Using Motivational Interviewing
with Juvenile Offenders
Joan Leary, LPC
jleary@uab.edu
May 7, 2014
National TASC Conference
Experts in Audience
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YEARS IN FIELD
POPULATION I WORK WITH
What do I know about MI? 0……………10
Glean from today’s workshop?
• DO I CONSIDER MYSELF AMENABLE OR
RESISTANT TO CHANGE?
Juvenile Arrest Rates
Frustrations with Juvenile Offenders?
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Failure to comply
“Back talk”
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Disrespect/defiance
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Tired of arguing and convincing
No follow through
“Know it alls”
Burn-out
Paperwork
Approach
• Harsh verbal discipline increases the likelihood
that teens will misbehave and exhibit
symptoms of depression.
• Teens are more likely to exhibit problem
behaviors such as anger, aggression,
vandalism and misconduct. Wang et al.
MI
• is adapted to each individual and the specific
behavioral problems that the individual
presents
• it is a collaborative effort between the
therapist/PO/case manager and the individual
to identify and forge a path to
behavioral change
using the client’s own motivations
WHO, What, When, Where?
The concept of motivational
interviewing evolved from experience
in the treatment of problem drinkers,
and was first described by Miller
(1983) in an article published in
Behavioural Psychotherapy
30 yrs later- MI has Exploded!
Definition
• A person centered, goal directed method of
communication for enhancing intrinsic
motivation to change by exploring and
resolving ambivalence.
Motivational Interviewing
• Encourages positive behavior change in
offenders
• Evidence based practice
What is Motivation?
• Process that initiates, guides and maintains
goal-oriented behaviors, which cannot be
forced
• The reason or reasons one has for acting or
behaving in a particular way
• Cannot be given to someone
• About the choices we make/don’t make
• Variable with different times/situations
Motivation is NOT a Personality
Problem or trait
• Motivation is a STATE of readiness or
eagerness to change
• It may fluctuate from one time to
another or situation
• It CAN be influenced
Client Motivation
• READY: right time to make a change
• WILLING: person themself makes a decision
• ABLE: confidence to change
How?
• Do you motivate a client to change a pattern
of destructive behavior?
• Do you help someone to stop offending and
committing anti-social acts?
• Do you motivate a client to keep
appointments, participate in programs etc?
The Nature of Our Interactions
• When your objective is to change a person’s
behavior, what style works best?
– Confrontation
– Demonstrating our power over someone
– Lecturing
– Demanding
– Cheer-leading
– Pleading
– Begging
– Bribing
– Shaming
More Effective Approach
• Helping the person to appreciate the value in
changing themselves.
• Sparking Intrinsic motivation
An Effective Style
Is NOT
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Confrontational
Blaming
Hostile
Demanding
Commanding
Wishy-washy
Non-Direct
Non-specific
Unclear
Touchy-feely
Sympathetic
Parenting
Friend
IS
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Empathic
Genuine
Honest
Supportive
Trustworthy
Solution-focused
Fair
Consistent
Contingency Based
Interested
Non-argumentative
Non-judgmental
Respectful
Helping Change Occur
• Interviewing style is a significant factor in
dropout, retention, adherence and outcomes.
• Individuals who believe they can and will change
(self-efficacy) do change.
• Officers/practitioners who believe their clients can
and will change, influence them positively to do so.
Enhance Intrinsic Motivation
• Staff should relate to offenders in
interpersonally sensitive and constructive
ways to enhance intrinsic motivation in
offenders.
• Research strongly suggests that motivational
interviewing techniques, rather than
persuasion tactics, effectively enhance
motivation for initiating and maintaining
behavior changes.
Listening Matters
What doesn’t work! - Famous programs based on
flawed theories/models
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Scared Straight – deterrence theory; “make them
fear prison.”
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Nearly every study over the past 25 years has found dismal results, many even
showing higher recidivism rates for Scared Straight participants. Has been
characterized as criminal justice malpractice.
Drug Abuse Resistance Education (DARE) – didactic
model; “kids don’t know drugs are bad for them.”
o Most studies have found neutral effects for DARE. More recent versions of DARE,
based upon cognitive-behavioral principles, have been more promising
Sheriff Joe Arpaio’s (Maricopa County Jail, Arizona) Tent
Cities and Chain Gangs – more deterrence theory; “make
them hate prison.”
o By the jail’s own admission, its recidivism rate exceeds 60 percent.
NIJ
Ambivalence
is a normal part
of considering and making change
and is
NOT pathological.
Healthcare
Where is MI Used?
Alcohol use
HIV
MD
appts
Work
Smoking
cessation
Drugs
Stress
Therapy
Corrections
Preven
tion
Medication
compliance
Weight
loss
Exercise
Nutrition
Balance
Condom
use
ART
Therapy
Teens
Why Use MI in Corrections?
• Helps to get offender to be honest/open in
assessment process
• Helps create a more engaging environment
with less defensiveness from offender
• Elicits more accurate information which aids in
determining
– Supervision levels
– Types of treatment
-Placements
Paradigm Shift
• Gone are the days of;
– Shouting insults at offenders
– Denial busting
– “Alcoholics are liars”
– Abusing addicts because it was “good for them”
– Confrontation and polarization
– 20 yrs ago a punitive, moralistic and arrogant
stance was common in U.S. treatment
Hierarchical Environment
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Corrections staff often use;
Coercive power
Authority
Dynamics which increase defensiveness and
resistance
MI
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More collaborative
More respectful
Supportive
Directive
Simpler Definitions
• 1. It’s a way of using questions and statements
strategically to help people think and talk in a
positive direction.
Simpler Definitions
• 2. It’s a way of helping people find
their OWN reasons for change.
Spirit of Motivational Interviewing
• Collaboration
• Evocation
• Autonomy
5 MI Principles
• 1. Express empathy
• 2. Develop discrepancy
• 3. Avoid argumentation
• 4. Roll with resistance
• 5. Support self efficacy
4 Fundamental Processes in MI
•1. Engaging – The Relational Foundation
•2. Focusing – The Strategic Focus
•3. Evoking – The Transition to MI
• 4. Planning – The Bridge to Change
“Changes attributed to oneself are
more likely to endure.”
Davison, Tsujimoto & Glaros, 1973
Rolling with Resistance
“Discord” ”
• Like Verbal Martial Arts
• Resistance is not challenged
• Use the client’s energy to take you where you want
to go
• Decreases the client’s tendency to play devils
advocate
Roll with Resistance/Discord
• Opposing resistance can reinforce it
• Counselor/interviewer rolls or flows with it
• Reluctance & ambivalence are acknowledged
as normal & understandable
• Interviewer invites client to consider new
information or ways of thinking about things
Righting Reflex
• Our desire to fix people and set them on a
better course
Righting reflex
Counselor
Client
Argument for the
change
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Change is important
because..
You should change…
Drinking is serious you need
to quit.
Your baby is going to be
impaired due to your drug
use.
DHR will take your kids
away..
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Argument against the
change
I don’t want/need to
change
You don’t know me…
No I shouldn’t…
I don’t have a
problem…
Yes, but…
Sustain Talk
• “Who are you to tell
me what to do?
• ” I’m not going to do
it and no one can
make me.”
• Status quo
• We blame client for
being difficult
• One side of
ambivalence
Learning is not a one-way "push" model.
“ASK”
rather
than
“TELL”
http://headrush.typepad.com/creating_passionate_users/2006/01/crash_course_in.html
Confrontation
• A confrontational and directive approach may
= more client resistance
• May lead to poorer client outcomes
• 1993, Miller study found, the more a client
was confronted the more alcohol the client
drank
• Confrontational counseling included;
challenging, disputing, refuting and sarcasm
ASSESS Offender
• URICA
• Prochaska and DiClemente’s Stages of Change
• Most change happens slowly
– Offenders may make small incremental positive
steps toward change
Stages of Change
From DOC
• Motivational Interviewing principle is
– Listening to offenders and following up on positive
aspects of their speech
– Awareness that corrections professionals can help
INCREASE an offender’s motivation
– Positive behavior changes are possible which
reduce likelihood of re-offending
Goal
• The interviewer/case manager/PO must have
a GOAL in mind;
– a GOAL of “Directed change”
• Not just talking/chatting with offender but have an
intention in helping the offender set and achieve
positive life changes
Win/Win
• Secure compliance/impose sanctions
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• Increase readiness to
change/establish a helping
relationship
=Behavior Change
=Better outcomes
Participants
• How might an increased motivation for
change from the offender
BENEFIT YOU in your job??
Considerations
• 1) offender be more involved in making life
changes
• 2) we won’t force change on the offender
• 3) we will have less burn-out
• 4) more sustained change likely when a
person makes their own decision
Motivational Interviewing is;
• NOT about forcing change
• Is about encouraging the use of selfperception
• Using open-ended questions to generate a
DESIRE for change
Scaling Ruler
1..2..3..4..5..6..7..8..9..10
How important is it for you to make a
change? How confident are you that
you are going to be able to change?
MI
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Use your acute listening skills
Careful listening
Listening for meaning
Building upon cues heard from client
MAKING REFLECTIVE STATEMENTS:
• repeat
–rephrase
–paraphrase
– or make reflective summary
statements of what the client said
Group Exercise
• Pick one speaker and one listener (switch roles)
• Pick a topic you would like to change (something you
are ambivalent about)
• Listener
– Give no advice
– Ask these questions
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1) Why would you like to make this change?
2) How might you go about it, in order to succeed?
3) What are the best reasons to do it?
4) On a scale of 1-10, how important is it to you?
5) why are you at __ and not __?
Roles
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Do we often give advice?
Do we tell the clients what to do?
Do we make suggestions?
Do we make threats?
Benefits When Using MI
• Clients feel
– Heard
– Like they are really being listened to
– Understood
– More like being open
– More safe
– More empowered
– More free to be honest
MI
• Is built on internal desire for change
• We can’t force change to happen!
• We don’t have all the answers/all of the
time
• Ex; we tell offenders they can’t leave the
county, when in actuality they can do
whatever they please, but if they make
the wrong choices they may experience
consequences.
MI Interviewing Relationship w/Offender
• Is more like a DANCE
• NOT a Wrestling match
You as a GUIDE
• A guide to motivate offender to change
• You will point out pitfalls of poor decisions
• But the offender ultimately
– Makes his/her own decisions
MI
• Changes the process
• Instead of telling the offender what to do,
• We listen for the offender to express a need
for change, and then we capitalize on it.
3 aspects of a successful MI interview
• 1) collaborative
– Not authoritative
– Is a “partnership”
– Team approach
– Example, Not- “I have what you need.”
» But- “You have what you need and I’m
going to help you find/access it.”
2.) Evocative statements are part of a successful
MI interview
• It promotes self-discovery
• Offenders see problems through their own
eyes
3.) Autonomy
What can we do?
• 1. How can we help facilitate change?
• 2. What kinds of things can we say to get
client “buy-in?”
• 3. What do we say that might encourage client
momentum towards change?
We Use MI Techniques
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Open ended questions
Listen reflectively
Develop discrepancy/dissonance
Support self-efficacy
Roll with resistance; deflection
Avoid argument, lecture, shaming, threats or
sympathizing
Video Clip
• http://nicic.gov/MotivationalInterviewing
Traps to Avoid
Traps to Avoid
1. Question-Answer Trap
– Stifles client elaboration
– Reduces collaborative effort
2. Taking Sides Trap
– The most important trap to avoid
– Arguing one side elicits the other
Traps to Avoid
3. Expert Trap
– The client is the expert on themselves
– Opinions will come later
4. Labeling Trap
– Pressure to label can lead to wrestling
– Data does not support need to accept label
Traps to Avoid
5. Pre-mature Focus Trap
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May elicit dissonance
Start where client is…
6. Blaming Trap
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Render blame irrelevant in the counseling context.
“[Counseling is not about deciding who is at fault. That’s
what judges do, but not good counselors.”
Eliciting & Responding to
Change Talk
Change Talk is the river on which we row.
What is Change Talk?
Clients are more convinced by arguments they
have presented to themselves more so than
arguments presented by others.
In MET we strive to elicit their own arguments
for change and the value in such change.
Change Talk Model (2.0)
Desire
Ability
Reason
Need
}
Commitment
DARN-C
• Desire to change:
– I want a better life.
– I would like to be happier.
– I want to stop using.
• Ability to change:
– I could do it if I decided to.
– When I put my mind to something, I don’t quit until I’m
done.
– If I could give up drinking, I could quit weed too.
DARN-C
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Reasons to change:
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I would get to see my family.
They would send me home.
I would have some money.
I’d feel a lot better.
Need to change:
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I got to get out of jail.
I need to stop hurting other people.
I have to go to group.
DARN-C
• Desire: Why would you want to make this
change?
• Ability: How would you do it if you decided?
• Reason: What are the three best reasons?
• Need: How important is it? and why?
• Commitment: What do you think you’ll do?
Decisional Balance
Benefits/Pros
Making a
Change
Not Making a
Change
Costs/Cons
Change Plan Worksheet
1. The changes I want to make (or continue making)
are:
2. The reasons why I want to make these changes
are:
3. The steps I plan to take in changing are:
4. The ways other people can help me are:
5. I will know that my plan is working if:
6. Some things that could interfere with my plan
are:
7. What I will do if the plan isn’t working:
Resources
• Impact: Motivational Interviewing, Innovation Means Prisons and
Communities Together, EU
• NAADAC.org
• NIC, “Motivational Interviewing in Corrections: A comprehensive Guide to
Implementing MI in Corrections”
• SAMHSA Gains Center, 2011 “Motivational Interviewing”
• William Miller, Motivational Interviewing,” 3rd Edition
• www.offenderchange.org/programs/motivational-interviewing
• www.buildmotivation.com
• http://aspe.hhs.gov/hsp/08/boys/FactSheets/