Rolling with Resistance : Using a Motivational Interviewing Approach

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Rolling with Resistance Using a Motivational
Interviewing Approach

• Presented by
• Danette Heckathorn, M.S., L.P.C.

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Motivational Interviewing

• A Humanistic approach to counseling developed by
  Miller and Rollnick (1991, 2002).
• Motivational interviewing (MI) is not a theory.
  It is a tool to be used in conjunction with other
  theories.

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Agenda

• Motivation
• What this training will do for you
• Stages of Change Model
• Major goals of motivational interviewing
• How to address negative behavior
• Rolling with Resistance
• Practice

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Motivation

• What motivates?
• Is motivation enough?

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What will this training do for you?

• You will learn ways to use motivational
  interviewing as a tool to roll with client
  resistance.
• This training will give you a taste of MI and
  introduce you to some resources, but it cannot
  substitute for a 4-Day comprehensive MI training.

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Cycle of Change
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Stages of Change (Prochaska et. al., 1994)

• Precontemplation either unaware of problems
  related to negative health behavior or lack the
  desire to change their negative behavior, and
  they do not report any intention to change their
  negative habit within the next 6 months.

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Contemplation

• Individuals recognize that some aspect of their
  negative behavior is a problem, and they plan to
  take action in the next 6 months. They are often
  seen as ambivalent because the perceived costs
  and benefits of the negative behavior are
  equivalent (Rollnick et. al., 1991).

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Preparation

• Commitment to change has been made and they plan
  to take action in the near future.

Action

• Begin to actively change behaviors and
  environmental conditions to overcome problem.

Maintenance

• Changes have become a regular part of the
  individuals lifestyle.

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Why Determine Stage of Change?

• Identifying a clients stage of change will help
  you determine the best approach to take with
  them.
• Change is the responsibility of the client but
  the caregiver is responsible for enhancing
  motivation to change.

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Ways to Determine Their Stage of Change

• I noticed (behavior) is this something that is
  creating a problem for you or something you would
  like to change?
• People differ in how ready they are to change
  their (behavior) habits. What about you?

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Precontemplative Client

• I dont have any problems with (behavior)
• They may come across defensive
• Reluctant
• Resigned
• Rationalizing
• Rebellious
• No intention to change

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Comtemplative Client

• I have been thinking about changing (behavior)
• They have identified the behavior may be
  problematic
• More troubled about the behavior
• Ambivalent but may be weighing pros and cons
• Decisional balance exercise useful

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Preparation Stage and Client

• How can I change (behavior)?
• More committed
• Ready to start
• Sharing plans for change
• Change becomes a priority

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Action Stage and Client

• Here I go
• They decide on a change strategy and try it out
• Actively modify behavior including thoughts,
  feelings, and the environment
• Treatment and/or self-help
• Persistence and completion or drop-out

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Maintenance Stage and Client

• I think this will work and I am going to
  continue
• Trying to keep the ball rolling
• Preventing relapse learning new coping skills
• Watching out for triggers
• Acknowledging self for changes made and taking
  credit
• Moving toward more balance

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Practice Identifying Stage of Change

• Quick Exercise
• We will come back to the stages of change after
  discussing motivational interviewing

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Motivational Interviewing

• Defined as ...a client-centered directive method
  for enhancing intrinsic motivation to change by
  exploring and resolving ambivalence (Miller
  Rollnick, 2002, p. 25)
• Lets break it down

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Four Main Principles of MI

• Express empathy
• Develop discrepancy
• Roll with resistance
• Support self-efficacy

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Strategies Used in MI

• Eliciting Change Talk motivational statements
  from the client
• OARS Method
• Open-Ended Questions
• Affirming the client
• Reflective listening
• Summarizing

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Change Talk

• Client identifies that behavior might be
  problematic
• Client expresses concern about a behavior
• Client expresses a desire to change the behavior

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Reflective Listening

• What is it?
• How do you do it?
• Levels of reflective listening
• Optimal reflective listening
• Lets Practice

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Affirming the Client

• The idea here is to enhance self-efficacy
• Self-efficacy is our belief in our own ability to
  achieve a goal or accomplish a task
• Strengthen the relationship
• Enhance self-esteem

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Summarizing

• A technique to be used throughout the meeting
• Strategically repeat a clients self-motivational
  statements
• Include reluctance/resistance
• Reflect optimism for change

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Knowing When a Client is Ready to Change

• What do you expect to hear when a client is ready
  to change?
• What do you not expect to hear?
• What will the client look like?
• What other indications might the client make?

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How to Elicit Change Talk

• Open-ended questions (handout)
• Ruler (handout)
• Pros/Cons exercise
• Looking forward
• Looking back
• Goals and values

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Change Planning

• What changes?
• Why change?
• Goals SMART
• Steps to take?
• First steps concrete
• Help
• I will know it is working if
• Potential obstacles

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Resistance to Change

• 4 Categories
• Arguing
• Interrupting
• Denying
• Ignoring

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NO NOs for Dealing with Resistance

• Arguing, disagreeing and challenging
• Judging, criticizing, blaming
• Warning of negative consequences
• Seeking to persuade with logic
• Analyzing
• Confronting with authority
• Sarcasm

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How to Respond to Resistance

• Simple reflection
• Amplified reflection
• Double-sided reflection
• Agreement with a twist
• Shifting focus
• Reframing
• Rolling with resistance

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Simple Reflection

• Stating what you here the client saying
• It is sometimes helpful for the client just to
  hear their own words

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Amplified Reflection

• Reflect with modification

• Client I just dont think that I have a problem
  with gambling.
• Caregiver There is no cause for concern for you.
  
• Client I dont know how changing my eating
  habits could help me.
• Caregiver You feel your eating habits are
  perfectly reasonable.

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Double-Sided Reflections

• Reflect back the statement but also use the other
  side of the clients ambivalence
• Client I cant quit eating sweets. I look
  forward to having a nice desert each day.
• Caregiver It sounds like you are going to miss
  eating deserts, but you also dont want to take
  diabetic medication. What do you think would be
  the best way to resolve this situation?

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Agreement with a Twist and Shifting Focus

• Defuse resistance by shifting focus

• Add a slant or twist to the meaning when you
  reflect back to the client

• Client I cant imagine quitting drinking. All
  of my friends drink!
• Caregiver Its hard to imagine giving up a
  lifestyle that youre accustomed to. Im
  wondering, what can you imagine?

• Client I cant imagine quitting drinking. All of
  my friends drink!
• Caregiver It sounds like youll really miss the
  social interaction. And at the same time, it
  might provide an opportunity to expand your
  social network like you were wanting.

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Reframing

• Placing something in a more positive light
  (what are the benefits?)
• Client It is really going to be hard for me to
  quit eating sweets.
• Caregiver While it will be hard to quit eating
  sweets, you are determined to do it because it
  will allow you to control your diabetes without
  taking medication.

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Rolling with Resistance

• This is where you just want to validate what the
  client is telling you by letting them know you
  have heard their problem and understand their
  ambivalence
• It can be one of the most difficult techniques

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MI The BASICS

1. Dont ignore the behavior even if you simply
   say Hey, (name) I noticed (behavior).
2. Try to determine where they are with regards to
   stage of change.
3. Lets Practice

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Summary

• The Basics of MI
• Can be used to address any negative behavior

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Feedback and/or Questionsdheckat_at_uark.eduor
[phone]

• Thank you.