1. Charlotte Chapman, LPC May 7 and 8, 2009

2.  Name, program and types of clients  Expectations for the training  Review of MI Principles

3.  Code for OARS: Group Discussion

4.  Speaker: ◦ Something I am thinking about changing. Speaker talks for 10 minutes.  Listener: Practices OARS  Observer: Uses coding sheet  Switch roles and repeat

5.  Using OARS in response to resistance to change  Fishbowl exercise

6. Involves feelings, actions and behaviors of an interpersonal nature where there is ambivalence and/or a lack of collaboration.

7.  A state of mind in which a person has co-existing, but conflicting feelings, thoughts, and actions about something  Reasons People Change/Reasons People Don’t Change  The “I do, but I don’t dilemma”

8.  Ambivalence (feeling two ways about something) is a normal component of psychological problems.  Both sides seek expression.  Acknowledge and protect the side that doesn’t want to change.  MI is basically a conversation about the client’s ambivalence.

9.  Goal for processing ambivalence ◦ Identify as normal ◦ Client argues for change  Help client get unstuck  Help client make a decision  Move to change

10.  Simple reflection  Amplified reflection  Double sided reflection

11.  A good general principle is to respond to resistance with nonresistance. A simple acknowledgment of the person’s disagreement, feelings or perceptions can permit further exploration rather than continued defensiveness, thus avoiding the trap of taking sides. A reflective listening statement will often suffice for this purpose.

12.  “I just don’t want to take pills. I ought to be able to handle this on my own.”  “You don’t think that medication would work for you.”  “You don’t want to rely on a drug. It seems to you like a crutch.”

13.  Reflects back what the person has said in an amplified or exaggerated form – to state it in an even more extreme fashion. If successful, this will encourage the person to back off a bit and will elicit the other side of ambivalence.

14.  “My diabetes is not that bad, really. I know what I’m doing.”  “It may be that the freedom to eat whatever you want, whenever you want, is so important to you that you’re willing to put up with the consequences, no matter how severe.”  “Well, I don’t know if it’s that important. I don’t want to go blind or lose my feet or anything like that.”

15.  Captures both sides of ambivalence. If the person’s recent statement manifests only the resistance side of the argument, a double-sided reflection acknowledges what the client has said and adds to it the other side of his or her own ambivalence (not yours). This requires the use of material that the client has offered previously, perhaps not even in the same session.

16.  “Look, I don’t smoke any more than most of my friends. What’s wrong with having a joint now and then?”  I can see how this is confusing for you. You’ve told me how you’re concerned about your smoking and how it affects you, and it seems like you’re not using any more than your friends do. Hard to sort it out!”

17.  Examples of using these reflections

18.  Shifting focus  Reframing  Emphasizing personal choice

19.  Shifts the person’s attention away from what seems to be a stumbling block in the way of progress.  The general structure of a shifting focus response is to first defuse the initial concern and then direct attention to a more readily workable issue.

20.  “OK, the judge said that I had to come here, so tell me what I have to do.”  “I don’t know enough about you yet for us to even start talking about what it makes sense for you to do. What we need to do right now is ….”

21.  Acknowledges the validity of the person’s observations but offers a new meaning or interpretation for them.  The client’s information is recast into a new form and viewed in a new light that is more likely to be helpful and to support change.

22.  “I’ve tried so many times to change, and failed.”  “You’re very persistent, even in the face of discouragement. This change must really be important to you.”

23.  Resistance sometime arises from the phenomenon of psychological reactance. When people perceive that their freedom of choice is being threatened, they tend to react by asserting their liberty.  Probably the best antidote to this reaction is to assure the person of what is surely the truth: in the end, it is the client who determines what happens. As early assurance of this kind can diminish reactance.

24.  “The judge told me I have to come here. I don’t have any choice about it.”  “Actually you do, in several ways. You chose to come here instead of taking your chances with the judge. Also, if you find that you don’t want to come here, I can work with you and the court to find a different program for you, one you might like better.”

25.  Video  Code for strategies  Group discussion  Small group practice

26.  Role play  Group describes client profile  Everyone in the group must be willing to play this client

27.  What are the statements we want to hear clients say?  What approaches are we using that facilitate change talk?

28.  Desire to Change  Ability to Change  Reasons to Change  Need to Change  Commitment to Change

29.  Desire:  Ability:  Reasons:  Need:  Commitment: Research: Commitment language predicts behavior change

30.  Importance and Confidence Ruler  Reflections  Pros and Cons: Demonstrate  Looking back; build on any change already made  Looking forward

31.  Volunteer from group who will talk about something they want to change  Group practices OARS and eliciting change talk  Observers give feedback

32.  Rulers for importance, confidence and readiness in using MI with your clients  Implementation concerns and strategies  Feedback about the training  charlotte@chapmantraining.com **Free consultation for one year from training