1. Applying Motivational Interviewing to Job Corps Students and in GROUPS Presenter: Ian Schere, PhD, MINT www.IanSchere.com

2. Objectives To learn the fundamental spirit and principles that governs the practice of MI. To conceptualize “motivation” and “resistance” from a motivational interviewing perspective. To review the format of MI group interventions to address substance abuse and co-occuring disorders

3. What is Motivation? Probability of behavior change or movement toward or against a goal. Can be Internal, External, or Both

4. Traditional Assumptions of Motivation and Change Only the client has control over motivation Person must hit “Rock Bottom” No motivation = No treatment (Ping-Pong for individuals with COD) Change is linear and static (“on-off switch”) Double Standard of Efficacy

5. What is Motivation? What ROLE do we play? In impacting our client’s MOTIVATION towards their desired goals? (If any….)

6. Taste of MI Four opened ended questions –Why would you want to make this change? –How might you go about it, in order to succeed? –What are the three best reasons to do it? –On a scale from 0-10, how important would you say it is for you to make this change? –Follow up: “And why are you a ____ and not a zero” “So what do you think you’ll do?” and just listen

7. Taste of (non) MI Directive style –Explain why the person should make the change –Give at least three specific benefits that would result from making the change –Tell the person how they could make the change –Emphasize how important it is to make the change –Persuade the person to do it –If you meet resistance, repeat the above (this is NOT motivational interviewing)

8. The Righting Reflex Sometimes our intern’s efforts to HELP their clients HINDERS them instead. Actions requires preparation “Resist the Righting Reflex”

9. Normal Human Reactions to the Righting Reflex (Teach/Direct) InvalidatedResistWithdraw Not respectedArguingDisengaged Not understoodDiscountingDisliking Not heardDefensiveInattentive AngryOppositionalPassive AshamedDenyingAvoid/leave UncomfortableDelayingNot return Unable to change Justifying

10. Normal Human Responses to a Listen/Evoke/Empathic Style AffirmedAcceptApproach UnderstoodOpenTalk more AcceptedUndefensiveLiking RespectedInterestedEngaged HeardCooperativeActivated Comfortable/safeListeningCome back Empowered Hopeful/Able to change

11. Righting Reflex Which students would prefer to work with? They’re the same students!

12. What is Motivational Interviewing? A person-centered directive method for enhancing internal motivation for change by exploring and resolving ambivalence. (Miller & Rollnick, 1991; 2002)

13. Effectiveness of MI Addictions Medication Adherence Diet & Exercise Co-Occurring Disorders Various Self-Management challenges Various age groups, demographics, cultures

14. Basic Skills for MI How do we begin? Rowboat metaphor Using our OARS created by Ian Schere Ph.D.

15. OARS Basic Skills for ”resisting the righting reflex” and expressing empathy and understanding of our clients…. Using our “OARS” –Open-ended questions –Affirmations –Reflections –Summaries

16. Our clients feel understood…What’s next? Developing discrepancy Elicit change talk

17. Developing Discrepancy Understanding Motivation –Do people fail to make important changes in their lives because the lack motivation, or have too much? (role of values)

18. What is Ambivalence? The existence of mutually opposing emotions or thoughts about a person, object, or idea. (or simply) Feeling two ways about something. All of our VALUES don’t AGREE

19. Develop Discrepancy How does AMBIVALENCE Relate to MOTIVATION?

20. Develop Discrepancy Positives things about making the change Positives things about keeping things the way they are Negative things about making the change Negative things about keeping things the way they are problem

21. Develop Discrepancy Introduce and/or empathize with ambivalence. Discuss pros and cons. Stay with the ambivalence (double sided reflections). This allows the person to free up his/her own internal resources.

22. What’s next? Our clients feel connected to both their reasons for wanting change, and the obstacles….what’s next? –Roll with resistance –Elicit change talk –Tip the scale

23. Resistance Conventional ViewMI View Person is not motivated. A signal that the provider is being perceived as “not getting it”.

24. What do you like or find rewarding about working with the students at Job Corps?

25. What is motivational interviewing? Motivational interviewing is a collaborative, goal-oriented method of communication with particular attention to the language of change. It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own arguments for change.

26. What is motivational interviewing? People tend to believe the things they say! How would the conversation differ if I asked what you “dislike or find tedious or limiting about working with Job Corps students?”

27. Change Talk What is Change Talk?

28. Change Talk vs. Sustain Talk Change Talk Advantages of Change Disadvantages of status quo Intention to change Optimism about change Sustain Talk Disadvantages of Change Advantages of status quo Intention not to change Pessimism about change

29. Develop Discrepancy Positives things about making the change “change talk” Positives things about keeping things the way they are “sustain talk” Negative things about making the change “sustain talk” Negative things about keeping things the way they are “change talk” problem

30. Change Talk Research shows that when people express “change talk”, they are significantly more likely to act on is sooner. Eliciting clients to verbalize reasons and rationales for change, increases internal motivation for that change, which results in change behaviors.

31. Responding to Change Talk: All “EARS” E: Elaborating: Asking for elaboration, more detail, in what ways, an example, etc. A: Affirming – commenting positively on the person’s statement R: Reflecting, continuing the paragraph, etc. S: Summarizing – collecting bouquets of change talk

32. Where’s the Change Talk? created by Ian Schere Ph.D. See if you can find the Change Talk in these client statements

33. Where’s the Change Talk? “I really don’t want to stop using, but I know that I should. I’ve tried before and it’s really hard.” Would you reflect: 1.You really don’t want to stop using 2.You feel like you should and have tried before 3.It’s really hard created by Ian Schere Ph.D.

34. Where’s the Change Talk? “I know the “hard stuff” is not good for me. Usually it’s just beer and wine coolers.” 1.You usually drink beer and wine 2.You know the “hard stuff” is not good for you 3.It’s hard for you to stay away from drinking created by Ian Schere Ph.D.

35. Where’s the Change Talk? “Sharing needles every once in a while is no big deal. Everybody does it.” 1.You’re not the only person who shares needles 2.It’s pretty common to share needles these days 3.Sounds like you try to limit the amount of times you share needles, just every once in a while created by Ian Schere Ph.D.

36. Where’s the Change Talk? “There’s so much drama here at Job Corps! I can’t wait to finish my trade and get out of here!” 1.The drama here on center is really bothering you. 2.You want to get out of here. 3.It’s important for you to complete your trade and move on to the next chapter of your life. created by Ian Schere Ph.D.

37. Change Talk The more frequently they talk about it? Good The more definitively they talk about it? Better The more EMPATHIC and UNDERSTOOD they perceive the person they are talking about it to? Best

38. MI Spirit The “Spirit” of MI –Collaboration (vs. Confrontation) –Evocation (drawing out, rather than imposing ideas) –Autonomy (vs. Authority) –Compassion (vs. Self-interest) created by Ian Schere Ph.D.

40. Motivational Interviewing in GROUPS Maintaining the MI spirit –Work collaboratively –Remember that individuals are the REAL experts of themselves –All the wisdom is in the room! –Group focus on empathizing and understanding each other’s struggle rather than fixing or solving each other’s problems

41. Motivational Interviewing in GROUPS Group can be arranged on either shared “change goals” –Ex. Substance abuse group, chronic care management group, smoking cessation group Or mixed groups where individuals are focusing on unique, personal change goals

42. Motivational Interviewing in GROUPS Unlike traditional psycho-educational groups where students are learning and practice new skills….. MI groups focus on the students values, opinions, and personal arguments for making desired changes –As well as exploring their strengths are resources for accomplishing their goal

43. Motivational Interviewing in GROUPS Resource: Website www.groupmiforteens.org Free MI training videos Freetalk group MI curriculum

44. Motivational Interviewing in GROUPS FREETALK- developed by Elizabeth J. D’Amico Ph.D. 6 session group MI intervention for at- risk youth with a 1 st time alcohol or drug offense. For those interested in utilizing an MI approach, this program fits nicely into the TEAP group requirements for Job Corps.

45. In Summary Remember the RULE R- Resist the Righting Reflex U- Understand you client’s motivation L- Listen to you clients E- Empower your clients

46. Motivational Interviewing Web Site www.motivationalinterview.org