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SUPERVISOR TRAINING Motivational Interviewing Presented By: Jeanie McCarville Kerber MSW, MPA, LISW, CADC
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JEANIE MCCARVILLE KERBER MSW, MPA, LISW, CADC I have been in the human service field for 20
years. I have worked with both adolescents and adults in the residential, outpatient, school, and medical setting, as well as substance abuse Tx. I currently work at DMACC as Associate Professor in Human Services. I have provided Motivational Interviewing Training for Substance Abuse Providers, Corrections, Dept Public Health, DHS and Mental Health Professionals.
Thank You for inviting me to be with you today!
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GOALS FOR TODAY
Stages of Change Define Motivational Interviewing Spirit of MI Guiding Principles Communication Styles Noticing Change Talk Providing Supervision of MI
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BE CLEAR…..ARE YOU PROVIDING Supervision Case Consultation
What you do may look and be different!
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STOP IT!
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UNDERSTANDING CHANGE Jim Prochaska and Carlos DeClemente Stages of Change
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STAGES OF CHANGE
Behavior
Precontemplation
Contemplation
Preparation Action
Maintenence
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PRECONTEMPLATION Not thinking of quitting Feel that things are fine Do NOT see a problem
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CONTEMPLATION Thinking of quitting Wondering how I affect others Maybe trying small changes
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PREPARATION Have a plan to quit May Have “cut down” or “doing less of it” Can see benefits of stopping the behavior
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ACTION Have quit behavior Avoiding triggers Asking others for support
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MAINTENANCE No use of the behavior in a long time Accepting myself Helping others who are still using or displaying
the behavior (mentor, etc.)
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WHAT IS MOTIVATIONAL INTERVIEWING? Motivational Interviewing is a Client centered,
directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.
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HOW DOES IT WORK? MI works be activating patients’(client, employee,
self) own motivation for change and adherence to treatment. (pge. 5)
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MYTHS ABOUT EMPLOYEES When an employee/client seems unmotivated to
change or to take the sound advice of the practitioner/supervisor, it is often assumed that there is something the matter with the employee/client and that there is not much one can do about it.
No person is completely unmotivated. Resistance is actually a sign for the
practitioner/supervisor to try something different.
Pge 5/supervisor
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WHY MI? MI works by activating client/employees’ OWN
motivation for change and adherence to treatment/direction.
Reduces resistance
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AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL !
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THERE IS SOMETHING ABOUT THE WAY WE INTERACT… What is our mind set/biases? What assumptions have we already made? SPIRIT of Motivational Interviewing
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ATTENTION VIDEO
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SUPERVISING EXPERIENCES Think about a supervisor or leader in an agency
you worked who was instrumental in your life… What did they do? What characteristics did they have?
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THE SPIRIT OF MI Collaboration- Involves a partnership and
honors the persons’ expertise and perspectives. The counselor/supervisor provides an atmosphere that is conducive rather than coercive to change.
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EVOCATION The resources and motivation for change are
presumed to reside within the person. Intrinsic motivation for change is enhanced by drawing on the person’s own perceptions, goals, and values.
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AUTONOMY The supervisor/counselor affirms the person’s
right and capacity for self-direction and facilitates informed choice.
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MI – 3: PACE Partnership Acceptance Compassion Evocation
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PRINCIPLES OF MI Express Empathy Develop Discrepancy Roll with Resistance Support Self- Efficacy
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EXPRESS EMPATHY Acceptance facilitates change. Skillful reflective listening is fundamental. Ambivalence is normal.
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DEVELOP DISCREPANCY The clients rather than the counselor should
present the arguments for change. Change is motivated by a perceived discrepancy
between present behavior and important personal goals or values.
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ROLL WITH RESISTANCE Avoid arguing for change. Resistance is not directly opposed. New perspectives are invited but not imposed. The client is a primary resource for finding
answers and solutions. Resistance is a signal to respond differently.
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SUPPORT SELF EFFICACY A person’s belief in the possibility of change is an
important motivator. The client, not the counselor, is responsible for
choosing and carrying out change. The counselor’s own belief in the person’s ability
to change becomes a self-fulfilling prophecy.
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OARS Open Ended Questions Affirmations Reflections Summary
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FOUR GUIDING PRINCIPLES RULE
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R: RESIST THE RIGHTING REFLEX
We entered this field to make a difference and to help others.
Therefore, we try to convince, threaten, repeat ourselves, and sometimes even beg…but,
It is a natural tendency for someone to resist persuasion.
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U: UNDERSTAND YOUR EMPLOYEES MOTIVATIONS
What are your employees motivations to change….I mean really change?
What suggestions do they have on how to make changes?
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L: LISTEN TO YOUR EMPLOYEE Listen with Empathic interest in making sure
you truly understand. There is much more to listening than just waiting
long enough for person to finish their response to your question.
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E: EMPOWER YOUR EMPLOYEE Helping employees explore how they can make a
difference in their own work life. People who come up with their own solutions are
more likely to follow through.
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FROM THE 17TH CENTURY TO THE 21ST CENTURY “People are generally better persuaded by the
reasons which they have themselves discovered than by those which have come in to the mind of others.”
Blaise Pascal- 17th century French Polymath wrote in his Pensees.
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COMMUNICATION STYLES
Guide
Follow Direct
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FOLLOWING Listening predominates. You follow the person’s
lead. You are communicating “I won’t change you or push you.”
Synonyms for “following”: Go along with, Allow, Understand, Permit
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DIRECTING Supervisor takes Charge, at least for the
moment. It implies an uneven relationship with regard to knowledge, expertise, authority or power.
Synonyms for “directing”: Lead, rule, determine, tell, prescribe, authorize
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*GUIDING A guide or tutor, who is a resource to help
someone with self directed learning. You are communicating, ”I can help you to solve this for yourself.”
Synonyms for “guide”: enlighten, encourage, support, motivate, look after, elicit
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WHICH STYLE DO YOU USE MOST? Following? Directing? Guiding? Mix and Match: We use all three styles
everyday in our life depending on the circumstance. A “mismatch” can cause problems.
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ASKING: This is how you gather information.
Closed Open
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You get information from both However, Open questions often elicit more useful
information than closed. Open questions set up better situation for a
relationship. Question answer trap
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USEFUL OPEN QUESTIONS “What’s worrying you most today about your
work?” “What concerns you most about these results?” “ What exactly happens when you get that
reaction/response?” “Tell me more about…”
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CHANGE TALK Self Motivating Speech. Employee begins to
explore or discuss what they “want”, “can”or ”will” do in order to change the identified behavior.
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STATEMENTS OF PREFERENCE FOR CHANGE.
“I want to…” “I would like to…” “I wish…”
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ABILITY: STATEMENTS ABOUT CAPABILITY.
“I could…” “I can…” “I might be able to…”
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REASONS: SPECIFIC ARGUMENTS FOR CHANGE.
“I would probably feel better if…” “I need to have more energy to play with my
kids.”
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NEED: STATEMENTS ABOUT FEELING OBLIGATED TO CHANGE. “I ought to…” “I have to…” “I really should…”
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COMMITMENT: STATEMENTS ABOUT THE LIKELIHOOD OF CHANGE.
“I am going to…” “I will…” “I intend to…”
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TAKING STEPS: STATEMENTS ABOUT ACTION TAKEN.
“I actually went out and …” “This week I started…”
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LISTENING Open the Door to communication
Attend to the employee more than the paper Silence can be a good teacher. If you are silent you
have a better chance of listening.
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REFLECTING You want to reflect what you heard the employee
tell you Example: Practitioner: Tell me about your work habits Employee: Well I get in the office in the morning with a
schedule and list of things to get done, and then crisis comes and I am on the phone trying to fix it and then I am way off schedule within an hour and I don’t get anything done.
Supervisor: You have a plan each day but other things get in the way of you following it.
Patient: Sometimes. If I don’t immediately listen to my voice mails I can get a little more done.
Practitioner: Answering your phone a little bit later in the morning helps you complete some of your tasks.
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INFORMING Most commonly used tool in health
care/supervising communication.
Things can and do go wrong with the informing process. You may give what seems to be perfectly clear instructions, yet the employee doesn’t do it. (pge. 87)
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SOME IDEAS TO HAVE YOUR INFORMATION HEARD Slow Down and progress can be quicker Pay attention to the person, what are their needs Consider the Broader priorities Provide positive messages: good news and not so
good news Consider the amount of information you are
giving Deliver information with Care
(compassion/empathy)
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INFORMING WITHIN MI Ask Permission Offer Choices Talk about What Others Do
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DIRECTING WITH CARE In the busy world of many things to get done,
little time and people who are struggling. Simply, follow the Spirit of Directing them with
Care.
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WHAT NEXT?....HOW DO I SUPPORT MI IN THE OFFICE? Model- Model- Model Lunch and Learns Offer readings Practice
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QUESTIONS?
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CONTACT INFORMATION: Jeanie McCarville Kerber [email protected] 515-783-2779
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REFERENCES
Rollnick. S, Miller W., Butler, C. Motivational
Interviewing in Health Care; Helping Patients Change Behavior (2008)
Velasquez, Maurer, Crouch, DiClemente , 2001.