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A BRIEF OVERVIEW:MOTIVATIONAL INTERVIEWINGDEANNA COOPER, LCSW
UM, SCHOOL OF SOCIAL WORK APRIL, 2019
IBH TRAINING SERIES: SUDS TOOLKIT CONFERENCE
Motivational Interviewing
From Information based on the work of :Bill Miller, PhD and Steven Rollnick, PhD
And their Third Edition of MOTIVATIONAL INTERVIEWING (2013)
Research and Consultation Collaborations withUNM CASAA
And trainings presented byRaymond Anderson, PhD, LPCC, LADAC
Lifelink Institute, Santa Fe, NM
Goals of Overview
Introduce Current Evidence Based Practice s with SUD’s
Understand the History of MI as it relates to and supports EB Approaches
Current research on efficacy of MI as a tool to support behavior change
HISTORY
Developed in the 1980’s- Bill Miller1983: Arranging the conversation so the client makes the argument for change
First Edition in 1991,Bill Miller and Stephen Rollnick
Paralleled with other research in the field: Transtheoretical Theory ( Stages of Change ) DiClemente and Prochaska
Project Match- readiness to change, self efficacy, psych severity (co-occurring) Meta Analysis of What Works, focused on Alcohol Hester and Miller
WHAT WORKS?
Brief Interventions
Motivational Enhancement
Community Reinforcement Approach
M.A.T.
Self Directed Manuals
Behavioral Self Control Training
Cognitive Therapy
Marital/Relationship Therapy
Hester, Miller (2003)
PHARMACOLOGICAL- M.A.T.
BEHAVIORAL THERAPIES: BRIEF INTERVENTIONS
CONTINGENCY MANAGEMENT
COGNITIVE BEHAVIORAL – 3rd Wave
MOTIVATIONAL INTERVIEWING
COUPLES and FAMILY Treatment
HARM REDUCTION ApproachesSAMHSA EBP Registry, UW EBP (2013)
2003 ALCOHOLCURRENT SUD’s EBP
WHAT WORKS?
http://lib.adai.washington.edu/ebpsearch.htm
UNIVERSITY OF WASHINGTON: EBP SUBSTANCE ABUSE
EBP Substance Abuse was developed as a joint project of the University of the Washington Alcohol & Drug Abuse Institute and the Northwest Frontier Addiction Technology Transfer Center, with funding from the Washington State Division of Alcohol and Substance Abuse. 2013
MOTIVATIONAL INTERVIEWING
“Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change”
Miller and Rollnick, 2013
AMBIVALENCE… is to be expected
The Transtheoretical Model (Prochaska & DiClemente, 1983
AMBIVALENCE
AMBIVALENCEIs normal
Is to be Expected
With Confrontation, we WRESTLE with it…..
With MI, we DANCE with it,
RESISTANCE TO CHANGE
Resistance and "denial" are seen not as client traits, but as feedbackregarding therapist behavior. Client resistance is often a signal thatthe counselor is assuming greater readiness to change than is thecase, and it is a cue that the therapist needs to modify motivationalstrategies.
Stephen Rollnick & William R. Miller, Ph.D. (1995)
BASIC SKILLS: OARS
OPEN Requires more than one word answer
AFFIRMING Genuinely positive, Right Direction
REFLECTING What you hear them say
SUMMARIZING Shows you were listening, gives chance to correct
Miller, Rollnick, 1991
And those DARN CATS…. Preparatory and Mobilizing Change Talk
Miller, Rollnick, 2013
Third Edition: The Spirit of MI
The spirit of MI is based on three key elements:
1) collaboration between the therapist and the client
2) evoking or drawing out the client's ideas about change
3) emphasizing the autonomy of the client.
Accurate Empathy- Practitioner style matters
Miller and Rollnick, 2014
SPIRIT and SKILL: ENGAGEMENT
The Spirit of MI acknowledges the regard for the client.
Personalized – client is the expert
Compassionate- Change is hard
Strengths- giving credit for forward movement, past success
Partnership, Accompaniment
Evocation- Client identifies areas they want to work on
Accurate Empathy- Practitioner style matters
What does the evidence say?
Treatment works!!
Treatment outcomes are not predicted by setting/level of care (e.g., outpatient, residential, etc.).*
Counseling approaches have similar outcomes, but… Counselor/Alliance does make a
difference.**
3rd Edition: Four PROCESSES
PLANNING
EVOKING
FOCUSING
ENGAGING
SKILLS: Ask for Permission
In MI we do not give unsolicited advice.If we have suggestions, we ask for permission to share
REVISIT AMBIVALENCE: CHANGE and SUSTAIN TALK
Exercise to argue for and against change.
Giving client permission to look at change and sustain, and consider the positives and negatives of both
Eventual growth of MI skills allow evoking this in conversation and are measurable in speech patterns
Glynn, L. H., & Moyers, T. B. (2010)
WHERE ARE WE NOW?
Delivering the technical within the context of the relational
Delivering CBT in MI consistent way matters… predictor of change
Third Wave CBT- DBT, ACT, Mindfulness-Based CBT
MI used consistently with Behavioral Interventions, not separate from, or sprinkled on
Multi-Disciplinary- use with EBP within discipline, acknowledge when switching out for data, discord
WHERE ARE WE NOW?
SBIRT- EBP, Interprofessional
Healthcare Patient “Education”
Criminal Justice- Probation and Detention officers, Judges
Schools
Child Welfare
MI Is Lifelong Practice and Learning
Proficiency in MI is parallel to the concept of Cultural Competency:
Trainings do not create MI practitioners
The HUMILITY of fumbling about: reflecting on missed opportunities and willingness to engage in lifelong learning
Ongoing skill building through coaching, taping and learning community
REFERENCES
Columbia U Social Work, Motivational Interviewing: A Dialogue with the Practice's Co-founder William R. Miller, 2017https://www.youtube.com/watch?v=DSHh6V9yNzgRetrieved, March, 2019Glynn, H and Moyer. 2010..Chasing Change Talk: The clinician's role in evoking client language about change. Journal of Substance Abuse Treatment 39, 65
Hennesy, S. (2018) Subst Abuse Treat Prev Policy. 2018; 13: 26.Suspension of the National Registry of Evidence-Based Programs and Practices: the importance of adhering to the evidence. Subst Abuse Treat Prev Policy. 2018; 13: 26.
Hester, R.K. & Miller, Wm. (Eds.). (2003) Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.), 2003, Allyn & BaconMiller, W. MINT website, MINT Plenary https://vimeo.com/316279712 , 2018. Retrieved 3/2019Miller and S. Rollnick. Motivational Interviewing: Helping People Change (3rd edition) New York, Guilford Press, 2013
REFERENCES cont.
Hester, R.K. & Miller, Wm. (Eds.). (2003) Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.), 2003, Allyn & Bacon
UW, ATTAC .EBP Substance Abuse. University of Washington Alcohol & Drug Abuse Institute and the Northwest Frontier Addiction Technology Transfer Center, 2013, http://lib.adai.washington.edu/ebpsearch.htm, retrieved 4/16/19
Velasquez, M The Social Work Podcast, Motivational Interviewing: 3rd Edition,Interview with Mary Velasquez, Social Work Podcast, 2013http://socialworkpodcast.blogspot.com/2013/09/MI3.html