Directing <=> Guiding <=> Following - PowerPoint PPT Presentation

Directing <=> Guiding <=> Following Behavior therapy Cognitive therapy Dr. Phil????? Motivational interviewing Solution-focused therapy Psychodynamic psychotherapy

Directing <=> Guiding <=> Following

The Spirit of MI

Four Planning Foundational Processes Evoking Focusing Engaging

O pen question A ffirmation R eflective Listening-Remember that the learnable skills of reflective listening is Accurate Empathy- S ummary

▪ Change talk: any patient speech which favors movement in the direction of change on a particular behavior ▪ Shows up as natural language ▪ Several types ▪ Sustain talk: maintaining status quo

DARN D esire to change (want, wish, hope) A bility to change (can, could) R eason to change (if… then) N eed to change (have to, got to) Mobilizing Change Talk: CAT C ommitment to change (I will, I’m going to) A ctivation (I’m preparing, I’m ready) T aking steps (I alr eady…)

Flow of Change Talk Commitment Desire Activation Ability Change Taking Steps Reasons Need +/- (CAT) = (DARN) Change

(1) (2) (3) (4) (5) Weakest Weak Moderate Stronger Strongest I hope to I favor I look forward to I am devoted to I guarantee I will try I believe I consent to I pledge to I will I think I will I accept plan to I agree to I promise I suppose I will I aim I resolve to I am prepared to I vow I imagine I will I aspire I expect to I intend to I shall I suspect I will I am inclined I concede to I am ready to I give my word I will consider I anticipate I declare my intention to I assure I guess I will I predict I dedicate myself I know I will I will see (about) I presume

In MI, the pra ctitioner’s task is to: a. Recognize change talk b. Proactively elicit it, and c. Strategically respond to it.

50000 40000 30000 20000 10000 0 1983 1987 1991 1995 1999 2007 2003 2011 2015 Annual Cumulative

160 Obesity n = 150 Dental 140 Asthma Violence 120 Family Health Prom 100 Psychiatric n = 93 Diabetes Cardiac 80 HIV 60 Smoking/Tob n = 54 Adh/Retention n = 36 Eating Dis 40 Offenders Gambling 20 n = 6 Dual Dx AOD 0 1988‐94 1995‐99 2000‐02 2003‐06 2007‐09

Skills & Strategies Eliciting & Open Reflections Affirmations Summaries Responding Questions To Change Talk Processes Focusing Planning Engaging Evoking Spirit Partnership Acceptance Compassion Evocation Miller and Rollnick, 2013