1. © Ann D. Carden, Ph.D. - 20061 MOTIVATIONAL INTERVIEWING in CLINICAL SUPERVISION Ann D. Carden, Ph.D. CardenAnn@aol.com

2. © Ann D. Carden, Ph.D. - 20062 Guiding Principle #1 Express Empathy

3. © Ann D. Carden, Ph.D. - 20063 Self-Regulation Theory

4. © Ann D. Carden, Ph.D. - 20064 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

5. © Ann D. Carden, Ph.D. - 20065 “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

6. © Ann D. Carden, Ph.D. - 20066 Guiding Principle #2 Develop Discrepancy

7. © Ann D. Carden, Ph.D. - 20067 Trans-theoretical Stages of Change Model

8. © Ann D. Carden, Ph.D. - 20068 Stages of Change Precontemplation Precontemplation Contemplation Contemplation Preparation Preparation Action Action Maintenance Maintenance Termination Termination

9. © Ann D. Carden, Ph.D. - 20069 Resources – internal & external Resources – internal & external Risks – internal & external Risks – internal & external Readiness ------> intervention Readiness ------> intervention

10. © Ann D. Carden, Ph.D. - 200610 Guiding Principle #3 Roll with Resistance

11. © Ann D. Carden, Ph.D. - 200611 Self-Perception Theory

12. © Ann D. Carden, Ph.D. - 200612 IntentionCOMMITMENT Cognitive Affective Behavioral ProblemRecognitionREASONS ConcernNEEDDESIRE ConfidenceABILITY

13. © Ann D. Carden, Ph.D. - 200613 The Flow of Change TalkDesireAbilityReasonsNeed Commitment Change MI

14. © Ann D. Carden, Ph.D. - 200614 Guiding Principle #4 Support Self-efficacy

15. © Ann D. Carden, Ph.D. - 200615 Intentional Change is a process, not an event!

16. © Ann D. Carden, Ph.D. - 200616 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

17. © Ann D. Carden, Ph.D. - 200617 Three Phases in the Intentional Change Process

18. © Ann D. Carden, Ph.D. - 200618 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

19. © Ann D. Carden, Ph.D. - 200619 “Given a choice between changing and proving that it is not necessary, most people get busy with the proof.” John Galbraith

20. © Ann D. Carden, Ph.D. - 200620 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

21. © Ann D. Carden, Ph.D. - 200621 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

22. © Ann D. Carden, Ph.D. - 200622 Ambivalence approach-approachapproach-avoidanceavoidance-avoidance double approach avoidance

23. © Ann D. Carden, Ph.D. - 200623 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

24. © Ann D. Carden, Ph.D. - 200624 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

25. © Ann D. Carden, Ph.D. - 200625 Ongoing assessment of client’s:  stages  resources  risks  readiness

26. © Ann D. Carden, Ph.D. - 200626 Ongoing assessment of supervisee’s:  alliance with client  MI consistent interventions  goals for client  beliefs about outcomes

27. © Ann D. Carden, Ph.D. - 200627 Supervisory Responsibility “Above all do no harm”

28. © Ann D. Carden, Ph.D. - 200628 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

29. © Ann D. Carden, Ph.D. - 200629 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

30. © Ann D. Carden, Ph.D. - 200630 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

31. © Ann D. Carden, Ph.D. - 200631 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

32. © Ann D. Carden, Ph.D. - 200632 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

33. © Ann D. Carden, Ph.D. - 200633 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

34. © Ann D. Carden, Ph.D. - 200634 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

35. © Ann D. Carden, Ph.D. - 200635 MISpirit Principles Traps Opening Strategies Elicit/Explore Change Talk Counter Sustain Talk Consolidate Commitment MI Core Skills