Daniel Schmidt, MSW, LSW. Introductions Motivation and Strengths Motivational Interviewing (MI) Direct and Indirect Use of MI As a Therapy Tool

STRENGTHS-BASED MOTIVATIONAL INTERVIEWING

Daniel Schmidt, MSW, LSW

Agenda

Introductions Motivation and Strengths Motivational Interviewing (MI) Direct and Indirect Use of MI

As a Therapy Tool As a Management Tool

Thoughts, comments, questions

Program Objectives

Attendees will have an understanding of strengths-based concepts and skills associated with Motivational Interviewing.

Attendees will understand the use of MI techniques in clinical settings as well as supervision and dealing with other stakeholders.

Attendees will understand the “Ten strategies for evoking change talk” needed as a basis for MI.

Motivation

Motivation is defined as the desire and action towards goal-directed behavior.

Intrinsic Motivation: A person is intrinsically motivated if the desire for change comes from within the individual

Extrinsic Motivation: A person is extrinsically motivated if the desire for change comes from the outside, i.e. a bribe or reward to do something.

Intrinsic MotivationStrengths

Understand the strengths, limitations, motivation for change, and resistance to change that are applicable to the persons and systems involved. Family and friends Education/employment Problem solving/decision making Personal qualities and characteristics Physical and financial resources Attitudes and perspectives Miscellaneous strengths


Who Are You? Complete the following four “who are you”

statements. They can be adjectives, nouns, or longer statements. I am ___________________________________________________ I am ___________________________________________________ I am ___________________________________________________ I am ___________________________________________________


Who Are You? Cite your greatest “strengths”. They can

involve anything from personal qualities to talents to accomplishments. They do not have to be in any particular order or priority. Strength:

___________________________________________________ Strength:

____________________________________________________ Strength:

____________________________________________________ Strength:

____________________________________________________


Who Are You?How do you think your personal strengths will help you to work with clients in social work practice?

How do you think knowing your personal strengths will help you find strengths in your clients, supervisees, other involved parties?

Extrinsic Motivation

Extrinsic Motivation

This type of motivation comes from the results one gets from the task itself or from the sense of completing or even working on a task. School Grades Monetary Gains Awards or Recognition Punishment

http://psychology.about.com/od/mindex/g/motivation-definition.htm

Motivation

Intrinsic versus Extrinsic??

Which is most valuable in Motivational Interviewing?

Motivational Interviewing

A Definition

Motivational Interviewing is a person-

centered, strengths-based, directive method

of communication for enhancing intrinsic

motivation to change by exploring and

resolving ambivalence.


Principles in the Practice of MI

Find Strengths

Evoke “Change Talk”

Roll with Resistance

Support Self-efficacy (directive approach)

Relapse as an opportunity not a failure

Focus on Ambivalence


Stages of Change Pre-Contemplation Contemplation Preparation Action Maintenance Relapse & Recycling Termination

Strategies for Evoking Change Talk

Ask Evocative Questions: Ask open ended questions, the answer to which is change talk.

Explore Decisional Balance: Ask first for the good things about the status quo, and then ask for the not-so-good things.

Ask for Elaboration and examples: When a change talk theme emerges, ask for specific examples.

Look Back: Ask about a time before the current concern emerged.

Look forward: Ask what may happen if things continue as they are (status quo). Ask, “if you were 100% successful in making changes, what would that look like?”

Strategies for Evoking Change Talk

Query extremes: What are the worst things that might happen if you don’t make this change? What are the best things that might happen if you do make this change?

Use change rulers: Use positive scales. Explore Goals and Values: Ask what a

person’s guiding values are. What do they want in life?

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.


Change TalkProblem recognition:

What things make you think that your drinking may be a problem?

How has your drinking stopped you from doing some things you want to do?

In what ways do you think you or other people have been harmed by your drinking?


Change TalkConcern:

What worries you about your drinking? How much does this concern you? In what ways does this concern you? What do you think will happen if you don’t

make a change? How do you feel about your drinking?


Change TalkIntention to Change:

What makes you think that you may need to make a change in your drinking?

What makes you think it is time for a change? What would be the advantage of making a

change? I can see you are feeling stuck. What is going

to have to change?


Change TalkOptimism:

What makes you think if you decide to make a change in your drinking, you could do it?

What encourages you that you can change if you want to?

What do you think would work for you, if you decided to change?

Motivational Interviewing Reflective Listening

Seeking to understand the client’s frame of reference is done thru reflective listening. Expressing acceptance and affirmation Eliciting and selectively reinforcing the client’s

own self motivational statements expression of problem recognition, concern, desire and intention to change, and ability to change.

Monitoring the client’s degree of readiness to change, and ensuring that resistance is not generated by jumping ahead of the client.

Affirming the client’s freedom of choice and self-direction.

Motivational Interviewing Reflective Listening

Gordons Twelve Roadblocks To Good Listening

Ordering or Directing Warning or Threatening

Giving Advice/Suggestions Persuading with logic, arguing, lecturing

Moralizing, preaching Judging, criticizing, blaming

Agreeing, approving, praising Shaming, ridiculing, labeling

Interpreting or analyzing Reassuring, sympathizing, consoling

Questioning or probing Withdrawing, distracting, humoring


Resistance Simple Reflection: Re-stating what the client

has said to you to insure you have heard the client correctly.

Amplified Reflection: Adding something to increase the intensity of what the client is saying.

Double-Sided Reflection: Reflect the Ambivalence that a client is thinking/feeling in responding to what they are saying.

Shifting Focus: Moving the client away from a difficult issue that is not necessary to discuss at this point in time.


Resistance Reframing: Make a change in the meaning of

what the client might say. Agreement With a Twist: Use reflection

followed by a reframe in responding to the client.

Emphasize Personal Choice and Control: Making sure that the client knows that the choice to change or not change a behavior is entirely up to them.

Siding with the Negative: Placing emphasis on the reasons a client may be resistive to change a thought or behavior.


Support Self-Efficacy The extent or strength of one's belief in one's

own ability to complete tasks and reach goals

Directive Approach (with a twist) Directive counselling is where the therapist

follows a line of therapy right for the client's condition.

Relapse as an opportunity not a failure

http://en.wikipedia.org/wiki/Goal

Motivational InterviewingAmbivalence

“I want to, but I don’t want to”

Natural phase in process of change Problems persist when people “get stuck”

in ambivalence Normal aspect of human nature, not

pathological Ambivalence is the key issue to resolve

for change to occur

Motivational InterviewingDevelop Discrepancy

This is a state of discomfort that needs to exist within the client, what the client wants from life and the contradiction of the self-destructive nature of the addiction. In MI this type of discomfort is not one to be avoided but rather to be a catalyst for change. The development of the discrepancy is used to allow the client to see how the addiction might be at odds with what they say they want. Here again it is imperative that the client be the one to discover and explore these facts with a directive approach. Otherwise developing discrepancy could turn into resistance and not benefit the client.


The Spirit of Motivational Interviewing

MI The OppositeCollaboration ConfrontationEvocation EducationAutonomy AuthoritySelf Efficacy IntimidationDiscrepancy Absolute Direction


Strengths-based intervention Elicits motivation from within people in

order to promote a change in behavior Needs a confrontation to arise and

confront ambivalence within the client Discomfort for the client towards a

behavior should increase the probability of change

Client centered counseling


Motivation to change is elicited from the client and not imposed from without.

It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence.

Direct persuasion is not an effective method for resolving ambivalence.

The counseling style is generally a quiet and eliciting one.


The counselor is directive in helping the client to examine and resolve ambivalence.

Readiness to change is not a client trait but a fluctuating product of interpersonal interaction.

The therapeutic relationship is more like a partnership or companionship than expert/recipient roles.

MET

Combines Motivational Interviewing with client feedback of their assessment results

Not limited to a particular set of assessment measures, only need comparison to some set of norms

Asks for client’s responses to feedback rather than telling clients what they should think or do

MET

Differences from other Treatment Approaches Lack of diagnostic labels Emphasizes personal choice regarding future

use of substances Non-confrontational Uses reflection rather argumentation Relies on clients’ own natural change

processes and resources

Motivational Interviewing as a Management Tool

A student/supervisee with several years’ experience working with a population who thinks she/he has mastered the skills needed to work with that population.

A very timid student/supervisee or one with low self-esteem or lack of confidence.

A very young, inexperienced, or anxious student/supervisee dealing with abusive clients.

An angry or judgmental student/supervisee who may feel the population or work is beneath them.

Students/supervisees with real life experience in treatment area who may feel that they have all the answers

References

Miller, W. (1995). Motivational enhancement therapy with drug abusers. Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions. University of New Mexico, New Mexico.

Rollnick, S. (2004). Motivational interviewing. In N. Heather & T. Stockwell (Eds). The essential handbook of treatment and prevention of alcohol problems. (pp. 105 – 110) New York: John Wiley & Sons


Thoughts, Comments, Questions

Documents

Daniel Schmidt, MSW, LSW. Introductions Motivation and Strengths Motivational Interviewing (MI) Direct and Indirect Use of MI As a Therapy Tool