Motivational Interviewing Cliff Notes, Exams of Negotiation

Download Motivational Interviewing Cliff Notes and more Exams Negotiation in PDF only on Docsity! Motivation Interviewing Adapted irom Miller & Rollnick, 2002, and Miller and Rose, 2009 Basic Concepts: e The person should make the arguments for change 9° Get the client to verbalize their own arguments for change o Evoke the person’s own concems and motivations co Strategic eliciting of change talk e Listen with empathy © Minimize resistance o Roll with it, this will defuse rather than amplify it. ¢ All people have the Righting Reflex; it’s our desire to keep people from going down the wrong path and to set things right. o When the therapist's Righting Reflex mixes with a client's ambivalence, presto: instant resistance, MI Principles !. Express Empathy (be able to provide 50% reflective listening responses in session) 2. Develop Discrepancy a. Motivation ‘s a function of the discrepancy between the client's present behavior and values. Reflect the discrepancy. 3. Roll with Resistance 4. Support Self-Efficacy a. The client is the final word in the change process Eight Stages in Learning MI 1. Asopenness to the collaborative rather than prescriptive approach a. Willing to attempt to elicit motivation rather than install it, b. Honoring of client autonomy Being proficient at accurate empathy and client centered skills Distinguish change talk from other forms of client speech. (Natural language markers of readiness) | a. Desire, Ability, Reasons, Need, Commitment. b. Especially aware of commitment talk due to its high predictor of change. Elicit and reinforce change talk to increase and strengthen it. Minimize resistance and don’t reinforce “sustain talk”: talk about staying the same. Know when to move past ambivalence talk and into discussion of the Change Plan. Ability te enlist the client's commitment to the plan; requires negotiation. Art of flexibly blending MI with other therapeutic (more dircetive) methods. wb ONDA Practical © Give no advice © Why would you want to make this change? e How might you go about it, in order to succeed? ¢ What are three best reasons for doing it?  4 Eight Tasks in Learning Motivational Interviewing This is content from Miller and Moyers (2006) that can be useful in conceptualizing training. Where is the trainee or audience currently in this developmental process? What tasks will be addressed in this training? These tasks can also provide a framework for developing a sequence of training. 1 Overall Spirit of MI Openness to a way of thinking and working that is collaborative rather than prescriptive, honors the client=s autonomy and self-direction, and is more about evoking than installing. This involves at least a willingness to suspend an authoritarian role, and to explore client capacity rather than incapacity, with a genuine interest in the client=s experience and perspectives. 2 OARS: Client-Centered Counseling Skills Proficiency in client-centered counseling skills to provide a supportive and facilitative atmosphere in which clients can safely explore their experience and ambivalence. This involves the comfortable practice of open-ended questions, affirmation, summaries, and particularly the skill of accurate empathy as described by Carl Rogers. 3 Recognizing Change Talk and Sustain Talk Ability to identify client Achange talk@ and commitment language that signals movement in the direction of behavior change, as well as client sustain talk. Preparatory change talk includes desire, ability, reasons, and need for change, which favor increased strength of commitment. 4 Eliciting and Strengthening Change Talk Ability to evoke and reinforce client change talk and commitment language. Here the client-centered OARS skills are applied strategically, to differentially strengthen change talk and commitment. 5 Rolling with Sustain Talk and Resistance Ability to respond to client sustain talk and resistance in a manner that reflects and respects without reinforcing it. The essence is to roll with rather than opposing it. 6 Developing a Change Plan Making the transition into Phase 2 of MI. Ability to recognize client readiness, and to negotiate a specific change plan that is acceptable and appropriate to the client. This involves timing as well as negotiation skills. 7 Consolidating Commitment Ability to elicit increasing strength of client commitment to change, and to specific implementation intentions. 8 Transition and Blending Ability to blend an MI style with other intervention methods and to transition flexibly between MI and other approaches. Open Questions In the early phases of motivational interviewing, the client should do most of the talking, while the counselor listens carefully and encourages expression. One way to do this is to ask open questions —questions that do not invite bricf answers. Examples of open questions: {. What would you like to discuss? 2. What do you like about using marijuana? 3. What changes have you noticed? Open or closed? . What do you like about drinking? Where did you grow up? . Isn’t it important for you to have meaning in your life? Are you willing to come back for a follow-up visit? What brings you here today? Do you want to stay in this relationship? . Have you ever thought about walking as a simple form of exercise? . Do you want to quit, cut down, or stay the same? 9. In the past, how have you overcome an obstacle? 10. What would you like to set as your quit date? i]. What possible long-term consequences of diabetes concern you most? 12. Do you care about your health? 13. What are the most important reasons why you want to stop? 14. Will you try this for one week? 15. Is this an open or closed question? NAUEwWHE ~ Affirming Directly affirming and supporting the client during the counseling process is another way of building rapport and reinforcing open exploration. This can be done as complements or statements of appreciation and understanding. Examples: Thanks for coming in today. [ appreciate that you took a big step in coming here today. That’s a good suggestion You're clearly a resourceful person to cope with such difficultics for so long. You seem like the type of person who really sticks to their goals. T enjoyed talking with you today and getting to know you a bit. from Miller & Rollnick, 2002 Ro) Levels of Reflection Simple Reflection (repeat or rephrase) These reflections add nothing at all to what the client has said, but simply repeat or restate it using some or all of the same wards Client: This has been a rough week for me. I came that close to using when my ex and I had an argument. I think ?’'m feeling kind of down Therapist: It’s been rough for you this week, and you’re fecling down. Simple reflections may slightly rephrase what the client has said, usually by substituting a synonym (herapist: You’re feeling pretty discouraged. Complex Reflection Complex reflections change or add to what the client has said in a significant way, to infer the client’s meaning. The therapist is saying something that the client has not yet stated directly. Complex reflections include: Continuing the Paragraph — in which the therapist anticipates the next statement that has not yet been expressed by the client. (ff scared you, how close you came to using again.) Amplificd Reflection — in which content offered by the client is exaggerated, increased in intensity, overstated, or otherwise reflected in a manner that amplifies it. //t’s heen such a hard week that vou’re really demoralized.) Double-side Reflection — in which both sides of ambivalence are contained in a single reflective response. (You've been doing really well these past few weeks, and then this week has been harder.) ly collapsed this week.) Metaphor and Simile — used as a reflection. (Z's like the bridge n Reflection of Feeling that was not directly verbalized by the client before. (This really surprised you.) from Miller & Rollnick, 2002 ~ Summaries Summary statements serve to link together and reinforce material that has been discussed. ‘Lheve are at least three types of summaries. Collecting summary: Offered during the process of exploration, particularly after hearing several change talk themes. These are usually short (just a few sentences) and should continue rather than interrupt the client’s momentum. ‘he purpose is to draw together change talk and invite the person to keep going. It is useful to end with “What clse?” Example: “So this heart attack has left you feeling vulnerable. It’s not dying that scares you, really. What worries you is being only half alive living disabled or being a burden to your family. In terms of things you want to live for, you mentioned seeing your children grow up and to continue your work, which is meaningful to you. What else?” Linking summary: Ties together something the client has just said with material from earlier. Purpose is to encourage the client to reflect on the relationship between two or more previously discussed items. Can be especially helpful in clarifying ambivalence. It’s better to use “and” rather than “hut” to link discrepant components (“and” emphasizes the siniultaneous presence of both). Example: “On the one hand, you’re somewhat worried about the possible long-term effects of your diabetes if you don’t manage it well. The ER visit a while back also scared you, and you realized that ifno one had found you, your children could be without a father, On the other hand, you’re young and you feel fairly healthy most of the time. You enjoy eating what you like, and the long-term consequences seem far away.” Transitional summary: Marks a shift from one focus to another, such as the wrap-up at the end ofa session, or a transition from Phase i to Phase 2. Remember that you are deciding what to include and emphasize, not everything that has transpired. Transitional summaries are typically somewhat longer than linking or collecting summaries. Example: “OK, we’re almost out of time, so I’d like to pull together what’s been said so far so we can figure out where to go from here. Your husband is concerned about your drinking and marijuana smoking. You’ve been very open about exploring this, and I appreciate that. You mentioned several problems in your life that could be related to alcohol and marijuana, such as... When you were arrested that time two years ago, your breath lest showed that you were over 0.20, which is really quite intoxicated, even though you didn’t feel very drunk. On the other hand, it helps you to relax and... So you're not sure what to do at this point. Is that a fair summary? What have I missed?” trom Miller & Rollnick, 2002 10 Ten Strategies for Evoking Change Talk 1. Ask Evocative Questions – Use Open-Ended Questions Examples: - Why would you want to make this change? (Desire) - How might you go about it, in order to succeed? (Ability) - What are the three best reasons for you to do it? (Reasons) - How important is it for you to make this change? (Need) - So what do you think you’ll do? (Commitment) 2. Ask for Elaboration When a change talk theme emerges, ask for more detail: - In what ways? - How do you see this happening? - What have you changed in the past that you can relate to this issue? 3. Ask for Examples When a change talk theme emerges, ask for specific examples. - When was the last time that happened? - Describe a specific example of when this happens. - What else? 4. Looking Back Ask about a time before the current concern emerged: - How have things been better in the past? - What past events can you recall when things were different? 5. Look Forward Ask about how the future is viewed: - What may happen if things continue as they are (status quo). - If you were 100% successful in making the changes you want, what would be different? - How would you like your life to be in the future? 6. Query Extremes Ask about the best and worst case scenarios to elicit additional information: - What are the worst things that might happen if you don't make this change? ! "#$%&$'(&%#(&)(*%&%#+,-*&%#$%&.+-#%&#$//(,&+0&123&42&.$5(&%#+*&6#$,-(7& 7. Use Change Rulers Ask open questions about where the client sees themselves on a scale from 1 – 10. - On a scale where one is not at all important, and ten is extremely important, how important (need) is it to you to change _______? -Follow up: Explain why are you at a ___ and not (lower number)? - What might happen that could move you from ____ to a _____[higher #]? - How much you want (desire), - How confident you are that you could (ability), - How committed are you to ____ (commitment). 8. Explore Goals and Values Ask what the person's guiding values are. - What do they want in life? - What values are most important to you? (Using a values card sort can be helpful). - How does this behavior fit into your value system? - What ways does ________ (the behavior) conflict with your value systen 9. 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. - It may not be the main area that you need to focus on in our work together. Importance and Confidence Rulers It is useful in understanding a person’s ambivalence to know his or her perceptions of both importance and confidence. Both should be addressed, because they are both components of intrinsic motivation for change. One simple method involves the use of rulers with gradations from 1 to 10 for each dimension. Importance: “How important would you say it is for you to _ ? Ona scale from I 10 10, where | is not at all important, and 10 is extremely important, where would you say you are? I 2 3 4 5 6 7 8 9 10 Not at all Extremely Important Important This can be followed up with two questions: “What makes you a __ and nota This question pulls for change talk, as it encourages the client to verbalize any reasons it may be important to make a change “What would it take for you to go from 10 fa higher number] ?” This question is generally useful if the client is not interested in changing at the moment, but indicates he or she may change in the future. In other words, the question encourages reflection on the idea “it’s not bad enough to change now, but if ___ happens, I should change.” Confidence: “How confident are you that if you decided to from I to 10, where 1 is not at ail confident, and 103 you are? , you could do it? Ona scale extremely confi ident, where would you say 1 2 3 4 5 6 7 8 9 10 Notat all Extremely Confident Confident This can be followed up with two questions: “What makes you a _ and nota 1?” This question pulls for confidence talk, eliciting from the client reasons he or she believes in his or her ability to make a change. “What would it take for you to go from to [a higher number] ?” This question is generally useful if the client is somewhat low in confidence. This may elicit ideas of other resources or sources of strength. from Miller & Rolnick, 2002