Motivational Interviewing Understanding the language of change

What do you know already? What do you know or what have you already heard about Motivational Interviewing?

Motivational Interviewing is… Motivational Interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. So what does this mean?

Old Assumptions People in treatment / therapy were considered motivated if they… Agreed with the professional’s views / opinions Accepted their diagnosis Expressed a desire for help Showed distress Based on these signs, early decisions about the person’s potential for success were often made.

After 12 Months Individuals involved in the HARP study had… Higher rates of abstinence Longer spans of abstinence Fewer slips Higher rates of employment

Motivational Enhancement 15 minutes of MI utilized before beginning an assessment affects patient outcomes up to a year after treatment. Brief interventions make a difference! Patient responses are highly dependent on professional approach.

Who is Motivated?

Who is Motivated? 100% of all people are motivated all of the time.

Who is Motivated? 100% of all people are motivated all of the time. The question isn’t whether or not people are motivated, it’s what is motivating them?

MI Approach Assumptions Motivation is influenced by numerous internal and external conditions, including relationships. Ambivalence about change is normal.

MI Approach Assumptions Direct persuasion is not an affective method for resolving ambivalence. Individuals can develop solutions for problems on their own.

MI Approach Assumptions Belief in ability to change is an important source of motivation. Expectations of the clinician affect outcomes.

MI Approach Assumptions Pressure to change often evokes resistance. Think of something you want to change, need to change, or someone has said you should change. What if…

Helper’s Righting Reflex Humans have a built in desire to set things right People in helping professions are more likely to have this tendency It is important to inhibit this tendency Analogy: Turn into the skid

Brehm’s Theory on Reactance Perceived threats to personal freedom and choice will elicit behavior's designed to demonstrate and restore that freedom. When behavioral autonomy and freedom are threatened, the probability and perceived desirability of the to-be-lost behavior will increase.

Ambivalence Is not pathological Feeling two ways about something is a common human experience Is a friend and a precursor to change

Ambivalence Is a sign that something is happening The issue is that people get stuck in ambivalence The purpose of MI is to help explore and resolve ambivalence

Continuum of Readiness Not Ready Unsure Ready Behavior Specific

Ready, Willing, and Able Willing: How important a change is Able: The confidence in ability to change Ready: A matter of priorities If the change is IMPORTANT and you are CONFIDENT, you will feel more READY.

1 X Y 10 Assessing Importance How important is the change on a scale of 1 to 10? Why an X and not a 1? What would have to happen for you to go from an X to a Y?

1 X Y 10 Assessing Confidence If you did decide to change, how confident would you be that you could do it? Why an X and not a 1? What would it take… How can I help?

Practice On a scale of 1 to 10 how important would you say it is for you to change _________? Why are you at a ____ and not a (lower number)? If you decided to change, on a scale of 1 to 10 how confident are you that you could change ________?

Readiness Rulers (Behavior Specific) Importance Not Important Unsure Very Important Confidence

Simplified Motivational Categories Strategies Principles Spirit

Language as a Convention for Change

Language as a Convention for Change

The Spirit is as Important as the Tools… Autonomy Collaboration Evocation

What are You Pulling For? A + B = C

What are You Pulling For? Client’s Internal State A + B = C

What are You Pulling For? Client’s Internal State A + B = C Clinician’s Reflection Or Question

What are You Pulling For? Client’s Internal State Client’s Response A + B = C Clinician’s Reflection Or Question

What are You Pulling For? Client’s Internal State Client’s Response Think Here A + B = C Clinician’s Reflection Or Question

It’s All About Slope

Develop Discrepancy Roll with Resistance Express Empathy The Principles… Develop Discrepancy Roll with Resistance Express Empathy Support Self Efficacy

Summaries Open Ended Questions Affirmations Reflective Listening The Tools… Open Ended Questions Affirmations Reflective Listening Summaries

Some Final Thoughts Our assumptions about our patients can become self-fulfilling prophecies. Being aware of our internal dialogue about patients can help us influence outcomes. A collaborative approach with patients is predictive of success. “Therapeutic Alliance”

Some Final Thoughts Sometimes you can be effective or right, but not necessarily both. It’s okay and normal if our client’s motivation for change fluctuates frequently. Keep the destination in mind when having conversations with your clients.

Some Final Thoughts Managing conversations productively with clients is a skill that is developed over years. It’s a skill that improves with conscious practice. Increasing change talk over the course of a conversation with a client increases odds.

Questions?

The Recovery Village at Palmer Lake Thanks for Playing! Michael Hunter Executive Director The Recovery Village at Palmer Lake 719-955-1800 ext. 5001 mhunter@palmerlakerecovery.com