1. Section 24: Motivational Interviewing IV

2. How to Use Motivational Skills in Clinical Settings (continued)

3. 3 Training objectives At the end of this workshop, you will : 1.Demonstrate 2 additional strategies to elicit change talk 2.Know a minimum of 3 situations to avoid when using motivational strategies 3.Understand clinician traps 4.Understand Gordon’s 12 roadblocks 5.Have practised “the three chairs exercise”

4. Eliciting Change Talk The Decisional Balance and The Readiness Ruler 4

5. Weighing the Decisional Balance Strategies for weighing the pros and cons… “What do you like about drinking?” “What do you see as the downside of drinking?” “What Else?” Summarize both pros and cons… “On the one hand you said.., and on the other you said….”

6. The Payoff for Asking the Questions… These questions will lead to a working treatment plan Stage of change Benefits of use Consequences of use Willingness to work on these issues

7. THE DECISIONAL BALANCE Avoid questions that inspire a yes/no answer. The good things about ______ The not- so-good things about ____ The not-so- good things about changing The good things about changing

8. Importance/Confidence/Readiness Scale On a scale of 1–10… How important is it for you to change your drinking? How confident are you that you can change your drinking? How ready are you to change your drinking? For each ask… Why didn’t you give it a lower number? What would it take to raise that number? 1 2 3 4 5 6 7 8 9 10

9. Role Play of “Rolling with Resistance” Tarek is a 24 year old who has come to you with an addiction to pain medications. He says he understands he has to completely stop his use of pain medication since it is ruining his life. However, he also smokes cannabis and he doesn’t see cannabis as a problem. He wants you to help him stop using opiates, but does not want to stop his use of cannabis. Role play a discussion using the decisional balance and the readiness ruler with Tarek regarding his cannabis use. 9

10. 10 What techniques should I avoid? Techniques to avoid when motivating clients: Confrontation / denial Closed questions Clinician traps Roadblocks to reflective listening

11. 11 Clinician Traps Question-Answer Trap Confrontation-Denial Trap Expert Trap Labeling Trap Premature-Focus Trap Blaming Trap

12. 12 Roadblocks 1 Ordering, directing, or commanding Warning or threatening Giving advice, making suggestions, providing solutions Persuading with logic, arguing, lecturing Moralising, preaching, telling them their duty Judging, criticising, disagreeing, blaming

13. 13 Roadblocks 2 Agreeing, approving, praising Shaming, ridiculing, labeling, name- calling Interpreting, analysing Reassuring, sympathising, consoling Questioning, probing Withdrawing, distracting, humouring, changing the subject.

14. 14 Some questions to ask yourself when in conversation with a client... What am I doing? Where are we going, and who’s deciding? What am I saying, and to what end? Am I actively listening? Are we dancing or wrestling?

15. 15 Activity 8: The 3 Chairs exercise Observe the activity and provide feedback. 15 minutes

16. 16 Post-assessment Please respond to the post-assessment questions in your workbook. (Your responses are strictly confidential.) 20 minutes

17. Questions? Comments? 17