© Ann D. Carden, Ph.D MOTIVATIONAL INTERVIEWING in CLINICAL SUPERVISION Ann D. Carden, Ph.D.

© Ann D. Carden, Ph.D Guiding Principle #1 Express Empathy

© Ann D. Carden, Ph.D Self-Regulation Theory

© Ann D. Carden, Ph.D Intentional change is grounded in awareness of one’s core values and life goals and the gap between those values and goals and one’s present behaviors is grounded in awareness of one’s core values and life goals and the gap between those values and goals and one’s present behaviors

© Ann D. Carden, Ph.D “They say you can lead a horse to water, but you cant’ make him drink…but I say, you can salt the oats.” “They say you can lead a horse to water, but you cant’ make him drink…but I say, you can salt the oats.” Madeline Hunter

© Ann D. Carden, Ph.D Guiding Principle #2 Develop Discrepancy

© Ann D. Carden, Ph.D Trans-theoretical Stages of Change Model

© Ann D. Carden, Ph.D Stages of Change Precontemplation Precontemplation Contemplation Contemplation Preparation Preparation Action Action Maintenance Maintenance Termination Termination

© Ann D. Carden, Ph.D Resources – internal & external Resources – internal & external Risks – internal & external Risks – internal & external Readiness > intervention Readiness > intervention

© Ann D. Carden, Ph.D Guiding Principle #3 Roll with Resistance

© Ann D. Carden, Ph.D Self-Perception Theory

© Ann D. Carden, Ph.D IntentionCOMMITMENT Cognitive Affective Behavioral ProblemRecognitionREASONS ConcernNEEDDESIRE ConfidenceABILITY

© Ann D. Carden, Ph.D The Flow of Change TalkDesireAbilityReasonsNeed Commitment Change MI

© Ann D. Carden, Ph.D Guiding Principle #4 Support Self-efficacy

© Ann D. Carden, Ph.D Intentional Change is a process, not an event!

© Ann D. Carden, Ph.D Intentional change is more likely to occur when goals are  Small  Important to the goal-setter  Specific/Concrete/Measurable  Present-focused  Realistic/Practical  A presence rather than an absence

© Ann D. Carden, Ph.D Three Phases in the Intentional Change Process

© Ann D. Carden, Ph.D Common Barriers to Self- Enhancing Intentional Change Cluelessness Cluelessness Minimization Minimization Projection of responsibility Projection of responsibility Immediate gratification Immediate gratification Fear of failure Fear of failure Skills deficits Skills deficits Information gaps Information gaps Fear of the unknown Fear of the unknown Lack of social / material supports Lack of social / material supports Competing stressors Competing stressors

© Ann D. Carden, Ph.D “Given a choice between changing and proving that it is not necessary, most people get busy with the proof.” John Galbraith

© Ann D. Carden, Ph.D It’s not so much that we’re afraid of change or so in love with the old ways, but it’s that place in between that we fear … It’s like being between trapezes … It’s Linus when his blanket is in the drier. There’s nothing to hold on to. Marilyn Ferguson

© Ann D. Carden, Ph.D Ambivalence Ambivalence “People often get stuck, not because they fail to appreciate the down side of their situation, but because they feel at least two ways about it.” Miller & Rollnick

© Ann D. Carden, Ph.D Ambivalence approach-approachapproach-avoidanceavoidance-avoidance double approach avoidance

© Ann D. Carden, Ph.D Motivation When the balance tips away from resistance and toward commitment Never completely free of ambivalence and resistance Requires on-going “buy in” at the level of thinking thinking feelings feelings actions actions

© Ann D. Carden, Ph.D Six Supervisor Guidelines 1. Adhere to the MI Guiding Principles 2. Avoid Traps / Roadblocks to progress 3. Teach / model the Philosophical Foundations of MI 4. Maintain a clinical focus 5. Adapt to the Supervisee’s context 6. Assist supervisees to become proficient in MI clinical skills

© Ann D. Carden, Ph.D Ongoing assessment of client’s:  stages  resources  risks  readiness

© Ann D. Carden, Ph.D Ongoing assessment of supervisee’s:  alliance with client  MI consistent interventions  goals for client  beliefs about outcomes

© Ann D. Carden, Ph.D Supervisory Responsibility “Above all do no harm”

© Ann D. Carden, Ph.D Six Supervisor Guidelines 1. Adhere to the MI Guiding Principles 2. Avoid Traps / Roadblocks to progress 3. Teach / model the Philosophical Foundations of MI 4. Maintain a clinical focus 5. Adapt to the Supervisee’s context 6. Assist supervisees to become proficient in MI clinical skills

© Ann D. Carden, Ph.D Cultural Diversity Age Age Socio-economic status Socio-economic status Gender / sexual orientation Gender / sexual orientation Ethnicity / race Ethnicity / race Geographic location Geographic location Religion Religion Educational level and type Educational level and type Life roles Life roles Disability / diagnosis Disability / diagnosis

© Ann D. Carden, Ph.D Cultural effects …. Values Values Perspective Perspective Meanings Meanings Relationships Relationships Independence Independence Current focus / life task Current focus / life task Time orientation / pacing Time orientation / pacing Communication and learning style Communication and learning style Client-counselor alliance Client-counselor alliance

© Ann D. Carden, Ph.D Client-Related Stressors of Direct Service Providers Client resistance / supervisee’s unrealistic expectations of client change Client resistance / supervisee’s unrealistic expectations of client change Boundary issues/ethical dilemmas Boundary issues/ethical dilemmas Client suicide/attempts Client suicide/attempts Client anger/hostility Client anger/hostility Premature termination Premature termination Client violence toward others Client violence toward others Client death Client death

© Ann D. Carden, Ph.D Job-Related Stressors of Direct Service Providers Isolation / insufficient supports Isolation / insufficient supports Productivity pressures / time crunches Productivity pressures / time crunches Paperwork, paperwork, paperwork Paperwork, paperwork, paperwork Organizational politics Organizational politics Low pay Low pay Self-doubt Self-doubt Perfectionism / compulsive responsibility Perfectionism / compulsive responsibility Limited training opportunities Limited training opportunities

© Ann D. Carden, Ph.D Moving Toward Melt-down/Freeze-up Increased absenteeism Increased absenteeism Over-reacting Over-reacting Physical complaints Physical complaints Chronic exhaustion Chronic exhaustion Low self-confidence Low self-confidence Depression / Anxiety Depression / Anxiety Procrastination Procrastination Boundary violations Boundary violations Cynical attitude about job / clients Cynical attitude about job / clients Social withdrawal Social withdrawal Hostility Hostility Us-them mentality Us-them mentality Disorganized thinking / behavior Disorganized thinking / behavior

© Ann D. Carden, Ph.D Six Supervisor Guidelines 1. Adhere to the MI Guiding Principles 2. Avoid Traps / Roadblocks to progress 3. Teach / model the Philosophical Foundations of MI 4. Maintain a clinical focus 5. Adapt to the Supervisee’s context 6. Assist supervisees to become proficient in MI clinical skills

© Ann D. Carden, Ph.D MISpirit Principles Traps Opening Strategies Elicit/Explore Change Talk Counter Sustain Talk Consolidate Commitment MI Core Skills