Evidence – Based Practices Motivational Interviewing (MI)

History Developed by Drs. Miller & Rollnick in the early 1980s and developed into a curriculum in 1991 Evolved from experiences with treating “problem drinkers” From U.K., and implementation has slowly made it’s way to the U.S. and to the criminal justice field

A directive, client-centered counseling style for helping clients explore and resolve ambivalence about behavior change Goal directed Focused An evidence–based practice that is an alternative that staff in corrections can use to decrease resistance to change Definition

Client resistance typically is a behavior evoked by environmental conditions. The client/counselor relationship should be collaborative and friendly. Motivational Interviewing gives priority to resolving ambivalence. The counselor does not prescribe specific methods or techniques. Philosophy

Philosophy cont. Clients are responsible for their progress. MI focuses on clients' sense of self-efficacy. Philosophy cont.

8 Guiding Principles for Reducing Recidivism/Risk Risk/need – assess risk Enhance intrinsic motivation Target intervention Skill train w/directed practice Increase positive reinforcement Engage ongoing support Measure feedback Measure relevant practices

The Big 6 in Criminogenic Needs Substance abuse Criminal personality Anti-social values Dysfunctional family ties Low self-control Criminal peers

Effective Casework Model Mapping – review case file, administer assessment Finding the hook – motivation, prioritizing Moving forward – interventions, case planning Reviewing and supporting – monitoring, successes & obstacles

Benefits of MI Provides a model for the process of change Reframes “denial” as ambivalence Shows the counselors how to manage ambivalence about change Identifies client motivational structure Correlates with compliance

General Principles: DEARS Develop discrepancy Express empathy Amplify ambivalence Roll with resistance Support self–efficacy (the client is responsible for choosing and carrying out personal change) General Principles: DEARS

Open-ended questions – “tell me…, explain…, describe when…” Affirmations – “good job,” “I am proud of you” Reflective listening – “So…, “You mean…” Summarization – “What I hear you saying is…,” “Let me see if I understand…,” … “did I get that right?” Major Strategies

Traps to Avoid Question/Answer Premature Focus – you need to meet the client where they are Confrontation – “you HAVE to do this” Blaming “expert” role – “I have been a PO for 10 yrs and…” Labeling – you are just an addict Traps to Avoid

Taking sides – we need to phrase what we say as neutrally as possible Big hammer – “I’m the PO, and if you don’t do what I tell you then you are going to prison” The righting reflex – when someone comes to you with a problem, you feel the need to immediately fix it Traps to Avoid cont.

What is Change Talk?? The Desire Ability Reason Need and Commitment to change What is Change Talk??

Once you hear Change Talk, you need to … Reflect Elaborate Summarize Affirm Utilize skills like the importance/confidence scale, querying extremes, and looking back/looking forward to develop this change talk.

Resistance Talk Desire for status quo Inability to change Reason for the status quo Need for the status quo Commitment for the status quo Resistance Talk

Clinical Factors Encourage the client to be a self-investigator Encourage the client to see choices in situations and consequences of those choices Help the client define goals Promote increased hope, confidence, and positive attitude Clinical Factors

Handling Resistance Simple reflection Amplified reflection – never, will always Double-sided reflection – on the one hand… on the other hand Shifting focus – “We’ve talked about what other people say about your drinking. What do you think?” Handling Resistance

Handling Resistance cont. Coming alongside – “It sounds like the pros of smoking outweigh the cons of quitting. So maybe you will decide to never stop smoking.” Agreement with a twist – a reflection with reframing A new meaning, interpretation, perspective “My husband is always nagging me.” “It sounds like your husband really cares about you.” Handling Resistance cont.

Handling Resistance cont. Emphasizing personal choice / control – “No one can make you do this. This decision is yours.” Disclosing feelings – “I’m getting a stuck feeling as we are sitting here, and I’m wondering if you are feeling the same way?” Handling Resistance cont.

Examples http://www.youtube.com/watch?v=cj1BDPBE6W k http://www.youtube.com/watch?v=dm- rJJPCuTE http://www.youtube.com/watch?v=EJ6A7C3pc HE https://www.youtube.com/watch?v=s3MCJZ7O GRk (Great intro video) Examples

Rationalizing Reluctant Rebellious Resigned Types of Resistance

Stages of Change Pre-contemplation Contemplation Determination (Preparation) Action Maintenance Relapse Stages of Change