Motivational Interviewing in Drug Courts Ron Jackson, MSW, LICSW School of Social Work University of Washington Seattle, WA

MI is a fancy way of selling people on their need to change behavior. A. True B. False

Motivational Interviewing Motivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change. Miller & Rollnick, 2012

Motivational Interviewing Theoretical Foundation Client-centered approach – Rogers Client-centered approach – Rogers Empathic Reflections Self-Perception Theory – Bem Self-Perception Theory – Bem “We come to know what we believe by listening to ourselves talk.” Self-Efficacy – Band Self-Efficacy – Bandura Power to Change Focus on Intrinsic Motivation – Brehm Focus on Intrinsic Motivation – Brehm External pressure can lead to resistance to change Respect for client/patient autonomy – Medical Ethics Respect for client/patient autonomy – Medical Ethics Transtheoretical Model “Stages of Change” – Prochaska & DiClemente Transtheoretical Model “Stages of Change” – Prochaska & DiClemente

STAGES OF CHANGE PROCHASKA & DiCLEMENTE PRECONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE TERMINATION RELAPSE is viewed as a loss of motivation and movement back down the spiral of change.

Spirit of MI Partnership Acceptance Compassion Evocation

The Spirit of Motivational Interviewing (MI) Therapeutic relationship is a collaborative partnership, rather than separate ‘expert’ & ‘recipient’ roles. Motivation for change is elicited from the client, not imposed. It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence. The counseling style is an eliciting one. Direct persuasion is infrequently effective in resolving ambivalence. Instead, the counselor supports a client’s autonomy while helping to explore the prospect of change.

Process Structure Engagement OARS Focusing – Strategic Direction Evoking Motivation – Change Talk Planning

EngagingFocusingEvokingPlanning FOUR PROCESSES OF MI

Four Principles of Motivational Interviewing R – Resist the righting reflex U – Understand client’s motivation L – Listen to the client E – Empower the client

Four Elements of Motivational Interviewing Express empathy Develop discrepancy – Gap Roll with resistance Support self-efficacy – Can Do

Supporting Self-Efficacy Encourages hope or the possibility of change. Our expectations about the likelihood of client change has a powerful effect on the outcome. We want to enhance our client’s confidence in their capacity to change. The client is responsible for choosing and carrying out change.

Four Goals of Motivational Interviewing Increase problem awareness Resolve ambivalence Increase the value of change Increase confidence

O.A.R.S. Tools for Moving in the MI Session Open-ended questions Affirmations Reflective listening Summaries Motivational Interviewing is not a series of techniques for doing therapy but instead is a way of being with patients. William Miller, Ph.D.

Question Answer or Assessment Premature Focus Labeling Chat Trap Blaming Expert MI TRAPS

CHANGE TALK AND SUSTAIN TALK

Desire for status quo (don’t want to change) Inability to change (can’t change) Reasons for sustaining the status quo Need for the status quo (have to stay) Commitment to status quo (not going to change) EXAMPLES OF SUSTAIN TALK

Change Statements Problem recognition Statements of concern  Problems with the status quo Desire to change Optimism  Ability to change  Benefits of change

Preparatory Change Talk DARN D esire A bility R easons N eed

Mobilizing Change Talk CAT Commitment A ctivation T aking steps

Recognize Evoke Respond CHANGE TALK Desire Ability Reason Need CAT

Desire Ability Reasons Need (preparatory) CHANGE TALK Activation Taking Steps (mobilizing) Behavior Change Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M., & Fulcher, L. Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology.Vol 71(5) Oct 2003, Commitment

Readiness to Change From Chris Dunn & Stephen Rollnick, Lifestyle Change.

Exploring Importance Assess : “On a scale of 1-10, how important is it to you now to…(change)?” Explore : “Why did you give it a ___ and not a ___ (lower number)?” “What would have to happen to raise that score?” “How can I help you with that?”

Exploring Confidence Assess : “On a scale of 1-10, how confident are you now that could make that change, if you decided to make it?” Explore : “Why did you give it a ___ and not a ___ (lower number)?” “What would have to happen to raise your confidence?” “How can I help you with that?”

Partnership Autonomy Compassion Evocation MI Spirit DD -Developing Discrepancie s EE -Expressing Empathy SS -Supporting Self Efficacy RR - Rolling with Resistance O-OEQ Affirmations Reflections Summaries E-P-E Elicit- Provide-Elicit Engaging Focus Evoking Planning Heart- Set Mind- Set Being Working Doing Going Principle s Skills Path MI Package

Resources: Books Motivational Interviewing (3 rd Ed.), Miller, W.R. & Rollnick, S., Guilford Press, Motivational Interviewing in Health Care, Rollnick, S, Miller, W.R., & Butler, C. C., Guilford Press, Lifestyle Change, Dunn, C. & Rollnick, S., Mosby, Building Motivational Interviewing Skills Rosengren, David, Guilford, 2009.

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Resources: Websites – excellent source of MI resource material. leaders/ce/motivational.asp – Overview & video demonstrations of brief interventions contrasting MI consistent & inconsistent styles. Requires broadband connection. leaders/ce/motivational.asp