1. No category

MOTIVATIONAL
INTERVIEWING
AZ PROBLEM SOLVING COURTS CONFERENCE
APRIL 28, 2015
INTRODUCTIONS
•Your name and the court you
serve.
•“What I’d like to get out of
this MI intro … ”
3
MI is a conversation
ABOUT CHANGE
4
MI has a particular purpose
The purpose is to evoke and
strengthen personal motivation
for change
5
MI is
COLLABORATIVE
6
MI HONORS AUTONOMY and
self-determination
7
MI is EVOCATIVE
MI evokes the person’s own
motivations for change
8
MI uses SPECIFIC SKILLS
9
MI is
GOAL ORIENTED
10
MI attends to a specific forms of SPEECH
And attuned to and guided by particular
aspects of client language
11
MI RESPONDS TO CHANGE TALK
in specific ways
Elaboration
Affirmation
Reflection
Summary
12
MI RESPONDS TO RESISTANCE and
sustain talk in specific ways
VS
13
Change Talk
Sustain Talk
DARN CAT
DIRN CAT
Elicit
Change Talk
O
A
R
S
IQLEDGE
DEARS
Discord &
Sustain Talk
Skills
SAD-AA
SCARER
“Motivational
Interviewing is a
collaborative
conversation style for
strengthening a
person’s own
motivation and
commitment to
change.”
Miller & Rollnick (2012)
Motivational Interviewing
Spirit Measures:
Empathy
Genuineness
Egalitarianism
Acceptance / Unconditional Positive Regard
Warmth
“MI Spirit”
 Collaboration
 Evocation
 Autonomy (“It’s your choice”)
Motivational Interviewing =
Spirit + Skills + Strategy
MI Strategic Map
1. Opening
2.ENGAGING
3. FOCUSING: Establish Target Behavior
4.EVOKING: Amplify Ambivalence
Obstacles to Change
Summarize both sides
“What do you think?”
Reasons for Change
5. EVOKING and Reinforcing Change Talk
Summarize Change Talk
“What do you want to do?”
6. PLANNING: Strengthening Commitment
7. Closure
© Avani G. Dilger
EIGHT STAGES IN LEARNING MI
1.
2.
3.
4.
5.
6.
7.
8.
Overall Spirit of MI
OARS: Basic MI Skills
Recognizing Change Talk and Sustain Talk
Eliciting and Strengthening Change Talk
Rolling with Resistance
Developing a Change Plan
Consolidating Commitment
Transition and Blending
(Miller, W. & Moyers, T.)
General Principles Underlying
Motivational Interviewing
•
Develop Discrepancy
•
Express Empathy
•
Amplify Ambivalence
•
Roll With Resistance
•
Support Self-Efficacy
20
Open Questions
Summaries
Affirmations
Reflections
OPEN QUES TIONS
Op en
Clos ed
How … ?
W h a t … .?
Tell m e … .
In w h a t w a y … ..?
Is … .?
Does … .?
How m a n y … .?
W h ere … ..?
OPEN QUES TIONS
EXAMPLES
“What do you like to see change?”
“You mentioned ___. What is frustrating to you about
that?”
”What was that like for you when…?”
“Why do you think that happened?”
“What are your views about that?”
“Tell me more about …..
“What do you think you should do …?”
AFFIRMATIONS
• Ap p recia tion , u n d ers ta n d in g, a n d s u p p ort
• Ack n ow led ge effort, a ch ievem en t or h a rd s h ip
AFFIRMATIONS
• Specific
• Genuine
• Personal
• Supporting behavior change
AFFIRMATIONS
“This is hard work you’re doing”
“You did great on completing
your community service”
“You are dealing with a tough situation right now!”
“It must have taken a lot of courage to come in today
knowing you had a positive UA”
Reflections
A hypothesis about meaning
A statement of understanding
Intonation down
Short stems:
“It sounds like…”
“It seems like...”
“So you...”
“Its like...”
“You feel...”
Summaries
“Let m e s ee if I got t h is
r igh t…”
–Reflect ion
–Reflect ion
–Reflect ion
“Is th a t a b ou t r igh t? ”
“Wh er e d oes th a t lea ve
you ?”
Please write down:
Something you want to
change
Something someone else
wants you to change
DISCORD & SUSTAIN TALK SKILLS
Activity
Discord & Sustain
Talk Skills
Straight reflection
Amplified reflection
Double-sided reflection
Affirmation
Apology
Reflections
A hypothesis about meaning
A statement of understanding
Intonation down
Short stems:
“It sounds like…”
“It seems like...”
“So you...”
“Its...”
“Its like...”
“You feel...”
Reflections
Content
Feeling
Meaning
Metaphor
Amplified Reflection
In creas in g th e in ten s ity
of th e res is tan t elem en t
Double Sided Reflections
On One Hand
&
On the Other Hand
Affirmations
Diminish
defensiveness
Reflect a respectful
relationship
An Apology
acknowledges a
collaborative relationship
B a ttin g P r a c tic e
•S t r a i g h t R e fl e c t i o n
•A m p l i fi e d R e fl e c t i o n
•D o u b l e -s i d e d
R e fl e c t i o n
•A ffi r m a t i o n
STRATEGIC SKILLS
FOR DISCORD & SUSTAIN TALK
• Shifting focus
• Coming alongside
• Agreement with a twist
• Reframing
• Emphasizing autonomy
• Running head start
SHIFTING
FOCUS
COMING
ALONGSIDE
“It seems like for you the pros of using
drugs and alcohol still far outweigh the
cons. So it sounds like that you are not
ready to stay clean and sober.”
“We’ve talked about what other
people want you to do about your
drinking; let’s now talk about what you
think.”
40
Agreement with a
t
w
i
s
t
41
Reflection with a
REFRAME
Sign in a dental office –
“You don’t have to floss all your teeth
– just the ones you want to keep.”
“So _______ is so important to you,
you are willing to risk going to jail for
it?”
Response to I can’t – “So you are
worried you will fail if you tried?”
Response to I don’t care – “Wow! So
you are at a point you want other
people to decide for you?”
42
REFRAMING
• Offer new meaning to
client’s statement
• Finding the strength in a
perceived weakness or
problem
• Pointing out the risk in a
perceived strength
EMPHASIZING AUTONOMY
• “It really is your choice about what you do in this
situation”
• “No one can make you do this. The decision is yours.”
44
MI Strategic Map
1. Opening
2.ENGAGING
3. FOCUSING: Establish Target Behavior
4.EVOKING: Amplify Ambivalence
Obstacles to Change
Summarize both sides
“What do you think?”
Reasons for Change
5. EVOKING and Reinforcing Change Talk
Summarize Change Talk
“What do you want to do?”
6. PLANNING: Strengthening Commitment
7. Closure
© Avani G. Dilger
ELICIT-PROVIDE-ELICIT
• Open Question:
Would you like to hear
some feed back?
• Feedback:
Information, Concerns,
Strengths, etc.
• Open Question:
What are your thoughts
on this?
46
CHANGE TALK:
MI BECOMES MORE DIRECTIVE
Change Talk
Sustain Talk
DARN CAT
DIRN CAT
Elicit
Change Talk
IQLEDGE
O
A
R
S
DEARS
Core
Resistance
Skills
SAD
SCARED
Supporting Theories
RESEARCH ON CHANGE
TALK
Change talk
Commitment language
Behavior change
THREE PARTS OF ELICITING
CHANGE TALK
Elicitation
Recognition
Response
Desire
IQLEDGE
Ability
Elaborate
Reason
Affirm
Need
Reflect
Commitment
Summarize
Activation
Taking Steps
DRUMMING FOR CHANGE TALK
ELICITING CHANGE TALK
TECHNIQUES:
•
•
•
•
•
•
•
Importance/ Confidence Ruler
Q uerying Extremes
Looking Back / Looking Forward
Evocative Q uestions
Decisional Balance
Goals and V alues
Elaborating
52
Im portan ce/Con fiden ce Ru ler
Importance
How important is it for you right now to...? Why is it not lower?
Confidence
If you did decide to change, how confident are you that you would
succeed? O n a scale from 0 -10 ... what number would you give
yourself? What would raise your confidence?
Q u ery in g Ex trem es
Wors t cas e s cen ario
Bes t cas e s cen ario
TARGET BEHAVIOR
Look in g
Forw ard
Look in g
Back
Targ et Beh avior
EVOCATIVE OPEN QUESTION S
D es ire: “Wh a t d o y ou
w a n t t o d o a bou t t h is
beh a vior ?”
A bility : “Wh a t m a k es y ou
believe y ou ca n d o
t h is ?”
R eas on /N eed: “Wh y w ou ld y ou
wan t to m ak e
t h is ch a n g e?”
Com m itm en t: “So w h a t a r e y ou
n ow ?”
56
w illin g t o d o
Decisional Balance
Benefits to
changing
Benefits to not
changing
Consequences to
changing
Consequences
to not
changing
Elaboratin g
As k in g for a s pecific ex am ple.
As k in g for clarification .
As k in g for a des cription of th e las t tim e
th is occu rred
As k in g “Wh at els e?”
MI Strategic Map
1. Opening
2.ENGAGING
3. FOCUSING: Establish Target Behavior
4.EVOKING: Amplify Ambivalence
Obstacles to Change
Summarize both sides
“What do you think?”
Reasons for Change
5. EVOKING and Reinforcing Change Talk
Summarize Change Talk
“What do you want to do?”
6. PLANNING: Strengthening Commitment
7. Closure
© Avani G. Dilger
Implementation of MI:
61
Where do we go from here?
Implementation Issues
• Obstacles for implementing MI
•What Support do you need?
•Formats for MI Practice
•How to keep the “MI Spirit” going?
62
Practice Formats That Work!
•MI Buddy
•MI Reminders (email, cheat sheets, reminders)
•MI Practice in Teams (MI Modules)
•Training Videos & Discussions
•Audio Tapes: Coding & Coaching
MI TRAINING RESOURCES
• MI Website: www.motivationalinterview.org
• Miller, Rollnick: Motivational Interviewing, 3nd Edition
• Motivating Offenders to Change:
http://nicic.org/Downloads/PDF/Library/022253.pdf
• TIP 35:
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.61302
• Rosengren, David: Building Motivational Interviewing Skills. A
Practitioner Workbook
• Fuller, C. & Taylor, P.: A Toolkit of Motivational Skills. 2nd Ed.
• MI Training Videos (see website)
• [email protected]
Tak e Aw ay s
•My Take Away from this MI class
•My Commitment to support my MI Practice