Motivational Interviewing PDF

Motivational Interviewing Text borrowed from Liliane Drago, MA, CASAC, MAC Outreach Training Institute Alexandra Smith, MBA, LCSW  Definition A form of collaborative conversation for strengthening a person’s own motivation for change.  Shift Th...

Motivational Interviewing Text borrowed from Liliane Drago, MA, CASAC, MAC Outreach Training Institute Alexandra Smith, MBA, LCSW  Definition A form of collaborative conversation for strengthening a person’s own motivation for change.  Shift The counselor is not responsible for changing the client’s behavior, but rather we support them in thinking and talking about their own reasons for change.  Ambivalence Most current programs address people who are already willing to try to change. – 12 steps, CBT, etc. MI addresses those who have mixed feelings about change. Ambivalence comes before change. – This is normal!  Ambivalence When you confront someone who is ambivalent about change and you address one side of the argument, they will take up the other side, very passionately! They will become defensive which is not conducive to behavior change. We want to be in synch with the client. Not fighting them for control.  Resist the “Righting Reflex” The "righting reflex" is the urge to fix someone's pain or make it go away. It stems from our discomfort with another's discomfort.  Be Present Attending skills – Listen – Eye contact – Body language – Verbals – Vocals  OARS Open-ended questions; Affirm, notice their strengths, see the motivation in what they do or are saying; Reflection, empathy, more reflections than questions; Summarize.  Empathic Reflections Response with a clear and assertive statement acknowledging… – What the client said – Make a guess at what they meant – State it back to them This is not a question  Empathic Reflections A reflection makes a guess about what the person means ( this can also be the latent content) Voice inflection goes down Examples: – So you feel… – You’re wondering if… – You’re feeling… – It sounds like you… – It seems to you that.. – So you…  Levels of Reflection “I don’t see why I have to stop smoking weed.” Simple reflection Repeating: “You don’t get why you have to stop smoking” Rephrasing: “You don’t really want to stop.” Complex reflection Paraphrasing: “You like smoking weed and don’t see anything wrong with it. Reflection of feeling: “You resent people telling you how to live your life.”  Open-Ended Questions They: – May provoke change talk – Allows for the client to fill in what they want to talk about so you know what’s on their mind. One question to 2-3 reflections  Open-Ended Questions What concerns you about your smoking? How would you like things in your life to be different? What are positive things about your drinking? What are less good things about your drinking? What will you lose if you give up…? What do you think you should do? What are some benefits of not smoking?  Affirmations Statements that recognize the person’s strengths/values Builds confidence Reduces defensiveness Builds rapport  Affirmations You’re working hard to get you life back on track. It takes a lot of discipline and hard work to stay on program all week. You care a great deal about your children and want to be a good dad. Thanks for being honest about your feelings. Your intention was good even if it didn’t turn out the way you planned.  Summaries Use at transitions in conversation, after initial engagement to set the agenda for the rest of the session, and at the end. You get to choose what to include & emphasize. Include patient’s concerns about change, problem recognition, optimism & ambivalence about change. Invite the client to respond to your summary.  Example of a Summary So let’s make sure we’re on the same page. You enjoy drinking and find it helps you relax and enjoy yourself with friends. At the same time, you don’t like the way you feel after a night of drinking and have missed getting up with your kids to get them to school on time. You’re also worried about the things you do when you’re drinking, like sleeping with men who you shouldn’t and worry about the message you’re giving your kids. You don’t want them to drink or do drugs. Did I get that right?  Include in a Summary Affirmation Summary of the ambivalence/sustain talk Summary of change talk Did I get that right?  Sustain Talk Straight reflection: “I don’t think that cocaine is really my problem.” “Your cocaine use hasn’t caused any real problems for you.” Amplified reflection: “I think things are fine the way they are now.” “There’s really no room for improvement.”  Double-Sided Reflection “You like the way coke makes you feel and at the same time you hate being broke and are afraid that your wife is going to leave if you don’t stop.” Avoid BUT, use AND Acknowledge the ambivalence State the sustain talk first and the change talk last.  Strategic Responses Emphasizing Autonomy: “I really don’t want to stop drinking” “And it’s certainly your choice. No one can make you do it.” Reframing: “My wife is always nagging me about this.” “She must really care about you.”  Strategic Responses Emphasizing Autonomy I really don’t want to stop drinking. And it’s certainly your choice, nobody can make you do it. Reframing My wife is always nagging me about this. Your wife must really care about you.  Signs of Discord Defending, blaming, minimizing, justifying Interrupting Disengagement-ignoring you, looking at the clock.  Responding to Discord How old are you? Reflection-You’re wondering if I can really help you. Amplified reflection-It seems there’s no chance at all that I could help you. Double-sided reflection-You’re looking for some help and you’re not sure if I’m the right person to provide it.  Responding to Discord Apologizing-I didn’t mean to lecture you. Affirming-Once you make your mid up about something, you can get it done. Shifting focus- Patient-Do you think I have a drinking problem? Interviewer-I don’t care about labels, what I care about is you.  Change Talk Ruler If 0 was not important and 10 was very important what number would you give yourself?  Elicit-Provide-Elicit Elicit-ask what the person wants to know Ask permission- Would it be ok if I shared some things that have worked for other people? Exploring prior knowledge- Tell me what you already know about… Asking about interest-What would you like to know about… Defense Mechanisms