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Essentials MI.1 Motivational Interviewing
 

Essentials MI.1 Motivational Interviewing

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Motivational Interviewing is a semi-directive counseling style. In this training, the clinical MI skills of expressing empathy and the OARS skills are demonstrated. The segment is oriented toward work ...

Motivational Interviewing is a semi-directive counseling style. In this training, the clinical MI skills of expressing empathy and the OARS skills are demonstrated. The segment is oriented toward work with substance abusing clients.

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  • Collaborative respecting and supporting client’s autonomy, supporting self efficacyEvocative calling forth client’s insights, motivations, resourcesAccepting Rolls with resistance, rather than confronting or challengingSupports the idea that change is within the client’s reach (client has competency and self-efficacy)Client should believe they have a voice in the decision (“relatedness of choice”)communicating empathy and compassion, a fundamental commitment to the client’s welfare
  • Best Practices are those which have been found to be effecitve for working with clients with avruous disorders. In this workshop, we’ll regard best practices as those which are effective at helping clients reduce or give up drug or alcohol use. This part of the workshop is about Motivational interviewing. Motivational interviewing is a semi-directive meothod of engaging clietnmotviation to change bheavior which accepts different levels of readiness for change. It includes: expressing empahty; recognizing that the counselrlo’s style and warmth are powerful treatmetn factors; developing discrepancy to help clients understand their behavior; reolling with resistance until a strong working alliance has been built; supporting self-efficacy by using positive feedback for clditns. Motivational Enhancement specifically refers to providing assessment feedback in combination with the clinical style of MI. In this workshop, we will be referring to MI and MIT as Motivational Interviewing.
  • Cannabis use disorder is the most commonly occurring illicit substance use disorder in the general population. For adolescents and adults, cognitive behavioral interventions have been shown to be effective to reduce marijuana use both in individual sessions and groups when compared with social support or motivational enhancement therapy. The most recent, best quality and largest controlled trial, foundextended individual CBT to bemore effective than brief individual motivational therapy. The two studies on contingency-managementtreatments concluded that this may enhance outcomes combined with CBT or motivational enhancement
  • Effective addiction treatment is not just a matter of WHAT you do but is also strongly influences by WHO you are a nd How you work with clients. Counseling style has a t least as muc impact on client outcomes as the particular treatment methods you use. One finding in research on SA tx is that clients’ outcomes differ depending on counselor to whom they are assigned. One of the strongest predictors of a counselor’s effectiveness in tx SUD is empathy. In one study, among 9 therapists all delivering same behavior therapy, clients’ drinking outcomes were strongly predicted by the extent to which counselro practiced empathic, reflective listening during treatment. Clients of the most empathic counselor showed a 100% improvement rate, where those of the least empathic counselor showed a 25% improvement rate (p 50). Antoher study showed that the more empathic and clietn centered the counselor’s style, the lower the relapse rate of his/her clients after counseling. Beneath empathy is an attitude of total interst in and focus on understanding how your client perceives things, on seeing the workld through his/her eyes. . Empathic listener suspends, at least for time being, all of her or his own material, advice, questions, suggestions, stories, brilliant insight, and focuses on person’s own experience. Roger’s belief concerning drive for health, mastery, seed in client waiting to grow.
  • four fundamental skills form a client-centered foundation and safety net in counseling. When you’re just getting started, or whenever you’re lost and aren’t sure what to do next, you can always fall back to these fundamental four and be reasonable sure that you are helping and not harmingyour client . These four skills are summaried by the acronmym OARS: Open questions, affirmation, reflection, and summaries. Try not to start off your counseling with a slew of questions. Asking a number of question in a row, particularly closed questions, tends ot create a mind-set of passivity in the client. If possible, just sit down and listen to your client for a while, even just for 15 minutes, before you start questioning. Open quesetions allow the client the possibility of reflecting on his/her own experience, and demand more than a one-word answer, while closed questions usually require a one-word answer
  • The second of the four OARS skills is to affirm your client. This sounds easy enough. Look for opportunities to comment positively, Thank your clietn for being on time or for coming in at all, even if late. Find things that you can genuinely appreciate, admire, respect. Reframe client experiences as laudable strenghts. Look for successes, even small ones, in the client’s past or present and affirm them. Here’s the familyiar choice of half-full or half-empty. After years of having between 8-12 drinks every night, and some initial success in cutting back, a client wanted to make it rhough a whole week without drinking at all. On Monday, she came back to the clinic looking dejected and dereated. She had had six alcohl-free dyas, but on the weekend she had 2 drinks on Saturday. You could shame her: “I thought you said that you weren’t going to drink this week! What happened?” Why not instead congratualte her on her first six days of sobrieyt in eyars, be impressed that she somehow managed to go from abou t 70 drinks a week down to 2 and askher how she did it?
  • Skillful reflective listening actually does more than repeat what a cleitn says. It moves ahead, if only just a little. It considers what the person has not quite spoken, but may mean. Instad of merely repeating what the client has just said, complex reflections offer what might be the next, as yet unspoken, sentence of the person’s paragraph. How do you know what a clietn hasn’t said? Sometims nonverbal cues, sometimes by a word or phrase that you heard, your hypothesis about how that is connected, perhaps your own clinical experience, perhaps remembering sometihg from two sessions ago. Sonetimes you do mostly repeat what the client said, or just substitute a synonym. Sometimes, the client does not respond with a yes or no followed by elaboration. Sometimes what you see is a kind of resistance, a backing off, closing down, taking back, or arguing. That’s usually a sign that your reflection was not accurate or perhaps that you jumped too far ahead of your client. Analysts call it a premature interpretation. Tone of voice may have something to do with it. Good reflection is a statement, not a question. The effect of questioning is often to cause the person to step back. When you’re listening with accurate empathy, there are also a lot of things that you’re not doing. You’re not giving advice, offering solutions, or asking questions. You’re not warning, educating, persuading or sympathizing. You’re not agreeing or disagreeing, analyzing or diagnosing. Your whole attention is focused on understanding and following the person’s own perspectives.
  • Beyond immediate reflections, it is helpful to pull together in short summaries what your clietns say. This shows and requires, of course, that you have been listenig carefully. Summaries allowyouto emphasize and integrate what a client has offered. At least 3 kinds of summaries can be helpful. First, there are collecting summaries. These happen in the midst of a counseling session, and pull together a variety of related things the person has said. If, for example, you have asked about ways in which drug use ahs had negative effects int eh person’s lie, you begin collecting those mentally, and in addition to reflecting them as you go, you also periodically give them back to the client lie a small bouquet. The you continue the process by asking ‘what else?”

Essentials MI.1 Motivational Interviewing Essentials MI.1 Motivational Interviewing Presentation Transcript

  • Essentials for Teen and Adult SubstanceEssentials for Teen and AdultUse: Mastery of CBT, MI, and IntegratedSubstance Use: Mastery of CBT,TreatmentMI, and Integrated Treatment INTRODUCTION SPIRIT OF MOTIVATIONAL INTERVIEWING EVIDENCE OF EFFECTIVENESS CLINICAL SKILLS PART I Best Practice Trainers, Inc. Ruth Campbell, LCSW; Richard Coleman, Psychotherapist Lynne Rachlin, LCSW, Tina Iler, LCSW; George Ramos, MA
  •  The trainers in the videos are from the non- profit organization Best Practice Trainers, Inc. Others playing the roles of clients in the videotapes are students in training for the Master’s Degree in Social Work or an Alcohol and Drug Abuse Counseling Certification. 2
  •  Description Stages of Change, Foundational Processes & Strategies and Skills Spirit of Motivational Interviewing Evidence of Effectiveness Clinical Skills Part I  Empathy  OARS skills 3
  •  Description of Motivational Interviewing  Collaborative, goal oriented style of communication  Particular attention to the language of change.  Strengthens motivation for and commitment to specific goal by eliciting/exploring person’s reasons for change  Accepts different levels of readiness for change  Adds personal clinician feedback with permission ▪ MI + clinician feedback with permission has been termed Motivational Enhancement Therapy (MET) 4
  • Precontemplation Not aware Relapseprevention ContemplationWhat now? Stages of ambivalence Readiness for Change Maintenance Action Developing skills Taking steps 5
  •  Planning  Evoking  FocusingEngagement 6
  •  STRATEGIES  Rolling with Resistance  Avoiding Argumentation  Developing Discrepancy  Supporting Self-efficacy SKILLS  Expressing Empathy  OARS skills  Facilitating Change Talk 7
  •  Collaborative  Respect and support client’s autonomy Accepting  Supports the idea that change is within the client’s reach, that the client has competency and self- efficacy ▪ Client should believe they have a voice in decisions  Communicates empathy and compassion, a fundamental commitment to the client’s welfare Evocative  Calling forth client’s insights, motivations, resources  Uses supportive-reflective counseling style instead of confrontive-directive 8
  • +++++ ++++ Evidence RulerEvidence of Effectiveness
  •  Dale et al. ( 2011) secondary analysis  Motivational Interviewing increased treatment retention for alcohol dependent  Motivational Interviewing improved outcomes for alcohol use at 12 months Denis’ Meta-analysis (2006)  Motivational Interviewing reduced cannabis use and symptoms of dependence. Hester & Miller, (2003) systematic review  Motivational Interviewing was 72% effective with alcohol problems 10
  •  Aubrey, (1998) with 77 teens using alcohol, marijuana, or cocaine, suggests that Motivational Interviewing with clinician feedback (Motivational Enhancement Therapy) is successful in diminishing use of all three drugs. Some results of Motivational Interviewing techniques are mixed  for participants abusing other drugs (e.g., heroin) for adolescents who use multiple drugs 11
  • MOTIVATIONAL INTERVIEWING 12
  •  Research suggests  Clients of most empathic counselors showed 100% improvement in drinking outcomes Accurate empathy is:  Client centered  Uses listening & reflecting  Serves 3 purposes ▪ Understanding, respect, clarification 13
  •  Planning  Evoking  FocusingEngagement 14
  •  Open questions need more than 1-word answer.  DO: Offer about 2 reflections for each question  DON’T : Ask 3 questions in a row Put a frame around the questions you must ask, “ in a little while. . .” Examples: Open questions  What brings you here today?  Tell me about your family.  What do you like about marijuana? 15
  •  Find opportunities to comment positively  Thanking ▪ Being on time ▪ Coming  Strengths, successes ▪ Relapse can be reframed as time sober  When people feel acceptance, they are freed to change 16
  •  Reflective listening  Statement which repeats what a client says +.  Complex reflections ▪ Non-verbal cues ▪ Remembering earlier things your client has said You may see resistance  Client backs off, closes down, takes back, argues  Sign your reflection was not accurate, perhaps you are too far ahead 17
  •  Collecting summaries  Summarize your client’s responses to open-ended questions Linking summaries  make a connection between something that your client has just said and earlier material Transitional summaries  draw together what has gone before, point toward something new  end a session  shift from one task or topic to another within a session.8 1
  • Presentation of OARS Skills: Alexis & GeorgeClosed QuestionSession forComparison:Alexis and Mariel 19
  • 1. Which of the following is true? A: Motivational Interventions results in greater treatment retention for cocaine - using clients than educational films. B: Marijuana-using clients are likely to have more abstinent days if treated with Motivational Interventions rather than psycho-educational techniques C. Both are true. 20
  • 2. Which of the following is true? A: Motivational Interviewing results in greater treatment retention than ‘treatment –as-usual’ techniques for alcohol abusing clients. B: Motivational Interviewing is one of the Best Practices useful with heroin addiction. 21
  • Choose One answer for each of the following questions.3. One of the purposes for reflective listening is: A: to repeat exactly what the client has said B: to help the client clarify their own understanding4. One of the purposes of summarizing is:  A: to show the client you were listening  B: to link current material with material presented earlier 22
  • 5. Affirmation is:  A: finding and mentioning things about your client that you can genuinely admire, like, respect  B: offering constructive criticism to your client 23