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STRENGTHS-BASED MOTIVATIONAL INTERVIEWING
Daniel Schmidt, MSW, LSW
Agenda
Introductions Motivation and Strengths Motivational Interviewing (MI) Direct and Indirect Use of MI
As a Therapy Tool As a Management Tool
Thoughts, comments, questions
Program Objectives
Attendees will have an understanding of strengths-based concepts and skills associated with Motivational Interviewing.
Attendees will understand the use of MI techniques in clinical settings as well as supervision and dealing with other stakeholders.
Attendees will understand the “Ten strategies for evoking change talk” needed as a basis for MI.
Motivation
Motivation is defined as the desire and action towards goal-directed behavior.
Intrinsic Motivation: A person is intrinsically motivated if the desire for change comes from within the individual
Extrinsic Motivation: A person is extrinsically motivated if the desire for change comes from the outside, i.e. a bribe or reward to do something.
Intrinsic MotivationStrengths
Understand the strengths, limitations, motivation for change, and resistance to change that are applicable to the persons and systems involved. Family and friends Education/employment Problem solving/decision making Personal qualities and characteristics Physical and financial resources Attitudes and perspectives Miscellaneous strengths
Intrinsic MotivationStrengths
Who Are You? Complete the following four “who are you”
statements. They can be adjectives, nouns, or longer statements. I am ___________________________________________________ I am ___________________________________________________ I am ___________________________________________________ I am ___________________________________________________
Intrinsic MotivationStrengths
Who Are You? Cite your greatest “strengths”. They can
involve anything from personal qualities to talents to accomplishments. They do not have to be in any particular order or priority. Strength:
___________________________________________________ Strength:
____________________________________________________ Strength:
____________________________________________________ Strength:
____________________________________________________
Intrinsic MotivationStrengths
Who Are You?How do you think your personal strengths will help you to work with clients in social work practice?
How do you think knowing your personal strengths will help you find strengths in your clients, supervisees, other involved parties?
Extrinsic Motivation
Extrinsic Motivation
This type of motivation comes from the results one gets from the task itself or from the sense of completing or even working on a task. School Grades Monetary Gains Awards or Recognition Punishment
Motivation
Intrinsic versus Extrinsic??
Which is most valuable in Motivational Interviewing?
Motivational Interviewing
A Definition
Motivational Interviewing is a person-
centered, strengths-based, directive method
of communication for enhancing intrinsic
motivation to change by exploring and
resolving ambivalence.
Motivational Interviewing
Principles in the Practice of MI
Find Strengths
Evoke “Change Talk”
Roll with Resistance
Support Self-efficacy (directive approach)
Relapse as an opportunity not a failure
Focus on Ambivalence
Motivational Interviewing
Stages of Change Pre-Contemplation Contemplation Preparation Action Maintenance Relapse & Recycling Termination
Strategies for Evoking Change Talk
Ask Evocative Questions: Ask open ended questions, the answer to which is change talk.
Explore Decisional Balance: Ask first for the good things about the status quo, and then ask for the not-so-good things.
Ask for Elaboration and examples: When a change talk theme emerges, ask for specific examples.
Look Back: Ask about a time before the current concern emerged.
Look forward: Ask what may happen if things continue as they are (status quo). Ask, “if you were 100% successful in making changes, what would that look like?”
Strategies for Evoking Change Talk
Query extremes: What are the worst things that might happen if you don’t make this change? What are the best things that might happen if you do make this change?
Use change rulers: Use positive scales. Explore Goals and Values: Ask what a
person’s guiding values are. What do they want in life?
Come alongside: Explicitly side with the negative (status quo) side of ambivalence. Perhaps _______ is so important to you that you won’t give it up, no matter what the cost.
Motivational Interviewing
Change TalkProblem recognition:
What things make you think that your drinking may be a problem?
How has your drinking stopped you from doing some things you want to do?
In what ways do you think you or other people have been harmed by your drinking?
Motivational Interviewing
Change TalkConcern:
What worries you about your drinking? How much does this concern you? In what ways does this concern you? What do you think will happen if you don’t
make a change? How do you feel about your drinking?
Motivational Interviewing
Change TalkIntention to Change:
What makes you think that you may need to make a change in your drinking?
What makes you think it is time for a change? What would be the advantage of making a
change? I can see you are feeling stuck. What is going
to have to change?
Motivational Interviewing
Change TalkOptimism:
What makes you think if you decide to make a change in your drinking, you could do it?
What encourages you that you can change if you want to?
What do you think would work for you, if you decided to change?
Motivational Interviewing Reflective Listening
Seeking to understand the client’s frame of reference is done thru reflective listening. Expressing acceptance and affirmation Eliciting and selectively reinforcing the client’s
own self motivational statements expression of problem recognition, concern, desire and intention to change, and ability to change.
Monitoring the client’s degree of readiness to change, and ensuring that resistance is not generated by jumping ahead of the client.
Affirming the client’s freedom of choice and self-direction.
Motivational Interviewing Reflective Listening
Gordons Twelve Roadblocks To Good Listening
Ordering or Directing Warning or Threatening
Giving Advice/Suggestions Persuading with logic, arguing, lecturing
Moralizing, preaching Judging, criticizing, blaming
Agreeing, approving, praising Shaming, ridiculing, labeling
Interpreting or analyzing Reassuring, sympathizing, consoling
Questioning or probing Withdrawing, distracting, humoring
Motivational Interviewing
Resistance Simple Reflection: Re-stating what the client
has said to you to insure you have heard the client correctly.
Amplified Reflection: Adding something to increase the intensity of what the client is saying.
Double-Sided Reflection: Reflect the Ambivalence that a client is thinking/feeling in responding to what they are saying.
Shifting Focus: Moving the client away from a difficult issue that is not necessary to discuss at this point in time.
Motivational Interviewing
Resistance Reframing: Make a change in the meaning of
what the client might say. Agreement With a Twist: Use reflection
followed by a reframe in responding to the client.
Emphasize Personal Choice and Control: Making sure that the client knows that the choice to change or not change a behavior is entirely up to them.
Siding with the Negative: Placing emphasis on the reasons a client may be resistive to change a thought or behavior.
Motivational Interviewing
Support Self-Efficacy The extent or strength of one's belief in one's
own ability to complete tasks and reach goals
Directive Approach (with a twist) Directive counselling is where the therapist
follows a line of therapy right for the client's condition.
Relapse as an opportunity not a failure
Motivational InterviewingAmbivalence
“I want to, but I don’t want to”
Natural phase in process of change Problems persist when people “get stuck”
in ambivalence Normal aspect of human nature, not
pathological Ambivalence is the key issue to resolve
for change to occur
Motivational InterviewingDevelop Discrepancy
This is a state of discomfort that needs to exist within the client, what the client wants from life and the contradiction of the self-destructive nature of the addiction. In MI this type of discomfort is not one to be avoided but rather to be a catalyst for change. The development of the discrepancy is used to allow the client to see how the addiction might be at odds with what they say they want. Here again it is imperative that the client be the one to discover and explore these facts with a directive approach. Otherwise developing discrepancy could turn into resistance and not benefit the client.
Motivational Interviewing
The Spirit of Motivational Interviewing
MI The OppositeCollaboration ConfrontationEvocation EducationAutonomy AuthoritySelf Efficacy IntimidationDiscrepancy Absolute Direction
Motivational Interviewing
Strengths-based intervention Elicits motivation from within people in
order to promote a change in behavior Needs a confrontation to arise and
confront ambivalence within the client Discomfort for the client towards a
behavior should increase the probability of change
Client centered counseling
The Spirit of Motivational Interviewing
Motivation to change is elicited from the client and not imposed from without.
It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence.
Direct persuasion is not an effective method for resolving ambivalence.
The counseling style is generally a quiet and eliciting one.
The Spirit of Motivational Interviewing
The counselor is directive in helping the client to examine and resolve ambivalence.
Readiness to change is not a client trait but a fluctuating product of interpersonal interaction.
The therapeutic relationship is more like a partnership or companionship than expert/recipient roles.
MET
Combines Motivational Interviewing with client feedback of their assessment results
Not limited to a particular set of assessment measures, only need comparison to some set of norms
Asks for client’s responses to feedback rather than telling clients what they should think or do
MET
Differences from other Treatment Approaches Lack of diagnostic labels Emphasizes personal choice regarding future
use of substances Non-confrontational Uses reflection rather argumentation Relies on clients’ own natural change
processes and resources
Motivational Interviewing as a Management Tool
A student/supervisee with several years’ experience working with a population who thinks she/he has mastered the skills needed to work with that population.
A very timid student/supervisee or one with low self-esteem or lack of confidence.
A very young, inexperienced, or anxious student/supervisee dealing with abusive clients.
An angry or judgmental student/supervisee who may feel the population or work is beneath them.
Students/supervisees with real life experience in treatment area who may feel that they have all the answers
References
Miller, W. (1995). Motivational enhancement therapy with drug abusers. Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions. University of New Mexico, New Mexico.
Rollnick, S. (2004). Motivational interviewing. In N. Heather & T. Stockwell (Eds). The essential handbook of treatment and prevention of alcohol problems. (pp. 105 – 110) New York: John Wiley & Sons
Motivational Interviewing
Thoughts, Comments, Questions