Using Motivational Interviewing with Juvenile Offenders Joan Leary, LPC email@example.com May 7, 2014 National TASC Conference
Experts in Audience • YEARS IN FIELD • POPULATION I WORK WITH • What do I know about MI? 0……………10 • Glean from today’s workshop? • DO I CONSIDER MYSELF AMENABLEOR RESISTANT TO CHANGE?
Frustrations with Juvenile Offenders? • Failure to comply • “Back talk” _______________ • Disrespect/defiance _______________ • Tired of arguing and convincing • No follow through • “Know it alls” • Burn-out • Paperwork
Approach • Harsh verbal discipline increases the likelihood that teens will misbehave and exhibit symptoms of depression. • Teens are more likely to exhibit problem behaviors such as anger, aggression, vandalism and misconduct. Wang et al.
MI • is adapted to each individual and the specific behavioral problems that the individual presents • it is a collaborative effort between the therapist/PO/case manager and the individual to identify and forge a path to behavioral change using the client’s own motivations
WHO, What, When, Where? The concept of motivational interviewing evolved from experience in the treatment of problem drinkers, and was first described by Miller (1983) in an article published in Behavioural Psychotherapy
Definition • A person centered, goal directed method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence.
Motivational Interviewing • Encourages positive behavior change in offenders • Evidence based practice
What is Motivation? • Process that initiates, guides and maintains goal-oriented behaviors, which cannot be forced • The reason or reasons one has for acting or behaving in a particular way • Cannot be given to someone • About the choices we make/don’t make • Variable with different times/situations
Motivation is NOT a Personality Problem or trait • Motivation is a STATE of readiness or eagerness to change • It may fluctuate from one time to another or situation • It CAN be influenced
Client Motivation • READY: right time to make a change • WILLING: person themself makes a decision • ABLE: confidence to change
How? • Do you motivate a client to change a pattern of destructive behavior? • Do you help someone to stop offending and committing anti-social acts? • Do you motivate a client to keep appointments, participate in programs etc?
The Nature of Our Interactions • When your objective is to change a person’s behavior, what style works best? • Confrontation • Demonstrating our power over someone • Lecturing • Demanding • Cheer-leading • Pleading • Begging • Bribing • Shaming
More Effective Approach • Helping the person to appreciate the value in changing themselves. • Sparking Intrinsic motivation
An Effective Style Is NOT IS Empathic Genuine Honest Supportive Trustworthy Solution-focused Fair Consistent Contingency Based Interested Non-argumentative Non-judgmental Respectful • Confrontational • Blaming • Hostile • Demanding • Commanding • Wishy-washy • Non-Direct • Non-specific • Unclear • Touchy-feely • Sympathetic • Parenting • Friend
Helping Change Occur • Interviewing style is a significant factor in dropout, retention, adherence and outcomes. • Individuals who believe they can and will change (self-efficacy) do change. • Officers/practitioners who believe their clients can and will change, influence them positively to do so.
Enhance Intrinsic Motivation Staff should relate to offenders in interpersonally sensitive and constructive ways to enhance intrinsic motivation in offenders. Research strongly suggests that motivational interviewing techniques, rather than persuasion tactics, effectively enhance motivation for initiating and maintaining behavior changes.
What doesn’t work! - Famous programs based on flawed theories/models • Scared Straight – deterrence theory; “make them fear prison.” • Nearly every study over the past 25 years has found dismal results, many even showing higher recidivism rates for Scared Straight participants. Has been characterized as criminal justice malpractice. • Drug Abuse Resistance Education (DARE) – didactic model; “kids don’t know drugs are bad for them.” • Most studies have found neutral effects for DARE. More recent versions of DARE, based upon cognitive-behavioral principles, have been more promising • Sheriff Joe Arpaio’s (Maricopa County Jail, Arizona) Tent Cities and Chain Gangs – more deterrence theory; “make them hate prison.” • By the jail’s own admission, its recidivism rate exceeds 60 percent.
Ambivalence is a normalpart of considering and making change and isNOTpathological.
Where is MI Used? Healthcare MD appts HIV Alcohol use Work Smoking cessation Drugs Stress Therapy Medication compliance Corrections Weight loss Prevention Nutrition Teens Exercise Balance Condom use ART Therapy
Why Use MI in Corrections? • Helps to get offender to be honest/open in assessment process • Helps create a more engaging environment with less defensiveness from offender • Elicits more accurate information which aids in determining • Supervision levels -Placements • Types of treatment
Paradigm Shift • Gone are the days of; • Shouting insults at offenders • Denial busting • “Alcoholics are liars” • Abusing addicts because it was “good for them” • Confrontation and polarization • 20 yrs ago a punitive, moralistic and arrogant stance was common in U.S. treatment
Hierarchical Environment • Corrections staff often use; • Coercive power • Authority • Dynamics which increase defensiveness and resistance
MI • More collaborative • More respectful • Supportive • Directive
Simpler Definitions • 1. It’s a way of using questions and statements strategically to help people think and talk in a positive direction.
Simpler Definitions • 2. It’s a way of helping people find their OWN reasons for change.
Spirit of Motivational Interviewing • Collaboration • Evocation • Autonomy
5 MI Principles • 1. Express empathy • 2. Develop discrepancy • 3. Avoid argumentation • 4. Roll with resistance • 5. Support self efficacy
4 Fundamental Processes in MI •1. Engaging – The Relational Foundation •2. Focusing – The Strategic Focus •3. Evoking – The Transition to MI • 4. Planning – The Bridge to Change
“Changes attributed to oneself are more likely to endure.”Davison, Tsujimoto & Glaros, 1973
Rolling with Resistance “Discord” ” • Like Verbal Martial Arts • Resistance is not challenged • Use the client’s energy to take you where you want to go • Decreases the client’s tendency to play devils advocate
Roll with Resistance/Discord • Opposing resistance can reinforce it • Counselor/interviewer rolls or flows with it • Reluctance & ambivalence are acknowledged as normal & understandable • Interviewer invites client to consider new information or ways of thinking about things
Righting Reflex • Our desire to fix people and set them on a better course
Righting reflex Argument for the change Argument against the change I don’t want/need to change You don’t know me… No I shouldn’t… I don’t have a problem… Yes, but… Counselor Client • Change is important because.. • You should change… • Drinking is serious you need to quit. • Your baby is going to be impaired due to your drug use. • DHR will take your kids away..
Sustain Talk • “Who are you to tell me what to do? • ” I’m not going to do it and no one can make me.” • Status quo • We blame client for being difficult • One side of ambivalence
Learning is not a one-way "push" model. “ASK” rather than “TELL” http://headrush.typepad.com/creating_passionate_users/2006/01/crash_course_in.html
Confrontation • A confrontational and directive approach may = more client resistance • May lead to poorer client outcomes • 1993, Miller study found, the more a client was confronted the more alcohol the client drank • Confrontational counseling included; challenging, disputing, refuting and sarcasm
ASSESS Offender • URICA • Prochaska and DiClemente’s Stages of Change • Most change happens slowly • Offenders may make small incremental positive steps toward change
From DOC • Motivational Interviewing principle is • Listening to offenders and following up on positive aspects of their speech • Awareness that corrections professionals can help INCREASE an offender’s motivation • Positive behavior changes are possible which reduce likelihood of re-offending
Goal • The interviewer/case manager/PO must have a GOAL in mind; • a GOAL of “Directed change” • Not just talking/chatting with offender but have an intention in helping the offender set and achieve positive life changes