Using Motivational Interviewing To
Enhance Engagement
PCCYFS Annual Spring
Conference
Thursday, April 14, 2011
8:30 - 10:00
Dave Vactor
Christy Pfleger
“MI Preparation Prayer”
Guide me to be a patient companion
To listen with a heart as open as the sky
Grant me vision to see through her eyes
And eager ears to hear her story
Create a safe and open mesa on which we may walk
together
Make me a clear pool in which she may reflect
Guide me to find in her your beauty and wisdom
Knowing your desire for her to be in harmony-healthy,
loving, strong
Let me honor and respect her choosing of her own
path
And bless her to walk it freely
May I know once again that although she and I are
different
Yet there is a peaceful place where we are one
-Bill Miller, co-founder of MI, Rollnick and Miller 1995
Purpose



Provide an overview of the
process of change and basic MI
skills
Explore how to use MI skills to
effectively engage families
Learn strategies to help clients tap
into their motivation for change
So What Exactly is MI?
Definition:
 a perspective that views a client as the most
influential agent of change and aims to empower
the client to actively engage in the process of
change.


a method or approach, not a technique, that is not
based on a singular theory.
“A directive, client-centered counseling style for
eliciting behavior change by helping clients
explore and resolve ambivalence.”-Rollnick and
Miller, 1995
Rollnick and Miller 2006
Benefits of using MI

Address and move past ambivalence

Motivate towards change

Helping the decision making process

Address and decrease resistant
behaviors
History

MI was developed in 1983 by Bill Miller for use
with substance abuse clients.


Empirical data has been collected for use
of MI treatment with: drug and alcohol
abuse, smoking cessation, psychiatric
disorders, HIV related risk behaviors, diet
and exercise.
Note: These effects did not diminish
significantly over time.
Beliefs Essential to the MI
process



Person-Centered (closely linked to Rogerian
Theory)
Resistance to change and ambivalence are
natural human processes
• Lack of motivation=unresolved
ambivalence
• Negative feelings and experiences can
inhibit change
• Change occurs when it is connected to
something of importance and value
The client needs to show you the reason for
change in order to proceed successfully
(“change talk”)
“Change Talk”

What people say and how they talk about
change is important.
Defensiveness =
Confrontation =
Change
Change
Confidence and Self-Efficacy



When people and service providers
believe that change can happen, it is
more likely it will happen
Self-efficacy=hope that change can
occur
Empathy facilitates change



Positive reinforcement increases likelihood of
trying new behaviors
Sets up the collaborative relationship
“Friendly consultant” role
Approach
 Direct
persuasion is not an
effective method for
resolving ambivalence

Increases resistance behaviors,
decreases willingness for change
 The
style is generally a
quiet and eliciting one


Focus is on drawing out from the
client, and providing guidance through
questions, scaling, etc.
60/40
Approach, continued
o The counselor is directive in
helping the client to examine and
resolve ambivalence
o Readiness to change is a not a client
trait, but fluctuating product of
interpersonal interaction
• Resistance and denial are a product of the
client’s interactions with the world around
him, not a personality trait
Three Key Components
 Collaborate

Empathy, respect
 Evocation

(Draw Out)
Guided questions, reflection
 Autonomy

(Partner)
(Client stands on own)
Implements and sustains change
Identifying “Change
Talk”
 Disadvantages
 Advantages
of status quo
of change
 Optimism
 Intention
to change
What is Unique about MI?


MI is Directive
Client-Centered= focused on client’s interest
and concerns
•

MI is a method of communication
•


Do not teach new skill, alter thought patterns
or look to the past
Not something we do to, but we are with and
for clients
Change is not forced or imposed (i.e.,
through punishment, pressure, financial
gain)
The client is the expert to their situation
Wheel of Change

Motivational Interviewing and the
Trans-theoretical model to change
were developed separately but
synchronously.
•

Trans-theoretical model of change is
used to breakdown the concept of
readiness to change into stages.
The Wheel of Change was created
to to assess what MI strategies to
use for forward movement.
Prochaska, Di Clemente and Norcross, 1992
Wheel of Change

Based on self-help change, but applies to
all types of change.

Tool to help us understand where clients
are in their cycle of change.

Assists in engaging clients to help them
want to change.

Relapse is viewed as an inevitable stage
of change.
Wheel of Change
Prochaska, Di Clemente and Norcross, 1992
Stages of Change
Pre-Contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Stage 1: Pre-Contemplation
Characteristics:

No intention of changing anytime soon

Unaware that a problem exists “ignorance is bliss”

Discouraged, Rationalization, Denial, Minimization

Persons close to them are aware of problems

If a pre-contemplative person is in treatment
- normally a result of coercion by someone in their
environment. (e.g. spouse, employer, legal, agency)
Pre-Contemplation
Techniques/Strategies:
 Avoid giving advice
 Validate lack of readiness
 Clarify: decision is theirs
 Encourage self-exploration, not action
 Engage by acknowledging thoughts,
fears, feelings, concerns
 Information and feedback
 Explain and personalize the risks
Stage 2: Contemplation
Characteristics:

Ambivalence: “Sitting on the fence”

Reasons for concern more evident

Justification for lack of concern

Beginning recognition of problem

Evaluating pro’s and con’s
Contemplation
Techniques/Strategies:
 Avoid giving advice
 Create awareness of defenses
 Identify relationships that help not enable
 Increase perception of risks &
consequences
 Engage by acknowledging thoughts,
fears, feelings, concerns
 Identify and promote new positive
outcome expectations
Stage 3: Preparation
Characteristics:

Intention to change, but no specific goals

Attempts to change: “Testing the waters”

Reduction in poor choices, negative behavior

Changes have a minimal impact on their life

Temporary exit and return to precontemplation
Preparation
Techniques/Strategies:
 Identify and assist in problem
solving i.e. obstacles, barriers
 Help identify positive social support
 Validate client’s underlying skills for
behavior change
 Encourage small initial steps
 Articulate choices in client’s words
Stage 4: Action
Characteristics:
 Changes in environment to achieve
goals
 Doing things to make change
 Experience of success (may remain
here)
 Client gain sense of hope
 Combat feelings of loss, isolation,
despair
Action
Techniques/Strategies:
 Cheering on/Encouraging
 Reflecting on goals
 Bolster self-efficacy
 Pointing out long-term benefits
 Maintain focus on accomplishments
and social supports
Stage 5: Maintenance
Characteristics:
 Continued commitment to sustain
change
 Post 6 months to 5 years
 Working to prevent relapse
 New skills drawn out are practiced
Maintenance
Techniques/Strategies:
 Identify and
 Reflecting on goals
 Bolster self-efficacy
 Pointing out long-term benefits
 Maintain focus on accomplishments
and social supports
Stage 5: Relapse
Characteristics:
 Oops
 Step backward
 Slip=minor
 Off the wagon=major
 Challenge is to start again
 Use relapse as opportunity to grow
Relapse
Techniques/Strategies:
 Help prepare for expected relapse
 Avoid demorilzation
 Don’t give up
 Clarify consequences
 Liken to experience of loss
-Shock, Denial, Anger, Bargaining, Acceptance, Moving on
Using MI with the
Stages of Change
 Each
stage contains certain
helping behaviors that are
particularly constructive
 Assist in measuring/gauging
•
•
•
Readiness
Confidence
Motivation
Instead of asking “Why isn't this
person motivated?” ask “What is
this person motivated by?”
Resistance Behaviors





Arguing
Interrupting
Denying
Ignoring
Overt compliance/Covert defiance
Skills
Get Permission
 Drawing from past successes
 Scaling
 Imagine ideal future and change needed
to get there
 Extremes-worst and best possible
outcomes of change
 Scaling
Mandated Clients:
 Acknowledge mandate
 Provide choices
 Empathize with lack of choice

Principles
 Express
Empathy
 Develop
Discrepancies
 Roll
with Resistance
 Support
Self-Efficacy
How to Make it Work
o
Express empathy- reference
listening, reflective listening
o
Develop discrepancies – bring
client on board with the
importance for change by:
•
•
highlighting differences between current
behavior and personal values
Have the person argue for change
Rolling with Resistance
 Accept
it
 Respect it
 Flow with it
 “Roll with it” rather than
oppose it
Supporting Self-Efficacy
 Empowering
the client to be
the change agent
 Have confidence in client’s
ability



Be a cheerleader!!
Punctuate positives and strengths
Convey understanding
Elements of a Change Plan/
Case Plan






Goals
Reasons
Steps
Support
Obstacles
Signs of Progress
MI Skills (OARS)

Ask Open ended questions

Affirm

Reflective Listening

Summarizing
References
Baer, J.S., Garrett .S.B., Beadnell, B,Wells E.A, & Peterson
P.L., (2007). Brief Motivational Intervention With Homeless
Adolescents: Evaluating Effects on Substance Use and
Service Utilization, Psychology of Addictive Behaviors, 21,
582-586.
Burke B.L., Arkowitz. H & Menchola. M., (2003). The Efficacy
of Motivational Interviewing: A Meta-Analysis of Controlled
Clinical Trials Journal of Consulting and Clinical Psychology,
21, 843-861.
Miller, W. R., & Rollnick, S.,(1995). What is motivational
interviewing? Behavioral and Cognitive Psychotherapy, 23,
325-334.
Miller, W. R., & Rollnick, S., (2002). Motivational interviewing:
Preparing people for change (2nd ed.) New York: Guilford
Press.
Petrocellim, J.V., (2002). Process and change: counseling
with the transtheoretical model of change, Journal of
Counseling and Development, 80, 22-28.
Russell .C.R., Motivational Interviewing training for new
trainers., (2002). The Motivational Interviewing Network of
Trainers.
Wagner,C, .C,. Ingersoll. (2008). Beyond cognition:
broadening the emotional, base of motivational
Interviewing Journal of Psychotherapy. Integration and
American Psychological Association 18, 191–206.
Wiles, M. (2005). Motivational interviewing: overcoming client
resistance to change. Cross Country Education Inc.
Zuckoff, A., & Daley, D. C., (1999). Improving Treatment
Compliance: Counseling & Systems Strategies for
Substance Abuse & Dual Disorders.
Download

“MI Preparation Prayer”