Presentation on theme: "Motivational Interviewing and Solution Focused"— Presentation transcript:
1Motivational Interviewing and Solution Focused Centre for Coaching, Counselling and Groupwork TrainingMotivational Interviewing and Solution FocusedDr. Merav Devere | Joint Diversity | 40 Rodmell Avenue | Saltdean East Sussex | BN2 8PG |Tel: |
2Figure 1 – Adapted from Carlo C. DiClemente Addiction and Change 2003 Stages of Change ModelPre-ContemplationContemplationPreparationRelapse and RecyclingMaintenanceActionTerminationFigure 1 – Adapted from Carlo C. DiClemente Addiction and Change 2003
3Importance and confidence ruler How important is it for you to change …?How confident are you?Why not lower, why not higher?Not at all12345678910Extremely
5Motivational Interviewing (MI) Developed by Bill Miller & Steve Rollnick in the mid 80sMotivational Interviewing is a collaborative conversation style for addressing the common problem of ambivalence about change and strengthening a person’s own motivation and commitment to change.Solution Focused brief Therapy (SFBT)Developed by Steve de Shazer and Insoo Kim Berg in the mid 80sFocuses on what clients want to achieve rather than on the presenting problem and on what works rather than what’s wrong.
6Integrated model main principles Collaborative and client centred relationship – the client is the expert and director of their own journey.Strengths based - focus on strengths rather than deficits.Optimism and hope - belief that change is possible.Empathy - ability to convey an understanding of the perspective of anotherEvocation - Elicit motivation the client needs to present the arguments for change Elicit solutions; Elicit confidence and skillsResist the righting reflex - advocacy for change evokes resistance
7How well does each example fit with the model principles? ‘If you’d listened to the advise you were given and done what we suggested, you probably wouldn’t be in this mess now’‘You just need to stay out of trouble, keep your job, and pay your bills and everything will work out fine’‘I can see you are making a big effort to manage this tenancy, so what would be the most useful thing to focus on to keep things on the right track?’‘Why don’t you try joining a few local groups, get involved in the community, get yourself out of the house, it’ll do you good’
8Fundamental processes Engage – form collaborative relationshipClarify client’s goals - identify preferred future, set agenda and focusElicit and highlight client’s motivation and resourcesNegotiate action planIdentify maintenance and relapse prevention strategiesManage resistanceExchange information
9Fundamental processes - Engage The relational foundation to build trust and good working alliancePerson centred styleListen and understand dilemma (ambivalence), motivation and valuesOARS core skillsOpen ended questionsAffirmationsReflectingSummarisingLearn this first!
10Key open Questions :-‘’What in particular has prompted you to come here today?’’“What do you think you will do?”“What are you thinking of at this moment?”“What changes, if any, are you thinking about making at this point?”“What could you do first?”“What are your options?”‘’What has worked for you in the past?’’‘’How might you achieve that?’’
11Closed to Open Are you going to stick to the plan this time? Did you try talking to the teacher?So now that you are planning to get pregnant, are you going to try and lose some weight first?Have you thought about the effects your drinking is having on your kids?
12Forming reflections:1.) Make an unhelpful reactive response (get it off your chest!!)2) Form a simple reflection (stick with an aspect of the ‘visible’ content)3) Form a complex reflection (reflect your hypothesis e.g. the deeper meaning, the unspoken feelings etc)‘I’ve tried everything you people have suggested, and it’s just not working, if anything things are getting worse’‘I’ve been to those kind of self help groups before, but nobody there had problems as bad as mine’‘ I do want to be a good mum and provide the best I can for my daughter, but I’m still young and I want to let my hair down and have some fun too’
13AffirmationsAffirmations are neutral to positive complex reflections containing observations, acknowledgements and validations of clients personal qualities, strengths abilities, efforts etc.There is a very subtle, yet highly significant difference between affirming and approving.“I’ve been getting him to use the alarm on his phone to get up for school ”“You are really supporting him to take responsibility for himself”“I try not to smoke around the little ones”“ You are already taking positive steps to protect your children’s health ”
14Summaries Useful at the start of a session to set the scene from the last session, or to draw a session to a closeUsed periodically to provide feedback to theclient and to give pace to the interview.Useful way to collect up and link togetherthe main points that have beendiscussedCan illustrate progressUsed strategically to gently move clientforward in direction of change.
15Fundamental processes- Clarify client’s goals Open ended questions to identify client’s goalsWhat are your hopes in coming here?How will you know if this is useful?If coming here turns out to be a really good idea what differences will you notice in your life?The miracle question – to identify more details“Imagine that when you are asleep a miracle happens and all the difficulties that you have been having disappear. Because you are asleep you don’t know that a miracle has happened. When you wake up in the morning, what will be the first signs for you that a miracle has happened?”
16Clarify client’s goals The miracle question is expanded with relationship questions:Who else would notice that this miracle had happened?What would that person notice different about you?What would you see different about the other person if this miracle happened?And questions to establish what the person has already done/is already doing to achieve the desired changeAre there any times that you can remember that bits of the miracle already occur?
17Focusing -Agenda mapping chart.... Where to start?Cannabis?personal safety?Relationship ??Housing?future contraception?Pregnancy andBaby??
18Clarify client’s goals ScalingThe aim of scaling questions is to help clients:set small identifiable goalsmeasure progressestablish priorities for action.The client asked to scale from zero to 10,Worse Best
19Clarify client’s goals Scaling questions:Where are you now?Why not lower? Why not higher?How motivated are you?How confident are you?What would need to happen for you to move up the scale in the next few days?What do you need to do to prevent you going down the scale?What was happening at the time when you were higher/lower?What is the range to go up and down for it to still be considered a success?
20Evoking Change Talk – ‘DARN CAT’ 2 different strengths:Preparatory:DESIRE “I wish, I want”ABILITY “I can, I might, I could”REASONSNEED “I must, I ought, I need, I should”Mobilising and Implementing:COMMITMENT “I will, I promise, I plan toACTIVATION (ready, willing, able, preparing)TAKING STEPS (examples of doing in current time)
21Responding to change talk Using EARS ElaborateAffirmReflect (selective)Summarise“I really don’t want to stop smoking, but I know that I should. I have tried before and it’s really hard”You really don’t want to quitIt’s pretty clear to you that you ought to quitYou don’t think you can quit
23Elicit motivation and resources Coping questions: "I can see that things have been really difficult for you, yet I am struck by the fact that, even so, you manage to get up each morning and do everything necessary to get the kids off to school. How do you do that?" Exception seeking: “Tell me about an incident when you managed to deal with your anger better”
24Elicit motivation and resources Open ended questions to elicit confidence:If you wanted to change how would you do it?How do you manage to make sure things don’t get worse?What are you good at?What do you like doing?Confidence ruler – why not lower?If I asked your parents/children/teacher/boss/partner/friends etc. What do they like most about you, what would they say?What are you already doing?
25Fundamental processes- Elicit motivation and resources Reframing “My depression was so bad last week I could hardly get out of bed to go to the shop.” “Even though your depression was particularly bad last week you managed to get out of bed and go to the shop. How did you manage that?” “I don’t really want to be here. I don’t think you can help” “Despite your doubts you have decided to give this a go Externalisation “When does your anger/ADHD/depression get the best of you? When are you better at keeping it under control”
26Providing Information and Advice – using OARS with E-P-E Elicit – Provide – ElicitMI is not incompatible with giving advice and information. Two circumstances exist when advice can and probably should be given –a)When the client requests it - explicitb)When the client gives permission – implicitAsk permissionOffer choicesTalk about what others do
27Managing Discord Rolling with resistance skills: Reflections: You can’t help me. You don’t know what it is like.Simple reflection – “You are concerned that I won’t be able to help you”Amplified reflection – “It seems like there is no chance at all that I could help you”Double sided reflection – “From the one hand you are looking for some help. On the other hand you are not sure I can provide it.”Shifting focusReframing/affirmingEmphasising personal choice and control
28Fundamental processes- managing Resistance Working with involuntary clientStart with compliment acknowledging the client’s showing up to session. Followed by the following questions:Whose idea is it that you come here?What makes____ think you should come here?What does____ want you to be doing differently?Is this something you want? (Goal frame)If yes proceed as with a voluntary clientIf no, ask: Is there something you would like out of coming here? (Goal frame)If yes proceed as if voluntary clientIf no explore the consequences of not coming to sessions
29Fundamental processes- managing resistance Additional strategies for involuntary clients:Dyadic questions – questions referring to the client and one more person“What do you think your mom thinks of you being excluded?”Normalisation - non-judgemental acceptance and understanding“I understand how difficult this is and I really appreciate your coming here”“It is often the case when one feels depressed/anxious..”Deframing; deconstructing – a strategy that questions client’s interpretation“How do you know that to be so? What is the evidence?”Could there be another explanation? For example...”Use and tolerate silence
30Fundamental processes- Negotiate action plan Set SMART goals: Specific, Measurable, Attainable, Realistic, Time orientedIdentify obstacles and how to overcome themDiscuss what constitutes successBackground readingMiller W.R. & Rollnick S , (Third edition) Motivational Interviewing, Preparing People for Change.O’Connell B. 2005, (Second edition) Solution-Focused Therapy.Milner J.& Bateman J.,2011, Working with Children and Teenagers using Solution Focused Approaches