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Motivational Interviewing: Refining Your “Change Talk”
with Adolescents Using Marijuana
ALLEN E. LIPSCOMB, PSYD, LCSW
ASSISTANT PROFESSOR
CSUN DEPARTMENT OF SOCIAL WORK
JANUARY 28TH, 2019
Agenda
A.
•Part 1: History and Philosophy
B.
•Part 2: Fundamental Processes of Motivational Interviewing
C.
•Part 3: Intervention Strategies
Let’s Start with Teens and Marijuana
Marijuana is the most commonly used substance among adolescents after alcohol.
Young people who use marijuana may experience poor health outcomes.
Unfortunately, fewer adolescents believe that marijuana use is a threat than in the past. This
belief may undermine prevention efforts.
Let’s start with Cultural Humility
Cultural humility is about accepting our limitations. Those who practice cultural humility work to increase their self-awareness of their own biases and perceptions and engage in a life-long self-reflection process about how to put these aside and learn from clients (Tervalon & Murray-Garcia, 1998).
Clients are approached humbly and are viewed as collaborators in the helping process. Clients teach us about their unique places at the intersections of their different cultures and the role of the clinician is to be willing to learn about their experiences.
Intersectionality is a concept that enables us to recognize the fact that perceived group memberships can make people vulnerable to various forms of bias; yet because we are simultaneously members of many groups, our complex identities can shape the specific way we each experience that bias. -Adapted from Crenshaw, 1991
Intersectionality Theory-coined by Kimberlee Crenshaw – has its origins in Black feminist legal theory and has been used in Queer theory.
Why you need this tool
Client behavior can be puzzling, frustrating and irritating. Consideration of intersectionality not only makes sense of behavior, but it allows for empathy, which is not easy when we are providing clinical services to clients with complex concerns and systems or organizations that may be inadvertently maintaining oppressive practices.
WHY INTERSECTIONALITY IS CRITICALFOR EFFECTIVE MOTIVATIONAL INTERVIEWING
What is motivational interviewing?
MI is a clinical method for helping people to resolve
ambivalence about change by evoking intrinsic
motivation and commitment
A skillful, clinical style for eliciting from clients their
own motivations for making behavior
change
MI is also described as:
“a way of helping people talk themselves into
changing”
Primary goals of Motivational
interviewingMinimize resistance
Elicit change talk
Explore and resolve ambivalence
Nurture hope and confidence
30 years of research
Evidence-based >200 clinical trials
Grounded in a testable theory
With specifiable mechanisms of action
Verifiable
Generalizable across many problem areas
Goes well with other treatment methods
Can be utilizing by many human services and medical professionals
Part 1 History and Philosophy
History of Motivational interviewing
Originally came about as a different approach to substance/alcohol treatment
1970’s - tough love treatment approach was to use counselors who were also in recovery to “confront” patients about their addiction and “make them” change
However, when patients were confronted, their natural instinct was to defend themselves - thereby removing any desire to behave any differently
Labelled unmotivated, unwilling to work
Dr. William Miller
Dr. Miller “accidentally” discovered that other
approaches could positively affect the behavior of
addicted patients
-Listening
-Empathy
Over time, these experiences were studied, replicated,
modified and enhanced to become the field of
Motivational Interviewing
Rather then the job of the client to be motivated for
change….
It’s our job as mental health professionals to help people
find the motivation for change that’s already there within
themselves
What is motivation?
Motivation is most simply defined as:
readiness for change
Why do people change???
What impacts motivation?
Distress (iedepression or
anxiety)
Critical life events
How we view things
Recognizing negative consequences
Positive and negative external
incentivesYour style
Warmth, respect,
affirmation and empathy
vs. challenging and disputing
clients
Ambivalence
“Uncertainty or fluctuation, especially when caused by inability to make a choice or by a simultaneous desire to say or do two opposite or conflicting things.”
Ambivalence
Looks like: “I want to, but I don’t want to”
Often lack of motivation is a manifestation of
ambivalence
It is key for us to understandand accept client’s
ambivalence, because it is often a central problem
What does
Ambivalence look
like in
treatment/services
Resistance
What does it mean?
Can be predictive of:• lack of involvement
in the treatment process
• poor treatment outcomes
Practice reframing resistance from defiance to:
• the client views the situation differently
• change direction or listen more carefully
Shifts from an obstacle to an opportunity!
Ambivalence or resistance?
Is there a relationship
between ambivalence and resistance in how clients
present?
Activity
Break into groups of two (dyads) or small groups
•PERSON A – Tell person B (or your group) one of your most favorite foods
•PERSON B (or small group) – Convincingly argue to person A why they should NEVER eat that food item
Discussion
The paradox of change
When a person feels accepted for
who they are & what they do, no
matter how unhealthy, it allows
them the freedom to consider
change rather than needing to
defend against it.
What is your position? Dancing vs wrestling
Tapping vs. Pulling
Eliciting vs. Imparting
Consulting vs. Instructing
Guiding vs. Directing
Intervention strategies must be specific to
client’s stage of readiness
Pushing clients = defensiveness, which can look like denial, resistance
or noncompliance
Meeting them where they are = development of
rapport and the resolution of ambivalence
Stages of ChangeProchaska and
DiClemente, 1983
Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse/ Recurrence
Stages of Change
1. Precontemplation
•The client is not yet considering change or is unwilling or unable to change
Stages of Change
2. Contemplation
•The client acknowledges concerns and is considering the possibility of change but is ambivalent and uncertain
Stages of Change
3. Preparation
•The client is committed to and planning to make a change in the near future but is still considering what to do
Stages of Change
4. Action
•The client is actively taking steps to change but has not reached a stable state
Stages of Change
5. Maintenance
•The client has achieved initial goals and is now working to maintain goals
Stages of Change
6. Recurrence/relapse
•The client has experienced a recurrence of symptoms and must now cope with consequences and decide what to do next
Part 2
FUNDAMENTAL
PROCESSES OF MI
Four fundamental processes of MI
Engaging –
Establish helpful connection & working relationship
1
Focusing –Particular agenda the client came to discuss
2
Evoking –Client’s own motivation for change
3
Planning –Developing commitment to change, forming specific plan of action
4
1. Engaging
2. Focusing
3. Evoking
4. Planning
35
Part 3 Intervention Strategies
So what do we do with all
of this information…
Key principles of motivational interviewing
Express empathy through reflective listening
Develop discrepancy between clients' goals or values and their current behavior
Avoid argument and direct confrontation
Adjust to client resistance rather than opposing it directly
Support self-efficacy and optimism
Follow the RULE when engaging in MI
processes
R.U.L.E.
•Resist – the righting reflex
•Understand – the client’s motivation
•Listen – with empathy
•Empower – the client
O.A.R.S.
Open-ended
questionsAffirmations
Reflective listening
Summary statements
Underlying OARS is empathy
• The ability to understand the client's thoughts, feelings, and struggles from their point of view
Empathy is a strong predictor
of treatment outcome
Questions?
