Sponsored by: Sponsored by: Sangre de Cristo Sangre de Cristo - - PDF document
Motivational Interviewing: Motivational Interviewing: Some Basic Tools Some Basic Tools Ana Moseley, LISW, ACSW Ana Moseley, LISW, ACSW Thomas Peterson, Ph.D. Thomas Peterson, Ph.D. , Sponsored by: Sponsored by: Sangre de Cristo Sangre
1
2
3
A person centered goal orientated approach for A person centered goal orientated approach for facilitating change by exploring & resolving facilitating change by exploring & resolving g g y p g g g g y p g g ambivalence ambivalence ( (Miller 2006)
Miller 2006)
…a method of communication rather than a set …a method of communication rather than a set
people to do what they don’t want to do; rather, it people to do what they don’t want to do; rather, it p p y ; , p p y ; , is a fundamental is a fundamental way of being with & for people way of being with & for people – a facilitative approach to communication that a facilitative approach to communication that evokes change” evokes change”
(Miller & Rollnick 2002) (Miller & Rollnick 2002)
4
Give them
Give them
Give them
Give them
5
Maintenance Contemplation Relapse
Precontemplation Permanent exit
Preparation Action
Keyword: Doesn’t know or not ready
Task: Increase recognition and
Task: Increase recognition and
Keyword: Ambivalence
Task: Tip the balance
6
Keyword: Threshold
Task: Negotiate a change plan
Keyword: Movement
Task: Help person implement change
7
Keyword: Balance
Task: Help person continue change
Keyword: Guilt and Shame
Assist return to change behavior, Get
8
Explain why the person should should change change Give benefits that would result from Give benefits that would result from
Give benefits that would result from making the change making the change
Tell the person how they could make the change change
Persuade the person to do it
If you meet resistance, repeat the above. If you meet resistance, repeat the above. If you meet resistance, repeat the above.
Warn the speaker what may happen if change is not made. change is not made.
P.S. This is NOT NOT motivational Interviewing motivational Interviewing
9
Angry, agitated
Angry, agitated
Oppositional
Oppositional
Helpless
Helpless
Overwhelmed
Overwhelmed
Oppositional
Oppositional
Discounting
Discounting
Defensive
Defensive
Justifying
Justifying
Not understood
Not understood N t h d N t h d
Overwhelmed
Overwhelmed
Ashamed
Ashamed
Trapped
Trapped
Disengaged
Disengaged
Not come back
Not come back-
avoid
Not heard
Not heard
Procrastination
Procrastination
Afraid
Afraid avoid avoid
Uncomfortable
Uncomfortable
10
Direct persuasion is not very useful for
Motivation is elicited from the patient and
The patient is supported in identifying
Patient values and autonomy respected
“Change talk” recognized & responded to
Resistance is treated constructively
1. Express empathy
2. Develop discrepancy
3. Support self
4. Roll with resistance
11
Listen actively with the goal of
Skillful reflective listening is
Acceptance facilitates change.
Ambivalence is normal.
Motivation for change occurs when
Values and beliefs are key factors
The person rather than the practitioner
12
A person's belief in the possibility of
The patient, not the practitioner, is
The practitioner's own belief in the
The practitioner s own belief in the
Avoid arguing for change.
Resistance is not directly opposed.
New perspectives are invited and not
The patient is the primary resource
Resistance is a signal to respond
13
Reluctance and ambivalence are to be
Questions and problems may be turned
Explicit permission is given to disregard
Explicit permission is given to disregard
Resistance supplies energy which can be
14
ARGUING: Contesting the accuracy,
ARGUING: Contesting the accuracy, ti i t it f th i t i ti i t it f th i t i expertise or integrity of the interviewer expertise or integrity of the interviewer
INTERRUPTING: Cutting off or talking over
INTERRUPTING: Cutting off or talking over the interviewer in a defensive way the interviewer in a defensive way
UNWILLINGNESS: Not recognizing
UNWILLINGNESS: Not recognizing problems, cooperating, taking responsibility problems, cooperating, taking responsibility problems, cooperating, taking responsibility problems, cooperating, taking responsibility
IGNORING: Being silent, inattentive, non
IGNORING: Being silent, inattentive, non-
responsive or side-
tracking
Sim ple Reflection
Sim ple Reflection (focused on feelings; (focused on feelings; e g “You’re angry about being sent e g “You’re angry about being sent e.g., You re angry about being sent e.g., You re angry about being sent here.”) here.”)
Am plified Reflection
Am plified Reflection (overstating (overstating feelings; e.g., “You’re feelings; e.g., “You’re furious furious about being about being sent here.”) sent here.”)
Double
Double-
Sided Reflection ("On one hand ("On one hand you like the way things are; and on the you like the way things are; and on the
like to make a change.") like to make a change.")
15
Em phasizing
Em phasizing Personal Choice and Personal Choice and Control Control ("It's really your decision...") ("It's really your decision...")
Shifting Focus
Shifting Focus (“We've gotten ahead of (“We've gotten ahead of
Refram ing
Refram ing
Agreem ent w ith a tw ist
Agreem ent w ith a tw ist
Siding w ith the negative ( Com ing
Siding w ith the negative ( Com ing alongside) alongside)
O
A
R
S - Summarize
S
16
Patients should do most of the talking
Useful early in session to build rapport
Ask for “both sides of the coin”
The general pattern in MI is to ask an
In what ways has alcohol been a problem for
In what ways has alcohol been a problem for you? you?
What do you think keeps you from
What do you think keeps you from abstaining? abstaining?
Why don’t you try going to AA?
Why don’t you try going to AA?
Why would you want to put your baby at risk
Why would you want to put your baby at risk by drinking? by drinking?
What’s wrong with trying a few days without
What’s wrong with trying a few days without alcohol? alcohol?
17
Compliments or statements of
The point is to notice and appropriately
Genuineness is critical
Genuineness is critical
Appreciation vs. approval
Demonstrates a desire for mutual
Start with simplest levels of reflection
Good follow up to open
“Listen more than tell”
Being selective as we hold up a mirror
18
Periodic summaries reinforce what
It’s like collecting flowers one at a
It s like collecting flowers one at a
Think of reflective listening as a way to Think of reflective listening as a way to act as a mirror and help clients see act as a mirror and help clients see themselves themselves-hopefully at a deeper level hopefully at a deeper level themselves themselves hopefully at a deeper level hopefully at a deeper level because of your reflections. because of your reflections.
19
One of the most important and most
One of the most important and most challenging skills required for MI challenging skills required for MI challenging skills required for MI challenging skills required for MI
The essence of reflective listening is that it
The essence of reflective listening is that it makes a guess as to what the speaker makes a guess as to what the speaker means. means.
The reflective listener gives voice to the
The reflective listener gives voice to the guess in the form of a statement of guess in the form of a statement of d t di d t di understanding. understanding.
Start with simple reflections and move
Start with simple reflections and move towards complex reflections towards complex reflections
(reflections should outnumber questions) (reflections should outnumber questions)
Start with your question
Cut the question words
Inflect your voice down at the end
20
CONTENT
FEELING
MEANING
Content:
Feelings:
Meaning:
21
Getting present
Turning down the noise in my head
Being clear about my own goals for
Focusing on the person or family in
Repeating (same words)
Rephrasing (same content, different
Paraphrasing (reflecting meaning)
Reflection of feelings (“You feel
Reflection of feelings ( You feel… )
Deeper meaning (“You feel ____
22
You mean that…
You’re wondering if…
So you feel…
You…
(36 year old female) “I can’t quit drinking.
(36 year old female) “I can’t quit drinking. Everyone I hang out with drinks all the Everyone I hang out with drinks all the Everyone I hang out with drinks all the Everyone I hang out with drinks all the time.” time.”
(19 year old male) “Hey, I get smashed
(19 year old male) “Hey, I get smashed because its fun. It’s not a problem because its fun. It’s not a problem --
I just drink on the weekends.” drink on the weekends.”
(31 year old male) “You can’t understand
(31 year old male) “You can’t understand
(31 year old male) You can t understand
(31 year old male) You can t understand what I’ve been through unless you’ve what I’ve been through unless you’ve been there yourself.” been there yourself.”
23
Direct
Guide
Follow
– A child runs into the road A child runs into the road h ld l d b k h ld l d b k – A child is learning to ride a bike A child is learning to ride a bike – A child is crying and you don’t know A child is crying and you don’t know why why
24
May be the most effective way to
Motivational Interviewing
Asking
Sho t open Sho t open ended q estions ended q estions – – Short, open Short, open-ended questions ended questions
Listening
– Active use of reflection, especially with Active use of reflection, especially with change talk or resistance change talk or resistance
Informing
– Ask permission, elicit Ask permission, elicit-
provide-
elicit
25
“Have I elicited the client’s own ideas
“Is what I am going to convey
Miller and Rollnick, 2002, pg. 131 Miller and Rollnick, 2002, pg. 131
Ask
Reflection/ Roll with Resistance
Importance (or Interest) Ruler
Confidence Ruler
Summary
Menu of Options
“What do you think you’ll do”
26
Ask:
Ask: “Would it be okay with you to share “Would it be okay with you to share some information/ advice I have some information/ advice I have some information/ advice I have some information/ advice I have about_______” about_______”
“Elicit the patient’s own ideas and
“Elicit the patient’s own ideas and knowledge on the subject?” knowledge on the subject?”
Provide
Provide the information/ advice the information/ advice
Ask:
Ask: “What do you make of that?” “What do you make of that?”
Not at all important Not at all important extremely important extremely important 5 6 7 8 9 2 10 1 3 4
27
Importance Ruler
“On a scale of one to ten how important is it “On a scale of one to ten how important is it On a scale of one to ten how important is it On a scale of one to ten how important is it to make a change in your behavior?” to make a change in your behavior?”
Query: Query: “What makes it an 8 and not a 2?” “What makes it an 8 and not a 2?”
Confidence Ruler
“On a scale of one to ten how confident do “On a scale of one to ten how confident do you feel that you can make a change in you feel that you can make a change in your behavior?” your behavior?”
Query: Query: “What would it take to move it up to an 8?” “What would it take to move it up to an 8?”
Summary of information and change
Menu of choices / Agenda setting
Ask the client: “What do you think
28
29
Arranging conversation so that
Several strategies to elicit self
Easiest is to ask questions which
Easiest is to ask questions which
30
DARN
Desire
to change (want, like, wish )
Ability
) to change (can, could … )
Reasons
to change ( if .. then )
Need
) to change (need, have to, got to … )
Commitment to making change ( I will,
Commitment to making change ( I will, I’ve decided… ) I’ve decided… )
31
You don’t have to make change happen. Y ’t Y ’t You can’t You can’t
You don’t have to come up with all the answers. answers. You probably don’t have the best ones You probably don’t have the best ones
You’re not wrestling You’re dancing You’re dancing
32
amoseley444@yahoo.com
thomas.peterson@sdcchp.nm.org
nancy.miquelon@ihs.gov
mady.maraia@sdcchp.nm.org
33