Motivational Interviewing - OhioMHAS..."Motivational interviewing is a collaborative, goal-oriented...
Transcript of Motivational Interviewing - OhioMHAS..."Motivational interviewing is a collaborative, goal-oriented...
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www.centerforebp.case.edu
Motivational Interviewing - the evidence behind making change
Patrick Boyle PhD, MSSA, LISW-S
Center For Evidence-Based PracticesA partnership between the Mandel School of Applied Social Sciences &
Department of Psychiatry at the School of Medicine
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www.centerforebp.case.edu
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www.centerforebp.case.edu
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Making change
•Consider how you presently go about helping people make changes?
•What challenges do you face in helping people make changes?
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Target behaviorsNearly ANY health related behaviors
Substance use and abuse Nutrition
Mood management –anger/anxiety/depression
Weight loss
Treatment retention Smoking
Medication adherence Healthy dental practices
Gambling Diabetes health regimen
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Our culture and context influences the change relationship!
What do WE bring to the relationship?
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YOUValues
Gender Identity
Family Norms
Faith System
TraumaPhysical Health
Mental HealthMood
Substance Use
AbuseAge
Tenure(or Ego)
Schooling
Expectations
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1. What we believe and perceive(Perceptions are about connections…)
2. How we think and feel
3. How we communicate and behave
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Our culture and context has the potential to
HELPand
LIMIT / COMPLICATEour work with others 10
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People change voluntarily Only when they become… Become Interested and concerned about the
need for change
Become Convinced change is in best interest or will benefit them more than cost them
Organize plan of action that they are committedto implementing
Take the actions necessary to make and sustain the change
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Stages of Change
• A way of thinking about where people are in regard to a particular change
• Motivation for change is not constant
• People may return to an earlier stage of change – this is NORMAL
Prochaska, Norcross & DiClemente (1994)12
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Stages of Change
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Maintenance
Action
Preparation (Determination)
Contemplation
Precontemplation
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IntrospectionExerciseThink about a risky behavior you have tried to change at some point in your life.
1. What was your age at start of the behavior and how much time passed before the first time recognized a risk or negative consequence?
2. How much time passed before you noticed the risk or consequence of behavior and
3. How much time then till first time you made earnest attempt to change?
4. How much time till you made changes?
Who was most helpful in the process – Why?Who was least helpful in the process – Why?
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What Does MI Have To Do With Me?
1. Changes who does the talking2. Professional avoids doing all the work3. Includes effective tools for resistance4. Helps prepare consumers for change5. Changes what is talked about
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PrecontemplationIncrease awareness of need to change,
interest, and concern
ContemplationMotivate and increase confidence
in ability to change; risk/reward analysis
ActionImplement plan, reaffirm commitment
and follow-up
Termination
Stages of Change Model
RelapseAssist in Coping
MaintenanceEncourage active problem-solving; life-style changes
PreparationNegotiate a plan
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Pro’s Con’s
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Stage of Change Characteristics -Issues
Strategies
Pre-contemplation “Nothing needs to change” • RELATIONSHIP• TRUST
Contemplation“On the Fence”
“I am considering change” • ACKNOWLEDGE MIXED FEELINGS
• DEVELOP DISCREPANCY
Preparation“Testing the Waters”
“I am figuring out HOW to change”
• BUILD CONFIDENCE• INFO, OPTIONS, ADVICE• CAREFUL - DON’T PUSH…
Action“Started Moving”
“I’m working on reaching my goals.”
• PLAN REACHABLE GOALS• MONITOR AND
ENCOURAGE
Maintenance“Holding Steady”
“I’ve changed, now to just keep it up.”
• SUPPORT CHANGE• RELAPSE PRE-PLAN
Relapse Prevention“Falling off the Wagon”“Revisiting the Past”
“I’ve gone back to old behaviors. Have I lost everything I worked for?”
• CAREFUL -AVOID SHAMING
• WHAT WENT WRONG?!• TRY AGAIN!!
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What is Motivational Interviewing (MI)?
A collaborative conversation style for strengthening a person’s own motivation and commitment to change.
"Motivational interviewing is a collaborative, goal-oriented method of communication with particular attention to the language of change. It is intended to strengthen personal motivation for and commitment to a change goal by eliciting and exploring an individual’s own arguments for change."
(Miller and Rollnick, 2013)
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MI Studies by EraCurrently:
> 200 Randomized trials> 1000 Total publications
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Communication Styles with SkillsConceptual Framework
(Rollnick, et al, 2008)
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Chart1
DirectingDirectingDirecting
GuidingGuidingGuiding
FollowingFollowingFollowing
Skills
Styles
Informing
Asking
Listening
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Sheet1
InformingAskingListening
Directing503010
Guiding303030
Following103050
To resize chart data range, drag lower right corner of range.
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Resistance Ambivalence Motivation
Components of Change Overview
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What we perceive as the “problem” or the “issue”…
…they perceive as a solution to something difficult or painful.
If we try to eliminate what they see as a solution…..
…it is unlikely they will remain engaged.
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The “Spirit” of MI: Elements
Collaboration
AcceptanceCompassion
Evocation
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COLLABORATION27
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EVOCATION28
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COMPASSION 29
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Favorite teacher
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Common Obstacles & Solutions
to Engaging People
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7 Obstacles to Engagement
1. Question/Answer (interrogation)2. Being the Expert 3. Premature Focus4. Labeling5. Blaming/Shaming6. Arguing for/demanding Change7. Chat 32
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Motivating = Dancing
Not Wrestling33
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MI Guiding Principles
1. Express Empathy2. Develop Discrepancy3. Roll with Resistance4. Support Self-Efficacy
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Person-Centered Core Skills:Basic Skills
Utilize O.A.R.S.
• Open-ended questions • Affirm the person• Reflect feelings and change talk• Summarize topic areas related to
changing
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Elicit - Provide – Elicit(Ask – Inform – Ask)
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Elicit
•Ask permission•Clarify information needs
and gaps
•May I? •Would you like to know about...?•What do you know about...?•What would you like to know
about...?
Provide
•Prioritize•Be clear•Support autonomy•Don’t prescribe response
•Avoid jargon•Offer small amounts•Acknowledge freedom•Present w/o your meaning
Elicit•Ask for the client’s
interpretation, understanding or response.
•Ask open questions•Reflect reactions•Allow time to process
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Acknowledge Choice
• Explicitly acknowledge the person has a choice
• It conveys respect and promotes the relationship
• Be sincere and genuine
• When offering suggestions – provide multiple options
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Finding a Common FocusStaff’s Hopes, Values, Goals
Goals
Values:
Hopes:
Shared Hopes, Values, Goals
Goal
Values (strengths)
Hopes
Client’s Hopes, Values, Goals
Goals
Values
Hopes
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Agenda Setting
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What influences Readiness?
Importance & Confidence
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Importance Ruler
On a scale of 0 – 10, how important is it for you to (manage your anger)?
1. Why are you at a ____ and not a zero?
2. What would it take for you to be at a ____ (one number higher)?
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Confidence Ruler
On a scale of 0 – 10, how confident are you that you can (take care of your daily needs)?
1. Why are you at a ____ and not a zero?
2. What would it take for you to be at a _____ (one number higher)?42
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Identifying Change & Sustain Talk
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Change Talk
Any language used by the person that leans in the direction of change
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Sustain Talk
Any language used by the person that leans in the direction of maintaining the status quo.
• Not wanting to change
• Needing to continue with a behavior
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Strategies to Elicit Change Talk
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Eliciting Change Talk - Strategies
• Pros/cons• Importance/Confidence Rulers• Looking back/looking forward• Asking for more information• Exploring goals and values
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Listening
Helps you gather important information
Communicates understanding (allows for a check of understanding)
Promotes the relationship48
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Listening Skills
Refrain from distractionsLook at the personSilenceFacilitative responsesReflections
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Relationship is Critical
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Committing to a Change Process
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Signs of Readiness for Change
• Diminished resistance• Decreased discussion about the problem
or need for something to stay the same• Questions or language in favor of making
a change• Expressing (willingness, readiness,
intention, feeling more secure and safe about change)
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HOMEWORK• Increase your self awareness
• Take notice of signs of Discord & Common Traps • Focus on Rolling with Resistance• Increased Engagement
• Share successes and less than perfect experiences with your team
• Next steps for you?
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www.centerforebp.case.edu
Patrick E. Boyle, PHD, MSSA, LISW-SConsulting Director
Center for Evidence-Based Practices (CEBP)Case Western Reserve University10900 Euclid AvenueCleveland, Ohio 44106-7164 216-368-0808 [email protected]
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Motivational Interviewing �- the evidence behind making change ��Patrick Boyle PhD, MSSA, LISW-S��Slide Number 2Slide Number 3Slide Number 4Making changeTarget behaviors�Nearly ANY health related behaviorsOur culture and context influences �the change relationship!���What do WE bring to the relationship?�Slide Number 8Slide Number 9Slide Number 10People change voluntarily Stages of ChangeStages of ChangeIntrospection�Exercise�Think about a risky behavior you have tried to change at some point in your life. ��1. What was your age at start of the behavior and how much time passed before the first time recognized a risk or negative consequence?��2. How much time passed before you noticed the risk or consequence of behavior and ��3. How much time then till first time you made earnest attempt to change?��4. How much time till you made changes? ��Who was most helpful in the process – Why?�Who was least helpful in the process – Why?What Does MI �Have To Do With Me?Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20What is Motivational Interviewing (MI)?MI Studies by EraCommunication Styles with Skills�Conceptual FrameworkSlide Number 24Slide Number 25Slide Number 26COLLABORATIONEVOCATIONCOMPASSIONFavorite teacherCommon Obstacles �& Solutions �to Engaging People 7 Obstacles to Engagement�Motivating = Dancing MI Guiding PrinciplesPerson-Centered Core Skills:�Basic SkillsElicit - Provide – Elicit�(Ask – Inform – Ask) Acknowledge Choice Finding a Common FocusAgenda SettingWhat influences Readiness?Slide Number 41Slide Number 42Identifying �Change & Sustain Talk�Change TalkSustain TalkSlide Number 46Eliciting Change Talk - StrategiesListeningListening SkillsRelationship is CriticalSlide Number 51Signs of Readiness for ChangeHOMEWORKSlide Number 54