Motivational Interviewing in Motivational Interviewing in Drug CourtsDrug Courts

Ron Jackson, MSW, LICSWRon Jackson, MSW, LICSW

School of Social WorkSchool of Social Work

University of WashingtonUniversity of Washington

Seattle, WASeattle, WA

MI is a fancy way of selling people on their need to change behavior.

A. True

B. False

50%50%

Motivational InterviewingMotivational Interviewing

Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.

Miller & Rollnick, 2012

Motivational InterviewingMotivational InterviewingTheoretical FoundationTheoretical Foundation

Client-centered approach – RogersClient-centered approach – RogersEmpathic Reflections

Self-Perception Theory – BemSelf-Perception Theory – Bem “We come to know what we believe by listening to

ourselves talk.” Self-Efficacy – BandSelf-Efficacy – Bandura

Power to Change Focus on Intrinsic Motivation – BrehmFocus on Intrinsic Motivation – Brehm

External pressure can lead to resistance to change Respect for client/patient autonomy – Medical EthicsRespect for client/patient autonomy – Medical Ethics Transtheoretical Model “Stages of Change” – Transtheoretical Model “Stages of Change” –

Prochaska & DiClementeProchaska & DiClemente

STAGES OF CHANGESTAGES OF CHANGEPROCHASKA & DiCLEMENTEPROCHASKA & DiCLEMENTE

PRECONTEMPLATION

CONTEMPLATION

PREPARATION

ACTION

MAINTENANCE

TERMINATION

RELAPSE is viewed as a loss of motivation and movement back down the spiral of change.

Spirit of MISpirit of MI

• Partnership• Acceptance• Compassion• Evocation

The The SpiritSpirit of Motivational Interviewing (MI) of Motivational Interviewing (MI)

Therapeutic relationship is a collaborative partnership, rather than separate ‘expert’ & ‘recipient’ roles. Motivation for change is elicited from the client, not imposed.

It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence. The counseling style is an eliciting one.

Direct persuasion is infrequently effective in resolving ambivalence. Instead, the counselor supports a client’s autonomy while helping to explore the prospect of change.

Process StructureProcess Structure

Engagement

OARS

Focusing – Strategic Direction

Evoking Motivation – Change Talk

Planning

FOUR PROCESSES OF MIFOUR PROCESSES OF MI

Four Principles ofFour Principles ofMotivational InterviewingMotivational Interviewing

R – Resist the righting reflex

U – Understand client’s motivation

L – Listen to the client

E – Empower the client

Four Elements of Four Elements of Motivational InterviewingMotivational Interviewing

Express empathy

Develop discrepancy – Gap

Roll with resistance

Support self-efficacy – Can Do

Supporting Self-EfficacySupporting Self-Efficacy

Encourages hope or the possibility of change. Our expectations about the likelihood of client

change has a powerful effect on the outcome. We want to enhance our client’s confidence in

their capacity to change. The client is responsible for choosing and carrying out change.

Four Goals ofFour Goals ofMotivational InterviewingMotivational Interviewing

Increase problem awareness

Resolve ambivalence

Increase the value of change

Increase confidence

O.A.R.S.O.A.R.S.Tools for Moving in the MI SessionTools for Moving in the MI Session

Open-ended questions

Affirmations

Reflective listening

SummariesMotivational Interviewing is not a series of techniques for doing therapy but instead is a way of being with patients.

William Miller, Ph.D.

Question Answer or Assessment Premature Focus Labeling Chat Trap Blaming Expert

MI TRAPSMI TRAPS

CHANGE TALK ANDCHANGE TALK ANDSUSTAIN TALKSUSTAIN TALK

Desire for status quo (don’t want to change)Inability to change (can’t change)Reasons for sustaining the status quoNeed for the status quo (have to stay)Commitment to status quo (not going to

change)

EXAMPLES OF SUSTAIN TALKEXAMPLES OF SUSTAIN TALK

Change StatementsChange Statements

Problem recognition

Statements of concernProblems with the status quo

Desire to change

OptimismAbility to change

Benefits of change

Preparatory Change Talk Preparatory Change Talk

DARN

Desire

Ability

Reasons

Need

Mobilizing Change Talk Mobilizing Change Talk

CAT

Commitment

Activation

Taking steps

Recognize EvokeRespond

CHANGE TALKCHANGE TALK

Desire

Ability

Reason

Need

CAT

Desire AbilityReasonsNeed

(preparatory)

CHANGE TALKCHANGE TALK

Activation

Taking Steps

(mobilizing)

Behavior

Change

Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology.Vol 71(5) Oct 2003, 862-878.

Commitment

Readiness to Change

Importance

Confidence Readiness

From Chris Dunn & Stephen Rollnick, Lifestyle Change.

Exploring ImportanceExploring Importance

Assess: “On a scale of 1-10, how important is it to you now to…(change)?”

Explore: “Why did you give it a ___ and not a ___ (lower number)?”

“What would have to happen to raise that score?”

“How can I help you with that?”

Exploring ConfidenceExploring Confidence

Assess: “On a scale of 1-10, how confident are you now that could make that change, if you decided to make it?”

Explore: “Why did you give it a ___ and not a ___ (lower number)?”

“What would have to happen to raise your confidence?”

“How can I help you with that?”

PartnershipAutonomyCompassionEvocation

MI Spirit

DD - Developing

DiscrepanciesEE -Expressing

EmpathySS -Supporting

Self EfficacyRR - Rolling with

Resistance

O-OEQAffirmationsReflectionsSummariesE-P-E Elicit-Provide-Elicit

EngagingFocusEvokingPlanning

Heart-Set

Mind-Set

Being

Working

Doing

Going

Principles

Skills

Path

MI Package

Resources: BooksResources: Books Motivational Interviewing (3rd Ed.), Miller,

W.R. & Rollnick, S., Guilford Press, 2013. Motivational Interviewing in Health Care,

Rollnick, S, Miller, W.R., & Butler, C. C., Guilford Press, 2008.

Lifestyle Change, Dunn, C. & Rollnick, S., Mosby, 2003.

Building Motivational Interviewing Skills Rosengren, David , Guilford, 2009.

BOOKS FOR LEARNING BOOKS FOR LEARNING MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING

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Resources: WebsitesResources: Websites

www.motivationalinterview.org – excellent source of MI resource material.

www.msleaders.org/ms-leaders/ce/motivational.asp – Overview & video demonstrations of brief interventions contrasting MI consistent & inconsistent styles. Requires broadband connection.