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 Motivational Interviewing: Preparing People for Change (second edition) William R. Miller & Stephen Rollnick 2002 Guilford Press www.guilford.com ……………. www.motivationalinterview.org

3. © Ann D. Carden, Ph.D. - 20063 Three Kinds of Change Developmental CoercedIntentional

4. © Ann D. Carden, Ph.D. - 20064 Motivational Interviewing is … Focused on  Intentional change and non-change processes  Their natural course  Ways to empower a person to choose to engage in an intentional change process

5. © Ann D. Carden, Ph.D. - 20065 Motivational Interviewing  an integrative philosophy  a way of being with a person  a method of communication --------------------------- creates and guides … that creates and guides strategies and techniques

6. © Ann D. Carden, Ph.D. - 20066 Clinical Supervision A form of mentoring in which one person draws on her personal power (knowledge, skills, experience, influence) to assist another person to:  recognize his personal power and potential  apply it in his clinical work  continually improve and refine that power  For the benefit of the consumer

7. © Ann D. Carden, Ph.D. - 20067 “It is in the shelter of each other that the people live.” Irish Proverb

8. © Ann D. Carden, Ph.D. - 20068 Self-Reflection Describe a negative supervisory relationship you have experienced at some point your career. What characteristics/ behaviors of that particular supervisor were most harmful to you in your personal/ professional growth?

9. © Ann D. Carden, Ph.D. - 20069 Self-Reflection Describe a positive supervisory relationship you have experienced at some point your career. What characteristics/ behaviors of that particular supervisor were most helpful to you in your personal/ professional growth?

10. © Ann D. Carden, Ph.D. - 200610 Self-Reflection List what you believe to be the most important attributes of an effective supervisor. Rate yourself as a supervisor on each attribute on a scale of 1(not there yet) to 10 (absolutely there).

11. © Ann D. Carden, Ph.D. - 200611 You’re on the right track when… You employ a full range of supervisory methods Case review and analysis Skill rehearsal and role play Co-facilitation Direct observation Indirect observation Skill assessment and structured feedback

12. © Ann D. Carden, Ph.D. - 200612 You’re on the right track when… Your supervisee is actively involved in setting the agenda and reviewing his/her clinical material Your supervisee is evaluating his/her work and making the arguments for any needed changes There is less resistance behavior and more problem-solving behavior in your interactions Your supervisee is actively seeking your feedback

13. © Ann D. Carden, Ph.D. - 200613 Motivational Interviewing “Spirit”  A  A utonomy vs.Authority  C  C ollaboration vs.Confrontation  E  E vocation vs.Education and and  and and  E  E xplorationExplanation COMPETENCE DEFICIT (a COMPETENCE vs. a DEFICIT view of persons)

14. © Ann D. Carden, Ph.D. - 200614 Reflective Listening The “heart” of the MI approach Simple but not easy Non-verbal as well as verbal Affirms & validates the client/supervisee Allows for the revelation of information that might otherwise be overlooked Encourages ownership and creative priority setting and problem solving by the client/supervisee

15. © Ann D. Carden, Ph.D. - 200615 MI Guidelines for Feedback of Fact  Elicit person’s readiness, interest, current understanding current understanding  Provide information in a non-judgmental, non-interpretive manner non-interpretive manner  Elicit person’s interpretation of information provided information provided

16. © Ann D. Carden, Ph.D. - 200616 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

17. © Ann D. Carden, Ph.D. - 200617 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

18. © Ann D. Carden, Ph.D. - 200618 Research suggests that … The Four MI Guiding Principles create consonance/harmony in the therapeutic / supervisory relationship and support the client’s / supervisee’s progression toward motivation to change and grow.

19. © Ann D. Carden, Ph.D. - 200619 Guiding Principle #1 Express Empathy  Radical acceptance of the other person  Skillful and respectful reflective listening  Curious attitude and sincere interest in the other person’s perspective

20. © Ann D. Carden, Ph.D. - 200620 Guiding Principle #2 Develop Discrepancy  Explore her professional values and goals  Heighten awareness of consequences of his present approach with clients  Amplify any gaps between her professional values and goals and her present actions

21. © Ann D. Carden, Ph.D. - 200621 Guiding Principle #3 Roll with Resistance  Go with your supervisee’s energy  Shift focus as needed  Avoid judgment

22. © Ann D. Carden, Ph.D. - 200622 Guiding Principle #4 Support Self-efficacy  Believe in the possibility / carry the hope  Honor his organismic wisdom  Affirm any progress toward her goal

23. © Ann D. Carden, Ph.D. - 200623 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

24. © Ann D. Carden, Ph.D. - 200624 Research suggests that … Six MI Traps/Roadblocks create dissonance in the therapeutic / supervisory relationship, block the client’s / supervisee’s progress and may even cause regression away from motivation to change and grow. (Even within the same session)

25. © Ann D. Carden, Ph.D. - 200625 Common Trap #1  Closed Question trap … - blocks exploration - distances

26. © Ann D. Carden, Ph.D. - 200626 Common Trap #2  Arguing for change trap … - evokes opposition - creates an unsafe environment - encourages shame

27. © Ann D. Carden, Ph.D. - 200627 Common Trap #3  Expert trap … - invites dependency - discourages creative problem- solving - deflates self-confidence

28. © Ann D. Carden, Ph.D. - 200628 Common Trap #4  Labeling trap … - depersonalizes - demoralizes - disempowers

29. © Ann D. Carden, Ph.D. - 200629 Common Trap #5  Premature focus trap … - inhibits exploration - prevents “unpacking” of meaning - weakens the relationship

30. © Ann D. Carden, Ph.D. - 200630 Common Trap #6  Blaming trap … - damages self-esteem - evokes defensiveness

31. © Ann D. Carden, Ph.D. - 200631 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

32. © Ann D. Carden, Ph.D. - 200632 Motivational Interviewing is … Motivational Interviewing is … related to: o Client-Centered Therapy o Self-Regulation Theory o Trans-Theoretical Stages of Change Model o Self-Perception Theory

33. © Ann D. Carden, Ph.D. - 200633 Client-Centered Therapy Model

34. © Ann D. Carden, Ph.D. - 200634 “Non-specific Factors” “Non-specific Factors” Empathy Unconditional Positive Regard Genuineness