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
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