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Basic Tenets of Motivational Interviewing

This presentation was used to train juvenile detention center staff in engaging resistant youth in discussing change.

About Mark Loewen, LPC:
Mark Loewen was born in Asuncion, Paraguay. He completed his BA in Marketing but decided to follow his passion and moved to the United States to complete his master’s degree in counseling. His love for children and teenagers brought him to Richmond, and specialize in play therapy.

Mark has years of experience ranging from work with teens in residential facilities to joining children and families in reaching their goals in private practice. He currently also serves as a supervisor to residents pursuing their counseling license.

As a Registered Play Therapist, Mark uses research validated interventions that include games, sand tray and art to facilitate expression and growth. Mark provides play therapy to children ages three and up. He uses neuroscience-informed techniques to help children and adults process traumatic events they experienced.

Clients enjoy meeting with Mark. Children and teens often report not realizing that they are doing hard work because they are having fun. At his counseling practice in Richmond VA, Mark also works closely with parents, providing parenting feedback that strengthens the relationship with their children. When working with adults, Mark uses mindfulness and art to help his clients gain a deeper understanding of themselves and move forward.

Mark is a member of the Association for Play Therapy, The Theraplay Association, and the American Counseling Association.

He is fluent in German and Spanish.



CONTENT
Intro to MI
MI style and traps
Basic tools
Dealing with ambivalence
Developing discrepancies
Eliciting change talk

Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change
by helping clients to explore and resolve ambivalence.

The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal.

Motivation is elicited from the client, not imposed
Resolving the ambivalence is the client’s task
Direct persuasion is not effective for resolving ambivalence
Readiness to change is not a trait, but a fluctuating product of interpersonal interaction
The therapeutic relationship is more like a partnership than expert/recipient roles

Motivational Interviewing Style
Traps
Tools - OARS
Exploring Ambivalence
Developing Discrepancies
Change Talk

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Basic Tenets of Motivational Interviewing

  1. 1. 1 Motivational Interviewing Mark Loewen, LPC 10/26/11 Merrimac Detention Center
  2. 2. 2 Content • Intro to MI • MI style and traps • Basic tools • Dealing with ambivalence • Developing discrepancies • Eliciting change talk
  3. 3. 3 What are we talking about • Motivational interviewing is • a directive, • client-centered counseling style • for eliciting behavior change • by helping clients to explore and resolve ambivalence. • The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal.
  4. 4. 4 Motivational Interviewing Style • Motivation is elicited from the client, not imposed • Resolving the ambivalence is the client’s task • Direct persuasion is not effective for resolving ambivalence • Readiness to change is not a trait, but a fluctuating product of interpersonal interaction • The therapeutic relationship is more like a partnership than expert/recipient roles
  5. 5. 5 Motivational Interviewing Style • Collaboration • Evocation • Autonomy • Rolling with resistance
  6. 6. 6 Traps • Question-Answer • Labeling • Premature Focus • Taking Sides /Arguing • Expert
  7. 7. 7 MI Tools - OARS • Reflections • Reflect words and behaviors • Communicate that you are listening • Foster commitment (you took them seriously) • Put attention on client’s thoughts and behaviors instead of your reaction to them • Help clients help themselves *Practice: Interview about a life lesson learned.
  8. 8. 8 MI Tools – OARS (cont’d) • Open-ended questions • Require more thought on behalf of the client • Start with “What”, “How”, “How come”, “Tell me about”, “Help me understand”. • Affirmations • Strengthen behavior change • Highlight the positive • Build rapport • Summaries • Bring everything together
  9. 9. 9 Practicing the skills • 1) In dyads, interview your partner using only Reflections and Open-Ended Questions on: • What it was like growing up in my home • How I came to do the work I’m doing 2) In dyads, interview your partner including Affirmations and a Summary on: • What I would like to accomplish in the future • Ways in which I have changed as a person
  10. 10. 10 Exploring Ambivalence • Everyone experiences ambivalence • We want things to change but also stay the same • Reasons for change need to be stronger to “tip the balance” for change
  11. 11. 11 Exploring Ambivalence • What is likely to happen when you push or argue with the part of the client that wants to change, pointing out the reasons for change? •The client needs to be have freedom to talk about the side that doesn’t want to change. Decisional BalancePros and Cons Confidence vs. Importance
  12. 12. 12 Developing discrepancies • Heightens the internal conflict to enhance motivation to change • Increases awareness between where the client is and where he/she wants to be • Highlights contradictions/inconsistencies • Increases client’s awareness of irrational thoughts/behavior Remember to roll with resistance!
  13. 13. 13 Fishing for Change Talk • Change talk: • Statements by the client that indicate the possibility of change. • DARN C: Desire, Ability, Reasons, Need that lead to Commitment.
  14. 14. 14 Evoking Change Talk • Ask evocative questions • Explore decisional balance • Ask first for good things about status quo, then for “not so good” things. • Ask for elaboration • After a hint of change talk, ask for more detail. (How come? How so? Tell me about that) • Examples • Ask for examples. When was the last time that happened?
  15. 15. 15 Evoking Change Talk • Look back • Ask about a time before the current concern emerged. How were things better? • Look forward • What may happen if things continue as they are? Miracle question: If you were 100% successful in making the changes you want, what would be different? • Explore extremes • What are the worst things that might happen if you don’t make a change? What are the best if you do make the change?
  16. 16. 16 Evoking Change Talk • Change rulers • Importance of change vs. confidence • 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.
  17. 17. 17 Bibliography • Martino, 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 for Enhancing Proficiency. Salem, OR: Northwest Frontier Addiction Technology Transfer Center, Oregon Health and Science University • Miller, W.R. and Rollnick, S. (2002) Motivational Interviewing: Preparing People to Change. NY: Guilford Press, 2002. • Moyers, T.B., Miller, W.R., & Hendrickson, S.M.L. (2005). How Does Motivational Interviewing Work? Therapist Interpersonal Skill Predicts Client Involvement Within Motivational Interviewing Sessions. Journal of Consulting and Clinical Psychology, Vol 73(4), Aug 2005. pp. 590-598. • Hettema, J. E., Miller, W. R., & Steele, J. M. (2004). A Meta-Analysis of Motivational Interviewing Techniques in the Treatment of Alcohol Use Disorders. Alcoholism-Clinical and Experimental Research, 28, 74A.
  18. 18. 18 This presentation was used to train juvenile detention center staff in engaging resistant youth in discussing change. About Mark Loewen, LPC: Mark Loewen was born in Asuncion, Paraguay. He completed his BA in Marketing but decided to follow his passion and moved to the United States to complete his master’s degree in counseling. His love for children and teenagers brought him to Richmond, and specialize in play therapy. Mark has years of experience ranging from work with teens in residential facilities to joining children and families in reaching their goals in private practice. He currently also serves as a supervisor to residents pursuing their counseling license. As a Registered Play Therapist, Mark uses research validated interventions that include games, sand tray and art to facilitate expression and growth. Mark provides play therapy to children ages three and up. He uses neuroscience-informed techniques to help children and adults process traumatic events they experienced. Clients enjoy meeting with Mark. Children and teens often report not realizing that they are doing hard work because they are having fun. At his counseling practice in Richmond VA, Mark also works closely with parents, providing parenting feedback that strengthens the relationship with their children. When working with adults, Mark uses mindfulness and art to help his clients gain a deeper understanding of themselves and move forward. Mark is a member of the Association for Play Therapy, The Theraplay Association, and the American Counseling Association. He is fluent in German and Spanish.
  19. 19. 1919 For more information: We would love to hear from you! 2008 Libbie Ave, Ste 101, Richmond, VA 23226 Ph: 804-665-4681 Email: contact@launchpadcounseling.com www.launchpadcounseling.com
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This presentation was used to train juvenile detention center staff in engaging resistant youth in discussing change. About Mark Loewen, LPC: Mark Loewen was born in Asuncion, Paraguay. He completed his BA in Marketing but decided to follow his passion and moved to the United States to complete his master’s degree in counseling. His love for children and teenagers brought him to Richmond, and specialize in play therapy. Mark has years of experience ranging from work with teens in residential facilities to joining children and families in reaching their goals in private practice. He currently also serves as a supervisor to residents pursuing their counseling license. As a Registered Play Therapist, Mark uses research validated interventions that include games, sand tray and art to facilitate expression and growth. Mark provides play therapy to children ages three and up. He uses neuroscience-informed techniques to help children and adults process traumatic events they experienced. Clients enjoy meeting with Mark. Children and teens often report not realizing that they are doing hard work because they are having fun. At his counseling practice in Richmond VA, Mark also works closely with parents, providing parenting feedback that strengthens the relationship with their children. When working with adults, Mark uses mindfulness and art to help his clients gain a deeper understanding of themselves and move forward. Mark is a member of the Association for Play Therapy, The Theraplay Association, and the American Counseling Association. He is fluent in German and Spanish. CONTENT Intro to MI MI style and traps Basic tools Dealing with ambivalence Developing discrepancies Eliciting change talk Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal. Motivation is elicited from the client, not imposed Resolving the ambivalence is the client’s task Direct persuasion is not effective for resolving ambivalence Readiness to change is not a trait, but a fluctuating product of interpersonal interaction The therapeutic relationship is more like a partnership than expert/recipient roles Motivational Interviewing Style Traps Tools - OARS Exploring Ambivalence Developing Discrepancies Change Talk

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