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Join us for a comprehensive training on Motivational Interviewing techniques to empower your practice and drive positive change in your clients. Learn valuable tools and strategies to elicit change talk, respond to resistance, and enhance client motivation. Don't miss this opportunity to elevate your clinical approach with evidence-based methods.
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IMR Booster TrainingApril 30th 2007 Tim Gearhart MSW Alan McGuire MS
Tentative Agenda 9am-noon • Spirit of MI • OARS • Elliciting Change Talk • Responding to Change Talk • Responding to Resistance 1p-4p
Spirit of Motivational Interviewing • “Words without the music”. • Spirit + OARS = close but not quite MI • Docere – Expert • Ducere – Calling forth that which is already there. • Acceptance • “The curious paradox is that when I accept myself just as I am, then I can change.” Carl Rogers
What MI is Not p. 21 • Ask Questions: Why haven’t you made the change? What is in the way? • You should change because... • It’s important for you to change because… • If you don’t change…will happen. • You could make the change by… • I’m sure that you will make this change because…
Favorite Teaching Exercise • Why were they your favorite? • What characteristics did they have that you admired?
Exercise • Rules: No giving advice. Just listen. • 1. Why would you want to make this change? • 2. If you decided to do it, how would you go about it? • 3. What are the 3 best reasons to make this change? • 4. From 0 – 10 how important is this to you? Why not 0? • 5. Provide a summary statement. • 6. So what do you think you’ll do?
Thomas Gordon 2. What the speaker says. 3. Words the listener hears. 1. What the speaker means. • 4. What the listener thinks the speaker means.
Exercise 1: Hypothesis Testing 42 • Cl: “One thing I like about myself is that…” • T: “Do you mean…” • Cl: “Yes/No”
Types of Reflective Statements • 1. Repeating: restating what the speaker said. • 2. Rephrasing: slightly rephrase what was offered. • 3. Paraphrasing: continuing the paragraph or inferring meaning. • 4. Reflection of feeling: a paraphrase that emphasizes the emotional dimension via metaphors.
Exercise 2: Forming Reflections • Cl: “One thing about myself I’d like to change…” • T: responds only with reflective statements. Questions are not allowed. • Cl: elaborates following the reflection.
OARS • Open ended questions. • Affirmations. • Reflections. • Summaries.
Open or Closed Questions? • Is this an open or closed ended question? • Do you want to stay in the system forever? • What are the important reasons to make this change? • If you were less depressed how would life look differently? • In what way does this concern you?
Change TalkChapter 7 of 2nd addition • “It is the truth we ourselves speak rather than the treatment we receive that heals us.” O. Hobart Mowrer • The more one makes statements utilizing change talk, the more likely they will make a change (Amrhein et al) • Given this information, what should our goal be as clinicians?
Types of Change Talk • D – Desire (ex. “I’d really like to …”) • A – Ability (ex. “I think I could change if…”) • R – Reason (ex. “I should try because…”) • N – Need (ex. “I need to change because…”) • C – Commitment (“Do you take this woman to be your lawfully wedded bride?) • Change talk is preparatory language to commitment language.
How to Elicit Change Talk • OARS • Asking Evocative Questions • Using the importance ruler • Exploring the decisional balance • Looking Back/Forward • Exploring Goals and Values
Responding to Change Talk • Reflect it • Ask more about it • Affirm it • Summarize it (bouquet's)
Responding to Resistance • Simple reflection: acknowledge the person’s disagreement, feeling, or perception. • Amplified reflection: reflect back in an exaggerated form • Double-sided reflection: acknowledgment + adds to the other side of ambivalence
Cont… • Shifting focus: diverting the focus • Reframing: validate and build new meaning • Agreeing with a twist: (reflect/reframe) • Emphasize personal control • Coming alongside: (therapeutic paradox) recommend that they continue the behavior or even increase it. Need to be done non-manipulatively.
How does all of this relate to IMR? • Lots of opportunity to explore interest/motivation in changing specific behaviors. • Assists in developing meaningful goals. • The Spirit of MI is consistent with the values of Recovery.
Giving advice or going over material. • ASK: Prior to getting into the material you should make sure that you have the permission of the client. • TELL: Work through some material. • ASK: What do you think about that?
Exercise RoleplayCl. Didn’t complete hmwk.? • Team Consult Role Play • Demographics • Life situation • Target Behaviors • Reasons to change • Agree to be a 5 on importance/confidence
Cognitive-Behavior Techniques for IMR Alan McGuire MS, Tim Gearhart MSW ACT Center of Indiana
Scope & Goals • CB Techniques vs. CBT-P • Why all the SZ? • Applied to IMR • A little hx/philosophy • Tools • Your goals
Definition of CBT • A broad set of approaches to improving adaptive and emotional functioning based on theories of learning and behavior change.- Penn, 2006
Brief History • Early Therapy Research • Psychoanalytic • Unsuccessful • Hiatus • Problem/Symptom focus
CBT-P Onslaught! Gould, R. A., et al., (2000). Cognitive therapy for psychosis in schizophrenia: An effect size analysis. Schizophrenia Research, 48, 335-342. Penn, D. L., Waldheter, E. J., Mueser, K. T., Perkins, D. O., & Lieberman, J. (2005). Psychosocial treatment for first episode schizophrenia: A research update. American Journal of Psychiatry, 162, 2220-2232. Pilling, S. et al. (2002). Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 32, 763-782. Rector, N. A., & Beck, A. T. (2001). Cognitive therapy of schizophrenia: A quantitative review. Journal of Nervous and Mental Disease, 189, 278-287. Tarrier, N., & Wykes, T. (2004). Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behaviour Research and Therapy, 42, 1377-1401. Turkington, D., Kingdon, D., & Weiden, P. (2006). Cognitive behavioral therapy for schizophrenia. American Journal of Psychiatry, 163, 365-373. Zimmermann et al. (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research, 77, 1-9.
Research Conclusions • Positive & Negative Sx • Effects increase in follow-up • Dropout Rates • Time to Hos. Release • Subjects • Med Resistant • Acute Psychosis • Severity Outcome
Theoretical Foundations • Basic Learning Theory • Cognitive Theory
Basic Learning Principles • Classical conditioning (learning by association) • Operant conditioning (learning by consequences) • Social learning (learning by observation)
The Cognitive Model • Most people: • Actuating event Consequence • ABC Model • Actuating eventBelief Consequence • “ABC Model”
“Cognitive-behavioral techniques involve the systematic application of learning principles to help people acquire and use information and skills in Illness Management and Recovery.” -IMR Workbook
Importance of Approach • “The general approach is concerned with understanding and making sense, working to achieve collaboration between the person … and the therapist, rather than didactic, interpretative, or confrontational styles.” • -Garety, Fowler, and Kuipers (2000)
Basic Clinical Skills • Active listening (exercise) • Non-verbals • Empathy statements (exercise) • You feel _____ because ____
Targets of CBT • Positive Sx • Hallucinations • Delusions • Negative Sx • Depression/Anxiety • Relapse Prevention
Dealing with Sx • Important to consumer? • Relevant to Goal • + Sx • Cognitive Flexibility • Distress • ‘Work within’
The Tools • Reinforcement • Modeling/role-play • Relaxation Training • Cognitive Restructuring • Challenging Delusions* • Activity scheduling* • Shaping
Reinforcement • Positive Reinforcement • Examples? • Negative Reinforcement • Examples? • Why not extinction/punishment?
Modeling • Explain what your modeling • Model • Elicit feedback • Model Modeling
Role-play • Who uses? How? • Barriers to role-play? • Advantages? • Points to remember • Combine w/ Modeling • Positive feedback
Relaxation Training • Helps people learn techniques for reducing tension • Breathing • Progressive muscle relaxation • Guided imagery
Relaxation Tips • What does consumer use now? • Incorporate relaxation techniques into the daily routine • Make a relaxation tape • Practice, practice, practice • Help person set up a specific plan to practice
Cognitive Restructuring • Connection between thoughts and feelings (ABC) • Use for: • Affective Sx • Deal with psychotic Sx • Steps • Teach the idea • Assess connections • Change thoughts/beliefs
Teaching the connection • Explain ABC • Automatic thoughts
Automatic thoughts • All or nothing thinking • “Must,” “should,” or “never” statements • Overgeneralization • Catastrophizing • Mind-reading • Emotional reasoning • Disqualifying the positive • Personalization
Assessment • Thought record • Mood record • Downward arrow
Thought Record • SEE HANDOUT • This requires the client to record: • The event • Emotions (type and degree [1-100]) • ATs (type and belief [1-100]) • Rational Response (type and belief [1- 100]) • Outcome (Re-rate belief in ATs and emotion)
Mood Record • Choose emotion • Track for week • ~3-4x per day • 1-10 on intensity • Review • Trends • What was going on then?