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Motivational Interaction

Motivational Interaction

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Motivational Interaction

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  1. Motivational Interaction Addictions Ontario May 30th, 2011 Michael Dean & Associates

  2. Learning Objectives • Increase understanding of the technical components of MI • Gain increased awareness as to the application of MI • Obtain an overview of the day long training session for Motivational Interaction • Identify components of MI you are already using in your work Michael Dean & Associates

  3. Motivational Interviewing • What is it? • A directive, client centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence. • The ‘spirit’ of MI : “a way of being with the client”…Bill Miller Michael Dean & Associates

  4. What is Motivational Interaction • Based on principles of Motivational Interviewing PLUS • Incorporates some principles of Solution Focused Brief Therapy • A way to work with short episodes of client engagement Michael Dean & Associates

  5. WHY Motivational Interaction? • As stated re: short episodes of engagement • Traditional MI can be intimidating as it was intended for a process of “interviewing” • Literature supports some brief interventions as being effective as some longer episodes of care • You are already doing some of it…lets label it. Michael Dean & Associates

  6. Some supportive literature • Single-Session Motivational Interviewing for Drug Detoxification Inpatients: Effects on Self-Efficacy, Stages of Change and Substance Use ANNE H. BERMAN,LARS FORSBERG, NATALIE DURBEEJ, HA° KAN KA¨ LLME´N, AND ULRIC HERMANSSON. Substance Use & Misuse, 45:384–402. 2010 • SOLUTION-FOCUSED GROUP THERAPY FOR LEVEL 1 SUBSTANCE ABUSERS: Sara A. Smock, Virginia Polytechnic Institute and State University; Terry S. Trepper and Joseph L. Wetchler, Purdue University Calumet; Eric E. McCollum, Virginia Polytechnic Institute and State UniversityRose , Ray and Kent Pierce, Purdue University Calumet. • BRIEF INTERVENTION FOR SUBSTANCE USE:, A MANUAL FOR USE IN PRIMARY CARE, World Health Organization, Department of Mental Health & Substance Dependence Michael Dean & Associates

  7. Practicality • Traditional MI focuses on clients willingness to change ( once change talk is occurring) • Brief Solution Focused therapy focuses on the positive behaviors/decisions client is demonstrating • We need to identify those opportunities to apply principles of MI…………. Michael Dean & Associates

  8. Addictions Anxiety PTSD Obsessive Compulsive Suicidality General health issues Problem gambling Medication adherence Concurrent Disorders Depression Eating disorders Application Michael Dean & Associates

  9. Motivation • “The most prevalent common-sense view of motivation is that people do things because they perceive them as being better in some way than not doing them” (West, 1989) • “Motivation is the sum of the factors that influence an individual to behave in a certain way” (Saunders, 1994) • “People only change when the pain of change is less then the pain of staying the same” (Saunders law of behaviour change) Michael Dean & Associates

  10. Hand in Hand • In order to elicit change behaviour we need to determine the starting point. • Where is the client in regard to willingness/readiness to change? • We can’t start talking of change until we know what change is required. • To address the above we need a tool…a process……. Michael Dean & Associates

  11. Need to know where client is in Change Process Michael Dean & Associates

  12. Goals & Key Areas of MI • The overall goal of MI is to explore and resolve clients’ ambivalence in order to enhance their motivation to change • Successful resolution of said ambivalence will occur by facilitating client statements that reflect: • Self-Esteem – their belief that they are “OK” (this must happen so they feel powerful enough to change) • Concern – concern about their behaviours • Competence – their ability to make changes • Knowledge of Problem – recognize their problem behaviour's) • Knowledge of Strategies – reflect on strategies for change • Desire to Change – reflect a desire for things to be different Michael Dean & Associates

  13. Brief Interventions • Hallway conversation • In residential settings while performing residential related task • Pre and Post dialogue for other sessions e.g.. patient in to set broken arm or pick up workfare funds Michael Dean & Associates

  14. The FRAMES Acronym • Feedback • Responsibility • Advice • Menu • Empathy • Self-efficacy Michael Dean & Associates

  15. F, R, & A • Feedback – through structure, clients are encouraged to reflect on their lives, their choices, and their behaviours • Responsibility – all responsibility for change lies on the client • Advice – counsellor takes an active role and gives advice that is clear, simple, and non-authoritative Michael Dean & Associates

  16. M, E, & S • Menu – clients are given a menu of treatment choices (increases ownership) • Empathy – the active ability to understand, and reflect that understanding, to the client (can include confrontation and challenge) • Self-efficacy – the clients’ belief that they have the ability to succeed Michael Dean & Associates

  17. Helping Tasks to Support FRAMES • Be empathic – expressing warmth, acceptance, and a non-judgmental attitude • Point out discrepancies – between clients’ present behaviour and their long-term goals • Avoid arguments – confrontation leads to resistance, refer back to responsibility • Roll with resistance – change strategies, allow client to find their own solutions • Support self-efficacy – the most important aspect of MI Michael Dean & Associates

  18. Motivational Strategies • Ask open ended questions • Listen reflectively • Affirm • Summarize • Elicit self-motivational (or change ) statements • Use Visual cues and aids ( once again…we do this already. Lets put it into the context of motivation) Michael Dean & Associates

  19. Visual Aid Michael Dean & Associates

  20. Open Ended questions? • What brings you to the office today? • What can we help you with? • What have you been doing in your recovery since we last met? • How did your recent interaction with your employer go? • WE DON’T NEED STRUCTURED INTERVIEWS TO STATE THE ABOVE Michael Dean & Associates

  21. Affirmation? • That is great, seems like you are making progress • That was a big step for you • You stated that very well • WE DON’T NEED STRUCTURED INTERVIEWS TO STATE THE ABOVE Michael Dean & Associates

  22. Summarize? • What I am hearing you say is… • You have done A, B and C and what like to do D • Can I clarify what I think you want to do • WE DON’T NEED STRUCTURED INTERVIEWS TO STATE THE ABOVE Michael Dean & Associates

  23. Elicit Self Motivational (change ) statements? • Recognizing a problem exist ( example?) • Articulating concerns ( example?) • Expressing and intention to change ( example?) • Showing optimism ( example?) Michael Dean & Associates

  24. Change TalkDARN-C • Desire • Ability • Reasons • Need And • Commitment ( taking steps) Michael Dean & Associates

  25. OARS • Open Ended • Affirmation • Reflective listening • Summarizing Michael Dean & Associates

  26. Deploy Discrepancy Possible questions include: • “How does your (drug use) fit in with your goals?” • “How does the you ‘as a drug user’ fit in with the ‘you as… (their goals or positive self)’?” • “Is there anything about your drug use you need to change to get the things you want?” • “How would things be in a year if you stayed the same?” Give praise & support self-efficacy • “You recognize that things have to change for you to attain your goals…” Michael Dean & Associates

  27. Ask for a Decision • Restate the client’s dilemma or ambivalence Possible questions/comments include: • “You were saying that your were trying to decide whether to continue or cut down...” • “After this discussion, are you more clear about what you would like to do?” • “So have you made a decision?” Give praise & support self-efficacy • “Congratulations, you’ve made an important decision today. How do you feel about that?” Michael Dean & Associates

  28. Set a Short-Term Goal Possible questions include: • “What will be your next (first) step now?” • “What will you do in the next one or two days (week)?” • “Have you already been doing things to achieve this? Can you do more of this?” • “Who will be helping you on this?” • “On a scale of 1-10 how confident are you that you will do this next step?” Give praise & support self-efficacy • “That sounds like a meaningful goal. What will you need to make sure you achieve it?” Michael Dean & Associates

  29. Practice Case • Youth not wanting to consider usage of cannabis as a problem Michael Dean & Associates

  30. CASE : Client background You are 26 yr old youth who has been using cannabis (in all forms) for 12 years. You dropped out of school early, have not held regular employment…..your parents are now wanting you to leave their house. You are denying that cannabis is the root to your problems. Michael Dean & Associates

  31. Case : Clinician background You are a case manager in the out patient MH services. This client ( 28 yr old male) was referred to you by the crisis team, as the client presented two weekends in a row at ER and ended up in CRISIS, the client demonstrated signs of cannabis psychosis (schizophrenia type behaviors, denying drug use), though a joint was found on person in both episodes. He is denying that Cannabis is a problem. He dropped out of school early and is not very employable. His parents want him out of the house. Your goal is to at least have him admit some problem use. Michael Dean & Associates

  32. Next Steps • Practice, practice, practice • Other? • BOOK training session Michael Dean & Associates

  33. Thank You Michael Dean & Associates

  34. Resources • Motivational interviewing In the Treatment of Psychological problems. ED Miller W. Arkowitz, H. Westra, H. Rollnick, S., Guilford Press, New York NY. 2008 • Motivational Interviewing In Health Care.Rolnick,S. Miller, W. Butler, C., Guilford Press, New York NY. 2008 • Motivational interviewing: Preparing people for change. Rolnick,S. Miller, W., Guilford Press, New York NY. 2002 • Addiction and Change; how addictions develop and addicted people recover. DiClemente, C., • Guilford Press, New York NY. 2003 Michael Dean & Associates