Motivational Interviewing in Drug Courts

1
Motivational Interviewing in Drug Courts

• Ron Jackson, MSW, LICSW
• School of Social Work
• University of Washington
• Seattle, WA

2
MI is a fancy way of selling people on their need
to change behavior.

1. True
2. False

3
Motivational Interviewing
Motivational Interviewing is a collaborative
conversation style for strengthening a persons
own motivation and commitment to change. Miller
Rollnick, 2012
4
Motivational InterviewingTheoretical Foundation

• Client-centered approach Rogers
• Empathic Reflections
• Self-Perception Theory Bem
• We come to know what we believe by listening to
  ourselves talk.
• Self-Efficacy Bandura
• Power to Change
• Focus on Intrinsic Motivation Brehm
• External pressure can lead to resistance to
  change
• Respect for client/patient autonomy Medical
  Ethics
• Transtheoretical Model Stages of Change
  Prochaska DiClemente

5
STAGES OF CHANGEPROCHASKA DiCLEMENTE
TERMINATION
MAINTENANCE
ACTION
PREPARATION
CONTEMPLATION
PRECONTEMPLATION
RELAPSE is viewed as a loss of motivation and
movement back down the spiral of change.
6
Spirit of MI

• Partnership
• Acceptance
• Compassion
• Evocation

7
The Spirit of Motivational Interviewing (MI)

• Therapeutic relationship is a collaborative
  partnership, rather than separate expert
  recipient roles. Motivation for change is
  elicited from the client, not imposed.
• It is the clients task, not the counselors, to
  articulate and resolve his or her ambivalence.
  The counseling style is an eliciting one.
• Direct persuasion is infrequently effective in
  resolving ambivalence. Instead, the counselor
  supports a clients autonomy while helping to
  explore the prospect of change.

8
Process Structure

• Engagement
• OARS
• Focusing Strategic Direction
• Evoking Motivation Change Talk
• Planning

9
FOUR PROCESSES OF MI
10
Four Principles ofMotivational Interviewing

• R Resist the righting reflex
• U Understand clients motivation
• L Listen to the client
• E Empower the client

11
Four Elements of Motivational Interviewing

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

12
Supporting Self-Efficacy

• Encourages hope or the possibility of change.
• Our expectations about the likelihood of client
  change has a powerful effect on the outcome.
• We want to enhance our clients confidence in
  their capacity to change. The client is
  responsible for choosing and carrying out change.

13
Four Goals ofMotivational Interviewing

• Increase problem awareness
• Resolve ambivalence
• Increase the value of change
• Increase confidence

14
O.A.R.S.Tools for Moving in the MI Session

• Open-ended questions
• Affirmations
• Reflective listening
• Summaries

Motivational Interviewing is not a series of
techniques for doing therapy but instead is a way
of being with patients. William Miller, Ph.D.
15
MI TRAPS

• Question Answer or Assessment
• Premature Focus
• Labeling
• Chat Trap
• Blaming
• Expert

16
CHANGE TALK ANDSUSTAIN TALK
17
EXAMPLES OF SUSTAIN TALK

• Desire for status quo (dont want to change)
• Inability to change (cant change)
• Reasons for sustaining the status quo
• Need for the status quo (have to stay)
• Commitment to status quo (not going to change)
  

18
Change Statements

• Problem recognition
• Statements of concern
• Problems with the status quo
• Desire to change
• Optimism
• Ability to change
• Benefits of change

19
Preparatory Change Talk

• DARN
• Desire
• Ability
• Reasons
• Need

20
Mobilizing Change Talk

• CAT
• Commitment
• Activation
• Taking steps

21
CHANGE TALK

• Recognize
• Evoke
• Respond

CAT
22
CHANGE TALK

• Desire
• Ability
• Reasons
• Need
• (preparatory)

Activation Taking Steps (mobilizing)
Behavior Change
Commitment
Amrhein, P. C., Miller, W. R., Yahne, C. E.,
Palmer, M., Fulcher, L. Client commitment
language during motivational interviewing
predicts drug use outcomes. Journal of Consulting
and Clinical Psychology.Vol 71(5) Oct 2003,
862-878.
23
Readiness to Change
From Chris Dunn Stephen Rollnick, Lifestyle
Change.
24
Exploring Importance

• Assess On a scale of 1-10, how important is it
  to you now to(change)?
• Explore Why did you give it a ___ and not a
  ___ (lower number)?
• What would have to happen to raise that
  score?
• How can I help you with that?

25
Exploring Confidence

• Assess On a scale of 1-10, how confident are
  you now that could make that change, if you
  decided to make it?
• Explore Why did you give it a ___ and not a
  ___ (lower number)?
• What would have to happen to raise your
  confidence?
• How can I help you with that?

26
Principles
Mind-Set
DD - Developing Discrepancies EE - Expressing
Empathy SS - Supporting Self Efficacy RR -
Rolling with Resistance
Partnership Autonomy Compassion Evocation MI
Spirit
Heart-Set
Being
Doing
Working
Going
O-OEQ Affirmations Reflections Summaries E-P-E
Elicit-Provide-Elicit
Engaging Focus Evoking Planning
Skills
Path
MI Package
27
Resources Books

• Motivational Interviewing (3rd Ed.), Miller, W.R.
  Rollnick, S., Guilford Press, 2013.
• Motivational Interviewing in Health Care,
  Rollnick, S, Miller, W.R., Butler, C. C.,
  Guilford Press, 2008.
• Lifestyle Change, Dunn, C. Rollnick, S., Mosby,
  2003.
• Building Motivational Interviewing Skills
  Rosengren, David , Guilford, 2009.

28
BOOKS FOR LEARNING MOTIVATIONAL INTERVIEWING
28
29
Resources Websites

• www.motivationalinterview.org excellent source
  of MI resource material.
• www.msleaders.org/ms-leaders/ce/motivational.asp
  Overview video demonstrations of brief
  interventions contrasting MI consistent
  inconsistent styles. Requires broadband
  connection.