Motivational Interviewing for CEAPs

Motivational Interviewing
for CEAPs
Tom Broffman, PhD, LICSW, LCDP. LCDS, CEAP
Clinical Professor
University of St. Joseph
Department of Social Work & Latino Community Practice
tbroffman@usj.edu

Disclaimer: MI Not Appropriate for
1. People who are acutely homicidal or suicidal
2. Unstable psychiatrically
3. Having problems meeting their basic human
needs (food, clothing, shelter, safety)
4. Impaired or under the influence of alcohol or
drugs
5. Traumatic brain injury
6. Memory or cognitive impairment
7. Children & pre‐adolescents
2
Tomas E. Broffman, PhD, LICSW,LCDP, LCDS,
CEAP

2 Opening Questions
1. What do you already know about
motivational interviewing?
2. Based on what you already know
about MI, what would like to learn
more about?
3
CEAP

Why Do People Change?
1. ?
2. ?
3. ?
4. ?
5. ?
6. ?
4
CEAP

Why Don’t People Change?
1. ?
2. ?
3. ?
4. ?
5. ?
6. ?
5
CEAP

Exercise: The Change Exercise
1. Stand up and turn to stand face to face in pairs.
2. Silently observe your partner for 30 seconds.
3. Now turn back to back and change 3 things
about yourself. [appearance]
4. When you are done, turn back to face your
partner.
5. Each person should take a minute to name the 3
things your partner has changed.
7

Change Exercise Questions
1. What was your comfort level during this
exercise?
2. What made you comfortable or uncomfortable?
3. How hard was it to change things?
4. How did you decide what things to change about
yourself?
5. What does this exercise tell us about change?
6. Look around you did you notice how quickly
people changed back to the way they started as
soon as they sat down?
7. What implications might this have about change
for people and ourselves?
8

Change Exercise Key Points
1. Change is difficult
2. Change is not always comfortable
3. Change requires creativity
4. We tend to go back to old ways
5. It is easier to stay the same
6. We like our comfort zones
7. Change requires an open mind
8. Change has emotional and cognitive components
9

Change Exercise Key Points
9. Change is a process
10.Change happens over time
11.The process is as important as the result
12.Watch out for measuring success only if a change
occurred
13.Often there is a difference between what
someone knows they should do and there
readiness to do it.
14.Greatest chance to impact change is pacing it to
the specific stage of change
10

Precontemplation
Maintenance
Action Preparation
Contemplation
Relapse
Stages of Change
11
Tomas E. Broffman, PhD, LICSW,LCDP,
LCDS CEAP

REMEMBER:
“READINESS TO CHANGE”
IS A STATE,
NOT A TRAIT.
12
CEAP

DEFINITION APPLICATION
Not even thinking
about it
Not considering
possibility of
change
Does not feel there
is a problem
Goal: Raise awareness
Task: Engage
Inform and encourage
Validate lack of
readiness
Pre‐contemplation
13
CEAP

•On a scale of 1 to 10, how important is it for you to
make a change?
14
1 2 3 4 5 6 7 8 9 10
Not at all
important
Somewhat
important
Extremely
Important
Importance Ruler “Willing”
CEAP

•On a scale of 1 to 10, how important is it to your
family for you to make a change?
15
1 2 3 4 5 6 7 8 9 10
Not at all
important
Somewhat
important
Extremely
Important
Importance Ruler “Willing”
CEAP

•On a scale of 1 to 10, how confident are you that
you could make a change, if you wanted to?
16
1 2 3 4 5 6 7 8 9 10
Not at all
confident
Somewhat
confident
Extremely
confident
Confidence Ruler “Able”
CEAP

•On a scale of 1 to 10, how ready are you to make a
change?
17
1 2 3 4 5 6 7 8 9 10
Not at all
Ready
Somewhat
ready
Extremely
Ready
Readiness Ruler
“Ready”
CEAP

18
Simplified Motivational Categories
Importance of Change
Confidence
in Ability Low High
Low
Group 1 – Little interest
in change; don’t think
they could even if they
wanted to.
Group 2 – Want to
change, but don’t
think they are able.
High
Group 3 – Believe they
could change, but not
interested right now.
Group 4 – Want to
change and believe
they have the ability.
CEAP

Contemplation
19
Thinking about
their situation
Ambivalent
“On the fence”
Goal: Explore motivation and
Confidence
Task: Explore ambivalence
Evaluate pros and cons
CEAP

Appreciate Ambivalence
It is the Spirit of MI to…
20
CEAP

Decisional Balance
CONTINUING BEHAVIOR
Benefits Costs
1. 1.
2. 2.
3. 3.
4. 4.
CHANGING BEHAVIOR
Costs Benefits
1. 1.
2. 2.
3. 3.
4. 4.
21
CEAP

2 Clarifying Questions
Look Backward, Look Forward
Worst case Scenario,
Best case Scenario
Look Forward 6 Months
Look Backward 6 Months
Best
case
scenario
Worst
case
scenario

Preparation
23
Making a plan to
change by setting
achievable goals
Goal: Negotiate a plan
Task: Facilitate decision
making
Explore:
1. Fears of change
2. Barriers to
change
3. Strengths to
change
CEAP

Change Plan
1. The changes I want to make (or continue making) are:
2. The reasons why I want to make these changes are:
3. The steps I plan to take in changing are:
4. The ways other people can help me are:
5. I will know that my plan is working if:
6. Some things that could interfere with my plan are:
7. What I will do if my plan isn’t working:
24
CEAP

Action
25
Implementation of
specific action
steps
Initiate changes in
attitude, feelings,
thoughts and
behaviors
Goal: Implement the plan
Task: Affirm
Support self-efficacy
CEAP

Maintenance
26
Continue to
maintain changes
for at least 6
months
Proactively explore
relapse warning
signs
Goal: Maintain change and
deal with issues of
ongoing recovery
Task: Identify strategies
to cope with high
risk situations,
urges, cravings, and
social pressure
CEAP

Something to Consider About Relapse
• Confucius said: "Our greatest glory is not in
never falling, but in rising every time we fall."
• This quote is most helpful in working with
people who experience a relapse.
27
CEAP

Motivational Interviewing is:
1. A theory
2. A set of skills
3. A way of thinking
4. A way of relating
28
CEAP

Beliefs About Motivation (True or False?)
1. Until a person is motivated to change, there is not
much we can do.
2. It usually takes a significant crisis (“hitting bottom”)
to motivate a person to change.
3. Motivation is influenced by human connections.
4. Resistance to change arises from deep‐seated
defense mechanisms.
29
CEAP

Beliefs About Motivation (True or False?)
5. People choose whether or not they will change.
6. Readiness for change involves a balancing of “pros”
and “cons.”
7. Creating motivation for change usually requires
confrontation.
8. Denial is not a client problem, it is a therapist skill
problem.
30
CEAP

• A collaborative, person‐centered form of
guiding [or clinical method] to elicit or
strengthen motivation for change
• By exploring and resolving ambivalence
• Not just a series of technique but a way of being
with people that improves with considerable
practice over time
• Miller and Rollnick, 2009
MI Defined
31
CEAP

So What’s Motivational Interviewing?
• It’s about
helping
people to
resolve their
ambivalence
to change
• By NOT,
increasing
their
resistance to
change
32
CEAP

Four Guiding MI Principles:
1. Resist the righting reflex
• If a client is ambivalent about change and
the clinician champions the side of change…
33
“Righting”
Reflex Ambivalence
CEAP

2. Understand your client’s motivations
• With limited consultation time, it is more
productive asking clients what or how they
would make a change rather than telling
them that they should.
34
CEAP

3. Listen to your client
• When it comes to behavior change, the
answers most likely lie within the client, and
finding them requires some listening
35
CEAP

4. Empower your client
• A client who is active in the consultation,
thinking aloud about the what and how of
change, is more likely to do something about
it.
36
CEAP

Core MI Strategies
Four Early Change
Strategies: OARS
 Open Questions
 Affirming
 Reflective Listening
 Summarizing
Goal:
Elicit
Positive
“Change
Talk”


• “What worries you about your current situation?”
(disadvantages of status quo)
• “How would you like your life to be five years from
now?” (advantages of change)
• “What encourages you that you can change if you
want to?” (optimism about change)
• “What would you be willing to try (intention) or
what do you think you might do?”
Open Ended Questions
38
CEAP

• “Thanks for coming on time today”
• “That’s a good suggestion”
• “It seems like you’re a spirited and strong person”
• “You enjoy being happy with other people and
making them laugh”
• “You are clearly a resourceful person to cope with
such difficulties for so long”
Affirmations
39
CEAP

Client: “I know we made all these goals about my getting
out and meeting people, but I’m just not comfortable
around other people.”
Worker: “Getting the support you need hasn’t been easy.”
Client: “I just don’t like the way my family talks to me
about my drinking.”
Worker: “You’re annoyed with your family.”
Client: “Yes, it just irritates me how they are always judging
me.”
Reflective Listening
40
CEAP

“Look, it’s not like I’m lazy. I just haven’t
found the right job yet. ”
How Might You Reflect This Statement?
41
CEAP

“I am never in one place and so it’s hard to
check my blood sugars when I’m
supposed to.”
42
CEAP

“These medications the doctor prescribed
just make me feel tired and depressed.
Why should I take meds that make me
feel worse?”
43
CEAP

• Special form of reflective listening
• Structure:
– Indicate you’re about to summarize
– Be selective
– Note ambivalence & attend to change statements
– Be concise!
– End with invitation
• Use to change directions or ask a key question
Summaries
44
CEAP

Avoid Righting Reflex:
“Taking Sides” Trap
Helper Helpee
“You must change” “I don’t want to change”
“You’ll be better off” “Things aren’t half bad”
“You can do it!!” “No I can’t!!”
“You’ll die…” “Uncle Fred is 89 and
healthy as can be”

Autonomy
Person is responsible for
change
Collaboration
Work in partnership with
person
Evocation
Learn from the person
Versus ‐Authority
Versus‐ Confrontation
Versus‐ Explanation
Spirit Of Motivational Interviewing

Listen For Change Talk
47
Desire
I want/wish/prefer to
Ability
I can, could, able, possible
Reason
Why do it? What would be
good?
Need
Important, have to, matter,
got to
Commitment
I will/am going to – signals
behavior change
CEAP

Desire
48
CEAP

Ability
49
CEAP

Reasons
50
CEAP

Need
51
CEAP

Commitment
52
CEAP

Why Do We Want The Reasons For
Change To Come From Them?
Change talk predicts change!
53
CEAP

Confrontation Is Not Consistent With MI
54
CEAP

Common Misconceptions
1. This person OUGHT to (or should WANT to) change.
2. Clients are either motivated or not. If not, there’s
nothing we can do for them.
3. Now is the right (only?) time to change.
4. A tough approach is always best.
5. I’m the expert, so he/she should follow my advice.
6. If the person decides not to change, the consultation
has failed.
55
CEAP

Closing Thought
MI is dancing & not wrestling!
56
CEAP

Motivational Interviewing’s
Money Back Guarantee
57
CEAP

• MI is an evidence based practice
• A large body of literature shows that MI can
directly impact client outcomes
• Both the relational and technical attributes of
MI contribute to outcome
• Training in MI has been shown to improve
clinician performance on MI skills that are
themselves related to client outcomes
(workshops and coaching combined)
In Summary
58
CEAP

• Learning MI takes practice and feedback.
• Starting with a few skills is usually more
effective than trying to use every skill
you’ve learned at once.
Where Do We Go From Here?
59
CEAP

• Motivational Interviewing: Preparing People for
Change, Miller and Rollnick, Guilford 2012
[http://www.amazon.com/Motivational‐
Interviewing‐Helping‐Edition‐
Applications/dp/1609182278]
• Ten Things that Motivational Interviewing Is Not,
Miller and Rollnick, Behavioural and Cognitive
Psychotherapy, 2009, 37, 129‐140
• www.motivationalinterviewing.org
• broffmat@easternc.edu Office: 860.465.5164
Sources of Information on MI
60
CEAP

Helpfulness Ruler
On a scale of 1 to 10, how helpful
was today’s presentation?
61
1 2 3 4 5 6 7 8 9 10
Not at all
Helpful
Somewhat
Helpful
Extremely
Helpful
CEAP

Thank You For Being Open to Learning
About Motivational Interviewing!
Any Questions?
62
CEAP

Motivational Interviewing for CEAPs

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