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Motivational interviewing Training

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The objections of this presentation include: to experience and practice motivational interviewing, learn motivational interviewing styles and principles and see how it integrates into everyday practice.

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Motivational interviewing Training

  1. 1. Motivational Interviewing:Motivational Interviewing: Working with TheWorking with The Resistant ClientResistant Client  Dr Louise A. Stanger Ed. D,Dr Louise A. Stanger Ed. D, LCSW, BRI II, CIPLCSW, BRI II, CIP  MINT Trainer of TrainersMINT Trainer of Trainers  Faculty SDSUFaculty SDSU  Director All AboutDirector All About InterventionsInterventions
  2. 2. ObjectivesObjectives  To experience and practice the basics of MI  To learn MI Style and Principles  To directly experience the MI approach and contrast with others  To see how it integrates into everyday practice
  3. 3. Getting To Know YouGetting To Know You  Hello, Tell us aboutHello, Tell us about Yourself ?Yourself ?  What brought you hereWhat brought you here today ?today ?  What do you want to getWhat do you want to get out of training ?out of training ?
  4. 4. What is Motivation?What is Motivation?  Probability ofProbability of behavior change orbehavior change or movement toward ormovement toward or against goalagainst goal  Extrinsic…….Extrinsic…….  Intrinsic ……Intrinsic ……
  5. 5. Personal Goal :Personal Goal :  Choose a personal goalChoose a personal goal  Develop an action PlanDevelop an action Plan Action Thinking Idea
  6. 6. SO…………………..SO…………………..  How realistic is this plan for you & how soon will youHow realistic is this plan for you & how soon will you start?start?  How faithful will you be to the plan?.. Be Honest!How faithful will you be to the plan?.. Be Honest!  Will it be easy or hard?Will it be easy or hard?  How long will you do this plan for?How long will you do this plan for?  How will you view yourself if you stop, do it partially ,How will you view yourself if you stop, do it partially , stop & start, never start at all?stop & start, never start at all?  Can others help you and how will you respond toCan others help you and how will you respond to reminders?reminders?
  7. 7. Second ThoughtsSecond Thoughts
  8. 8. AfterthoughtsAfterthoughts  How was this for youHow was this for you  Is the process of changeIs the process of change simple or complexsimple or complex  Is change linearIs change linear  Is it all or nothing forIs it all or nothing for you?you?  Motivation >>>Motivation >>>  Confidence >>>>Confidence >>>>
  9. 9. When do People ChangeWhen do People Change  Stages of ChangeStages of Change  Readiness to ChangeReadiness to Change
  10. 10. In between the cravingsIn between the cravings Find the Spaces InbetweenFind the Spaces Inbetween Omar Manejawa MDOmar Manejawa MD Cravings – MyopicCravings – Myopic Spaces- ChangeSpaces- Change Habits -ActionsHabits -Actions
  11. 11. Stages Of ChangeStages Of Change Precontemplation Contemplation Preparation Action Maintenance
  12. 12. PrecontemplationPrecontemplation  Person is not seeing need for lifestyle changePerson is not seeing need for lifestyle change  Client believes there is no problemClient believes there is no problem  May feel forced into treatment.May feel forced into treatment.  Response to resisistanceResponse to resisistance  What does this sound like?What does this sound like?
  13. 13. Counselors Task : PrecontemplationCounselors Task : Precontemplation  Raise DoubtRaise Doubt  Increase the person’s perception of risks andIncrease the person’s perception of risks and problems with current behaviorproblems with current behavior
  14. 14. 2. Contemplation2. Contemplation  Person is consideringPerson is considering making a change and hasmaking a change and has not decided yetnot decided yet  Response to resistanceResponse to resistance  Estimates put 80% ofEstimates put 80% of people eitherpeople either precontemplative orprecontemplative or contemplativecontemplative  Maybe I willl …………Maybe I willl …………
  15. 15. Task : ContemplationTask : Contemplation  Client is considering changeClient is considering change  Client not fully convinced he / she will makeClient not fully convinced he / she will make change- eovke responses to changechange- eovke responses to change  Tip the Balance –strengthen self efficacyTip the Balance –strengthen self efficacy  Case example :Lisa visits CVSCase example :Lisa visits CVS
  16. 16. PreparationPreparation  Person has decided toPerson has decided to change and ischange and is considering how to Makeconsidering how to Make changeschanges  Motivation fluctuates asMotivation fluctuates as does ambivalencedoes ambivalence  MI used to elicit changeMI used to elicit change talktalk
  17. 17. ActionAction  Person is actively doingPerson is actively doing something to changesomething to change  May experience setbacksMay experience setbacks  Encourage action, setEncourage action, set example, give homeworkexample, give homework
  18. 18. MaintenanceMaintenance  Person is maintaining activity over timePerson is maintaining activity over time  Some temptation to return to former behaviorSome temptation to return to former behavior or small lapses ( TRIGGER LANE )or small lapses ( TRIGGER LANE )  Change has existed over 6 months or moreChange has existed over 6 months or more
  19. 19. RELAPSE & RECYCLERELAPSE & RECYCLE  Restart, reboot the processesRestart, reboot the processes  Help the person renew the process ofHelp the person renew the process of contemplation, determination, and action w/ocontemplation, determination, and action w/o getting stuck in Shameville !getting stuck in Shameville !
  20. 20. What is Motivational Interviewing?What is Motivational Interviewing?  A directive client-centered counseling approachA directive client-centered counseling approach for eliciting behavior change by helping clientsfor eliciting behavior change by helping clients to explore and resolve ambivalence.to explore and resolve ambivalence.  Rollnick and Miller 1995Rollnick and Miller 1995
  21. 21. MI StyleMI Style  Process not TechniqueProcess not Technique  CollaborativeCollaborative  Evocation- elicit clientsEvocation- elicit clients internal viewpointinternal viewpoint  AutonomyAutonomy  Roll With ResistanceRoll With Resistance
  22. 22. MI SpiritMI Spirit  Rogerian approachRogerian approach  Coupled with a directionCoupled with a direction  EqualitarianEqualitarian  Warm, Empathetic, Affirming & RespectfulWarm, Empathetic, Affirming & Respectful  Guiding & eliciting vs. instructing & persuadingGuiding & eliciting vs. instructing & persuading  Video- Join Up (Horse Whisper)Video- Join Up (Horse Whisper)
  23. 23. Characteristics of MICharacteristics of MI  Counselor is active and directiveCounselor is active and directive  Counselor helps shape behaviorCounselor helps shape behavior  MI strategy is specific and systematicMI strategy is specific and systematic  Consistent with principles of client choice andConsistent with principles of client choice and empowermentempowerment  Consistent with cultural sensitivity in that clientConsistent with cultural sensitivity in that client leads and counselors agenda is not imposedleads and counselors agenda is not imposed
  24. 24. Traps to AvoidTraps to Avoid  Question-AnswerQuestion-Answer  Labeling Trap – dx codesLabeling Trap – dx codes  Premature Focus Trap-start withPremature Focus Trap-start with clients concern not yoursclients concern not yours  ExpertExpert  Taking sidesTaking sides  Blaming Others _ who is toBlaming Others _ who is to blame is not as important asblame is not as important as to what your concerns areto what your concerns are
  25. 25. MI PrinciplesMI Principles EE-DD-RR-SSEE-DD-RR-SS  Express EmpathyExpress Empathy  Develop Discrepancy- help one get unstuck fromDevelop Discrepancy- help one get unstuck from ambivalent feelingsambivalent feelings  Roll with Resistance ( get out of the way )Roll with Resistance ( get out of the way )  Support Self Efficacy ( Bandura) The capacity of aSupport Self Efficacy ( Bandura) The capacity of a person to believe they can carryspecific act or behaviorperson to believe they can carryspecific act or behavior
  26. 26. Guiding StrategiesGuiding Strategies  How to Express EmpathyHow to Express Empathy  How to Develop DiscrepancyHow to Develop Discrepancy  How to Roll With ResistanceHow to Roll With Resistance  How to Elicit Self-MotivationHow to Elicit Self-Motivation  Brief NegotiationBrief Negotiation
  27. 27. How to Express EmpathyHow to Express Empathy Use your OarsUse your Oars  Open Ended QuestionsOpen Ended Questions  AffirmationsAffirmations  ReflectionsReflections  SummariesSummaries
  28. 28. Open and Closed EndedOpen and Closed Ended  What types of things do youWhat types of things do you want to talk aboutwant to talk about  Tell me about…Tell me about…  How do you think smokingHow do you think smoking pot is related to the problemspot is related to the problems you talk about in youryou talk about in your marriagemarriage  What brings you hereWhat brings you here today?/today?/  Don’t yuu think your wifeDon’t yuu think your wife and kids are hurt enough byand kids are hurt enough by your drinking ?your drinking ?  Isn’t your friends idea thatIsn’t your friends idea that you quit ?you quit ?  Are there good things aboutAre there good things about your drug use?your drug use?  How long have you beenHow long have you been concerned about x ?concerned about x ?
  29. 29. Mining for AffirmationsMining for Affirmations Group ExerciseGroup Exercise  20 Strengths20 Strengths  Groups of 5-with 5Groups of 5-with 5 strengthsstrengths  Identify open endedIdentify open ended question to elicit strengthquestion to elicit strength and an affirmation youand an affirmation you might offer in responsemight offer in response to a strengthto a strength
  30. 30. Affirm your clientAffirm your client  I appreciate your honestyI appreciate your honesty  I can see that caring forI can see that caring for your children isyour children is important to youimportant to you  It shows courage andIt shows courage and commitment to comecommitment to come back to meetingsback to meetings  You have good ideasYou have good ideas
  31. 31. Listening ExerciseListening Exercise  Break up in dyadsBreak up in dyads  Practice Listening – 3Practice Listening – 3 minutesminutes  DebriefDebrief
  32. 32. 12 Roadblocks to Listening12 Roadblocks to Listening  1. Ordering, directing,1. Ordering, directing, commandingcommanding  2. Warning or threatening2. Warning or threatening  3. Giving advice, suggestions,3. Giving advice, suggestions, solutionssolutions  4. Persuading with logic,4. Persuading with logic, arguing,arguing,  5. Moralizing, preaching5. Moralizing, preaching  6.Disagreening, judging,6.Disagreening, judging, criticizing , blamingcriticizing , blaming
  33. 33. 12 Roadblocks to Listening12 Roadblocks to Listening  7.Agreeing, approving,7.Agreeing, approving, praisingpraising  8. Shaming, ridiculing or8. Shaming, ridiculing or labelinglabeling  9. Interpreting or analyzing9. Interpreting or analyzing  10. Reassuring, sympathizing10. Reassuring, sympathizing  11. Questioning or probing11. Questioning or probing  12.Withdrawing, distracting12.Withdrawing, distracting
  34. 34. Assumptions To AvoidAssumptions To Avoid  Person OUGHT to changePerson OUGHT to change  Person WANTS to changePerson WANTS to change  Persons health is primePersons health is prime motivation factormotivation factor  If she/he decides not toIf she/he decides not to change consultation is achange consultation is a failurefailure  Individuals are eitherIndividuals are either motivated to change or theymotivated to change or they are notare not  Now is the right time toNow is the right time to consider changeconsider change  A tough approach isA tough approach is always the best approachalways the best approach  I am the expert andI am the expert and know bestknow best  A egotiation approach isA egotiation approach is always bestalways best
  35. 35. Persuasion ExercisePersuasion Exercise  Grps of 2Grps of 2  Identify change you are consideringIdentify change you are considering  Counselors roleCounselors role  1. Explain why perosn should make this change1. Explain why perosn should make this change  2. Give three specific benefits that result from change2. Give three specific benefits that result from change  3. Tell the person how they can change3. Tell the person how they can change  4. Emphasize its important for them to make change/include4. Emphasize its important for them to make change/include negative consequencesnegative consequences  5. Tell persuade the person to do it5. Tell persuade the person to do it  And if you encounter resitance try harderAnd if you encounter resitance try harder
  36. 36. Listen ReflectivelyListen Reflectively  Being quiet and activelyBeing quiet and actively listeninglistening  Responding with aResponding with a statement that accuratelystatement that accurately reflects the essence ofreflects the essence of what the client meantwhat the client meant  Listen carefully thinkListen carefully think ReflectionsReflections
  37. 37. ReflectionsReflections  Think in terms of forming anThink in terms of forming an hypotheses or best guess athypotheses or best guess at what client is sayingwhat client is saying  Take a guess –Do youTake a guess –Do you mean…mean…  You have to differentiateYou have to differentiate between a question and abetween a question and a statementstatement  Voice goes down at end ofVoice goes down at end of statement rather then up withstatement rather then up with a questiona question  ““You're angry with yourYou're angry with your mother …mother …  A statement does not requireA statement does not require an answer .an answer .  Used strategically emaphsize,Used strategically emaphsize, clients view , feelings,clients view , feelings, ambivalence, emotion changeambivalence, emotion change talktalk
  38. 38. Level of ReflectionLevel of Reflection  Repeating repeat what someone has just saidRepeating repeat what someone has just said  Rephrase – substitute a few different wordsRephrase – substitute a few different words  Paraphrasing-make a fairly major restatementParaphrasing-make a fairly major restatement inferring what you think a person has saidinferring what you think a person has said  Reflecting feeling – special kind of paraphraseReflecting feeling – special kind of paraphrase where you are not necessarily relecting contentwhere you are not necessarily relecting content rather feelingrather feeling
  39. 39. Simple ReflectionSimple Reflection  Client: She is driving meClient: She is driving me crazy trying to get me tocrazy trying to get me to do quitdo quit  Counselor; Her methodsCounselor; Her methods are really bothering youare really bothering you  Client: I don’t haveClient: I don’t have anything to sayanything to say  Counselor- You are notCounselor- You are not feeling talkative todayfeeling talkative today
  40. 40. Amplified ReflectionsAmplified Reflections  Exaggerate what clientExaggerate what client says be careful not to besays be careful not to be sarcasticsarcastic  All my friends smokeAll my friends smoke weed and I don’t seeweed and I don’t see giving it upgiving it up  So you are likely to keepSo you are likely to keep smoking foreversmoking forever
  41. 41. Doubled Sided ReflectionDoubled Sided Reflection ((meant to capture both sides of ambivalencemeant to capture both sides of ambivalence ))  C- It would stink to lose my job over a dumb policyC- It would stink to lose my job over a dumb policy because I have been using,because I have been using, butbut do way do I want to quitdo way do I want to quit partying just because of thatpartying just because of that  Co-Co- On the one handOn the one hand you value your job because it allowsyou value your job because it allows you to live comfortably and on the other hand you alsoyou to live comfortably and on the other hand you also enjoy using drugs with your friendsenjoy using drugs with your friends  C -It would be hard to stick to a plan (workout)……….C -It would be hard to stick to a plan (workout)……….  CO--------CO--------
  42. 42. Other strategies for HandingOther strategies for Handing ResistanceResistance  ClarificationClarification  Shift focus away fromShift focus away from stumbling blockstumbling block  Emphasize PersonalEmphasize Personal Choice and ControlChoice and Control
  43. 43. Provide SummariesProvide Summaries  Communicate what you have tracked what theCommunicate what you have tracked what the client has said so that you have understanding ofclient has said so that you have understanding of what is being saidwhat is being said  Helps structure session so you do not getHelps structure session so you do not get sidetrackedsidetracked  Provide opportunity to emphasize statements aProvide opportunity to emphasize statements a client has made about change talk gives clientclient has made about change talk gives client another opportunity to hear what she has saidanother opportunity to hear what she has said in context provided by the counselorin context provided by the counselor
  44. 44. ExampleExample  So Sally , let me know if I heard you correctly.So Sally , let me know if I heard you correctly. You care about your children and you areYou care about your children and you are hoping social services does not intervene. Youhoping social services does not intervene. You believe you need to change your realtionshipsbelieve you need to change your realtionships that involve using and aren’t quite sure how tothat involve using and aren’t quite sure how to do that?do that?  Or what else would you add ?......Or what else would you add ?......
  45. 45. Exploring AmbivalenceExploring Ambivalence  The Existence ofThe Existence of conflicting emotions orconflicting emotions or thoughts about a personthoughts about a person object or ideaobject or idea  Protagonist ExerciseProtagonist Exercise
  46. 46. Decisional Balance WorksheetDecisional Balance Worksheet ((Fill in what you are considering as change )Fill in what you are considering as change ) Good things aboutGood things about Changing behaviorChanging behavior Good things about changingGood things about changing behaviorbehavior Not so good things aboutNot so good things about behaviorbehavior Not so good things aboutNot so good things about changing behaviorchanging behavior
  47. 47. Protagonists' ExerciseProtagonists' Exercise  Explore Roles forExplore Roles for resolving ambivalenceresolving ambivalence  Break up in groups of 6Break up in groups of 6  Client is to discuss anClient is to discuss an issue on which he/she isissue on which he/she is ambivalentambivalent  Four counselors areFour counselors are assigned a role & eachassigned a role & each has 3 minuteshas 3 minutes  1 observer1 observer
  48. 48. Protagonists' ExerciseProtagonists' Exercise  #1- argues for one side#1- argues for one side of ambivalenceof ambivalence  #2 argues other side of#2 argues other side of ambivalenceambivalence  #3 communicates#3 communicates disinterest- “I really don’tdisinterest- “I really don’t care what you to”care what you to”  #4 show interest in how#4 show interest in how the person is doingthe person is doing
  49. 49. Eliciting Change TalkEliciting Change Talk  Desire StatementsDesire Statements  I’d like toI’d like to quit drinking ifquit drinking if I couldI could  I wish I couldI wish I could make mymake my life betterlife better  I want toI want to ……….……….  Getting in shape wouldGetting in shape would make me feel…….make me feel…….  Ability StatementsAbility Statements  II thinkthink I can do thatI can do that  ThatThat mightmight be possiblebe possible  I’m thinkingI’m thinking I might beI might be able to……..able to……..  If I had someone to helpIf I had someone to help me ,me , I probablyI probably couldcould …..…..
  50. 50. Eliciting Change TalkEliciting Change Talk  REASON StatementsREASON Statements  I have to quit smokingI have to quit smoking becausebecause of my asthmaof my asthma  To keep my truck license ITo keep my truck license I probably shouldprobably should cut down oncut down on my meth and drinkingmy meth and drinking  My kids may be taken fromMy kids may be taken from me if I keep usingme if I keep using  I don’t like my kids to see meI don’t like my kids to see me this waythis way  NEEDNEED StatementsStatements  It’s really important to myIt’s really important to my health to change my diethealth to change my diet  Something has to change orSomething has to change or my marriage will breakmy marriage will break  I will die if I keep using likeI will die if I keep using like thisthis
  51. 51. Do You Swear????Do You Swear????  Person 1: “I want to”Person 1: “I want to”  Person 2: “ I could”Person 2: “ I could”  Person 3: “ I have goodPerson 3: “ I have good reasons to”reasons to”  Person 4 : “ I need to”Person 4 : “ I need to”  Person 5: I willPerson 5: I will
  52. 52. DARN (DARN (Desire, Ability , Reason, Need)Desire, Ability , Reason, Need)  What do you think you willWhat do you think you will do ?do ?  What does this mean aboutWhat does this mean about your habit ?your habit ?  What are your options?What are your options?  What's the next step for you?What's the next step for you?  What are some good thingsWhat are some good things about making a change ?about making a change ?  Where does this leave you?Where does this leave you?
  53. 53. On A Scale of 1-10On A Scale of 1-10 Not at all ImportantNot at all Important Very ImportantVery Important Not at all ConfidentNot at all Confident You picked a 7 , why wasn’tYou picked a 7 , why wasn’t a lower scorea lower score Very ConfidentVery Confident You picked a seven whyYou picked a seven why wasn’t a higher scorewasn’t a higher score
  54. 54. ResistanceResistance  TraditionalTraditional  Client not getting itClient not getting it  MI ViewMI View  Counselor may not beCounselor may not be getting itgetting it  Case Example – LisaCase Example – Lisa
  55. 55. Signs of ResistanceSigns of Resistance  ArguingArguing ChallengingChallenging DiscountingDiscounting HostilityHostility  IgnoringIgnoring -Inattention-Inattention -Non-answer-Non-answer -No response-No response -Sidetracking-Sidetracking  DenyingDenying  BlamingBlaming  DisagreeingDisagreeing  ExcusesExcuses  Claiming impunityClaiming impunity  MinimizingMinimizing  PessimismPessimism  ReluctanceReluctance  Unwilling to changeUnwilling to change •InterruptingInterrupting Taking OverTaking Over Cutting OffCutting Off
  56. 56. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change  1.1. Ask Evocative questionsAsk Evocative questions  Why would you want to make this change? (Desire)Why would you want to make this change? (Desire)  How might you go about that ? (Ability)How might you go about that ? (Ability)  What are the three best reasons for doing that ?What are the three best reasons for doing that ? (Reasons)(Reasons)  How important is it for you to make this change?How important is it for you to make this change? (Need)(Need)  So what do you think you will do? (Commitment)So what do you think you will do? (Commitment)
  57. 57. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change  2.2. Ask for ElaborationAsk for Elaboration  When change talk emerges ask for more detail. InWhen change talk emerges ask for more detail. In what ways?what ways?  3. Ask For Examples3. Ask For Examples Ask for specific examples, when was the last time thatAsk for specific examples, when was the last time that happened ? give me an examplehappened ? give me an example  4. Look Back4. Look Back Ask about a time before current concern emerged.Ask about a time before current concern emerged. How were things better? different?How were things better? different?
  58. 58. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change  5. Looking Forward-5. Looking Forward- What would happen if thingsWhat would happen if things stay the same/ If you arestay the same/ If you are 100% successful in making100% successful in making changes you want whatchanges you want what would life look like ?would life look like ?  6. Extremes6. Extremes What is the worst thing thatWhat is the worst thing that could happen? What is thecould happen? What is the best thing that could happenbest thing that could happen
  59. 59. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change  7.7. Use Change RulersUse Change Rulers  On a scale ofOn a scale of 1-------------------101-------------------10  8.8. Explore Goals andExplore Goals and ValuesValues  What are the personsWhat are the persons values and goalsvalues and goals  9.9. Join upJoin up –Come along–Come along sideside
  60. 60. Ten Strategies for Evoking ChangeTen Strategies for Evoking Change  10. Responding to10. Responding to Change Talk (Change Talk (EARSEARS))  EXPLOREEXPLORE  AFFIRMAFFIRM  SUMMARIZESUMMARIZE
  61. 61. Closing Skills –Closing Skills – 55 44 33 22 11 I guaranteeI guarantee I willI will I promiseI promise I vowI vow I shallI shall I give myI give my wordword I assumeI assume I dedicateI dedicate myselfmyself I knowI know I am devotedI am devoted toto I pledge toI pledge to I agree toI agree to I intend toI intend to I am ready toI am ready to I look forwardI look forward toto I consent toI consent to I plan toI plan to I resolve toI resolve to I expect toI expect to I concede toI concede to I declare myI declare my intention tointention to I favorI favor I endorseI endorse I believeI believe I acceptI accept I volunteerI volunteer I aimI aim I aspireI aspire I proposeI propose I amI am predisposedpredisposed I anticipateI anticipate I predictI predict I presumeI presume I mean toI mean to I forseeI forsee I envisageI envisage I assumeI assume I betI bet I hop esoI hop eso I will tryI will try I think I willI think I will I suppose II suppose I willwill I imagine II imagine I willwill I guessI guess
  62. 62. Setting a Course of ActionSetting a Course of Action  Set Specific Short term goalsSet Specific Short term goals  Consider Your optionsConsider Your options  Establish a PlanEstablish a Plan  Establish Monitoring ( CBT)Establish Monitoring ( CBT)
  63. 63. 10 Things MI is not10 Things MI is not  Based on transtheoreticalBased on transtheoretical modelmodel  TrickeryTrickery  A specific techniqueA specific technique  Decisional balanceDecisional balance (equally exploring pros(equally exploring pros and consand cons  Assessment feedbackAssessment feedback  CBTCBT  Just clinet centeredJust clinet centered  Easy tpo learnEasy tpo learn  What yu are alreadyWhat yu are already doingdoing  Panacea for every clinicalPanacea for every clinical challengechallenge
  64. 64. Traditional Assumptions ofTraditional Assumptions of Motivation & ChangeMotivation & Change  Symptoms are weaknesses that need to be fixed.Symptoms are weaknesses that need to be fixed.  Client is damaged, Counselor fixes clientClient is damaged, Counselor fixes client  Doctor knows bestDoctor knows best  Only client has control over motivationOnly client has control over motivation  Client must hit “Rock Bottom”Client must hit “Rock Bottom”  Change is linear and static, “on-off switch”Change is linear and static, “on-off switch”  No motivation=No treatment. ( Ping-Pong for DuallyNo motivation=No treatment. ( Ping-Pong for Dually Diagnosed clients)Diagnosed clients)  Double Standard of Efficacy.Double Standard of Efficacy.
  65. 65. Non-Directive Counseling vs. MINon-Directive Counseling vs. MI  Non-Directive CounselingNon-Directive Counseling  Client determines content 7Client determines content 7 directiondirection  Counselor avoids adviceCounselor avoids advice giving 7 feedbackgiving 7 feedback  High use of empathicHigh use of empathic reflectionreflection  Explores clients conflictsExplores clients conflicts and emotionsand emotions  Motivational InterviewingMotivational Interviewing  Systematically directs clientSystematically directs client towards motivation fortowards motivation for changechange  Counselor offers advice &Counselor offers advice & feedback when appropriatefeedback when appropriate & solicited& solicited  Empathic reflection usedEmpathic reflection used selectively to reinforceselectively to reinforce processprocess  Seeks to create & amplifySeeks to create & amplify clients discrepancy in orderclients discrepancy in order to enhance motivation.to enhance motivation.
  66. 66. Skills Training/ CBT vs. MISkills Training/ CBT vs. MI  CBT/ Skills TrainingCBT/ Skills Training  Assumes Client is motivatedAssumes Client is motivated  Seeks to modify maladaptive cognitionsSeeks to modify maladaptive cognitions  Treatment provides specific copingTreatment provides specific coping strategiesstrategies  Teaches through instruction, modelingTeaches through instruction, modeling practice & feedbackpractice & feedback  Specific problem solving strategies areSpecific problem solving strategies are taught.taught.
  67. 67. Role PlaysRole Plays
  68. 68. Role PlaysRole Plays

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