategic direction 3. Evoking: Preparing for change 4. Planning: The bridge to change
Pre contemplation Preparation Action 43 MI Methods 1. Engaging 2. Focusing 3. Evoking PLANNING 4. Planning EVOKING
FOCUSING
ENGAGING
44 Questions Regarding Each MI Process
Engaging • How comfortable is this person in talking to me? • How supportive and helpful am I being? • Do I understand this person’s perspective and concerns? • How comfortable do I feel in this conversation? • Does this feel like a collaborative partnership?
45 Engagement Traps to Avoid
1. Assessment 2. Expert 3. Premature Focus 4. Labeling 5. Blaming 6. “Chat Therapy”
46 Questions Regarding Each MI Process
Focusing • What goals for change does this person really have? • Do I have different aspirations for change for this person? • Are we working together with a common purpose? • Does it feel like we are moving together, not in different directions? • Do I have a clear sense of where we are going? • Does this feel more like dancing or wrestling? 47 Questions Regarding Each MI Process
Evoking • What are this person’s own reasons for change? • Is the reluctance more about confidence or importance of change? • What change am I hearing? • Am I steering too far or too fast in a particular direction? • Is the righting reflex pulling me to be the one
arguing for change? 48 Questions Regarding Each MI Process
Planning • What would be a reasonable next step toward change? • What would help this person to move forward? • Am I remembering to evoke rather than prescribe a plan? • Am I offering needed information or advice with permission? • Am I retaining a sense of quiet curiosity about what will work best for this person? 49 Phase I: Build Motivation to Change (Why)
1. Opening Strategies A. Use OARS Open ended questions Affirm Reflect Summarize B. Agenda Setting C. Scaling Questions
2. Decrease Resistance: A. Reflections B. Others 1. Paraphrase 1. Shift focus 2. Amplified 2. Reframe 3. Double sided 3. Agree w/twist (Reflect/Reframe) 4. Emphasize Personal Control
5. Coming Along Side 50 3. Evoke “Change-Talk” A. Types: B. Methods: 1. Disadvantage of Status Quo 1. Evocative questions 2. Advantage of change 2. Elaborate 3. Optimism for change 3. Importance/Confidence rulers 4. Intention to change 4. Explore decisional balance C. Look for: DARN CaT 5. Query extremes Desire 6. Look behind/look forward Ability 7. Explore goals (values) Reasons Need Commitment And Taking Steps 4. Responding to Change-Talk (EARS) 1. Elaborate 2. Affirm 3. Reflect 4. Summarize 51 Phase II: Strengthening Commitment to Change (How)
1. Recapitulation (Grand Summary)
2. Ask Key Questions · Where do we go from here? · What do you want to happen? · What’s the next step · Where do you see yourself in 2 4 weeks? · What might interfere with this? · Who are your support people?
3. Provide information/Advise with permission · May I offer some possibilities/options? · Are you interested in some suggestions? · Are you open to other considerations? · Would a review of some options be helpful? · Are you looking for helpful information? 52 4. Negotiate a Change Plan · Go to Change Plan worksheet
5. End tasks: · Summary Reflection · Close the deal “Is this what you want to do?”
6. Helpful Hints · 2 Reflections/questions · We can dance or wrestle · Empathy=accurate reflection of client’s meaning · Avoid questions or comments that elicit resistance · Reduce resistance, evoke change talk · Stabilize the changes
53 “If a patient wants to go, let him go. If he wants to stay, let him stay. Do not deny him what he wants and do not suppress him. If we comply to his wishes and let him satisfy his needs, then all of his excessive positive force will be appropriately discharged and he will consequently get well.” - Zhang Zhongiing Ca. 200 A.D.
54 Least Favorite/Most Favorite Person Exercise
Least Favorite Most Favorite
55 Motivational Interviewing Facilitates Change By:
• Reducing resistance • Raising discrepancy • Eliciting change talk • Responding to change talk •Creating a change plan • Sustaining change
56 Conditions that Enhance Change Rollnick and Miller (2002) Motivational Interviewing: • is a client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. (p.25) • elicits change from within, (not imposed). (p. 326) • makes client responsible for change. (p. 326) • avoids direct persuasion. (p.326) • is interactive/directive. (p. 327) • resolves ambivalence. (p. 327) • works through the therapeutic “partnership”. (p. 327)
57 Key Assumptions Behind Motivational Interventions
• Encourage empathy • Maintain congruence • Promote collaborative spirit • Recognize ambivalence is normal • Resistance can be altered • Support self efficacy
58 Principle 1: Express Empathy.
• Acceptance facilitates change. • Skillful reflective listening is fundamental. • Ambivalence is inevitable.
59 60 “Being empathic is to perceive the internal frame of reference of another with accuracy and with the emotional components and meanings which pertain thereto...it means to sense the hurt or pleasure of another as he senses it and to perceive the causes thereof as he perceives them...” - Carl Rogers
61 Components of Empathy
1. Cognitive: Understand another’s situation, perspective, feelings, and motives 2. Affective: Appreciation of emotional reactions to perceived experiences 3. Behavioral: Capacity to communicate understanding; verbal and nonverbal expression
• Different from “detachment” • Not the same as “sympathy” 62 Empathy – “The not so secret sauce” that:
• Expedites therapeutic rapport • Boosts client satisfaction • ______treatment efficiency • Improves treatment outcomes • Reduces practitioner stress
63 Strategies for Conveying Empathy
Non verbal Stance Verbal • Voice tone • Welcoming • Inviting input • Facial • Respectful • Open ended questions expression • Authentic • Reflective listening • Pausing • Accepting • Non interrupting • Eye contact • Patient • Checking for accuracy • Posture of understanding • Asking for permission
64 Principle 2: Develop Discrepancy.
• Client presents argument for change. • Discrepancy is the difference between present behavior and future goals. • Exaggerate discrepancy.
65 Discrepancy (2)
“Are your current behaviors leading toward or away from your goals/values?”
Status Quo Goals
“Sustain Talk” “Commitment Language” vs.
(No Change) (Behavior Change) = = Resistance Motivation
66 Principle 3: Roll with Resistance
• Avoid arguing for change. • Avoid direct opposition. • Invite new perspectives, do not impose. • Client is responsible for finding solutions. • Resistance is a signal to respond differently.
67 Principle 4: Support self-efficacy
• Self efficacy = a client’s belief in their ability to succeed. • Reinforce self efficacy frequently. • Individual is responsible for change. • Provider’s view of client’s self efficacy affects outcome.
68 Traps to Avoid
Question Answer Trap Trap of Taking Sides Expert Trap Labeling Trap Premature Focus Trap Blaming Trap
69 Communication can go wrong because…
1. The speaker does not say exactly what is meant. 2. The listener does not hear the words correctly. 3. The listener gives a different interpretation to what the words mean. 4. The speaker does not “feel” understood.
70 Active Listening (Thomas Gordon, Ph. D.)
Client2 Facilitator What is said What is heard
3 1
What is meant/felt What is understood 4 71 The Process of Communication
Hearing Words the Words the Speaker Says Listener Hears
Encoding Decoding
What the Speaker What the Listener Means Thinks the Heard Words Mean Reflection 72 Based on Gordon (1970) Thomas Gordon’s 12 Roadblocks to Listening (From the Facilitator) 1. Ordering, directing, or commanding 2. Warning, cautioning, or threatening 3. Giving advice, making suggestions, or providing solutions 4. Persuading with logic, arguing, or lecturing 5. Telling people what they should do; moralizing 6. Disagreeing, judging, criticizing, or blaming 7. Agreeing, approving, or praising 8. Shaming, ridiculing, or blaming 9. Interpreting or analyzing 10. Reassuring, sympathizing, or consoling 11. Questioning or probing 12. Withdrawing, distracting, humoring, or changing the 73 subject Which Roadblock Error?
CLIENT INTERVIEWER
“I just don’t now whether to leave him “You should do whatever you think is #5 or not.” best.” “But that’s the point! I don’t now “Yes, you do, in your heart.” #6 what’s best!” “Well, I just feel trapped, stifled in our “Have you thought about separating relationship.” for a while to see how you feel?” #3
“But I love him, and it would hurt him “Yet, if you don’t do it, you could be #2 so much if I left!” wasting your life.”
“But isn’t that kind of selfish?” “It’s just what you have to do to take #4 care of yourself.” “I just don’t know how I could do it, “I’m sure you’ll be fine.” #10 how I’d manage.” 74 Non-change Behavior (From the Client)
Categories of “resistance” •Arguing •Interrupting •Negating •Ignoring
75 Four Categories of Client Resistance Behavior
Arguing • Challenging • Discounting • Hostility
76 Interrupting • Talking over • Cutting off
77 Negating •Blaming •Disagreeing •Minimizing •Pessimism •Reluctance
78 Ignoring •Inattention •Nonanswer •No response •Sidetracking
79 Four Core Skills of MI (OARS)
(O): Open ended Questions (A): Affirming (R): Reflective Listening (S): Summarizing
80 Using O.A.R.S. 1. Ask open ended questions.
2. Directly affirm and support the client.
3. Listen reflectively.
4. Summarize periodically.
81 CORE MI SKILLS (OARS)
Open-ended questions: • What brings you here today? • How has this problem affected your day to day life? • Where do you hope your life might be different 5 years from now? • Where do you think this path that you’re on is leading you? • What would you say are the five things that you most value in life? • How do you hope I might be able to help you? 82 CORE MI SKILLS (OARS)
Closed-ended questions: • What is your address? • How long have you been feeling this way? • How many calls have you made? • Do you smoke? • Do you think you can do this? • Who lives with you? • When did you have your last drink? • Where did that happen? 83 EXERCISE Is it an open or closed question?
1. What do you like about your current situation? ___ 2. Is this strategy effective? ___ 3. What kind of specific assistance are you looking for? ___ 4. Have you ever considered just going to AA? ___ 5. Isn’t it important to you to follow your doctors orders? ___ 6. What obstacles do you anticipate in making the specific changes we’ve discussed? ___ 7. What are the most important reasons for making these changes? ___ 8. Don’t you care about your health? ___ 9. What do you think about coming back for a follow up visit? ___ 10. Is this an open or closed question? ___ 84 Open-Ended Questions
•Stimulates elaboration •Asks for more than 1 word responses •Examples: •“What would you be doing differently if you had already made the change you're considering?” •“How might you get from where you are today to where you want to be in the near future?”
85 “Good listening helps a person keep going, to continue considering and exploring what may be uncomfortable material.” MI 3, p. 49
86 CORE MI SKILLS (OARS)
Affirming • To Affirm is to: – Accentuate the positive – Recognize and acknowledge the good – Supports – Encourage – Positive regard and respect • What you say, think, and feel matters
87 AFFIRM = “you” statements (motivates)
VERSUS
PRAISE = “I” statements (roadblock)
88 Affirm/Support
•Use complements and statements of appreciation and understanding Examples: “I think it’s great that you want to tackle this problem.” “I appreciate your willingness to discuss this.”
89 CORE MI SKILLS (OARS)
Examples of Affirmations: • “You really tried hard this week!” • “Your intention was good even though it didn’t turn out as you would like.” • “Look at this! You did a really good job of keeping records this week.” • “Thanks for coming in today, and even arriving early!” • “So you made three calls about possible jobs this week. Good for you!” 90 91 CORE MI SKILLS (OARS)
Well Formed Reflections: • Guess at meaning / hypothesis testing • Decrease Defensiveness, Increase Exploration • Moves the conversation forward • Assumes client knows best • Focuses on client narrative (not providers) • Sees through client’s eyes • Solidifies engagement
92 Reflective Listening
Techniques That Reduce Resistance
Simple Reflection Amplified Reflection Double sided Reflection
93 Simple Reflection
Repeating or rephrasing what a client has said to you is one way to let the person know that you heard them.
Client But I can’t quit using. I mean, all of my friends get high!
Facilitator – Quitting seems nearly impossible because you spend so much time with others who use.
Client – Right, although maybe I shouldn’t.
94 Amplified Reflection
With this, the facilitator will want to cause the client to disagree with what’s being said. The facilitator may exaggerate or intensify the point in order to accomplish this, however, it is important not to over embellish. If the client feels threatened he or she may respond in anger.
Client But I can’t quit using. I mean, all of my friends get high!
Facilitator – Oh, I see. So you already couldn’t quit because then you’d be too different to fit in with your friends and they might not accept the “new you”.
Client – Well, that would make me different from them, although they might not really care as long as I don’t pressure them to quit. 95 Double-sided Reflection
The facilitator reflects both the current, resistant statement with a previous, contradictory statement that the client has made.
Client But I can’t quit using. I mean, all of my friends get high!
Facilitator – You can’t imagine how you could not get high with your friends, and at the same time you’re worried about how it’s affecting you.
Client – Yes. I guess I have mixed feelings.
96 CORE MI SKILLS (OARS) Types of Reflections: 1. Simple = Paraphrase 2. Complex = Adds Meaning and Feelings
Simple Reflections are what shows above the water.
Complex Reflections are what shows beneath the water.
97 Asking Questions v. Making Statements
• You’re feeling uncomfortable? • You’re feeling uncomfortable.
• You don’t think this is a problem? • You don’t think this is a problem.
• You’re considering divorce? • You’re considering divorce.
98 Summaries (1) Three types: 1. Collecting – The bouquet: Putting it all together 2. Linking Phrases – “On the one hand...on the other” “At the same time” Ex. – “On the one hand, you’re concerned that your drinking is affecting your health. On the other, you’re not sure if you want to stop.“ 3. Transitional to the next phase – “Let me see if I have everything so far...” (at the end of one session) “Let’s review briefly where we are...” (at the beginning of the next session)
99 Summaries (2)
• Special form of reflection • Selective – facilitator chooses what to emphasize • Lets client know you’re listening • Includes: Client’s concerns about change, problem recognition, optimism, and ambivalence about change • Invite client to respond: “Have I left out anything...?”
100 CORE MI SKILLS (OARS)
Summarizing • Collecting – “a bouquet” • Linking – Connecting past and present • Transitional – Shifting from old to new.
101 “Listening Is An Act of Love”
Dave Isay (2007)
102 O.A.R.S. Coding Listen for examples of the speaker’s use of each of the O.A.R.S. responses. As you hear them, place a hash mark (/) in the appropriate row. Make notes of examples of each type of O.A.R.S. response that you heard.
Facilitator Response Count (Hash Marks) Good example(s)
Open Ended questions
Affirm
Reflect
Summary
103 Strategic Responses to Diffuse Resistance
1. Shifting focus = Move attention away from barriers. 2. Reframing = A positive interpretation to negative info. 3. Agreement w/twist = Agree with client, then add change of direction. 4. Side w/the negative = Take the “no change” side of ambivalence. 5. Personal choice = “It’s really up to you.” 6. Support self efficacy = Emphasize hope, feasibility, optimism 7. Coming Along Side = Match client’s position.
104 Types of Change Talk Self-Motivating Speech
• Disadvantages of Status Quo • Advantages of Change • Optimism for Change • Intention to Change
105 Recognizing Change Talk “DARN CaT” • What is Change Talk? • How do we know when we hear it?
We listen for and strengthen natural language expressions of change: D=Desire to Change (the “want to”) A=Ability to Change (confidence) R=Reasons to Change (argument for) N=Needs to Change (importance) C=Commitment to change (“I’ll try” – “I’ll do”) and T=Taking Steps (“I’ve done...”) 106 Change Talk
• DARN predicts commitment talk
• Commitment talk predicts change
• Taking Steps = Change is happening
107 Flow of Change Talk
Desire Commitment Ability And Change Reasons Taking Steps Need (DARN) +(CaT) = Change
108 The Six Kinds of Change Talk “DARN CaT” Change Talk (+) To Change ( ) Not to Change Desire Motivates Progress Toward Ability Action (change) Reasons
Need
Independent Commitment Predictors of Change Taking Steps 109 Relative Strengths of Commitment Language
(1) (2) (3) (4) (5) Weakest Weak Moderate Stronger Strongest I hope to I favor I look forward to I am devoted to I guarantee I will try I believe I consent to I pledge to I will I think I will I accept plan to I agree to I promise I suppose I will I aim I resolve to I am prepared to I vow I imagine I will I aspire I expect to I intend to I shall I suspect I will I am inclined I concede to I am ready to I give my word I will consider I anticipate I declare my I assure I guess I will I predict intention to I know I will I will see (about) I presume I dedicate myself
110 111 Change Questionnaire What is the change that you are considering? to ______Now answer each of the following questions about this change that you are considering. Wherever there is a blank ______, think of the change that you have written above, and then circle the one number that best describes where you are right now. For example, if you had written “get a job” on the line above, then item 1 would be “I want to get a job” and you would indicate how much you want to get a job. 1. I want to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
2. I could ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
3. There are good reasons for me to 0 1 2 3 4 5 6 7 8 9 10 ______Definitely Not Probably Not Maybe Probably Definitely
4. I have to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
5. I intend to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
6. I am trying to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely 112 7. I hope to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
8. I can ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
9. It is important for me to 0 1 2 3 4 5 6 7 8 9 10 ______Definitely Not Probably Not Maybe Probably Definitely
10. I need to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
11. I am going to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
12. I am doing things to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
William R. Miller, Theresa B. Moyers, and Paul Amrhein (2005)113 Department of Psychology, University of New Mexico, Albequerque Methods for Evoking Change Talk
1. Asking evocative questions “What worries you about this?” “What problems has this behavior created for you?” 2. Elaborating – Ask for Clarification – Ask for specific examples •In what ways…? •How much…? •What else? 3. Using the importance ruler 4. Exploring the decisional balance
114 5. Querying extremes “What’s the worst that could happen if you don’t make a change?” “What’s the best thing that could happen?”
6. Looking back – Compare past to present (Ex.) “Do you remember when things were going well? What changed?
7. Looking forward – Envision a changed future What would be better about your future?
8. Exploring goals and values •Compare current behavior with values. •Enhance discrepancy. •Use positive motivation toward goals.
115 Responding to Change Talk (1)
EARS Elaborating change talk Affirming change talk Reflecting change talk Summarizing change talk
116 Responding to Change Talk (2) (E.A.R.S.)
E – Elaborating “So you’re thinking about setting a quit date. Tell me a little more about that.” A – Affirming “I think it’s great that you’ve picked out an AA meeting to attend.” R – Reflecting “So you’ve scheduled a time to meet with a personal trainer, and you’re eager to get going.” S – Summarize “Now let me see if I have all of this, you have begun...”
117 Readiness for Phase II Work
• Decreased resistance to change. • Decreased discussion about the problem and a feeling of waiting for the next step. • A sense of resolution in which the client may seem more relaxed and unburdened about the problem. • Increased change talk. • Increased questions about change. • Greater envisioning a future that includes the changes. • Experimenting with possible change actions between sessions.
118 Two Phases of Motivation
Phase 1 Phase 2 Building Motivation Strengthening Commitment
119 Phase II Activities: Strengthening Commitment to Change (How)
1. Recapitulation (Grand Summary)
2. Ask Key Questions · Where do we go from here? · What do you want to happen? · What’s the next step · Where do you see yourself in 2 4 weeks? · What might interfere with this? · Who are your support people?
3. Provide information/Advise with permission · May I offer some possibilities/options? · Are you interested in some suggestions? · Are you open to other considerations? · Would a review of some options be helpful? · Are you looking for helpful information? 120 4. Negotiate a Change Plan · Go to Change Plan worksheet
5. End tasks: · Summary Reflection · Close the deal “Is this what you want to do?”
6. Helpful Hints · 2 Reflections/questions · We can dance or wrestle · Empathy=accurate reflection of client’s meaning · Avoid questions or comments that elicit resistance · Reduce resistance, evoke change talk · Stabilize the changes
121 MI Sandwich
STEP 1:
[10 min.] Establish Rapport
[40 min.] STEP 2: Review any previously collected objective assessment material. Collect additional information about use. STEP 3: [10 min.] Continue to use OARS
122 Summary: Motivational Interviewing •Motivation resides in the interaction •Motivation can be influenced •Clients always respond with motivation toward or away from change •Resistance informs the therapeutic relationship •Resistance can be reduced or increased •A collaborative relationship facilitates change •Clients are responsible for their progress •Ambivalence is normal •Resistance is a signal to respond differently •The provider’s and the client’s expectations affect outcome •Arguing for change creates resistance •A primary goal of MI is to help the client explore and resolve ambivalence 123 124 Change Tool Kit
1. Agenda Setting 2. Scaling Question 3. Stepping Stones to Better Health 4. Levels of Reflection Worksheet 5. OARS Coding 6. Six Kinds of DARN CaT 7. Change Questionnaire 8. Rulers 9. Planning Change 10. A Decisional Balance 11. Decisional Balance Worksheet 12. Change Plan Worksheets 13. BECCI 14. Resources 125 An Agenda-Setting Chart
126 Scaling Question Most 10 Pressing 9 8 7 6 5 4 3 2 1 Least 0 127 Pressing Stepping Stones to Better Health
Possible Obstacles: Destination 1. ______2. ______3. ______4. ______5. ______
Possible Solutions: 1. ______2. ______3. ______4. ______Starting 5. ______Place 128 Levels of Reflection Worksheet Listen for reflections the counselor makes. Write the level in the Reflection Level column. Write what the counselor actually said in the Counselor’s Words column on the line next to the level of reflection. •Level 1 – Repeat using the same words.
•Level 2 – Rephrase using similar words.
•Level 3 – Paraphrase capturing meaning and emotions. Perhaps adding something implied but not stated. Reflection Level Counselor’s Words
129 O.A.R.S. Coding
Listen for examples of the speaker’s use of each of the O.A.R.S. responses. As you hear them, place a has mark (/) in the appropriate row. Make notes of examples of each type of O.A.R.S. response that you heard.
Facilitator Response Count (Hash Marks) Good example(s)
Open Ended questions
Affirm
Reflect
Summary
130 The Six Kinds of Change Talk “DARN CaT” Change Talk (+) To Change ( ) Not to Change Desire Motivates Progress Toward Ability Action (change) Reasons
Need
Independent Commitment Predictors of Change Taking Steps 131 Change Questionnaire What is the change that you are considering? to ______Now answer each of the following questions about this change that you are considering. Wherever there is a blank ______, think of the change that you have written above, and then circle the one number that best describes where you are right now. For example, if you had written “get a job” on the line above, then item 1 would be “I want to get a job” and you would indicate how much you want to get a job. 1. I want to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
2. I could ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
3. There are good reasons for me to 0 1 2 3 4 5 6 7 8 9 10 ______Definitely Not Probably Not Maybe Probably Definitely
4. I have to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
5. I intend to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
6. I am trying to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely132 7. I hope to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
8. I can ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
9. It is important for me to 0 1 2 3 4 5 6 7 8 9 10 ______Definitely Not Probably Not Maybe Probably Definitely
10. I need to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
11. I am going to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
12. I am doing things to ______0 1 2 3 4 5 6 7 8 9 10 Definitely Not Probably Not Maybe Probably Definitely
William R. Miller, Theresa B. Moyers, and Paul Amrhein (2005)133 Department of Psychology, University of New Mexico, Albequerque Change Questionnaire William R. Miller, Theresa B. Moyers, and Paul Amrhein (2005) Department of Psychology, University of New Mexico The CQ was developed as a brief measure of six different components of motivation for change, based on psycholinguistic analyses of natural language (Amrhein, et. al., 2003). In order to complete the questionnaire, the respondent must have a particular change in mind. That change is specified at the top of the questionnaire, and the open line (______) in each item then represents that same change. It is also possible to modify the items of the CQ to specify a particular change. For example, “quit drinking” could be substituted for the open line in every item. Item 1 would then read, “I want to quit drinking.” (The instructions at the top of the questionnaire would also need to be modified.) The key word in every item is intentionally emphasized by boldface italic font in order to focus respondents on the aspect of motivation that is being queried.
Scoring Key: There are six subscales, each of which consists of two items. Each subscale score is the sum of responses to the two key items. The six subscale scores can also be summed to compute a total CQ score.
Desire Ability Reasons Need Commitment Taking Steps Total
Item 1: __ Item 2: __ Item 3: __ Item 4: __ Item 5: __ Item 6: __
Item 7: __ Item 8: __ Item 9: __ Item 10: __ Item 11: __ Item 12: __
Sum: ______
134 Amrhein, P.C., Miller, W.R., Yahne, C.E., Palmer, M., & Fulcher, L. (2003). Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology, 71, 862 878. Rulers How important is it to you to change this?
0…..1…..2…..3.….4…..5.….6…..7.…..8…..9…..10 Not at all Extremely
How confident are you that you can change this?
0…..1…..2…..3.….4…..5.….6…..7.…..8…..9…..10 No confidence Completely confident How much do you desire to change this?
0…..1…..2…..3.….4…..5.….6…..7.…..8…..9…..10 Dread changing Excited about change
135 10
A (Motivation)
0 0B 10 (Confidence) 136 Adapted from Health Behavior Change: A Guide for Practitioners by Stephen Rollnick, Pip Mason, and Chris Butler (Churchill Livingstone 1999) 186, with permission from Elsevier. Resolving Ambivalence The Decisional Balance
Costs of Status Quo Costs of Change Benefits of Change Benefits of Status Quo
137 A Decisional Balance Sheet
Continue to drink as before Abstain from alcohol Benefits Costs Benefits Costs
Helps me relax Could lose my family Less family conflict I enjoy getting high
Enjoy drinking with Bad example for my More time with my What to do about my friends children children friends? Damaging my health Feel better physically How to deal with stress? Spending too much Helps with money money problems Impairing my mental ability Might lose my job
Wasting my time/life Resistance Motivation Resistance
138 Decisional Balance Worksheet Name:______Date:______PROS AND CONS Continuing Behavior Stopping Behavior PROS (Benefits) CONS (Costs) PROS (Benefits) CONS (Costs)
Resistance Motivation Resistance 139 A Change Plan Worksheet The changes I want to make (or continue making) are:
The reasons why I want to make these changes are:
The steps I plan to take in changing are:
The ways other people can help me are:
I will know that my plan is working if:
Some things that could interfere with my plan are:
What could I do to remedy these?
What will I do if the plan isn’t working: 140 Change Plan Worksheet Outline The changes I want to make (or continue making) are: List specific areas or ways in which you want to change. Include positive goals (beginning, increasing, improving behavior) The reasons why I want to make these changes are: What are some likely consequences of action and inaction? Which motivations for change seem most important to you? The steps I plan to take in changing are: How do you plan to achieve the goals? Within the general plan, what are some specific first steps you might take? When, where, and how will these steps be taken? The ways other people can help me are: List specific ways that other people can help support you in your change attempt. How will you go about eliciting others’ support? I will know that my plan is working if: What do you hope will happen as a result of the change? What benefits can you expect from the change? Some things that could interfere with my plan are: Anticipate situations or changes that could undermine the plan. What could go wrong? How might you stick with the plan despite the changes or setbacks? What will I do if the plan isn’t working: List the changes you would make when recycling back to contemplation stage. 141 Who would you enlist to help you with these changes? A Change Plan Worksheet Example
The changes I want to make (or continue making) are: 1. Stop smoking crack. 2. Reduce my drinking. 3. Take better care of my kids. The reasons why I want to make these changes are: 1. Get out of trouble with probation – avoid dirty urines. 2. Take better care of my health. 3. Give my kids a better chance. The steps I plan to take in changing are: 1. Keep coming to group and treatment here. 2. Give urines to my P.O. every week. 3. Spend time each day focusing on my children 4. Go to my kids’ schools to meet their teachers. 5. Stop using crack, one day at a time. 6. Get a sponsor at NA. 7. Avoid hanging out with people who use. 8. Go back to church.
142 The ways other people can help me are: 1. My P.O. can encourage me when I give a clean urine. 2. My counselor can help me deal with my depression. 3. My group can help me talk about my difficulties in quitting. 4. My mom can care for my kids when I’m working or at treatment. 5. My sponsor can help me when I have a craving. I will know that my plan is working if: 1. I am not using crack. 2. I am giving clean urines. 3. I am coming to group 8 out of 10 times. 4. I am spending time each day focusing on my children and their needs. 5. I am going to NA 3 times a week. Some things that could interfere with my plan are: 1. If I get sent back to jail for a dirty urine. 2. If I don’t plan ahead for cravings and urges. 3. If I don’t stop hanging with using friends. 4. If I quit treatment. What will I do if the plan isn’t working: 1. Be honest with my counselor and my group and ask for help. 2. Make another plan that takes care of cravings/urges better. 3. Tell my P.O. I need residential treatment or more treatment. 4. Refuse to let myself feel like a failure. 143 Behavior Change Counseling Index (BECCI) BECCI is an instrument designed for trainers to score practitioners’ use of Behavior Change Counseling in consultations (either real or simulated). To use BECCI, circle a number on the scale attached to each item to indicate the degree to which the patient/practitioner has carried out the action described. Before using BECCI, please consult the accompanying manual for a detailed explanation of how to score the items. As a guide while using the instrument, each number on the scale indicates that the action was carried out: 0=Not at all; 1=Minimally; 2=To some extent; 3=A good deal; 4=A great extent The Topic: ______
Item Score 1. Practitioner invites the patient to talk about behavior change. Not applicable □ Not at all A Great Extent 0 1 2 3 4 2. Practitioner demonstrates sensitivity to talking about other issues. 0 1 2 3 4 3. Practitioner encourages patient to talk about current behavior or status quo. 0 1 2 3 4 4. Practitioner encourages patient to talk about change. 0 1 2 3 4 5. Practitioner asks questions to elicit how patient thinks and feels about the topic. 0 1 2 3 4 6. Practitioner uses empathic listening statements when the patient talks about the 0 1 2 3 4 topic. 7. Practitioner uses summaries to bring together what the patient says about the topic. 0 1 2 3 4
8. Practitioner acknowledges challenges about behavior change that the patient faces. 0 1 2 3 4
9. When practitioner provides information, it is sensitive to patient concerns and 0 1 2 3 4 understanding. Not applicable □ 10. Practitioner actively conveys respect for patient choice about behavior change. 0 1 2 3 4
11. Practitioner and patient exchange ideas about how the patient could change current 0 1 2 3 4 behavior. Not applicable □ Practitioner BECCI Score: ______Practitioner speaks for approximately: More than half the time □ About half the time □ Less than half144 the time □ (University of Wales College of Medicine, 2002) Blending SOC and MI
Tomlin and Richardson (2004)
145 Matching Motivational Tasks to the Stages of Change
Client Stage of Change Facilitator’s Motivational Tasks Precontemplation Raise doubt – increase the client’s perception of risks and problems with current behavior Contemplation Tip the balance – evoke reasons to change, risks of not changing, strengthen the client’s self efficacy for change of current behavior Preparation Provide the client with a menu of options to determine the best course of action to take in seeking change Action Assist the client in implementing the plans toward change Maintenance Facilitate a process to identify and use strategies to prevent relapse Relapse Help the client to recycle back to the processes of contemplation, determination, and action, without becoming stuck or demoralized because of relapse
146 Appropriate Motivational Strategies for Each Stage of Change
Stage Goals Interventions Pre- Help client engage in •Establish rapport, build trust. contemplation change process and •Explore and “decontaminate” the referral process. begin considering •Affirm clients for willingness to attend and talk. patterns and potential effects of the behavior •Explore the meaning of events that brought the client to treatment. in question •Elicit the client’s perceptions of their behaviors and the larger situation. •Offer factual information about the behavioral problem. •Provide personalized feedback about assessment findings. •Explore the good things and less good things about the behavior problem •Express concern and “keep the door open.” Contemplation Help client see the “big •Normalize ambivalence. picture”, discover •Help the client tip the decisional balance scales toward change by: discrepancies between –Eliciting and weighing pros and cons of continuing behavior current behavior and versus changing future goals, and consider making some –Examining the client’s personal values in relation to change lifestyle changes. –Imagining the future –Emphasizing the client’s free choice, responsibility, and self efficacy for change •Elicit self motivational statements of intent and commitment from the client. •Elicit ideas regarding the client’s expectations regarding treatment. •Summarize change talk. •Assess client’s sense of importance and confidence in changing. 147 (From Prochaska, DiClemente, & Norcross (1992), adapted by Chris Wagner) Stage Goals Interventions Preparation Help client resolve •Clarify the client’s own goals and strategies for change. ambivalence about •Develop a menu of options for change. changing, develop a •With permission, offer expertise and advice. sense of ability to change, and make •Help the client develop a change plan. initial plans for going •Help the client enlist social support. about changing. •Assist the client in decreasing barriers to change (e.g. financial, child care). •Ask client to consider announcing plan to change (“going public”) •Help client to identify and plan for high risk situations and other negative aspects of change. Action Help client initiate •Support small steps toward change. change, cope with •Acknowledge difficulties and losses involved in change. difficulties in the •Assist the client in finding new reinforcers of positive change change process, and gain social support for •Help client access and use social support. new ways of being. •Identify current triggers of behavior •Help client cope with unanticipated negative “side effects” of changing •Reframe setbacks and lapses as signs the plan needs re tuning and ultimately will help improve the long term plan. •Generate additional change strategies.
Maintenance Help client cope with •Affirm client’s resolve and self efficacy difficult situations, •Maintain contact and reaffirm appropriateness of seeking support. maintain commitment and energy, initiate new •Assist client in making the transition to working on other long term facets of living to protect goals. against behavior relapse, •Express willingness to assist client in event of setback or relapse. and process through 148 relapses that occur. Resources I. Stages of Change 1. Prochaska, J.O., Norcross, J.C., and DiClemente, C.C. (1994). Changing For Good: A Revolutionary Six Stag Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York: Avon Books, INC. 2. Prochaska, J.O., Norcross, J.C. (1994). Systems of Psychotherapy: A Transtheoretical Analysis, 3 rd ed. Pacific Grove, CA.: Brooks/Cole 3. DiClemente, C.C. and Hughes, S.O., (1990). “Stages of Change Profiles in Alcoholism Treatment.” Journal of Substance Abuse, 2, 217 235.
II. Motivational Interviewing 1. Arkowitz, H., et.al., (2008). Motivational Interviewing for the Treatment of Psychological Problems. New York, The Guilford Press 2. Enhancing Motivation for Change: Inservice Training – Based on a Treatment Improvement Protocol (TIP35). (2006) U.S. Department of Health and Human Services, (SAMHSA) Pub. # (SMA)06 4190, Rockville, MD. 3. Miller, W.R. and Rollnick, S. (2013). Motivational Interviewing: Programming People for Change, 3 rd ed. New York: The Guilford Press. 4. Miller, W.R., Zweben, A., DiClemente, C.C., &Rychtarik, R. (1992). Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence (Project MATCH Monograph Series, Vol. 2.) Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. 5. Substance Abuse and Mental Health Services Administrators, Center for Substance Abuse Treatment, U.S. Department of Health and Human Services. (2003). Enhancing Motivation for Change in Substance Abuse Treatment (TIP 35 – Publication # (SMA) 03 3811). Rockville, MD: Miller. 6. Rollnick, S.; Mason, P.; and Butler, C.; (1999) Health Behavior Change: A Guide for Practitioners . Edinburgh: Churchill Livingstone. 7. Rollnick, S., Miller, W., and Butler, C., (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, The Guilford Press. 8. Walters, S., et. al, (2007) A Guide for Probation and Parole: Motivating Offenders to Change . Washintgon,149 D.C.: National Institute of Corrections Resources (2)
III. Stages of Change and Motivational Interviewing 1. Tomlin, K., and Richardson, H. (2004). Motivational Interviewing and Stages of Change: Integrating Best Practices for Substance Abuse Professionals. Center City, Miinn: Hazelden.
IV. Additional Resources Video Training Series: Motivational Interviewing Professional Videotape Series 1998 A six tape set at $120.00 – from: University of New Mexico, Center on Alcoholism, Substance Abuse, and Addiction (CASAA) 2350 Alamo, S.E., Albuquerque, NM 87106 Websites: 1. www.motivationalinterview.org 2. www.CASAA.unm.edu 3. Addiction Technology Transfer Center – www.Nattc.org 4. Substance Abuse and Mental Health Services Administration – www.samhsa.gov *Resources on motivational interviewing, including general information, links, discussion board, training resources, and information on reprints and the latest research.
150 Evaluation Form MOTIVATIONAL INTERVIEWING William B. Webb, Ph.D.
(For scoring purposes: Strongly Agree=4, Agree=3, Neutral=2, Disagree=1, Strongly Disagree=0) PLEASE INDICATE YOUR AGREEMENT WITH Strongly Agree Neutral Disagree Strongly THESE STATEMENTS ABOUT THE TRAINING. Agree Disagree 1. The training was well organized.
2. The material presented is applicable to my clinical work. 3. The trainer was receptive to participant comments and questions. 4. The training enhanced my skills in this topic area. 5. I expect to use the information gained from this training to benefit my clients. 6. The trainer effectively modeled motivational interviewing behaviors. 7. Overall, how satisfied are you with your training Very Satisfied Neutral Unsatisfied Very experience? Satisfied Unsatisfied □ □ □ □ □ 8. What specific forms or skills are the most helpful in supporting you as a service provider?
9. What about the training will be difficult to apply in your daily work as a service provider?
10. How can the Trainer improve this training?
151 Thank you for completing this survey. Return your survey to the Trainer.