SA 202 Week 2 lecture 3 spirit and technique
- 1. MOTIVATIONAL INTERVIEWING: SPIRITAND TECHNIQUE Brent Scobie, Ph.D.
- 2. Objectives • Conceptual underpinnings • Transition to treatment approach
- 3. What is MI? • Motivation: The probability that a person will enter into, continue, and comply with change- directed behaviors • Motivational Interviewing: A brief intervention grounded in theory which views motivation as a state of readiness to change rather than a personality trait of an individual • A strategy for having difficult conversations with people about behavior change
- 4. Conceptual Underpinnings • Relies on different conceptual models to understand behavioral change • Client-centered (yet directive) • Self-efficacy theory • Outcome expectancy models • Motivation has to do with one’s perception of readiness, willingness and ability.
- 5. Assumptions of Motivationally Informed Treatment • Change happens • Addiction is progressive, so is recovery • Dual Disorders = fragmented, multilayered and complex, • Treatment must be cohesive, multilayered and simple…and congruent with client stage of readiness • Relapses begin when movement towards recovery stops • Treatment goals are negotiated not prescribed • Accept versus agree • Patient ambivalence is normal and expected • New ways of thinking are invited, not imposed • Solutions are evoked, not provided
- 6. The Spirit of MI 2 • Partnership • Work collaboratively and avoid being the expert • Acceptance • Respecting the client’s right to autonomy, potential, strengths and perspective • Compassion • Keep the client’s best interests in mind • Evocation • The best ideas come from the client
- 7. Practical Hands-on Elements of MI Strategy I: Develop patient’s commitment to change
- 8. 5 Principles of Motivational Interviewing • Express empathy • Avoid argumentation • Roll with resistance • Develop discrepancy • Support self-efficacy Miller and Rollnick
- 9. Express Empathy • Relationship factors • Reflective listening • Attention to client statements and ongoing generation of hypothesis as to meaning • Respect, support, gentle persuasion with safety • Encourages non-judgmental collaboration • Provider as knowledgeable consultant rather than expert • Suspension of your perspective in favor of patients • Listen rather than tell
- 10. Avoid Argumentation • Accept, not necessarily agree • Creates power struggle- Arguments for/against change lead to counter arguing • Shifting focus • Agreement with a twist (reflection then reframe) • Emphasize personal choice • Siding with negative
- 11. Roll With Resistance: Don’t Take the Bait • It’s in the relationship, not the client • A signal to change direction or listen more carefully • Merging with resistance allows use of one’s momentum • Roll by listening
- 12. Support Self-efficacy • Without self-efficacy, people’s defenses emerge • Strength-focus • Listen for change • Not a single solution • A negotiation • Foster a belief that change is needed and that change is possible • Potentiate change for future by blaming client for success • 15-66% of clients experience positive change before they enter treatment (Miller, 1999)
- 13. Develop Discrepancy • Help patient recognize what they are doing and where they want to be different • Enhances motivation • Identify how current behavior differs from ideal/desired behaviors • Consequence awareness helps to amplify problematic behaviors • Listen and highlight information about values and community connections, family, etc • Columbo approach (kanfer and Schefft, 1988) • Confusion and uncertainty to accentuate client control
- 14. Elicit Self-motivational Statements • Unstick ambivalence • Problem recognition (“If I keep going like this, I'll be dead in 6 months.”) • Expression of concern (“I am worried my husband will take the children.”) • Intention to change (“I don’t want to live my life like this.”) • Optimism about change (“things will be different this time.”)