welcome WELCOME The Use of Motivational Interviewing working with Women Clients’

COMMON FACTORS 40%-- CLIENT TRAITS – Strengths, Resources, Client Perceptions 30%-- THERAPEUTIC RELATIONSHIP – Empathy, Acceptance, Mutual Affirmation, Encouragement, Respect & Warmth 15%-- HOPE-EXPECTANCY – Belief in possibility of change 15%-- TECHNIQUES/ORIENTATION

Women’s Treatment Elements for Engagement/Retention  Available Child Care & Transportation  Relationship-Based  Family/Couples Counseling  Domestic Violence Services  Employment Services

TerminationMaintenance Action Preparation Contemplation Precontemplation Stages of Change Prochaska et al, 1991 Stages of Change

Why Enhance Motivation? Inspire Motivation Assist Individuals Readiness for Change Keep People in Treatment Improve Individuals Experiences in Treatment Improve Outcomes Increase Return Rate

 KEY TO CHANGE  MULTIDIMENSIONAL  CAN BE MODIFIED  DYNAMIC & FLUCTUATES  INFLUENCED BY OTHERS  STYLE OF CLINICIAN INFLUENCES  IS ELICITED & ENHANCED Motivation and change

Directive Client-centered Counseling style Elicits behavior change Client ambivalence Communication style Autonomy respected

 Express Empathy  Develop Discrepancy  Roll with Resistance  Support Self-efficacy

Motivational Interviewing PHASE I: BUILDING MOTIVATION PHASE II: STRENGTHENING COMMITMENT TO CHANGE

Phase One Strategies Building Motivation  Open-ended Questions  Affirmation  Reflective Listening  Summary  Eliciting Change Talk

Open- – Requires more than a yes or no response – Eliciting – more person centered – Aides individual cognitions Closed- – Quick, easier, & efficient – Less person centered – Less engaging

Affirmations Client Focused Build on Client Strengths Highlight Client Success Express Empathy

What is Reflective Listening? Hearing meaning behind the client’s words Building Hypothesis vs. Making Assumptions Creating a non-judgmental, accepting environment Genuineness

REFLECTIVE LISTENING  Levels of depth --  Level One: Repeat  Level Two: Rephrase  Level Three: Paraphrase

Reflections Options Some Starting Points Õ It sounds like you.... Õ You’re feeling.... Õ It seems to you that.... Õ So you....

Summarizing Special form of reflection Provider chooses what to include and emphasize Includes: concerns about change, problem recognition, optimism about change, ambivalence about change Client knows you are listening Invite client to respond to your summary

Change Talk Categories Self-Motivational Statement  Problem Recognition  Statements of Concern  Intention to Change  Optimistic about Change

Phase Two Strengthening Commitment Recognizing Readiness Transitional Summary Key Questions Information & Advise Negotiating a Plan

RAW GRAPH

Motivation Exercise Listener – Ask – What is something you are motivated to change? Use active listening, open-ended statements or questions Speaker- respond

Maintenance Termination Action Preparation Contemplation Precontemplation MI-SOC ROADMAP TOMLIN/RICHARDSON-2000 SPIRAL OF CHANGE DEVELOPED BY PROCHASKA, et al, ‘94 OARS IS A TERM DEVELOPED BY MILLER et al, ‘00 OARS CHANGE TALK Summary & Key Questions OARS S R A O