THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORK COURSE NUMBER: SOWO 764.01 COURSE TITLE, SEMESTER, YEAR: Motivational Interviewing, Spring 2012 OFFICE HOURS: L. Worth Bolton, MSW, ACSW, LCAS Phone: 919-962-4371 Cell: 919-389-9224 Fax: 919-962-6562 Email: lwbolton@email.unc.edu CLASS SCHEDULE: Mondays from 2:00 – 4:50pm in Room #300. OFFICE HOURS: Mondays and Tuesdays by appointment only. COURSE DESCRIPTION: This course presents the theoretical basis of Motivational Interviewing, its basic principles and key strategies for facilitating effective discussions with persons about behavior change. COURSE OBJECTIVES: By the end of this course, students will: 1. Understand what Motivational Interviewing is and what it is not. 2. Understand the central concepts of ambivalence and discrepancy and the rationale for Motivational Interviewing in facilitating behavioral change. 3. Understand the basic components and therapeutic principles of Motivational Interviewing strategies and how they create a climate and impetus for changing behavior. 4. Be knowledgeable about the research and evidence-base underlying Motivational Interviewing particularly as it pertains to diverse clients and settings. 5. Be able to delineate the philosophy and spirit that characterize this approach as well as their relevancy to social work ethics and values. 6. Demonstrate a beginning mastery of the skills involved in Motivational Interviewing and apply them to specific behavioral and health-related challenges. 7. Identify personal challenges, areas of growth, and steps needed to continue developing Motivational Interviewing skills and using them with consistency. 8. Recognize the importance of transitioning clients from Motivational Interviewing to other therapies when indicated to facilitate continued movement by the client towards change. 2 Also upon completion students will demonstrate a beginning proficiency with: 1. Reflective listening & responding to build rapport needed to engage clients 2. Assessing readiness for change on multiple levels 3. Eliciting self-motivating statements and supporting self-efficacy 4. Helping clients establishing and maintain a “change plan” EXPANDED DESCRIPTION: Even when clients wish to make important changes in their life, e.g. stop certain behaviors, adapt a healthier life-style, and/or become compliant with a treatment regimen, making behavioral changes can be very challenging. This course is an advanced direct practice elective which introduces students to the theoretical basis of Motivational Interviewing (MI) its basic principals, philosophy and skill sets. Motivational Interviewing is a directive, client-centered, evidence-based practice modality used to help clients explore and resolve ambivalence about making needed changes. The knowledge and skills learned in this course will be applicable to a wide range of diverse kinds of settings, problems, and populations. Students will have the opportunity to learn and practice MI strategies in an in-depth manner. Each session will include a brief lecture, followed by videotapes or demonstrations and then guided student practice sessions. Students will have choices on some of the readings to insure that these assignments match their interests and settings. REQUIRED READINGS: Class handouts will be used extensively in this course and provided during class activities in advance of the classes. Motivational Interviewing Website: http://motivationalinterview.net (Students will use website as a primary resource for written assignment.) (See Course Outline, page 6) TEACHING METHODS: This course will consist of the following: (1) Brief lectures on the rationale for, theoretical underpinnings, basic principles, and intervention strategies of motivational interviewing; (2) In-person and DVD demonstrations on how to implement motivational interviewing skills; (3) Practice and demonstration skills sessions in triads or larger groups; and (4) Providing and receiving feedback to your peers. The development of a supportive learning environment, reflecting the values of the social work profession, is essential for the success of this class. A supportive learning environment is fostered by listening to the ideas and views of others, being able to understand and appreciate a point of view which is different from your own, articulating clearly your point of view, and linking experience to readings and assignments. I will appreciate your contributions to making this a safe and respectful class for learning and growth, particularly by giving honest and constructive feedback to your peers. 3 CLASS ASSIGNMENTS Progress and achievement of the course objectives will be evaluated on the following three criteria: (1) Class participation (33%) – This will be based on class attendance, thoughtful participation in class discussions, and active involvement in the skill practice sessions. All students receive 33 points and points will then be deducted for missed classes, lateness, lack of engagement/preparedness, and level of active participation in guided practice sessions. NOTE: All class handouts and articles will be 3-hole punched and you are encouraged to have a three-ring notebook as handouts will be used over several class sessions. Additional copies will not be available to you; failure to have your handouts will deduct points for lack of prep/participation. TOPIC DUE BY JANUARY 23, 2012 AT THE BEGINNING OF CLASS (2) MI and Your Interest Area (33%) In this assignment you will choose an area of MI that is reflected in the MI website above addressing the population you would most like to see/read MI-related research and other articles. In this 5 page paper you will include the following: A description of the MI-related area of practice that you chose and how this matches you social work practice interests. A discussion of what you learned that was positive or not-so-positive in your review about MI, and how this did or did not affect your early in-class experiences. You may include other assigned readings that also influenced your in thinking through this interest area; a minimum of 5 references should be reflected in your paper. These should reflect at least 2 randomized clinical trials with relevance to your topic. APRIL 27th 2012 - LAST CLASS SESSION/WRITTEN ASSIGNMENTS DUE (3) Final Exam (33%) In this final exam you will be given multiple choice questions that has dialogue between client & therapist and you will identify from a list of choices what the MI therapist did in response to what the client is saying. Example#1: The Client says; “I really have been trying to stop eating so much but it is really hard when everyone I hang out with isn’t trying to lose weight and eats anything they want.” And the Therapist says: “You’re finding out that being with your friends at meal or snack times negatively affects your ability to eat in the healthy ways you have talked about wanting to maintain.” (a) (b) (c) (d) An Affirmation A Simple Reflection An Agreement with a Twist None of the above 4 Also on this final exam you will be given matching questions that ask you to match a definition to an MI concept discussed/practiced in assigned reading and/or class sessions. Example#2: Match the correct definition to the MI technique for dealing with resistance. Simple Reflection – - Re-stating what the client has said to you to insure you have heard the client correctly. Amplified Reflection – - Adding something to increase the intensity of what the client is saying. Double-Sided Reflection – - Reflect the AMBIVALENCE that a client is thinking/feeling in responding to what they are saying. Shifting Focus – - Moving the client away from a difficult issue that is not necessary to discuss at this point in time. Reframing – - Make a change in the meaning of what the client might say. Agreement With A Twist – - Use a Reflection followed by a Reframe in responding to the client. Emphasize Personal Choice & Control – - Making sure that the client knows that the choice to change or not change a behavior is entirely up to them. Siding With The Negative – - Placing emphasis on the reasons a client may be resistive to change a thought or behavior. Example #3: List four of the “Ten Things MI Is Not” Example #4: Write short definition for each letter in the acronym “OARS”. NOTE: Any test item that is missed by 50% of the class will be deemed a poor test item and excluded from the grading process without point penalties for the class. GRADING SYSTEM H = 94-100 P = 80-93 L = 70-79 F = 69 and below 5 POLICY ON INCOMPLETES AND LATE ASSIGNMENTS I prefer not to give an incomplete grade and will give incompletes only in compliance with University policy. If an assignment is late, (not handed in class on the due date), without prior approval the grade will be reduced 10 points. The grade will continue to be reduced by 2 points for each day it continues to be late. POLICY ON ACADEMIC DISHONESTY Please refer to the APA Style Guide, The SSW Manual, and the SSW Writing Guide for information on attribution of quotes, plagiarism and appropriate use of assistance in preparing assignments. All written assignments should contain a signed pledge from you stating that, "I have not given or received unauthorized aid in preparing this written work". In keeping with the UNC Honor Code all written assignments should contain a signed pledge from you stating that; “I have not given nor received unauthorized aid in preparing/completing this written work”. Additionally, if reason exists to believe that academic dishonesty has occurred, a referral will be made to the Office of the Student Attorney General for investigation and further action as required. POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES: Students with disabilities which affect their participation in the course may notify the instructor if they wish to have special accommodations in instructional format, examination format, or other issues to be considered and addressed. 6 SoWo 764.01 Motivational Interviewing Course Outline January 9, 2012 Session 1: Course Overview and Introduction to Motivational Interviewing (MI) - Syllabus Overview and Course Schedule Class Handouts - Introductions & Student’s Practice Focus - What is the “Spirit of MI” - “The Philosophy Behind Motivational Interviewing” - “Motivational Interviewing Priciples” - “The Eight Stages of Learning Motivational Interviewing” Reading Assignments for January 23, 2012 “What is MI” Miller & Rollnick (1995) “Toward a Theory of Motivational Interviewing” Miller & Rose (2009) “What MI is Not” Miller & Rollnick (2010) (January 17, 2012 – Observance of Dr. Martin Luther King Day) January 23, 2012 Session 2: Opening Strategies – OARS - “The MI Sandwich” - Stages of Change” and MI…What is the connection? - “Self-Change Wisdom” - “Stems” - DVD Clips of Opening Strategies - Practice, Practice, Practice Class Handouts January 30, 2012 Session 3: Eliciting Self Motivating Statements - aka (“Change Talk”) Class Handout - Clients: Problem Recognition, Statements of Concern, Intention to Change, Optimism for Change - DARN – Desire, Ability, Reasons, and Need - DVD Clips of Eliciting Self-Motivational Statements - Practice, Practice, Practice February 6, 2012 Session 4: Handling Resistance Using Motivational Interviewing - Eight Ways of Responding to Clients Struggling with Change - DVD Clips of Responding to Resistance - Practice, Practice, Practice February 13, 2012 Session 5: Additional Tools for MI Practice Ruled questions on Importance, Confidence, & Readiness Review importance of Desire, Ability, Reasons, & Need 7 - Practice, Practice, Practice February 20, 2012 Session 6: Change Plans and Transitioning to Other Therapies Feedback & Information Exchange – DVD Clip Completing a Change Plan – DVD Clip Practice, Practice, Practice . February 27, 2012 Session 7: Final Exam & Class Evaluations Additional Resources for further study in Motivational Interviewing: Miller, W.R., Rollnick, S. (2002). Motivational Interviewing: preparing people for change. 2nd edition. New York, NY: Guilford Press Rollnick, S., Miller, W.R., & Butler, C.C. (2007). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press. Arkowitz, H, Westra, H, Miller, W, & Rollnick, S (Eds.). (2008). Motivational interviewing in the treatment of psychological problems. New York, NY: Guilford Press. Naar-King, S, & Suarez, M.(2010) Motivational interviewing with adolescents and young adults.: New York, NY: Guilford Press.