[PDF] - INTRODUCE YOURSELF Im At work I am For me, leading groups is What PDF Document

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USING MOTIVATIONAL INTERVIEWING METHODS IN COUNSELING GROUPS

Steve Gallon, Ph.D. Janis Crawford, MA LPC ACS

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LET’S GET TO KNOW EACH OTHER…

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INTRODUCE YOURSELF

I’m… At work I am… For me, leading groups is… What attracted me to this workshop was…

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5/2/2017 2 HOW MIGHT M MI METHODS E ENHANCE GROUP EFFECTIVENESS?

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WORKSHOP OP OBJECTI JECTIVE VES

Clarify MI process Explore interconnect between MI process and group development Identify activities that integrate MI methods into group counseling

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AGENDA

DAY 1

Relationship between MI process and how

groups develop

Facilitating engagement

DAY 2

Establishing a focus on change
Evoking motivation & building confidence
Change planning

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Methods:

Brief instruction, structured learning activities, demonstrations, skill practice

Materials:

Workbook, evaluations

Sources:

Miller & Rollnick (2013):

Motivational Interviewing

Wagner & Ingersoll (2013):

Motivational Interviewing in Groups

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METHODS AND SOURCES

HOUSEKEEPING

 Schedule: 8:30–4:30 each day  CE Credits: 14  Breaks and lunch  Refreshments  Restrooms  Cell phones  Others

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GUIDELINES

 Be on time  Share comments & questions  Take risks  Stay open to new ideas  Decide what to use  Take care of personal needs

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HALLMARK CHARACTERISTICS OF MI

Make notes

n page 2

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 Acceptance and compassion  Collaborative partnership  Establishing a focus/goal  Exploring reasons to change  Strengthening motivation and commitment

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KEY ELEMENTS OF MI

RESEARCH ON MOTIVATION

Assume ambivalence
Motivation is interactive and interpersonal
Motivation is influenced by counselor style and

expectations

Internal motivation is more likely to produce

change that lasts

Client talk about change predicts action

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Increased Discord

TELL client HOW to change

ARGUE for the benefits of change try to CONVINCE client she has a problem WARN of result of not changing

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SPIRIT OF MI

Partnership Acceptance Compassion Evocation

p. 3

DANCING vs WRESTLING

SPIRI PIRIT of MI

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WHAT MAKES S MI DIFFERENT NT? Counselor RESISTS fixing Emphasizes AMBIVALENCE as NORMAL Reframes resistance as DISCORD Evokes talk about the FUTURE Acceptance & Support can yield CHANGE

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How have your professional thoughts, feelings, and/or behaviors been modified since first being trained in or introduced to Motivational Interviewing?

DISCUSSION

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SUMMARY

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The MI Process of Change

Engage Focus Evoke Motivation Plan Act

p. 4

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Strength of Relationships

(Engage)

Clarity of Group Purpose

(Focus)

Structure and Relevance

(Evoke)

Interdependence

(Plan & Act)

Group Effectiveness

Owning Change Process Build OARS Skills Increase Confidence & Autonomy Facilitate Decision Making Change Planning Reinforce Action

BENEFITS OF USING MI PRINCIPLES

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p. 5

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LEADERSHIP PRINCIPLES

Normalize AMBIVALENCE MOTIVATION Importance + Confidence + Willingness Combine EMPATHY & DIRECTION Embrace the SPIRIT of MI

1 2 3 4

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Leadership Behavior

Be IN THE PRESENT POSITIVE AND HOPEFUL Focus Explore the FUTURE

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p.6

“Overall, MI groups focus more on making positive changes than on resolving problems.”

Chris Wagner (2016)

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ACTIVITY

1. Small groups of 3-5
2. 15 minutes
3. Discuss the question assigned to you
4. Have a spokesperson to share how you

answered the question

5. Facilitate a brief discussion with the

whole group

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p. 6

SUMMARY

1. Key elements of MI
2. What makes MI different
3. Uses of MI in group
4. Leadership principles and

behavior

5. How MI fits you, your agency,

and your groups

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Process

Engaging Focusing Evoking Planning

Skills

Open Questions Affirmations Reflections Summaries

Advice with Permission

Spirit

Partnership Acceptance Compassion Evocation

THE LANGUAGE OF MI

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p. 7

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CORE MI SKILLS

Skill Impac act Open questions

exploration

Affirming

note strengths, appreciations

Reflecting

convey intent, meaning

Summarizing

essence, linkage, transition

What…

…do you think…? …was that like…? …might cause you…? …would happen if…?

How…

…does that make you…? …might you like to…? …could you…? …would you like…? …can you get past…?

OPEN QUESTIONS

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Increase change talk Reduce sustain talk

AFFIRMATIONS

J Subst Abuse Treat. 2016 Feb

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p. 8

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Something you appreciate Acknowledging effort Noticing a value Something positive

AFFIRMING

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REFLECTING

Close paraphrase
Keeps flow going

Simple

Describes both

sides of client’s ambivalence

Double- sided

A guess about

deeper unsaid meaning/emotion

Complex

What you think the person means

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What’s been

said

Synthesis

Connecting

inputs

Linking

Shifting the

focus

Transitions

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SUMMARIES

3 Types

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CLIENT TALK ABOUT CHANGE

OA&R increase change talk
Giving information and closed questions

reduce change talk

Affirmations reduce sustain talk
By using OARS counselors improve

potential for change

“What core MI skills do you prefer? Which come easily and which take a bit more work to feel proficient?”

DISCUSSION

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MI PROCESS GOALS

Strengthen relationships
1. Engaging
Clarify purpose, resolve

conflicts, & increase skills

2. Focusing
Elicit motivation for change
3. Evoking
Commit to action steps
4. Planning

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p. 9

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Planning Evoking Focusing Engaging

PARALLEL PROCESSES

Performing Norming Storming Forming

Group p Dev evelo lopm pment MI Proces ess

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In small groups,

1. Discuss:

What What do the questions in your assigned process suggest about a a facilitator’s responsibilities at that stage in the group’s development?

2. Make a list of responsibilities to share

with the other groups.

3. Present and discuss briefly

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ACTIVITY

pp. 9-10

Process 1

ENGAGING Get acquainted Build trust & respect Understand values & goals Offer hope

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p. 11

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You… or Your… Intonation goes down Types:

1. Simple restatement
2. Double-sided
3. Complex
Underlying meaning or emotion
Validate unstated client thought/feeling
Encourage deeper disclosure

REFLECTIONS

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pp. 11-12

SKILL PRACTICE

In pairs,

a. Speaker shares a hobby or something

about which he/she is passionate.

b. Listener encourages using only

reflections – no questions.

c. After several minutes summarize and

reverse roles.

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DEBRIEF

What do you think about using more

reflections than questions?

How did reflections help move the

conversation forward?

How did the use of reflections impact

the storyteller?

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Evoke energy Bridge change targets Link participant comments

MI METHODS IN GROUP

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p. 13

ENGAGE

Model Dyads OARS E-O-E Exercises Reframe

ENGAGING GROUP MEMBERS

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1. Share appreciation for the group’s

participation

2. Today’s task: Share methods we currently

use to engage group members and build cohesiveness

3. Facilitator engages members by using:
Open question to start
Reflections to expand the conversation
Linking members to each other
Noting themes

PRACTICE

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Getting members engaged

Orientation Decontaminate Referral Shift focus to the future Proactive Goals Structured Activities

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p. 14

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“If the client is raising the problems and you’re providing the answers, you’re in the wrong chair.”

Miller & Rollnick (2013), p.273

CLOSURE ACTIVITY

1. What have you liked or appreciated

about the workshop today?

2. What wishes do you have for

tomorrow’s session?

3. Share an affirmation with at least
ne other group member.

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Day 2

USING MI METHODS IN COUNSELING GROUPS

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Review

ONE WALK-AWAY MESSAGE FROM YESTERDAY THAT WAS IMPORTANT TO YOU

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p. 15

Getting familiar with methods for:

1. Building relationships
2. Focusing participation
3. Evoking motivation for change
4. Change planning

TODAY’S AGENDA

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MI PROCESSES

Engage Focus Evoke Plan

Integrate ACTION

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GROUP PROCESSES

Strengthening relationships
1. Engaging
Clarifying purpose
2. Focusing
Eliciting personal motivation

for improving life situation

3. Evoking
Committing to specific action

steps

4. Planning

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Members of MI groups increase:

 Sense of autonomy  Readiness to change  Awareness of ambivalence  Willingness to try new behaviors  Attendance  Participation  Completion rate

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EVIDENCE

p. 15

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Process 2

FOCUSING Clarify purpose and direction Explore

pportunities

for change Deeper collaborative interaction

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When facilitating:

Take a client-centered perspective
Focus on the positives
Bring the group into the moment
Acknowledge suffering without

eliciting grievances

SHARPENING FOCUS ACTIVITIES

Wagner & & In Ingersoll, 2013, chapt apter 10

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SHARPENING FOCUS ACTIVITIES

1. Lifestyles and habits
2. A typical day
3. Exploring values
4. Introducing ambivalence
5. Circle of ambivalence
6. The good and not-so-good

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ACTIVITY INSTRUCTIONS

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1. Trainer will demonstrate.
2. 4 small groups; each assigned a different

“sharpening focus” activity.

3. Each group will review the strategy in the

workbook and decide how to describe the activity to the larger group.

4. Each of the 4 activities is then presented

and discussed.

PRESENTATION TIPS

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1. Introduce the title and purpose
2. Clarify important concepts or terms
3. Identify appropriate stage (s) of group

development for which it may be used

4. Estimate the approximate time needed
5. Instructions for facilitating the activity
6. Options for modifying the activity, if any

LIFESTYLES AND HABITS

1. Define ‘lifestyle’ – How we spend our time
2. Ask members about their lifestyle habits
3. Summarize patterns you hear
4. You can ask, “How does_________ fit in?”
5. Facilitate sharing both positive and negative

aspects of _______.

6. Ask, “How have your habits impacted your

health, your relationships, other aspects?”

7. “What habits would you like to develop?”

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Strategy 1

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A TYPICAL DAY

1. Consider developing a worksheet that divides

a typical day into sections

2. Ask group members to share how a typical

day unfolds

3. Focus on feelings & behavior
4. Leader reflects themes, invites others to

reflect and summarize

5. Ask, “How does _________fit into your daily

pattern?”

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Strategy 2

EXPLORING VALUES

1. Introduce values as personal guides
2. Ask members to share what is important to

them – Frame those as “values”

3. Ask one person to describe how a value has

served as an important guide

4. Encourage others to share
5. “What about conflicts in values & behavior?”
6. “How could values guide your future?”
7. “Whose story really spoke to you?”

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Strategy 3

INTRODUCING AMBIVALENCE

1. Define ambivalence
2. Describe ambivalence as normal
3. Note you are not trying to force change
4. Goal is to be more aware of our choices

and what keeps us stuck

5. Invite members to share issues about

which they feel ambivalent

6. Be sure to acknowledge both sides of

ambivalence

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Strategy 4

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CIRCLE OF AMBIVALENCE

1. Divide a circle – ‘want to’ vs ‘don’t want to’ and

share some personal examples of ambivalence

2. “What are some examples of ambivalence in

your own lives?”

3. “What helped you make a decision or make a

change when you felt ambivalent?”

4. “What situations are you facing now that give

rise to ambivalence?”

5. Reflect and summarize what you hear

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Strategy 5

The Good and Not-So So-Good

1. When ambivalent it is helpful to

see the ‘big picture’

2. Think of something you have

thought about changing

3. Jot down some of the good

things about not changing and some of the not-so-good things about not changing

4. Members invited to share.
5. Facilitator uses reflections and

summaries to reduce defenses & consider alternatives

FOCUSING ON CHANGE

Skill Practice Strategy 6

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Member focus is the key

CHANGE TALK

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p. 22

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LISTEN FOR…

Self- expressed language …that is an argument for change

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Desire Ability Reason Need

PREPARATORY CHANGE TALK

D A R N

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Commitment Activation Taking steps

MOBILIZING CHANGE TALK

C A T

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1. 2 teams line up in front of the posters
2. First person in line has the swatter
3. Trainer reads a statement and whichever

team swats the correct type of change talk first gets a point and opportunity for bonus response statement

4. Bonus response: team huddles for 1 min

and decides on reflection for extra point

ACTIVITY

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How…? What…?

Evocative questions

Tell me about…

Elaboration request

The worst…? The best…?

Using extremes

How were you able to…?

Looking back

What does success look like?

Looking forward

HOW TO ELICIT CHANGE TALK

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USING RULERS

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USING RULERS

Follow-up to evoke change talk

“Why a 6 and not a 3?”

What’s pushing client toward change

“What would it take to move from a 6 to

an 8?” Possible next steps in change process

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1. Place numbers 1-10 on floor
2. Participants asked to position themselves on

the continuum with regard to IMPORTANCE

f the change each is considering
3. Discuss in large group, asking participants
What makes you a __ and not a__ (lower)?
What would have to happen to move you from

a to a (higher)?

4. Use OARS to highlight change talk and

encourage more sharing

ACTIVITY

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CHANGE TALK SHIFTS THE FOCUS TOWARD THE FUTURE Members often feel more hopeful, optimistic, supported

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BUILDING MOMENTUM

Using guided imagery to evoke motivation

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p. 24

Process 3

EVOKING Building Momentum

Listen for discrepancies Focus on positives Tilt toward the future Resolve ambivalence Respond to Change Talk

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7. Ready-Willing-Able
8. Re-examining Expectations
9. Exploring Importance and

Confidence

10.Change Success Stories

MOMENTUM BUILDING STRATEGIES

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4 groups One strategy assigned to each group Groups will have time to review their

assigned activity plan a description

Each group presents their activity and

invites discussion with the larger group

ACTIVITY

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READY-WILLING-ABLE

1. Introduce the concept
2. Inquire about meaning of each word
3. Regarding a change in alcohol/drug use, ask

members to rate themselves on 1-10 scale for each of the 3 words

4. Invite members to share their ratings and

what they mean

5. Encourage the sharing of both high and low

motivation examples

6. Leader reflects what was heard

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Strategy 7

RE-EXAMINING EXPECTATIONS

1. Ask members to consider their past dreams

and hopes for their lives.

2. After some sharing ask, “How are those

dreams different from how your life is today?”

3. A bit later ask, “What would it be like to let

go of some of your old wishes and modify them to better fit for today?”

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Strategy 8

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IMPORTANCE AND CONFIDENCE

1. Ask members to think of 1 specific change

they would like to make

2. Draw a line on flipchart or whiteboard:

0………………………5………………………10

no importance medium high importance

4. Ask members to share their importance

rating

5. Ask why the number and not zero?
6. Ask members to make a confidence rating
7. Again, why the number and not zero?

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Strategy 9

CHANGE SUCCESS STORIES

1. Ask members to think of 2-3 things they

have accomplished in their life

2. Reflect and summarize
3. Ask, “How could you apply what you learned

to your current situation?”

4. If need be, remind the group that everyone

has had successes in their life

5. Note themes

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Strategy 10

Process 4

PLANNING Moving to Action Build confidence Share

utcome

Commit to act What Where When How

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p. 29

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MOVING INTO ACTION

GOAL: Build hope and

confidence

ASSUMPTION: Members are considering a different future and willing to experiment MI STRATEGIES:

11. Hypothetical change
12. Strengthening

commitment

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Hypothetical Change

1. Start by summarizing what

you have heard that indicates readiness to change

2. Invite members to develop a

hypothetical change plan:

a. Change to be made
b. Reasons for the change
c. Steps to take, and
d. Ways others can help
3. Divide into groups of 3 to

discuss their plans

STRATEGY 11

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Strengthening Commitment to Change

1. Suggest members make a

commitment to the group:

a. What specifically is planned,

b. When they will start, and c. A commitment to it.

2. Share an example
3. Ask who is ready to commit
4. Ask the committed to write out a

statement of commitment

5. In pairs, commitment statements are

reviewed and modified before sharing

STRATEGY 12

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Workshop Review

Key elements of MI
Importance of MI Spirit
Core skills: O-A-R-S
Leadership principles
MI processes that parallel

group development

6 strategies to enhance focus
4 strategies for evoking

motivation

2 strategies for action

planning

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CHANGE PLANNING

1. Review the My Change Plan Draft on

page 32 in the Workbook.

2. Plan 1 change you intend to integrate

into your life or your group counseling practice

3. Review your plan with a partner
4. Sharing in the large group

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WRAPPING UP

You are invited to share affirmations with whomever you wish Share any final comments about your experience at the workshop

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