Motivational Interviewing Hands on Practices · 2019-11-05 · Motivational Interviewing Hands on...
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Motivational Interviewing Hands on Practices Workshops 10/7/19 – Jacksonville 10/7/19- Orlando 10/9/19 – Ft. Lauderdale 9 a.m. – 4 p.m. Presented by: J. Tyler Harrell, MS, LPC-S, LCDC of American Addiction Centers 9:00 am – 10:30 am Section I Concepts of Motivational Interviewing 10:30 am – 10:40 am Break 10:40 am – 12:00 pm Section II Addressing Change & Resistance 12:00 pm – 1:10 pm Lunch Break 1:10 pm – 2:30 pm Section III Practicing Motivational Interviewing 2:30 pm – 2:40 pm Break 2:40 pm – 4:00 pm Section IV Applications of Motivational Interviewing
Transcript of Motivational Interviewing Hands on Practices · 2019-11-05 · Motivational Interviewing Hands on...
Motivational Interviewing Hands on Practices
Workshops 10/7/19 – Jacksonville
10/7/19- Orlando 10/9/19 – Ft. Lauderdale
9 a.m. – 4 p.m.
Presented by: J. Tyler Harrell, MS, LPC-S, LCDC of American Addiction Centers
9:00 am – 10:30 am Section I Concepts of Motivational Interviewing
10:30 am – 10:40 am Break
10:40 am – 12:00 pm Section II Addressing Change & Resistance
12:00 pm – 1:10 pm Lunch Break
1:10 pm – 2:30 pm Section III Practicing Motivational Interviewing
2:30 pm – 2:40 pm Break
2:40 pm – 4:00 pm Section IV Applications of Motivational Interviewing
10/3/2019
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February 17, 2017
Motivational Interviewing
Hands on Practices
Presented by:J. Tyler Harrell, MS, LPC-S, LCDC
This training is sponsored by Florida Alcohol and Drug Abuse
Association and State of Florida, Department of Children and Families
February 17, 2017
To improve participant’s knowledge of the practice and concepts of Motivational Interviewing.
To present evidence as to the effectiveness of Motivational Interviewing with different populations.
To understand how to apply Motivational Interviewing to different populations and different care settings.
To demonstrate knowledge of the appropriate use of Motivational Interviewing in the helping professions.
To provide reference for continued reading and educational resources around Motivational Interviewing.
LEARNING OBJECTIVES
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9:00 am –10:30 am
Section I Concepts of Motivational Interviewing
10:30 am –10:40 am
Break
10:40 am –12:00 pm
Section II Addressing Change & Resistance
12:00 pm –1:10 pm
Lunch Break
1:10 pm –2:30 pm
Section III Practicing Motivational Interviewing with Different Populations
2:30 pm –2:40 pm
Break
2:40 pm –4:00 pm
Section IV Applications of Motivational Interviewing
AGENDA
Photo courtesy American Addiction Centers
February 17, 2017
SECTION I: CONCEPTS OF MOTIVATIONAL INTERVIEWING
Section I
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EXERCISE
• Motivation: Favorite Teacher
Section I
February 17, 2017
Motivational Interviewing
is defined as an effective
and evidence-based
approach to overcoming
the ambivalence that
keeps many people from
making desired changes
in their lives (Miller &
Rollnick 2002).
CONCEPTS OF MOTIVATIONAL INTERVIEWING
Section IPhoto courtesy American Addiction Centers
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Printed under Fair Use: https://cheezburger.com/7649801216/who-has-motivation-anymore
February 17, 2017
Instead of focusing then on why a person doesn’t want to make a particular change, it is sensible to explore what the person does want.
Why isn’t this person motivated? vs For what is this person motivated?
(Miller & Rollnick, 2002)
MOTIVATION
Section IPhoto courtesy American Addiction Centers
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A common misconception by lay-people, is that people suffering from Substance Use Disorders (SUD) simply lack motivation to quit.
When faced with legal, family, medical, financial and occupational consequences a person without a SUD would undoubtedly quit.
FIREHOSE METAPHOR
This Photo by Unknown Author is licensed under CC BY-SA
Section I
February 17, 2017
It is the deeply entrenched motivation that perpetuates SUD behaviors.
How do we point that motivation in the right direction?
FIREHOSE METAPHOR
This Photo by Unknown Author is licensed under CC BY-SA
Section I
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This common phrase contains the three critical components we are looking for in the individuals we are helping…
Ready, willing and able
Section I
February 17, 2017
Does the individual have what they need to change?
Have they thought about steps that need to be taken to change?
Is the individual pessimistic about changing?
“I wish I could”
“I know it is bad but…”
ABLE…
Section I
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Is the person realistic about how hard it will be to change?
"I got this!“
Willingness implies an understanding of the importance of change.
Does the individual agree?
Are they able to see the discrepancy between the current situation and the future one after the change has been implemented?
WILLING…
Section I
February 17, 2017
One can be willing and able to change, but not ready.
“I will quit tomorrow.”
They may perceive the importance of change and feel an ability to do so, but not take necessary action.
“I want to but not now”
“Quitting smoking is important to me.”
READY…
Section I
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MOTIVATION EXPERIMENT VIDEO
Section I
Video courtesy Tyler Harrell
February 17, 2017
“The counselor need only offer three critical conditions to elicit change: accurate empathy, non-possessive warmth, genuineness.”
CARL ROGERS
Under Fair Use: https://www.thoughtco.com/carl-rogers-4588296
Section I
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Research indicates that counselor empathy can be a significant determinant in outcomes.
Counselor empathy still accounted for half of the variance in outcomes at 12 months
(Miller & Rollnick, 2002)
CARL ROGERS
Section I
Under Fair Use: https://www.thoughtco.com/carl-rogers-4588296
February 17, 2017
Ambivalence: The health and safety quiz
EXERCISE
Section I
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Printed under Fair Use: https://weheartit.com/entry/224602939
February 17, 2017
Common belief is that change is triggered by suffering.
“If things get bad enough they will change.”
Many individuals with SUD have had much suffering.
Shame, guilt, humiliation are not engines of change. They actually will immobilize the person.
This is contrary to aversion programs such as ‘Scared Straight’ or confrontational treatment scenarios.
Acceptance and empowerment create an environment that fosters change.
(Miller & Rollnick, 2002)
WHAT TRIGGERS CHANGE?
Section I
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10 Minute Break
Section I
February 17, 2017
SECTION II: ADDRESSING CHANGE AND RESISTANCE
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VIDEO
Section IIhttps://www.youtube.com/watch?v=dI_M6U615dc
How to NOT roll with resistance…
February 17, 2017
VIDEO
Section II
How To roll with resistance…
https://www.youtube.com/watch?v=WE0OMWhEbTQ
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CHANGE AND RESISTANCE
Roll with the Resistance
Section IIPhoto courtesy American Addiction Centers
February 17, 2017
TYPES OF RESISTANCE
4 types of resistance behavior:
1. Arguing2. Interrupting3. Negating4. Ignoring
Section IIPhoto courtesy American Addiction Centers
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1. Arguing
Challenging
Discounting
Hostility
RESISTANCE BEHAVIOR
Section II
February 17, 2017
When you find yourself in the role of arguing for change while the individual you are helping is voicing arguments against it, you’re in precisely the wrong role.
It is the individual who should be voicing the argument for change.
(Miller & Rollnick, 2002)
ARGUING
Section IIPhoto courtesy American Addiction Centers
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2. Interrupting
Talking over
Cutting off
RESISTANCE BEHAVIOR
Section II
February 17, 2017
3. Negating
Blaming
Disagreeing
Excusing
Claiming impunity
Pessimism
Reluctance
Unwillingness to change
RESISTANCE BEHAVIOR
Section II
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4. Ignoring
Inattention
Non-answer
No-response
Sidetracking
RESISTANCE BEHAVIOR
Section IIPhoto courtesy American Addiction Centers
February 17, 2017
Ordering, directing or commanding
Warning, cautioning, or threatening
Giving advice, making suggestions or providing solutions
Persuading with logic, arguing or lecturing
NON-LISTENING BEHAVIORS
Section II
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Telling people what they should do, moralizing
Disagreeing, judging, criticizing or blaming
Agreeing, approving or praising
Shaming, ridiculing or labeling
NON-LISTENING BEHAVIORS
Section II
February 17, 2017
Interpreting or analyzing
Reassuring, sympathizing or consoling
Questioning or probing
Withdrawing, distracting, humoring or changing the subject
NON-LISTENING BEHAVIORS
Section II
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RESISTANCE VIDEO
Motivational interviewing in brief consultations: role-play focusing on engaging,https://www.youtube.com/watch?v=bTRRNWrwRCo ; Nov. 19, 2014.
Section II
February 17, 2017
Question-Answer Trap
Trap of taking sides
Expert Trap
TRAPS TO AVOID
Section II
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Labeling Trap
Premature Focus Trap
Blaming Trap
TRAPS TO AVOID
Section II
February 17, 2017
A goal is to elicit (Four Categories of) Change Talk
Disadvantages of the status quo
Advantages of change
Optimism for change
Intention to change
(Miller & Rollnick, 2002)
4 CATEGORIES OF CHANGE TALK
Section IIPhoto courtesy American Addiction Centers
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Addressing Resistance: Three in a Row…
EXERCISE
Section II
February 17, 2017
Lunch Break
12:00 – 1:10pm
Section II
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SECTION III: PRACTICING MOTIVATIONAL INTERVIEWING
February 17, 2017
VIDEO
Section IIIhttps://www.youtube.com/watch?v=3rSt4KIaN8I
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EMPATHIC LISTENING
A fundamental skill to MI
You must have an interest and willingness to hear a person’s inner world.
Reflective listening is a key component.
Section IIISection IIPhoto courtesy American Addiction Centers
February 17, 2017
Talk less than the individual does.
Offer two or three reflections for every question that you ask.
Ask twice as many open ended questions as closed questions.
When listening empathically, most reflections you offer should be deeper, more complex reflections rather than simple repetitions.
GENERAL PRACTICE GUIDELINES
Section IIIPhoto courtesy American Addiction Centers
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The Five Early Methods of MI are essential to ‘weaving the fabric’ of the Motivational Interviewing session. They are a great place to start.
First four acronym: OARS
Fifth is evoking change talk
FIVE EARLY METHODS - OARS
Section III
February 17, 2017
O – Ask Open Ended Questions
Encouraging the client to do most of the talking, by asking open ended questions that don’t allow for short or one-word answers.
“What would you like to discuss?”
“I understand there are some concerns, tell me about those.”
FIVE EARLY METHODS - OARS
Section III
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What do you dislike about your drinking? Open
Where are you from?
Closed
Don’t you want to make something of yourself? Closed
Are you willing to come back to the office for a second visit?
Closed
What brings you here today?
Open
LETS PLAY OPEN OR CLOSED!
Section III
February 17, 2017
Do you want to separate from your spouse?
Closed
Have you ever thought about quitting smoking?
Closed
What do you want to do about your bad eating habits? Diet, exercise or something different?
Closed
What has worked for you in the past, when you were able to maintain sobriety?
Open
What date was your last drink?
Closed
LETS PLAY OPEN OR CLOSED!
Section III
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What possible long-term consequences of drinking concern you the most?
Open
Do you care about your family?
Closed
What are your biggest reasons for wanting to improve your life?
Open
Are you willing to try this until the next time you see me?
Closed
Is this an open or closed ended question?
Closed
LETS PLAY OPEN OR CLOSED!
Section III
February 17, 2017
A – Affirming Making a guess as to what the speaker means, encourages them to go on
or clarify.
Examples of non-listening behaviors:
Ordering/Directing
Warning/Threatening
Providing Solutions/Answers
Interpreting/Analyzing
FIVE EARLY METHODS - OARS
Section III
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R – Reflecting
Paraphrase often to maintain organized and reality-based interactions.
‘So I hear you saying…”
(Martino & Moyers, 2008)
FIVE EARLY METHODS - OARS
Section III
February 17, 2017
S – Summarizing Use of thermometer like scales (1-10) to prompt discussions about level of
commitment to cutting down or quitting substance misuse may help patients
talk about their level of motivation and what might raise or strengthen their
commitment to change.
(Carey, Purnine, Maisto, & & Carey, 2001)
FIVE EARLY METHODS - OARS
This Photo by Unknown Author is licensed under CC BY-NC-NDSection III
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10 Strategies for Evoking Change-Talk.
REVIEW HANDOUT
Section III
February 17, 2017
1. Ask Evocative Questions
Ask open questions, the answer to which is change talk. Thequestions used in the “Taste of MI”
Exercise offers good examples:
Why would you want to make this change? (Desire)
How might you go about it, in order to succeed? (Ability)
What are the three best reasons for you to do it? (Reasons)
How important is it for you to make this change? (Need)
So what do you think you’ll do? (Commitment)
EVOKING CHANGE TALK
Section III
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2. Ask for Elaboration
When a change talk theme emerges, ask for more detail. In what ways?
3. Ask for Examples
When a change talk theme emerges, ask for specific examples. When was the last time that happened? Give me an example. What else?
4. Look Back
Ask about a time before the current concern emerged. How were things better, different?
EVOKING CHANGE TALK
Section III
February 17, 2017
5. Look Forward
Ask what may happen if things continue as they are (status quo). If you were 100% successful in making the changes you want, what would be different?
How would you like your life to be five years from now?
6. Query Extremes
What are the worst things that might happen if you don’t make this change?
What are the best things that might happen if you do make this change?
EVOKING CHANGE TALK
Section III
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7. Use Change Rulers
Ask, “On a scale from zero to ten, how important is it to you to [target change] -where zero is not at all important, and ten is extremely important?
Follow up: And why are you at ___ and not zero?
What might happen that could move you from ____ to [higher score]?
Instead of “how important” (need), you could also ask how much you want (desire), or how confident you are (ability), or how committed are you to ____ (commitment).
Asking “how ready are you?” tends to be a bit confusing because it combines competing components of desire, ability, reasons and need.
EVOKING CHANGE TALK
Section III
February 17, 2017
8. Explore Goals and Values
Ask what the person’s guiding values are. What do they want in life? Using a values card sort can be helpful here.
If there is a “problem” behavior, ask how that behavior fits in with the person’s goals or values. Does it help realize a goal or value, interfere with it, or is it irrelevant?
9. Come Alongside
Explicitly side with the negative (status quo) side of ambivalence. Perhaps ____________ is so important to you that you won’t give it up, no matter what the cost.
EVOKING CHANGE TALK
Section III
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Coding interactions
Roles:
Therapist - Volunteer
Individual - Volunteer
Coder (Audience)
Use coding worksheet
EXERCISE
Section IIIPhoto courtesy American Addiction Centers
February 17, 2017
10 Minute Break
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SECTION IV: APPLICATIONS OF MOTIVATIONAL INTERVIEWING
Section IV
February 17, 2017
APPLICATION OF MOTIVATIONAL INTERVIEWING
Motivational Interviewing - Good Example - Alan Lyme. TheIRETAchannel , Published on Jul 18, 2013 https://www.youtube.com/watch?v=67I6g1I7Zao
Section IV
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The goal is for the individual to advocate for themselves, not the therapist to advocate for them.
Too much of this and it can sour the whole intervention.
THERAPIST ADVOCACY RESPONSES
Section IVPhoto courtesy American Addiction Centers
February 17, 2017
Arguing for Change – The therapist directly takes up the pro-change side of ambivalence on a particular issue and seeks to persuade the client to make the change.
Assuming the expert role – The counselor structures the conversation in a way that communicates that the counselor ‘has the answers.’ This includes the question answer trap of asking many closed-ended questions, as well as lecturing the client.
THERAPIST ADVOCACY RESPONSES
Section IV
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Criticizing, shaming or blaming – the counselor’s underlying intent seems to be to shock or jar the client into changing by instilling negative emotions about the status quo.
Labeling – The counselor proposes acceptance of a specific label or diagnosis to characterize or explain the client’s behavior. The focus is on what the client “is” or “has” rather than on what he or she does.
THERAPIST ADVOCACY RESPONSES
Section IV
February 17, 2017
Being in a hurry – A perceived shortness of time causes the use of forceful tactics. “If you act like you only have a few minutes, something can take all day. Whereas if you act like you have all day, it may take only a few minutes.” (ROBERTS, 1997)
Claiming preeminence – Finally, resistance is created when a counselor claims preeminence – that the counselor’s goals and perspectives override those of the individual. The “I know what is best for you” approach.
THERAPIST ADVOCACY RESPONSES
Section IV
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Concept Review: Out of a hat…
EXERCISE
February 17, 2017
Dual Diagnosis: Some modification may be necessary.
Use crisp open-ended questions and reflections
Successive organizing summaries
USE WITH DIFFERENT POPULATIONS
Section IV
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Some modification may be necessary…
Frequent paraphrasing
Metaphor to elucidate meaning in seemingly odd statements or gestures
Simple, concrete and engaging materials and methods to maximize the effectiveness of dual diagnosis MI
USE WITH DIFFERENT POPULATIONS
Section IV
February 17, 2017
AMIGOS Scale
Measures group adherence to MI principles and can assist with training.
WORKING WITH GROUPS
Section IVPhoto courtesy American Addiction Centers
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MINT – Motivational Interviewing Training Network
Miller and Rollnick
FURTHER RESOURCES FOR MI STUDY
February 17, 2017
What questions do you have?
QUESTIONS
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www.greenhousetreatment.com
Or call 1-800-Alcohol
THANK YOU!
Photo courtesy American Addiction Centers
February 17, 2017
Farbring, C. A., & Johnson, W. R. (2008). Motivational Interviewing in the Correctional System: An Attempt to Implement Motivational Interviewing in Criminal Justice. In Motivational Interviewing in the Treatment of Psychological Problems (pp. 304-323). New York: Guilford Press.
Martino, S., & Moyers, T. B. (2008). Motivational Interviewing with Dually Diagnosed Patients. In Motivational Interviewing in the Treatment of Psychological Problems (pp. 277-303). New York: Guilford Press.
Miller, W., & Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change. New York, New York: Guilford Press.
BIBLIOGRAPHY
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Christopher C. Wagner, Karen S. Ingersoll. Assessment of Motivational Interviewing Groups – Observer Scale (AMIGOS - v 1.2), September, 2017.
Motivational Interviewing Network of Trainers (MINT). https://motivationalinterviewing.org/ Accessed 8/10/2019.
Roberts, M. (1997). The Man Who Listens to Horses. New York: Random House.
UW-CTRI Quit Smoking Videos. Rolling with Resistance: How NOT to Do It. https://www.youtube.com/watch?v=dI_M6U615dc/ Mar. 18, 2014.
BIBLIOGRAPHY
February 17, 2017
Advanced Motivational Interviewing for Clinicians. Advanced Motivational Interviewing: Depression. https://www.youtube.com/watch?v=3rSt4KIaN8I; Oct. 17, 2013.
BMJ Learning. Motivational interviewing in brief consultations: role-play focusing on engaging, https://www.youtube.com/watch?v=bTRRNWrwRCo ; Nov. 19, 2014.
TheIRETAchannel. Motivational Interviewing - Good Example - Alan Lyme. Published on Jul 18, 2013. https://www.youtube.com/watch?v=67I6g1I7Zao
UW-CTRI Quit Smoking Videos. Rolling with Resistance: How to Do It. https://www.youtube.com/watch?v=WE0OMWhEbTQ July 10, 2017.
BIBLIOGRAPHY
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Ten Strategies for Evoking Change Talk
1. Ask Evocative QuestionsAsk open questions, the answer to which is change talk. The questions used in the “Taste of MI” exercise are good examples:
Why would you want to make this change? (Desire) How might you go about it, in order to succeed? (Ability) What are the three best reasons for you to do it? (Reasons) How important is it for you to make this change? (Need) So what do you think you’ll do? (Commitment)
2. Ask for ElaborationWhen a change talk theme emerges, ask for more detail. In what ways?
3. Ask for ExamplesWhen a change talk theme emerges, ask for specific examples. When was the last time that happened? Give me an example. What else?
4. Look BackAsk about a time before the current concern emerged. How were things better, different?
5. Look ForwardAsk what may happen if things continue as they are (status quo). If you were 100% successful in making the changes you want, what would be different? How would you like your life to be five years from now?
6. Query ExtremesWhat are the worst things that might happen if you don’t make this change? What are the best things that might happen if you do make this change?
7. Use Change RulersAsk, “On a scale from zero to ten, how important is it to you to [target change] - where zero is not at all important, and ten is extremely important? Follow up: And why are you at ___ and not zero? What might happen that could move you from ____ to [higher score]? Instead of “how important” (need), you could also ask how much you want (desire), or how confident you are that you could (ability), or how committed are you to ____ (commitment). Asking “how ready are you?” tends to be a bit confusing because it combines competing components of desire, ability, reasons and need.
8. Explore Goals and ValuesAsk what the person’s guiding values are. What do they want in life? Using a values card sort can be helpful here. If there is a “problem” behavior, ask how that behavior fits in with the person’s goals or values. Does it help realize a goal or value, interfere with it, or is it irrelevant?
9. Come AlongsideExplicitly side with the negative (status quo) side of ambivalence. Perhaps ____________ is so important to you that you won’t give it up, no matter what the cost.
This training is sponsored by Florida Alcohol and Drug Abuse Association and State of Florida,
Department of Children and Families
Hello,
Welcome to Motivational Interviewing – Hands on Practice workshop by Tyler Harrell, COO. I hope you enjoyed the workshop. I have few logistics to share with you to hopefully to answer any questions you may have on obtaining your Continuing Education Units.
Florida Behavioral Health Association/Florida Alcohol and Drug Abuse Association (FADAA) produces many webinars and workshops through the support of the Florida Department of Children and Families. To help participants track credits earned through attendance, we host an online community that provides a personalized digital journal where participants can maintain Statements of Credit for webinars and workshops taken through FADAA.
At the end of today’s workshop, you will be asked to fill out and turn in an evaluation form that is located at the back of your packet. The information, you provide FADAA as part of registering remains confidential. Statements of Credit will be posted within 20 business days after the workshop. The statement of credits will be posted in your Professional Journals for person completing the evaluation and attending the full workshop. The proof of attendance is signing in and signing out. Completing the evaluation is necessary to receive CE Credits or to access your Statement of Credit.
We will provide up to 5.5 continuing education credits for participating in today’s workshop for persons licensed through the Board of Nursing, the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling, and for persons credentialed through the Florida Certification Board.
If you are licensed healthcare practitioner, be sure to include your Florida license number(s) for reporting to CE Broker. If you are certified with the Florida Certification Board or licensed outside the state of Florida, you don’t need to provide your certification number when you register with our site.
Note please that FADAA monitors arrival and departure of attendees by signing in and signing out. We are not permitted to provide Contact Hours or a certificate of attendance if you do not attend the entire workshop. We are not permitted to provide partial credit.
If you have any questions, regarding your statement of credit, please contact Diane Perez at [email protected].
Thank you for participating in today’s workshop. We’d also like to recognize and thank especially the Florida Department of Children and Families Office of Substance Abuse and Mental Health for funding today’s education.
Have a great rest of your day, and please turn in your evaluation.
Regards,
Diane
Diane Perez Florida Behavioral Health Association
Sponsored by the Florida Alcohol and Drug Abuse Association (FADAA)
and the State of Florida, Department of Children and Families.
Workshop Title: Motivational Interviewing – Hands on Practice
Date: October 10, 2019 Location: Coconut Creek
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