Advanced Practice in GroupFacilitationIntegrating Motivational Skills and StrategiesDr. Marilyn Herie PhD, RSWBrain Tumour...
Confidence Ruler
What do you most want to take away from today?• Turn to the person next to you andshare your responses• One or more key th...
Learning ObjectivesAt the end of this session, you will be able to…1. Resist the “righting reflex” in favour of “PACE”(Par...
“Group Dynamics 101”Quick Review
What is the value of groups?1. To communicate keyinformation2. To effect behaviour change3. Mutual support andempowerment
ContentProcess
Content versusProcessA person will not alwaysremember what you saidor did, but they will alwaysremember how you madethem f...
Some challenging issues…• A member monopolizes the conversation• A member discloses she is having smallseizures but has no...
Examples of Group Norms• Making sure that everyone has a voice (“Isit OK if I sometimes interrupt or redirect thegroup to ...
Some challenging issues(revisited)• A member monopolizes the conversation… Makingsure we all have a voice in this group/ M...
Stages and Tasks1. Orientation stage2. Dissatisfactionstage3. Resolution stage4. Production stage5. Termination stageBelon...
The Art of Counselling• Attending to process and content• Adapting materials to the needs of theclient and group• Elicitin...
Easier More DifficultFormat Support Psychoeducational PsychotherapeuticStructure Structured Semistructured UnstructuredCom...
Confidence Ruler
Best Practices in GroupFacilitation
2013
What is MI?Motivational interviewing is acollaborative conversation tostrengthen a person’s ownmotivation for and commitme...
Follow (Listen) Direct (Inform)Guide (Ask)
Research publications evaluating MIeffectiveness have been doubling everythree years.www.motivationalinterview.org
MI Outcome Studies by Era0204060801001988-94 1995-99 2000-02 2003-06Alcohol Drugs Dual Dx GamblingOffenders Eating Dis Adh...
MI Applications• Public health &workplace• Sexual health• Dietary change• Weight management• Voice therapy• Gambling• Phys...
Spirit of MI
http://tinyurl.com/c5gamll
The “Spirit” of MotivationalInterviewing• Partnership• Acceptance• Compassion• Evocation• Absolute worth• Accurate empathy...
Partnership“You are the best judge of what isgoing to work for you.”
Acceptance“I am here to help whatever you decide to do.”
“People are most able tochange when they feelfree not to.”- Carl Rogers
CompassionGuide me to be a patient companion,to listen with a heart as open as thesky. Grant me vision to see throughhis e...
Evocation“What were you hoping for by coming heretoday?”
“A Psychological Law”I learn what I believeas I hear myself speak.Bill Miller (Based on D. Bem, 1967, “Self-Perception: An...
EngagingFocusingEvokingPlanningFour Processes in MIAdapted from Miller and Rollnick, 2013, p. 26
Four Processes in MI1. Engaging: The relational foundation2. Focusing: Clarify directions: What is thehorizon?3. Evoking: ...
Engaging• Opening check-in• Attention to content(e.g. what peoplesay) and process(e.g. how they say it& others’responses)•...
Focusing• What are wecovering in thissession?• Therapist sessionchecklist andgroup input
Agenda-Mapping
So many choices, so little time…
Agenda-Mapping WorksheetPriorities
Agenda-Mapping WorksheetPrioritiesStrengths &SuccessesRelationships Grief & LossLoneliness/Isolation$$ IssuesSymptomsand C...
“Given these possible areas of focus,what would should we talk about in ourtime here today?”
Evoking• “I learn what Ibelieve as I hearmyself speak”
PlanningWhat is on thehorizon?What is the personworking towardschanging?
EngagingFocusingEvokingPlanningFour Processes in MIAdapted from Miller and Rollnick, 2013, p. 26
Confidence Ruler
Foundation Skills:O A R S
FOUR KEY STRATEGIES – OARSOPEN questions (to elicit client change talk)AFFIRM the client appropriately (support, emphasize...
Open Questionsalways the beautifulanswerwho asks a more beautifulquestion- e.e. cummings
Open versus Closed Questions• CLOSED questions invite a “yes/no”,one- word or very limited answer• OPEN questions encourag...
Open versus ClosedQuestionsRead the following sample questions,and “vote” for whether each one isOPEN or CLOSED
a. Open questionb. Closed question“Would you say you are looking forwardto these group sessions?”
a. Open questionb. Closed question“Would you say you are looking forwardto these group sessions?”
a. Open questionb. Closed question“Tell me some of your thoughts aboutcoming to these group sessions?”
a. Open questionb. Closed question“Tell me some of your thoughts aboutcoming to these group sessions?”
“What made you decide to sign up forthis group?”a. Open questionb. Closed question
a. Open questionb. Closed question“What made you decide to sign up forthis group?”
How severe would you rate yoursymptoms right now?a. Open questionb. Closed question
a. Open questionb. Closed questionHow severe would you rate yoursymptoms right now?
Can you describe some of theadjustments you’ve had to make?a. Open questionb. Closed question
a. Open questionb. Closed questionCan you describe some of theadjustments you’ve had to make?
If you were me…1. Formulate two open questions to aparticipant:One focused on contentOne focused on process2. Formulate tw...
When you are not sure where togo next…
“Tell me more…Tell me more…”
Affirmations
Allusions = To what has been said…• That sounds like a good idea...• I think that could work...• I think you’re right abou...
Attributions = To make someone feel noticedand “seen” as a person…• You are a bit of a philosopher really. You are reflect...
Example ofPraising:Look how faryou’ve come! Iknow you cando this.
I sure hope so...Praising canlead to…But I amactually not sosure
Example of AffirmingYou have hung in there eventhough things have been verystressful.
Affirming can lead to…Yes – I can’t believe how farI’ve comeMaybe I canreally do this!
Example ofPraising:You are such awonderful group -I have reallyenjoyed oursession.
Example of AffirmingThe group has worked hard todayin exploring some tough issues,and we have come closer as aresult of th...
Choose one of your mostchallenging groups – andcome up with an affirmationthat you could offer
Reflections
EAREYESUNDIVIDEDATTENTIONHEART“To Listen”IMPERIAL
Simple ReflectionComplex Reflection
Simple ReflectionComplex ReflectionThey are really on your caseabout coming to this group.It wasn’t your idea to cometo gr...
Practicing ReflectiveListeningIndividually, take a moment to writedown an example of a simple and acomplex reflection for ...
Practicing Reflective Listening (1)Individual Simple & Complex“I’ve been told I can’t return to myjob, and now they are ta...
Individual Simple Reflection:______________________________________________________________________Individual Complex Refl...
Individual Simple Reflection:First one thing, and then another!Individual Complex Reflection:You’re feeling like pieces of...
Individual ReflectionGroup Reflection
Individual ReflectionGroup Reflection“I’m only coming to group today because my doctor and mywife are both pressuring me.”...
Practicing Reflective Listening (2)Individual & Group Reflections“I’ve been told I can’t return to myjob, and now they are...
Individual Reflection:______________________________________________________________________Group Reflection:_____________...
Individual Reflection:You’re feeling like pieces of your life arebeing taken away, one by one.Group Reflection:These are m...
Group Simple Reflection:______________________________________________________________________Group Complex Reflection:___...
Group Simple Reflection:Everyone is experiencing major lossesand change.Group Complex Reflection:These are major losses, a...
Group Content ReflectionGroup Process Reflection
Content ReflectionProcess ReflectionWhatever your reason forcoming to group, ultimatelyeveryone would like to getsomething...
Practicing Reflective Listening (3)Group Content & Group Process“I’ve been told I can’t return to myjob, and now they are ...
Content Reflection:______________________________________________________________________Process Reflection:______________...
Content Reflection:These are major losses, and it’s hard toimagine how to cope with all of thechanges that people are expe...
Reflecting Panel
1.Three volunteers:Panel (Facilitators)
2. Four volunteers: ClientsSomething that irritates you
3. One volunteer: CoachA sounding board for the group
Reflecting Panel Instructions
Reflecting Panel Instructions1. Group: Each share one thing that you findirritating or annoying2. Panel: Take turns offeri...
Individual Reflection:Simple or complexGroup Reflection:Simple or complexGroup Content or GroupProcess Reflection
Confidence Ruler
http://tinyurl.com/ara93vh
…and the day came when the risk it tookto remain tightly closed in a bud was morepainful than the risk it took to bloom.(A...
The 5th Foundation Skill:Providing Information in aMotivational Way
“Unsolicited advice is the junkmail of life.” (Bern Williams)
The 5th Foundation Skill:Providing Information in aMotivational WayElicitProvideElicit
Elicit/Provide/Elicit• Elicit: What ideas do you (group) haveabout coping with…?• Provide: Can I offer some othersuggestio...
Mark TwainHabit is habit, and not to beflung out of the window by any[one], but coaxed down thestairs a step at a time.
Critical Issues in GroupFacilitation
A Strategy for “Taming”Skeptical/Hostile Participants:• Thank the person asking• Acknowledge their experience/commitment/w...
“I don’t really need to be here”
Here’s how we see the groupissue from our perspective:
Let’s re-imagine this issue in adifferent way
The goal is to find a way in
What are some compassionatepossibilities in how we respond?
What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflec...
“It’s all about me!”
What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflec...
“Us versus Them”
What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflec...
“I don’t know why he evenbothers coming to group”
What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflec...
“This is a really good class”
What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflec...
Basic MI ConversationalShaping Strategies• Establishing, developing, holding focus• Changing focus• Accelerating and Decel...
When you are not sure where togo next…
“Tell me more…Tell me more…”
Confidence Ruler
The main course!148
Four Group members:• Something about yourself that youwant to changeneed to changeshould changehave been thinking about ch...
Facilitator150• Listen carefully with a goal of understanding thedilemmas you hear from group members• AVOID giving advice...
Confidence Ruler
Page 10
Barriers and Enablers to Practice Change
What are your next steps?• What will you commit to doing to continue todevelop your facilitation skills? Some ideas…– Sta...
Confidence Ruler
Wrapping Up
SummaryQuick review of group dynamics andpractice implicationsOverview and practice: Resist the RightingReflex and evide...
Recommended ResourcesMartino, S., Ball, S.A., Gallon, S.L., Hall, D., Garcia, M., Ceperich, S., Farentinos, C., Hamilton,J...
EngagingFocusingEvokingPlanningMotivational Interviewing: Practice TipsMI Spirit: The Essential FoundationPartnership: You...
“When people are ready to, they change.They never do it before then, andsometimes they die before they getaround to it. Yo...
Remember to complete theWorkshop Evaluation
Thankyoumarilyn.herie@utoronto.cawww.educateria.com@MarilynHerie
If you have built castles in the air, yourwork need not be lost. That is wherethey should be. Now put thefoundation under ...
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Herie advanced groups 2013 final pub
Upcoming SlideShare
Loading in …5
×

Herie advanced groups 2013 final pub

323
-1

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
323
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Herie advanced groups 2013 final pub

  1. 1. Advanced Practice in GroupFacilitationIntegrating Motivational Skills and StrategiesDr. Marilyn Herie PhD, RSWBrain Tumour Support Group Facilitator and Convenor WorkshopApril 13, 2013Brain Tumour Foundation of Canada
  2. 2. Confidence Ruler
  3. 3. What do you most want to take away from today?• Turn to the person next to you andshare your responses• One or more key things you wouldlike to take away from this workshop?• We will check in as a large group in 5minutes
  4. 4. Learning ObjectivesAt the end of this session, you will be able to…1. Resist the “righting reflex” in favour of “PACE”(Partnership, Acceptance, Compassion, Evocation)2. Practice the foundation skills of Motivational Interviewing(Open questions, Affirmations, Reflections, Summaries,Information)3. Apply the foundation skills in shaping group conversationand engaging with challenging group members4. Adapt motivational group activities for your own groups5. Identify your preferred facilitation style, and increaseflexibility in incorporating other styles.
  5. 5. “Group Dynamics 101”Quick Review
  6. 6. What is the value of groups?1. To communicate keyinformation2. To effect behaviour change3. Mutual support andempowerment
  7. 7. ContentProcess
  8. 8. Content versusProcessA person will not alwaysremember what you saidor did, but they will alwaysremember how you madethem feel.
  9. 9. Some challenging issues…• A member monopolizes the conversation• A member discloses she is having smallseizures but has not told her doctor becauseshe wants to retain her driver’s license• A member starts to disclose childhood abuseor trauma• A member repeatedly talks about how muchhe loved injecting opioids and this is upsettingto other group members
  10. 10. Examples of Group Norms• Making sure that everyone has a voice (“Isit OK if I sometimes interrupt or redirect thegroup to keep us on track?”)• Mutual respect• Being on time• Missing a session• What this group can and cannot do• “Taboo subjects”• How we support ourselves and each otherwhen difficult feelings come up
  11. 11. Some challenging issues(revisited)• A member monopolizes the conversation… Makingsure we all have a voice in this group/ Mutualrespect and inclusion• A member discloses she is having small seizuresbut has not told her doctor because she wants toretain her driver’s license… Confidentiality & Dutyto Report• A member starts to disclose childhood abuse ortrauma… What this group can and cannot do• A member repeatedly talks about how much heloved injecting opioids and this is upsetting to othergroup members… Taboo subjects and how we talkabout/handle them
  12. 12. Stages and Tasks1. Orientation stage2. Dissatisfactionstage3. Resolution stage4. Production stage5. Termination stageBelongingFight-flightTrustConsolidation,endingInterdependence
  13. 13. The Art of Counselling• Attending to process and content• Adapting materials to the needs of theclient and group• Eliciting and integrating client feedback• An ongoing development process…
  14. 14. Easier More DifficultFormat Support Psychoeducational PsychotherapeuticStructure Structured Semistructured UnstructuredComposition Homogenous HeterogeneousSize 5 15SessionLength60 minutes 120 minutesAdmission Staggered Closed OpenWagner & Ingersoll (2013) p.103
  15. 15. Confidence Ruler
  16. 16. Best Practices in GroupFacilitation
  17. 17. 2013
  18. 18. What is MI?Motivational interviewing is acollaborative conversation tostrengthen a person’s ownmotivation for and commitment tochange.Miller & Rollnick, 2013
  19. 19. Follow (Listen) Direct (Inform)Guide (Ask)
  20. 20. Research publications evaluating MIeffectiveness have been doubling everythree years.www.motivationalinterview.org
  21. 21. MI Outcome Studies by Era0204060801001988-94 1995-99 2000-02 2003-06Alcohol Drugs Dual Dx GamblingOffenders Eating Dis Adh/Retention SmokingHIV Risk Cardiac Diabetes PsychiatricHealth Prom Family Violence AsthmaDental31Slide from Bill Miller, 2010
  22. 22. MI Applications• Public health &workplace• Sexual health• Dietary change• Weight management• Voice therapy• Gambling• Physical activity• Stroke rehab• Chronic pain• Medication adherence• Diabetes• Mental health• Addictions• Fibromyalgia• Chronic leg ulceration• Self-care• Criminal justice• Vascular risk• Domestic violenceAnstiss, 2009
  23. 23. Spirit of MI
  24. 24. http://tinyurl.com/c5gamll
  25. 25. The “Spirit” of MotivationalInterviewing• Partnership• Acceptance• Compassion• Evocation• Absolute worth• Accurate empathy• Autonomy support• Affirmation36
  26. 26. Partnership“You are the best judge of what isgoing to work for you.”
  27. 27. Acceptance“I am here to help whatever you decide to do.”
  28. 28. “People are most able tochange when they feelfree not to.”- Carl Rogers
  29. 29. CompassionGuide me to be a patient companion,to listen with a heart as open as thesky. Grant me vision to see throughhis eyes, and eager ears to hear hisstory…Let me honour and respect hischoosing of his own path.Adapted from Miller, 2013, “A Meditative Preparation” (p.24)
  30. 30. Evocation“What were you hoping for by coming heretoday?”
  31. 31. “A Psychological Law”I learn what I believeas I hear myself speak.Bill Miller (Based on D. Bem, 1967, “Self-Perception: Analternative interpretation of cognitive dissonancephenomena”)
  32. 32. EngagingFocusingEvokingPlanningFour Processes in MIAdapted from Miller and Rollnick, 2013, p. 26
  33. 33. Four Processes in MI1. Engaging: The relational foundation2. Focusing: Clarify directions: What is thehorizon?3. Evoking: The person’s own arguments forchange4. Planning: Developing commitment tochange + formulating a plan of actionMiller and Rollnick, 2013
  34. 34. Engaging• Opening check-in• Attention to content(e.g. what peoplesay) and process(e.g. how they say it& others’responses)• Openness andflexibility – whatdoes the groupwant or need?
  35. 35. Focusing• What are wecovering in thissession?• Therapist sessionchecklist andgroup input
  36. 36. Agenda-Mapping
  37. 37. So many choices, so little time…
  38. 38. Agenda-Mapping WorksheetPriorities
  39. 39. Agenda-Mapping WorksheetPrioritiesStrengths &SuccessesRelationships Grief & LossLoneliness/Isolation$$ IssuesSymptomsand Coping??? ??? ???
  40. 40. “Given these possible areas of focus,what would should we talk about in ourtime here today?”
  41. 41. Evoking• “I learn what Ibelieve as I hearmyself speak”
  42. 42. PlanningWhat is on thehorizon?What is the personworking towardschanging?
  43. 43. EngagingFocusingEvokingPlanningFour Processes in MIAdapted from Miller and Rollnick, 2013, p. 26
  44. 44. Confidence Ruler
  45. 45. Foundation Skills:O A R S
  46. 46. FOUR KEY STRATEGIES – OARSOPEN questions (to elicit client change talk)AFFIRM the client appropriately (support, emphasizepersonal control)REFLECT (try for complex reflections)SUMMARIZE ambivalence, offer double-sidedreflection
  47. 47. Open Questionsalways the beautifulanswerwho asks a more beautifulquestion- e.e. cummings
  48. 48. Open versus Closed Questions• CLOSED questions invite a “yes/no”,one- word or very limited answer• OPEN questions encourage elaboration –they evoke the group’s ideas, opinions,hopes, concerns, etc.
  49. 49. Open versus ClosedQuestionsRead the following sample questions,and “vote” for whether each one isOPEN or CLOSED
  50. 50. a. Open questionb. Closed question“Would you say you are looking forwardto these group sessions?”
  51. 51. a. Open questionb. Closed question“Would you say you are looking forwardto these group sessions?”
  52. 52. a. Open questionb. Closed question“Tell me some of your thoughts aboutcoming to these group sessions?”
  53. 53. a. Open questionb. Closed question“Tell me some of your thoughts aboutcoming to these group sessions?”
  54. 54. “What made you decide to sign up forthis group?”a. Open questionb. Closed question
  55. 55. a. Open questionb. Closed question“What made you decide to sign up forthis group?”
  56. 56. How severe would you rate yoursymptoms right now?a. Open questionb. Closed question
  57. 57. a. Open questionb. Closed questionHow severe would you rate yoursymptoms right now?
  58. 58. Can you describe some of theadjustments you’ve had to make?a. Open questionb. Closed question
  59. 59. a. Open questionb. Closed questionCan you describe some of theadjustments you’ve had to make?
  60. 60. If you were me…1. Formulate two open questions to aparticipant:One focused on contentOne focused on process2. Formulate two open questions to thegroup:One focused on contentOne focused on process
  61. 61. When you are not sure where togo next…
  62. 62. “Tell me more…Tell me more…”
  63. 63. Affirmations
  64. 64. Allusions = To what has been said…• That sounds like a good idea...• I think that could work...• I think you’re right about that...• It’s important to you to be a good parent…• I can see how that would concern you…Andréasson, Farbring, Miller & Resnicow (2002)http://www.motivationalinterviewing.org/sites/default/files/MINT9_2.pdf
  65. 65. Attributions = To make someone feel noticedand “seen” as a person…• You are a bit of a philosopher really. You are reflectingon some really deep issues here…• You are the kind of person who cares a lot for otherpeople…• You are a very creative person. It reflects a lot in yourpersonality…• You have what it takes to be a leader. Other peoplelisten to you…• You are the kind of person who does not like to talkbehind the backs of other people. You have a lot ofintegrity…Andréasson, Farbring, Miller & Resnicow (2002)http://www.motivationalinterviewing.org/sites/default/files/MINT9_2.pdf
  66. 66. Example ofPraising:Look how faryou’ve come! Iknow you cando this.
  67. 67. I sure hope so...Praising canlead to…But I amactually not sosure
  68. 68. Example of AffirmingYou have hung in there eventhough things have been verystressful.
  69. 69. Affirming can lead to…Yes – I can’t believe how farI’ve comeMaybe I canreally do this!
  70. 70. Example ofPraising:You are such awonderful group -I have reallyenjoyed oursession.
  71. 71. Example of AffirmingThe group has worked hard todayin exploring some tough issues,and we have come closer as aresult of that.
  72. 72. Choose one of your mostchallenging groups – andcome up with an affirmationthat you could offer
  73. 73. Reflections
  74. 74. EAREYESUNDIVIDEDATTENTIONHEART“To Listen”IMPERIAL
  75. 75. Simple ReflectionComplex Reflection
  76. 76. Simple ReflectionComplex ReflectionThey are really on your caseabout coming to this group.It wasn’t your idea to cometo group, and you’re notsure this is going to be at allhelpful to you.“I’m only coming to group today because my doctor and mywife are both pressuring me.”
  77. 77. Practicing ReflectiveListeningIndividually, take a moment to writedown an example of a simple and acomplex reflection for the followingstatement (coming up – next slide).Then compare what you wrote withothers at your table. As a group,choose the best examples to share withthe larger group.
  78. 78. Practicing Reflective Listening (1)Individual Simple & Complex“I’ve been told I can’t return to myjob, and now they are taking awaymy driver’s license!”
  79. 79. Individual Simple Reflection:______________________________________________________________________Individual Complex Reflection:______________________________________________________________________“I’ve been told I can’t return to my job, and now theyare taking away my driver’s license!”
  80. 80. Individual Simple Reflection:First one thing, and then another!Individual Complex Reflection:You’re feeling like pieces of your life arebeing taken away, one by one.“I’ve been told I can’t return to my job, and now theyare taking away my driver’s license!”
  81. 81. Individual ReflectionGroup Reflection
  82. 82. Individual ReflectionGroup Reflection“I’m only coming to group today because my doctor and mywife are both pressuring me.”Some people are herebecause they chose tocome, while others havebeen “mandated” to attend.It wasn’t your idea to cometo group, and you’re notsure this is going to be at allhelpful to you.
  83. 83. Practicing Reflective Listening (2)Individual & Group Reflections“I’ve been told I can’t return to myjob, and now they are taking awaymy driver’s license!”
  84. 84. Individual Reflection:______________________________________________________________________Group Reflection:______________________________________________________________________“I’ve been told I can’t return to my job, and now theyare taking away my driver’s license!”
  85. 85. Individual Reflection:You’re feeling like pieces of your life arebeing taken away, one by one.Group Reflection:These are major losses, and it’s hard toimagine how to cope with all of thechanges that people are experiencing.“I’ve been told I can’t return to my job, and now theyare taking away my driver’s license!”
  86. 86. Group Simple Reflection:______________________________________________________________________Group Complex Reflection:______________________________________________________________________“I’ve been told I can’t return to my job, and now theyare taking away my driver’s license!”
  87. 87. Group Simple Reflection:Everyone is experiencing major lossesand change.Group Complex Reflection:These are major losses, and it’s hard toimagine how to cope with all of thechanges that people are experiencing.“I’ve been told I can’t return to my job, and now theyare taking away my driver’s license!”
  88. 88. Group Content ReflectionGroup Process Reflection
  89. 89. Content ReflectionProcess ReflectionWhatever your reason forcoming to group, ultimatelyeveryone would like to getsomething of value for thetime spent here.Some people are herebecause they chose tocome, while others havebeen “mandated” to attend.“I’m only coming to group today because my doctor and mywife are both pressuring me.”
  90. 90. Practicing Reflective Listening (3)Group Content & Group Process“I’ve been told I can’t return to myjob, and now they are taking awaymy driver’s license!”
  91. 91. Content Reflection:______________________________________________________________________Process Reflection:______________________________________________________________________“I’ve been told I can’t return to my job, and now theyare taking away my driver’s license!”
  92. 92. Content Reflection:These are major losses, and it’s hard toimagine how to cope with all of thechanges that people are experiencing.Process Reflection:We’ve heard about a lot of loss in thegroup today, and it’s not always easy tohear that or talk about it and still feelhopeful.“I’ve been told I can’t return to my job, and now theyare taking away my driver’s license!”
  93. 93. Reflecting Panel
  94. 94. 1.Three volunteers:Panel (Facilitators)
  95. 95. 2. Four volunteers: ClientsSomething that irritates you
  96. 96. 3. One volunteer: CoachA sounding board for the group
  97. 97. Reflecting Panel Instructions
  98. 98. Reflecting Panel Instructions1. Group: Each share one thing that you findirritating or annoying2. Panel: Take turns offering a single reflection3. Group: After ALL Panel members are done,talk to your coach about which reflectionresonates most for you and why4. Group: Offer this feedback to the panel, andcontinue the paragraph
  99. 99. Individual Reflection:Simple or complexGroup Reflection:Simple or complexGroup Content or GroupProcess Reflection
  100. 100. Confidence Ruler
  101. 101. http://tinyurl.com/ara93vh
  102. 102. …and the day came when the risk it tookto remain tightly closed in a bud was morepainful than the risk it took to bloom.(Anais Nin)
  103. 103. The 5th Foundation Skill:Providing Information in aMotivational Way
  104. 104. “Unsolicited advice is the junkmail of life.” (Bern Williams)
  105. 105. The 5th Foundation Skill:Providing Information in aMotivational WayElicitProvideElicit
  106. 106. Elicit/Provide/Elicit• Elicit: What ideas do you (group) haveabout coping with…?• Provide: Can I offer some othersuggestions? You might consider…• Elicit: How does this fit for you(group)?
  107. 107. Mark TwainHabit is habit, and not to beflung out of the window by any[one], but coaxed down thestairs a step at a time.
  108. 108. Critical Issues in GroupFacilitation
  109. 109. A Strategy for “Taming”Skeptical/Hostile Participants:• Thank the person asking• Acknowledge their experience/commitment/willingness to take a risk• Mirror the question or comment back• Extrapolate to a broader context orprinciple• Respond to the question or comment• See what others think and check backTAMERS
  110. 110. “I don’t really need to be here”
  111. 111. Here’s how we see the groupissue from our perspective:
  112. 112. Let’s re-imagine this issue in adifferent way
  113. 113. The goal is to find a way in
  114. 114. What are some compassionatepossibilities in how we respond?
  115. 115. What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflectionGroup content reflectionGroup process reflection
  116. 116. “It’s all about me!”
  117. 117. What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflectionGroup content reflectionGroup process reflection
  118. 118. “Us versus Them”
  119. 119. What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflectionGroup content reflectionGroup process reflection
  120. 120. “I don’t know why he evenbothers coming to group”
  121. 121. What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflectionGroup content reflectionGroup process reflection
  122. 122. “This is a really good class”
  123. 123. What strategy could you use?• Open question• Affirmation• ReflectionIndividual content reflectionIndividual process reflectionGroup content reflectionGroup process reflection
  124. 124. Basic MI ConversationalShaping Strategies• Establishing, developing, holding focus• Changing focus• Accelerating and Decelerating• Broadening and Narrowing• Deepening and Lightening
  125. 125. When you are not sure where togo next…
  126. 126. “Tell me more…Tell me more…”
  127. 127. Confidence Ruler
  128. 128. The main course!148
  129. 129. Four Group members:• Something about yourself that youwant to changeneed to changeshould changehave been thinking about changingbut you haven’t changed yeti.e. – something you’re ambivalent aboutPutting it all together…149
  130. 130. Facilitator150• Listen carefully with a goal of understanding thedilemmas you hear from group members• AVOID giving advice unless you are explicitly asked• Ask these four open questions of the group, follow withreflective listening/affirmations…and listen with interest:1. Why would you want to make this change?2. How might you go about it, in order to succeed?3. What are the three best reasons to do it?4. On a scale from 0 to 10, how important would you say itis for you to make this change?Follow-up: And why are you at __ and not zero?• Give a short summary/reflection of the group’smotivations for change• Then ask: “So what do you think you’ll do?” and justlisten
  131. 131. Confidence Ruler
  132. 132. Page 10
  133. 133. Barriers and Enablers to Practice Change
  134. 134. What are your next steps?• What will you commit to doing to continue todevelop your facilitation skills? Some ideas…– Start or continue a peer supervision group focused onthe issues and topics we’ve discussed– Observe colleagues’ group facilitation and spend timedebriefing with them before and after– Ask clients for their feedback about what went well andwhat you could do differently as a facilitator– Buy a book on presentation, teaching or facilitationskills and/or surf the web– Set concrete goals and check back– Others?
  135. 135. Confidence Ruler
  136. 136. Wrapping Up
  137. 137. SummaryQuick review of group dynamics andpractice implicationsOverview and practice: Resist the RightingReflex and evidence base for MIIntegrating MI best practice skills (MI Spirit,Four Processes & OARS skills)Agenda Mapping and providing informationCritical issues in groupWhat is your style: Guide, Follow or Direct?Implementation planning & next steps
  138. 138. Recommended ResourcesMartino, S., Ball, S.A., Gallon, S.L., Hall, D., Garcia, M., Ceperich, S., Farentinos, C., Hamilton,J., and Hausotter, W. (2006). Motivational Interviewing Assessment: Supervisory Tools forEnhancing Proficiency (MIA STEP). Salem, OR: Northwest Frontier Addiction TechnologyTransfer Center, Oregon Health and Science University.http://www.motivationalinterview.org/Documents//MIA-STEP.pdfMiller, W.R. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (ThirdEdition). New York: Guilford.Miller, W.R. & Rollnick, S. (2009). Ten things that Motivational Interviewing is not. Behaviouraland Cognitive Psychotherapy, 37, 129-140.http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5318416Rollnick, S., Miller, W.R., & Butler, C.C. (2008). Motivational Interviewing in Health Care: HelpingPatients Change Behavior. New York: The Guildford Press.First chapter and table of contents available at www.motivationalinterview.orgRosengren, D.B. (2009). Building Motivational Interviewing Skills: A Practitioner Workbook. NewYork: Guilford.Wagner, C.C. & Ingersoll, K.S. (2013). Motivational Interviewing in Groups. New York: GuilfordUseful WebsitesMotivational Interviewing Websitehttp://www.motivationalinterview.net/Motivational Interviewing Network of Trainers (MINT) Websitewww.motivationalinterviewing.orgExamples of Motivational Interviewing Videos on YouTubehttp://www.youtube.com/user/teachproject#p/u
  139. 139. EngagingFocusingEvokingPlanningMotivational Interviewing: Practice TipsMI Spirit: The Essential FoundationPartnership: You and the client are equalexpertsAcceptance: Absolute worth, accurate empathy,autonomy support, affirmationCompassion: Beneficence, caring, focus on theotherEvocation: The client’s wisdom is mostimportantOARS: Key SkillsOpen Questions: What are your reasons forchange? How might you go about it in order tosucceed?Affirmation: You have worked hard to make thishappen. I can see that you’ve given this a lot ofthought.Reflections: You wish that… You would like to…Summary Statements: Let me make sure Iunderstand how this all fits together…DiagnosisTreatmentPlanSymptomsBenefitsFinancesStressRelationshipAgenda-MappingCan we take a few minutes to talk about the different issues orconcerns that you or others have? Just to get a “big picture” view ofwhat you are coping with right now…Given all of these possible areas for change, what are your priorities?Where would be the most helpful place for us to start?0 1 2 3 4 5 6 7 8 9 10People usually have multiple or competing priorities. On ascale of zero-to-ten, how important is it to change…? Howconfident are you that you could make this change?Readiness RulerWhy did you say [lower number] and not [higher number]?What would it take to go from [lower number] to [higher number]?Elicit: What do you already know about…?Provide information: Be brief!Elicit: How does that fit for you? What doyou make of that?Listen for Change Talk: DARN CATDesire, Ability, Reasons, NeedCommitment, Activation, Taking StepsReference: Miller, W. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd Edition). New York: Guilford.2013 Marilyn Herie, PhD RSW marilyn.herie@utoronto.caFour MI Processes
  140. 140. “When people are ready to, they change.They never do it before then, andsometimes they die before they getaround to it. You cant make them changeif they dont want to, just like when they dowant to, you cant stop them.”― Andy Warhol, Andy Warhol in His Own Wordshttp://en.wikipedia.org/wiki/File:Warhol-Campbell_Soup-1-screenprint-1968.jpg
  141. 141. Remember to complete theWorkshop Evaluation
  142. 142. Thankyoumarilyn.herie@utoronto.cawww.educateria.com@MarilynHerie
  143. 143. If you have built castles in the air, yourwork need not be lost. That is wherethey should be. Now put thefoundation under them.Henry David ThoreauCastles in the air?
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×