Motivational Interviewing in Corrections

1. Motivational Interviewing in Corrections FADAA/FCCMH Annual Conference August, 2014 Jim Elder MS, LCDP, CADC

2. Training Goals and Objectives • Conceptualize Change through the eyes of our own experience; thereby better appreciating the correctional clients’ experience with changes in their own lives. • Explore the Spirit and Basic Skills of MI. • Describe the stages of change and corresponding motivational strategies that are helpful during each stage. • Practice skills that may enhance treatment engagement, motivation and treatment retention of the correctional client. • Examine potential challenges with MI application in corrections.

3. Where Are You On The Tree?

4. Definitions of MI • A collaboration, person-centered form of guiding to elicit and strengthen motivation for change. • A collaborative conversation to strengthen a person’s own motivation for and commitment to change. • A person-centered counseling method for addressing the common problem of ambivalence about change.

5. What Is Motivational Interviewing? “…a directive intervention focused on resolving ambivalence in the direction of change.” • “… not a series of techniques … but a way of being with clients.” Motivational Interviewing. Miller and Rollnick, 1991

6. Motivational Interviewing • Based on Stages of Change. • Assumes motivation is fluid and can be influenced. • Motivation influenced in the context of a relationship. • Principal tasks - to work with ambivalence and resistance. • Goal - to influence change in the direction of health.

8. Spirit of MI • Openness to a more collaborative vs. prescriptive approach • Honors client autonomy and self-direction – we activate motivation • Involves invoking vs. installing – done “with” someone, not “to” them • Willingness to suspend authoritarian role and explore client capacity rather than incapacity – we are not the “experts” • Requires capacity for genuine interest in client experience and perspectives

9. Motivational Interviewing: A Way of Being “If you treat an individual as he is, he will stay as he is, but if you treat him as if he were what he ought to be and what he could be, he will become what he ought to be and could be.” - Johann Wolfgang Von Goethe “Any change, even a change for the better, is always accompanied by drawbacks and discomforts.” - Arnold Bennet

10. All Change Is Self Change “People tend to only listen to one person — themselves. And, as a result, they’re only influenced by one person … again — themselves. So, as frustrating as this may be for a parent who would like to sternly say, “You have to stop!” and to have that be enough, the real trick to motivating someone is to get them to convince themselves to make a change for their own good reasons. But how do you do this? • STOP trying to motivate your child by telling her about your feelings, thoughts or reasons for change, such as, “You’re worrying me to death!” “I think you HAVE to go to rehab right from the hospital,” or “The best reason for you to stop drinking is for your health.” • START asking your child questions that are specially designed to evoke her own good reasons for change.” Source: Michael V. Pantalon, PhD INSTANT INFLUENCE www.michaelpantalon.com. 

11. Success and the Correctional Client

12. Change… • A process and not a single event. • Is not easy. • Ambivalence is a normal part of the change process. • People move in and out of the change process. • Does not happen quickly or easily. • We all resist it.

13. What about your change…? Think about the last big change you made in your own behavior… • How long did it take before you considered that it could be a problem for you? • Before you decided to make a change? • To develop a plan? • Before you actually tried to make the change? • How long before you succeeded completely? • Did you ever go back, and go through the change process again?

14. Stages of Change (Prochaska and DiClemente, 1982) PERMANENT EXIT MAINTENANCE RELAPSE ENTER ACTION PRECONTEMPLATION PREPARATION CONTEMPLATION TEMPORARY EXIT

15. Precontemplation

16. Contemplation

17. Preparation

18. Action

19. Maintenance

20. Someone Special Exercise • I’d like you to think about someone in your life who had a positive influence on you, who helped you become a better person. • This person still could be in your life or could be someone from your past, but this person should mean a lot to you. • The person could be a teacher, a coach, a parent, friend, spouse, or someone else. • Take a minute and visualize this person in your mind. • Now, I would like you to think about this person’s traits or characteristics. • What was or is it about that person that made him or her so influential in your life?

21. O.A.R.S. The Basic Skills of Motivational Interviewing Open ended questions Affirmations Reflective listening Summaries

22. Basic Skills of MI Open ended questions • “How can I help you while your on probation?” • “Would you tell me about ___?” • “How would you like things to be different?” • “What are the positive things and what are the less good things about ___?” • “What will you lose if you give up ___?” • “What have you tried before?” • “What do you want to do next?”

23. Basic Skills of MI Affirmations • Statements of recognition of client strengths. • Build confidence in ability to change. • Must be congruent and genuine.

24. Basic Skills of MI Reflective listening “Reflective listening is the key to this kind of work. The best motivational advice we can give is to listen carefully to your clients. They will tell you what has worked and what hasn’t. What moved them forward and shifted them backward. Whenever you are in doubt about what to do, listen.” - Miller & Rollnick, 1991

25. Levels of Reflection 1. SIMPLE Repeating, rephrasing; staying close to the content, maintaining neutrality. 2. AMPLIFIED Paraphrasing, double-sided reflection; testing the meaning/what’s going on below the surface, reflects client statement in exaggerated form, but without sarcasm. 3. FEELINGS Emphasizing the emotional aspect of communication; deepest form.

26. Types of Reflective Listening 1. REPEATING OR REPHRASING Listener repeats or substitutes synonyms or phrases; stays close to what the speaker has said. 2. PARAPHRASING Listener makes a major restatement in which the speaker’s meaning is inferred. 3. REFLECTION OF FEELING Listener emphasizes emotional aspects of communication through feeling statements- this is the deepest form of listening.

27. Reflection: Responding To Resistance With Nonresistance Simple reflection • Client: I don’t plan to quit drinking anytime soon. • Clinician: You don’t see abstinence in your near future. Amplified reflection • Client: I don’t know why my parents are worried about this. I don’t drink any more than any of my friends. • Clinician: So your family is worrying needlessly.

28. Reflection: Responding To Resistance With Nonresistance Double-sided reflection • Client: Maybe I should give up drinking completely, but I’m not going to do that! • Clinician: You can see that there are some real problems here, but quitting altogether clearly is not what you want to do. Reflection of Feeling • Examples…?

29. Basic Skills of MI Summarizing “Let me see if I understand thus far …” • Special form of reflective listening. • Ensures clear communication. • Use at transitions in conversation. • Be concise. • Reflect ambivalence . • Accentuate “change talk.”

30. G.R.A.C.E. Five Principles of Motivational Interviewing Generate a Gap Roll with Resistance Avoid Argumentation Can Do Express Empathy

31. Principles of Motivational Interviewing Generate a Gap • Develop a discrepancy between individual’s current behaviors and his/her stated values and interests. • Let client present arguments for change. • Acknowledge both the positives and negatives of behavioral change.

32. Principles of Motivational Interviewing Roll with resistance • Seek to clarify, understand. • Invite consideration of new perspectives. • Reinforce person’s role as a problem-solver.

33. Principles of Motivational Interviewing Avoid argumentation • Keep on your client’s side. • Arguing for change often promotes resistance, thus causing the client to defend the behavior you want them to change.

34. Principles of Motivational Interviewing Can do • Increase individual’s perception of self as a capable person. • Affirm positive statements and behaviors. • Offer options, instill hope. • Encourage consideration of role models, past successes.

35. Principles of Motivational Interviewing Express empathy • Create a “free and friendly space” to explore difficult issues. • Use reflective listening. • An accepting attitude facilitates change, pressure to change thwarts it (paradox).

36. Rapport Breakers • Arguing for change • Assuming the expert role • Criticizing, shaming or blaming • Labeling • Being in a hurry • Claiming pre-eminence • Not being “present” - Miller & Rollnick, 1991

37. Other MI Techniques • Brief Situational Confidence Questionnaire • Measure of efficacy for resisting drinking or drug use in various situations. [See BSCQ handout] • Readiness/Confidence Ruler • Simple method for determining clients’ readiness and confidence to change by asking them where they are on a scale of 1-10. Not Ready/Confident Unsure Ready/Confident

38. Is It MI Yet?