2. Lowery Training Associates1 Presented at: OACCA’s 19 th Annual Spring Conference - 2016 Brian Lowery MPA, LSW Lowery Training Associates Cleveland, Ohio E-mail: Brian@LoweryAndAssociates.com Motivational Interviewing: Preparing Clients for Change

3. Lowery Training Associates2 Welcome & Introductions Welcome & Introductions Learning Objectives Ice Breaker: “Have You Ever???”

4. Lowery Training Associates3 What Matters Most

5. Lowery Training Associates4 *Miller and Rollnick, 1991 “A client-centered, directive intervention focused on resolving ambivalence in the direction of change.” “… not a series of techniques … but a way of being with clients.” *Miller and Rollnick, 1991 What is Motivational Interviewing?

6. Lowery Training Associates5 Have multiple tools in your tool chest Easier: Motivational Confrontational Harder: Confrontational Motivational Possible Helping Frameworks Motivational Client-Centered Partnership Confrontational Provider-Centered Paternalistic

7. Lowery Training Associates6 Necessary Conditions to Induce Change: FRAMES F eedback: Risk is given to individual R esponsibility: For change is placed with individual A dvice: About changing is clearly given in a nonjudgmental manner M enu: Of self-directed change options and treatment alternatives E mpathetic Counseling: Showing warmth, respect, and understanding; uses reflective listening S elf-Efficacy: Optimistic empowerment is engendered to encourage change

8. Lowery Training Associates7 How Does Behavior Change? Behavior ABehavior B

9. Lowery Training Associates8 Transtheoretical Model Individuals progress through stages of change. Movement may be forward or backward. Movement may be cyclical.

10. Lowery Training Associates9TerminationMaintenance Action Determination Contemplation Precontemplation Stages of Change Prochaska et al, 1991 MI -Phase 1 MI - Phase 2

11. 1. Pre-contemplation No perceived need to change 2. Contemplation Initial awareness of a problem Feelings of ambivalence about change 3. Preparation Stage Initial Movement away from ambivalence and toward action Statements reflect the beginnings of motivation 4. Action The person takes steps to bring about change 5. Maintenance Stage The person sustains the change accomplished by previous actions Steps for maintaining long-term change are different from steps for initial change 6. Relapse Stage Long-standing change often involves setbacks Person may relapse into previous problem behaviors STAGES OF CHANGE

12. Lowery Training Associates11 The Issue of Ambivalence The Issue of Ambivalence am·biv·a·lence 1. The coexistence of opposing attitudes or feelings, such as love and hate, toward a person, object, or idea. 2. Uncertainty or indecisiveness as to which course to follow.

13. Lowery Training Associates12 MI Response to Ambivalence Become comfortable with clients who are in an ambivalent state Communicate acceptance of ambivalence by trying to understand both sides of clients feelings Quietly spend time exploring a client’s ambivalent feelings

14. Lowery Training Associates13 PHASE 1: Building Motivation (We will examine today) PHASE 2: Strengthening Commitment to Change (You’ll have to take the 6 hour class to learn this) Motivational Interviewing

15. Lowery Training Associates14  Develop Discrepancy  Express Empathy  Avoid Argumentation  Roll with Resistance  Support Self-Efficacy Fundamental Principles of MI - Phase 1

16. Lowery Training Associates15 Develop Discrepancy Motivation for change occurs when people perceive a discrepancy between where they are and where they want to be. The MI approach seeks to enhance and focus the client's attention on such discrepancies with regard to issues interfering with their parenting.

17. Lowery Training Associates16 Express Empathy The counselors role is a blend of a supportive companion, and knowledgeable consultant. The client's freedom of choice and self-direction are respected. The counselor seeks ways to compliment rather than denigrate, to build up rather than tear down. Much of MI is listening rather than telling. Persuasion is gentle, subtle, always with the assumption that change is up to the client.

18. Avoid Argumentation Avoid Argumentation The MI style explicitly avoids direct argumentation, which tends to evoke resistance. No attempt is made to have the client accept or “admit” a diagnostic label. The practitioner does not seek to prove or convince by force of argument. Instead, the counselor employs other strategies to assist the client to see accurately the consequences of their behavior, and to begin devaluing the perceived positive aspects of the behavior. Lowery Training Associates17

19. Lowery Training Associates18 Roll with Resistance MI strategies do not meet resistance head-on, but rather "roll with" the momentum, with a goal of shifting client perceptions in the process. New ways of thinking about problems are invited but not imposed. Ambivalence is viewed as normal, not pathological, and is explored openly. Solutions are usually evoked from the client rather than provided by the counselor.

20. Lowery Training Associates19 Support Self-Efficacy A person will not move toward change unless there is hope for success. Self-efficacy is, in essence, the belief that one can perform a particular behavior or accomplish a particular task. In this case, the client must be persuaded that it is possible to change his or her own substance use and thereby reduce related problems. In everyday language, this might be called hope or optimism. It is the client's specific belief that he or she can change.

21. Lowery Training Associates20   O pen-ended Questions   A ffirmations   R eflective Listening   S ummaries O.A.R.S. Core Skills of Motivational Interviewing: Phase 1 Strategies

22. Lowery Training Associates21 Open vs. Closed Questions Open – –Requires more than a yes or no response – –Eliciting—more person-centered – –Aids individual cognitions Closed – –Quick, easier & efficient – –Less person-centered – –Less engaging

23. Lowery Training Associates22 AFFIRMATIONS Statements of recognition of client strengths Build confidence in ability to change Must be congruent and genuine Compliments Is a form of Reflective Listening Is client-focused

24. Lowery Training Associates23 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 - Miller & Rollnick, 1991

25. Lowery Training Associates24 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”

26. Lowery Training Associates25 Brief Example of a Motivational Interview https://www.youtube.com/watch?v=dm-rJJPCuTE

27. Lowery Training Associates26 Very Brief MI Outline Set the Agenda Ask about the Positive Aspects of No Change Ask about the Less Good Things Explore Life Goals Ask for a Decision Goal Setting

28. Lowery Training Associates27 Additional Resources on Motivational Interviewing SAMHSA/CSAT Treatment Improvement Protocol on Motivational Interviewing (#35) http://text.nlm.nih.gov SAMHSA/CSAT Treatment Improvement Protocol on Motivational Interviewing (#35) http://text.nlm.nih.gov www.motivationalinterview.org www.motivationalinterview.org Miller WR & Rollnick S. Motivational Interviewing. New York: Guilford, 1991 Miller WR & Rollnick S. Motivational Interviewing. New York: Guilford, 1991

29. Lowery Training Associates28 Conclusions & Evaluation Thank you for all your hard work today…and every day. Enjoy the rest of the conference! Brian