A Little About Shawn & MI Smith - 2-3 H… · •(And then let go …) 70 ENGAGING • REFLECT TO...
Transcript of A Little About Shawn & MI Smith - 2-3 H… · •(And then let go …) 70 ENGAGING • REFLECT TO...
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An Overview
If you treat a person as he is,
he will stay as he is;
But if you treat him as if he were what he ought to be and could be,
he will become what he ought to be and could be.
Johann Wolfgang von Goethe
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A Little About Shawn & MI
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1998
Read MI -1
2002 – 2009
Pretrial
Project Excel
Wiser Choice
2009
Convened Training for
New Trainers
2009 – 10
Coding & Coaching
MINT Review of Internal
WCS MI Trainings
2010 –Present
Trained over 300
professionals
September 2012
MINT
In helping people change,
your biggest challenge is…
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Why MI?
Definitions: Degrees of Practice
� “What works”� Link to general, positive outcomes� Are not necessarily measured
� “Best practices”� Produce a positive, measurable result� Do not necessarily pay attention to one outcome
over all others � “Evidence-based practices”
� Have a specific, targeted outcome (over all others)� Are measurable� Are defined in practical terms
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Example: Motivational Interviewing (MI)
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What Works• Collaborate with Clients to increase internal
motivation• Collaborate with Clients to increase internal
motivation
Best Practice • Identify and resolve ambivalence• Identify and resolve ambivalence
Evidence-Based
Practice
• Targeted outcome: Sustained behavior change
• Measureable: continued abstinence
• Practical terms: a person-centered, directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.
• Targeted outcome: Sustained behavior change
• Measureable: continued abstinence
• Practical terms: a person-centered, directive method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.
Evidence-Based Principle
• Enhance Intrinsic Motvation• Enhance Intrinsic Motvation
Why Implement EBPs?
�Aligns with Mission and Values
�Promotes positive behavioral change
�Reduces recurrence
�Improves quality of life
�Required by many funders
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Developments in MI
• Trainers and translations in 44 languages
• Over 200 randomized trials between 2003-2010
• Over 1000 publications
• Four meta-analyses
• Rapid diffusion into health care and corrections
• Newer diffusion into mental health and education
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TIC Alignment
My Goal For Our Explorations …
AM I … MI?
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L e a r n i n g M I
• You Do Learn MI by:
�Doing/Practicing
�Reflecting
�getting feedback
(coding
sessions/practice
groups/fidelity tools)
• You Don’t Learn MI:
• By the end of a two
hour overview
• By the end of a 2 day
skills training
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The 8 Stages of Learning MI
1. Overall Spirit
2. Client-centered Interviewing
Skills (OARS)
3. Recognizing Change Talk
4. Eliciting Change Talk (ECT)
5. Rolling With Resistance
6. Consolidating Commitment
7. Developing A Change Plan
8. Transition and Blending With
Other Methods
• Open Questions
• Affirmation
• REFLECTIVE
Listening
• SummariesAim for this
Class:
Our Choice: Presumption of Worth
Goals & Outcome
• Won’t/Will
• Sustain/Change
You:
•Awesome
•Skilled
•Helpful
•Artists
•Do-er
You:
•Awesome
•Skilled
•Helpful
•Artists
•Do-er
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C h a n g e C o n c e p t s
All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves; we must die to one life before we can enter another.
- Anatole France17
Coercion =
Short Term Change 18
WHY DO PEOPLE
MAKE CHANGES
IN THEIR BEHAVIOR?
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We are in the business of
Behavior Change
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Who is the expert
on the person’s life?
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Our Behavior
Effects
A Person’s Behavior
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Shawn’s MI NON-ADHERENT Example
� Volunteer:
“A change I should make that I’ve been putting off …”
\
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A Taste of MI• Speaker: “I’ve been thinking about …”
Interviewer: Ask,
� “Why would you want to make this
change?”
� “How might you go about it, in order to
succeed?”
� “What are the 3 best reasons to do it?”
� Summarize what you heard.
� Ask, “What will you do next?”Cue Sheet Exercise # 1
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What kind of questions are these?
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• “Why would you want to make this
change?”
• “How might you go about it, in order
to succeed?”
• “What are the 3 best reasons to do
it?”
O A R S
Open Ended Questions
Affirmations
Reflections
Summaries26
Open Ended Questions …
• Good conversation starters/continuers
• Changing the subject, topic, or agenda
• gather information, and increase
understanding
• opposite of closed-ended -- require brief
responses – “yay” or “nay”, “sure”,
“sometimes”, “I dunno” etc.
• invite others to “tell their story” in their own
words
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Motivational Interviewing is …
- a lay person’s definition
… a collaborative conversation style for
strengthening a persons’ own motivation and
commitment to change.
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Approach
4 Processes
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ENGAGING
FOCUSING
EVOKING
PLANNING
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ENGAGINGC H E C K I N G - I N
FOCUSINGA G E N D A M A P P I N G
EVOKINGE L A B O R A T I V E O P E N E N D E D Q U E S T I O N S
PLANNINGW H A T D O Y O U W A N T T O D O
B E T W E E N N O W A N D T H E N E X T T I M E
W E M E E T ?
Handout
O u r r o l e …
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Directing Guiding Following
MI
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Not Favorites. Favorites.
Authority Figure Qualities that Evoked …
Resistance Growth
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Partnership
Compassion
Evocation
Acceptance MISPIRIT
MI
SPIRIT
P a r t n e r s h i p
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Collaboration Between Experts
Requires:
Exploration
Interest
Support
Feels Like Dancing
A c c e p t a n c e
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Absolute Worth
Autonomy AffirmationAccurate Empathy
• Prizes Inherent
Worth & Potential
• Non-Judgmental
• We control our
perceptions, we
choose the
prophecy
• Recognizes the
FACT of self-
direction
• Relinquishes a
power we never
had
• Acknowledges the
persons strengths &
efforts
• Best if tied to
positive/healthy
behavior
• Active Interest to
understand the
world from the
others lens
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AcceptanceAcceptance
Accurate EmpathyAccurate Empathy
AutonomyAutonomy
Absolute Worth
Absolute Worth
AffirmationAffirmation
E m p a t h y
LISTENING UNDERSTANDING JUDGING HELPING
APATHY NO NO NO NO
ANTIPATHY YES NO YES NO
SYMPATHY YES YES YES NO
EMPATHY YES YES NO YES
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A PATHY No response to other’s distress
ANTI PATHY Minimizing other’s distress
SYM PATHY Sharing other’s distress
EM PATHY Understanding without sharing other’s distress
E m p a t h yEmpathy is not:
• Having had the same experience or problem
• Identification with the person
• “Let me tell you my story”
Empathy is:
• The ability to:
• accurately understand the person’s meaning
• reflect that accurate understanding back to
the person
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E v o c a t i o n
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Motivational Interviewing
(Practitioners Definition)
Motivational interviewing is a
person-centered counseling style
for addressing the common
problem of ambivalence about
change.
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Ambivalence
• Feeling 2
ways about
something
• Normal and
acceptable
• Must resolve
to move
forward with
change43
C h a n g e Ta l k and S u s t a i n Ta l k
Two Sides of the Same Coin
Change
• Desire
• Ability
• Reason
• Need
Sustain
• Desire
• Ability
• Reason
• Need
Ambivalence
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Research suggests that MI facilitates
change by promoting three conditions
reduces resistance.
Resistance
Sustain Talk
MI-N Helper
BehaviorDiscord
Approach
DIS-Engagement vs. Engagement
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M o t i v a t i o n a l Tr a p s
C o m e U p w / E x a m p l e s
• Question/Answer
• Confrontation/Denial
• Expert
• Labeling
• Premature Focus
• Blaming
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Handout
2 Kinds of Levels of Change Talk
Preparatory:
• DESIRE: Want, wish, like
• ABILITY: Can, could, able
• REASON: Specific reason for change
• NEED: Need to, have to, must, important, etc.
Research suggests that MI facilitates
change by promoting three conditions
elicits change
talk.
Dear Science, HOW does MI Do IT?
Change
Taking Steps
Commitment
DARN
MI
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T h r e e T h i n g s R E C h a n g e Ta l k
• Identify it (hear it, listen for it)
• Respond to it
•Evoke it
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D A R N - C AT ?
1. I think I’m doing about as well as I can.
2. I don’t want to go to jail.
3. I’ve just always hated school.
4. I’d like to graduate.
5. Well, I wouldn’t mind doing the work.
6. I probably could get up earlier.
7. Yes, I’m going to go to school everyday.
8. But I love being high!
9. I’ve got to get my PO off my back!
10. I started going to the after school program.
P r e p a r a t o r y C h a n g e Ta l kWhat’s it sound like from a family member?
•Desire (want, like, wish …)
•Ability (can, could, …)
•Reason (if … then)
•Need (need, have to, got to …)
• Change talk often comes intertwined with sustain talk.
• That’s the nature of ambivalence.
Ambivalence
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Snatching Change Talk From the Jaws of Ambivalence …
“I’m tired of drinking but I have to so I don’t have
the shakes in the morning. I don’t use cocaine like I
was but if the guys call me - I can’t say no - I end up
going over there and using. But they are just using
me they only call me when they want me to buy the
stuff they never have beer or cocaine to give me. I
don’t think I can stop drinking because both of my
parents were alcoholics I didn’t stand a chance. I
think I drink because I’m depressed. If I lived in low
income housing I would be okay.”
Responding to Change Talk: EARS
Elaborating: Asking for elaboration, more detail, in what ways, an example, etc.
Affirming – the person’s statement or behavior
Reflecting, continuing the paragraph, etc.
Summarizing – collecting bouquets of change talk
OARSOpen Ended Questions
Affirmations
Reflections
Summaries59
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LISTENING: That’s what I’m talkin’ about!
Twelve Roadblocks to Listening (Thomas Gordon, Ph.D.)
1. Ordering, directing, or commanding
2. Warning or threatening
3. Giving advice, making suggestions, or providing solutions
4. Persuading with logic, arguing, or lecturing
5. Moralizing, preaching, or telling clients what they "should" do
6. Disagreeing, judging, criticizing, or blaming
7. Agreeing, approving, or praising
8. Shaming, ridiculing, or labeling
9. Interpreting or analyzing
10. Reassuring, sympathizing, or consoling
11. Questioning or probing
12. Withdrawing, distracting, humoring, or changing the subject62
Reflective Thinking
• interest in what
the person has
to say
• and respect for
the person's
inner wisdom
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Express INTEREST & RESPECT
• What’s good listening
look like?
• Don’ts/Do’s of
nonverbal listening
• Value of silence?
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Express INTEREST & RESPECT
Exercise:
1. Pairs
2. Speaker Topics (pick one):
a. Growing up in my home.
b. What is X-person like?
c. How’d I end up in my career.
3. Listener: Nonverbal Active
Listening
4. 2 minutes, debrief, switch
Reflections …• Form of a statement (inflection down)
• “You feel that if you do that you will lose?”
• “You feel that if you do that you will lose.”
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Let’s HYPOTHOSIZE
• A good reflective
listening response tests
a hypothesis.
• (You mean that you …)
Engaging:
Reflect to Understand (no fixing)
� Break into Two’s:
� One Speaker, One Listener,
� Speaker: One thing I like about myself is … (abstract)
� Listener responds: “You mean that you_________ .”
� Speaker responds briefly. (Couple of sentences).
� Deepen the reflection each time.
� Do this five times then rotate.
� Example.
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Forming Reflections
• You mean that you …
• Sounds like …
• You’re feeling …
• Seems that you …
• So you …
• What I hear you saying …
• (And then let go …)
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ENGAGING• R E F L E C T T O E X P R E S S U N D E R S TA N D I N G
FOCUSING• R E F L E C T T O G U I D E T O A T A R G E T B E H A V I O R
EVOKING• R E F L E C T C H A N G E T A L K
PLANNINGR E F L E C T T O S U M M A R I Z E
• C H A N G E T A L K
• M E N U O F O P T I O N S
MI Technical Definition
Motivational Interviewing is a
collaborative, goal-oriented style of
communication with particular attention
to the language of change. It is designed
to strengthen personal motivation for and
commitment to a specific goal by eliciting
and exploring the persons reasons for
change within an atmosphere of
acceptance and compassion.