Motivational Interviewing in Action: Live Demonstration with

1
Motivational Interviewing in Action Live
Demonstration
with Scott Caldwell, MA CSAC, member of the
Motivational Interviewing Network of
Trainers Wisconsin Public Psychiatry Network
Teleconference January 5, 2012
2
Outline for this teleconference

• What is MI
• Demonstration with observer coding
• Debrief

3
Motivational Interviewing
First developed in 1983, MI is a collaborative
and person-centered way of being with people. It
involves a goal-oriented conversation about a
particular behavior and draws upon a persons own
reasons and motivations for positive behavior
change.
Source Miller Rollnick (2002)
4

• One contribution of MI has been a change in
  thinking, a realization that enhancing motivation
  for change is an important part of the
  therapists job. Rather than waiting for
  sufficient suffering to render the person ready
  for treatment, or dismissing clients because they
  are resistant to treatment, it is possible to
  evoke motivation for change. That makes it
  possible to treat a broader ranger of people and
  to do so earlier than might otherwise occur. This
  is a point of view that is sorely needed in the
  field of mental health. (p. 327)

Source Arkowitz, Miller, Westra, Rollnick
(2008)
5
What MI is NOT

• A technique or bag of tricks
• Just client-centered therapy
• Stages of Change
• Problem solving
• A panacea for tough clinical difficulties
• Easy to learn
• Source Miller Rollnick (2009)

6
What is MI?

• Clinician Spirit
• Person-centered, empathetic listening
• Target behavior
• Attending to client Change Talk
• OARS Skills

7
1. Clinician Spirit (a way of being with people)

• Collaboration developing a partnership that
  honors client knowledge, expertise, and
  experience power sharing
• Evocation resources and motivation for change
  reside in the client motivation is enhanced by
  eliciting client ideas, goals, values
• Support autonomy respect for client right to
  make informed choices client is in charge and
  thus responsible for outcome emphasis on client
  choice, control

8
2. Empathetic listening

• Counselor accurate empathy is the single best
  predictor of behavior change
• Good reflective listening looks easy, but its a
  complex skill
• Involves careful listening with the goal of
  understanding the clients meaning
• Make a guess about the meaning, then offer guess
  as a statement (not a question)
• Levels of Reflection Simple, Complex

9
(No Transcript)
10
3. Target behavior
Drinking
Family
Self-harm
Drug use
Showing up to group
Mental health
Medication adherence
Fun

• Agenda Setting

11
4. Client Change Talk

• Any client speech around a target behavior which
  favors movement in the direction of change
• Types of change talk (DARN-C)

12

• DARN-C
• DESIRE to change (want, like, wish)
• ABILITY to change (can, could)
• REASON to change (if then)
• NEED to change (need, have to, got to)
• COMMITMENT to change (I will, Im ready
  Im going to)

13
4. Client Change Talk

• Any client speech around the target behavior
  which favors movement in the direction of change
• Types of Change Talk (DARN-C)
• The skillful MI practitioner 1)
  recognizes
• 2) proactively evokes, and
• 3) differentially responds to Change Talk

14
5. Directive use of OARS Skills

• Open questions elicit client change talk
• Affirmation affirm change efforts
• Reflection reinforce change talk
• Summarizing collect client change talk
  statements (flowers) offer back in a summary
  (bouquet)

15
Demonstration w/ observer coding HANDOUTS

• Observer Sheet
• MI Spirit Ratings Key
• MI Skills Count Description

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Benchmarks of basic MI proficiency

• Spirit global ratings ave. (1 - 5) . . . . . . .
  . . 3.5
• Open questions of total questions . . . . .
  50
• of Complex reflections of total reflections 40
• Ratio of Reflections to Questions . . . . . . . .
  11
• MI Adherent behaviors . . . . . . . . . . . . . .
  . . 90
• MI Non-adherent behaviors . . . . . . . . . . . .
  10

Source Moyers et al. (2009, p. 27)
20
How MI works Path model
MI Spirit OARS
Change talk Desire Ability Reasons Need
Commitment
Behavior Change
Source Miller Rose (2009)
21

• Variables that do not predict outcome
• Clinical severity
• Voluntary vs. involuntary
• Socio-demographics
• Age, gender

Client predictors
MI Spirit OARS
Change talk D A R N
Commitment
Behavior Change
Source Amrhein et al. (2003) Moyers et al.
(2007)
22
Therapist predictors
MI Spirit OARS
High levels of Spirit and Skills
Change talk Desire Ability Reasons Need
Commitment
Behavior Change
Source Gaume et al. (2008) Glynn Moyers
(2010) Moyers, Miller, Hendrickson (2005)
23
When MI is particularly useful

• At the beginning of services
• With people who are uninterested or ambivalent
  about change
• With people who present as angry, resistant, or
  defiant
• Cross-culturally
• Integrated with other evidence-based treatments

24
How do clinicians learn MI?Stay tuned next MH
Teleconference on January 19, 2012 Advancing
Practice in MI
25
Thank you.

• Scott.Caldwell_at_wisconsin.gov

26
Presentation References

• Amrhein, P. C., Miller, W. R., Yahne, C. E.,
  Palmer, M., Fulcher, L. (2003). Client
  commitment language during motivational
  interviewing predicts drug use outcomes. Journal
  of Consulting and Clinical Psychology, 71,
  862-878.
• Arkowitz, H., Miller, W. R. (2008). Learning,
  applying, and extending motivational
  interviewing. In H. Arkowitz, H. A. Westra, W. R.
  Miller, S. Rollnick (Eds.), Motivational
  interviewing in the treatment of psychological
  problems (pp. 1-25). New York The Guilford
  Press.
• Arkowitz, H., Miller, W. R., Westra, H.,
  Rollnick, S. (2008). Conclusions and future
  directions. In H. Arkowitz, H. A. Westra, W. R.
  Miller, S. Rollnick (Eds.), Motivational
  interviewing in the treatment of psychological
  problems (pp. 324-342). New York The Guilford
  Press.
• Gaume, J., Gmel, G., Faouzi, M., Daeppen, J. B.
  (2008). Counselor skill influences outcomes of
  brief motivational interventions. Journal of
  Substance Abuse Treatment, 37, 151-159.
• Glynn, L. H., Moyers, T. B. (2010). Chasing
  change talk The clinicians role in evoking
  client language about change. Journal of
  Substance Abuse Treatment, 39, 65-70.
• Moyers, T. B., Martin, T., Christopher, P. J.,
  Houck, J. M., Tonigan, J. S., Amrhein, P. C.
  (2007). Client language as a mediator of
  motivation efficacy Where is the evidence?
  Alcoholism Clinical and Experimental Research,
  31(S3), 40S-47S.

27
Presentation References (cont.)
Moyers, T. B., Martin, T., Manuel, J. K., Miller,
W. R., Ernst D. (2009). Revised global scales
Motivational Interviewing Treatment Integrity 3.1
(MITI 3.1). University of New Mexico Center on
Alcoholism, Substance Abuse and Addictions.
Accessed from http//casaa.unm.
edu/download/MITI3_1.pdf Moyers, T. B., Miller,
W. R., Hendrickson, S. M. (2005). How does
motivational interviewing work? Therapist
interpersonal skill predicts client involvement
within motivational interviewing sessions.
Journal of Consulting and Clinical Psychology,
73, 590-598. Miller, W. R., Rollnick, S.
(2002). Motivational interviewing Preparing
people for change (2nd edition). New York The
Guilford Press. Miller, W. R., Rollnick, S.
(2009). Ten things that motivational interviewing
is not. Behavioural and Cognitive Psychotherapy,
37, 129-140. Miller, W. R., Rose, G. S. (2009).
Toward a theory of motivational interviewing.
American Psychologist, 64(6), 527-537.