Session 14 -mi


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Session 14 -mi

  1. 1. Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, NCC Executive Director,
  2. 2.  Components of a Motivational Interviewing Assessment  Examine Motivational Interviewing styles and traps  Define the MI Assessment ―sandwich‖  Develop MI Micro-Skills OARS  Discuss skills to identify, explore and handle resistance in clients  Examine appropriate interventions for each stage of change
  3. 3. Dr. Jonathan Fader discusses Motivational Interviewing
  4. 4.  Use of client-centered MI style  MI strategies that can be integrated into the agency’s existing intake assessment process  Methods that can be used with diverse substance use problems  Skills for assisting clients in assessing their own substance use  Understanding the client’s perception and willingness to enter into a treatment process
  5. 5.  Person-centered versus disorder-centered approach  Motivation is a state or stage, not a fixed character trait  Client defensiveness or resistance is a therapeutic process  Effect of therapist style on client behavior  Emphasis on collaboration, not confrontation  Examining resistance and change talk: opposite sides of ambivalence  Respect for client autonomy and choice  Define change talk DARN-C
  6. 6.  Styles ◦ Collaboration ◦ Evocation ◦ Autonomy ◦ Roll with Resistance
  7. 7.  Question-Answer Trap ◦ Have clients fill out questionnaires in advance ◦ Ask open ended questions ◦ Use reflective listening  Labeling Trap ◦ Labels are not important to change ◦ Can foster resistance
  8. 8.  Premature Focus Trap. ◦ When a counselor persists in talking about her own conception of ―the problem‖  Taking Sides Trap. ◦ When you detect some information indicating the presence of a problem and begin to tell the client about how serious it is and what to do about it, you have taken sides.
  9. 9.  Blaming Trap. ◦ Some clients show defensiveness by blaming others for their situation. It is useful to  Diffuse blaming by explaining that the placing of blame is not a purpose of counseling.  Expert Trap. ◦ When you give the impression that you have all the answers, you draw the client into a passive role. ◦ In MI the client is the expert about his/her situation, values, goals, concerns, and skills. ◦ Seek collaboration and give clients the opportunity to explore and resolve ambivalence for themselves
  10. 10.  Express empathy  Develop discrepancy  Roll with resistance, avoiding argumentation  Support self-efficacy
  11. 11.  MI Strategies (20 minutes) ◦ Building rapport ◦ Using the OARS micro-skills to elicit a discussion of the client’s perception of his/her problems  Agency Assessment  MI Strategies (20 minutes) ◦ Recapitulate ◦ Develop a change plan
  12. 12.  Open-ended questions  Affirmations: Reward what is being done ◦ I appreciate your honesty ◦ I can see that your children are important to you. ◦ It shows commitment to come back to therapy. ◦ You have good ideas.  Reflective listening  Summaries
  13. 13.  Types of reflections ◦ i. Simple ◦ ii. Amplified ◦ iii. Double-sided—On one hand…., but on the other hand….  Levels of reflection ◦ i. Repeat--Parrot ◦ ii. Rephrase ◦ iii. Paraphrase– Including underlying meaning
  14. 14.  Decision balance  Developing discrepancy ◦ i. Exploring goals and values ◦ ii. Looking forward
  15. 15.  Types of Resistance ◦ Arguing ◦ Interrupting ◦ Negating or ―denial‖ ◦ Ignoring  Give examples of how you have experienced each of these ◦ In your practice ◦ In your relationships ◦ In yourself  What is the function of resistance?
  16. 16.  What is it ◦ A cue to change strategies ◦ A normal reaction to having freedoms decreased or denied ◦ An interpersonal process
  17. 17.  Reflections focus on their change talk and provide less attention to non-change talk  Shift focus from obstacles and toward choice  Reframe offering a new and positive interpretation of negative information provided by the person  Emphasize personal choice and control
  18. 18.  Motivational Interviewing Demonstration by Dr. Thad Leffingwell
  19. 19.  Precontemplation ◦ Client is not considering, is unwilling or unable to change ◦ Establish rapport, ask permission, and build trust ◦ Raise doubts or concerns in the client about use ◦ Explore what brought client in & results of previous treatment ◦ Offer actual information about the risks of substance use ◦ Provide personalized feedback about assessment findings ◦ Explore the pros and cons of substance use ◦ Examine discrepancies between the client's and others' perceptions of the problem ◦ Express concern and keep the door open
  20. 20.  Contemplation ◦ The client acknowledges concerns but is ambivalent ◦ Normalize ambivalence. ◦ Help the client "tip the decisional balance scales" ◦ Elicit and weigh pros and cons of substance use & change ◦ Change extrinsic to intrinsic motivation ◦ Examine client's personal values in relation to change ◦ Emphasize client's free choice, responsibility, & self-efficacy ◦ Elicit self-motivational statements of intent and commitment ◦ Elicit perceived self-efficacy & expectations re: treatment ◦ Summarize self-motivational statements
  21. 21.  Preparation ◦ Client is planning to change but is still considering options ◦ Clarify the client's own goals and strategies for change. ◦ Offer a menu of options for change or treatment. ◦ With permission, offer expertise and advice. ◦ Negotiate a change--or treatment--plan ◦ Help the client enlist social support. ◦ Explore treatment expectancies and the client's role. ◦ Elicit what has worked for him or others whom he knows. ◦ Assist the client to identify and negotiate potential barriers. ◦ Have the client publicly announce plans to change
  22. 22.  Action ◦ The client is actively taking steps to change but is not yet stable ◦ Engage the client in treatment and reinforce the importance of remaining in recovery. ◦ Support a realistic view of change through small steps. ◦ Acknowledge difficulties for the client in early stages of change. ◦ Help the client identify high-risk situations through a functional analysis ◦ Develop appropriate coping strategies to overcome these. ◦ Assist the client in finding new reinforcers of positive change. ◦ Help the client assess sources of support
  23. 23.  As related to stages of change  Methods of measuring ◦ i. Readiness ruler ◦ ii. Instruments like URICA and SOCRATES  Key questions ◦ ―What does this mean about your (habit)?’ ◦ ―What do you think has to change?‖ ◦ ―What are your options?’ ◦ ―What’s the next step for you?‖ ◦ ―What would be some of the good things about change?‖ ◦ ―Where does this leave you?‖
  24. 24.  DARN-C ◦ Desire ◦ Ability ◦ Reasons ◦ Needs ◦ Commitment level  Eliciting change talk ◦ Evocative questions ◦ Elaborations
  25. 25.  Change Discussion ◦ The desired changes ◦ Reasons for wanting to make those changes, ◦ Steps to make the changes, ◦ People available to support the change plan, ◦ Impediments or obstacles to change and how to address them ◦ Methods of determining whether the plan has worked.  Role of information and advice  Menu options  Asking for commitment
  26. 26.  Motivational Interviewing Assessments use OARS to empower the client to examine motivations for change  Motivational Interviewing styles and traps: question- answer; labeling; premature focus and taking sides  Develop MI Micro-Skills OARS Open-ended questions; Affirmations; Reflective listening; Summaries  Discuss skills to identify, explore and handle resistance in client: Reflection, reframe, shift focus  Identify change talk DARN-C: Desire, Ability, Reasons, Needs, Commitment level