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SUPERVISOR TRAINING Motivational Interviewing Presented By: Jeanie McCarville Kerber MSW, MPA, LISW, CADC

JEANIE MCCARVILLE KERBER MSW, MPA, LISW, CADC I have been in the human service field for 20

years. I have worked with both adolescents and adults in the residential, outpatient, school, and medical setting, as well as substance abuse Tx. I currently work at DMACC as Associate Professor in Human Services. I have provided Motivational Interviewing Training for Substance Abuse Providers, Corrections, Dept Public Health, DHS and Mental Health Professionals.

Thank You for inviting me to be with you today!

GOALS FOR TODAY

Stages of Change Define Motivational Interviewing Spirit of MI Guiding Principles Communication Styles Noticing Change Talk Providing Supervision of MI

BE CLEAR…..ARE YOU PROVIDING Supervision Case Consultation

What you do may look and be different!

STOP IT!

UNDERSTANDING CHANGE Jim Prochaska and Carlos DeClemente Stages of Change

STAGES OF CHANGE

Behavior

Precontemplation

Contemplation

Preparation Action

Maintenence

PRECONTEMPLATION Not thinking of quitting Feel that things are fine Do NOT see a problem

CONTEMPLATION Thinking of quitting Wondering how I affect others Maybe trying small changes

PREPARATION Have a plan to quit May Have “cut down” or “doing less of it” Can see benefits of stopping the behavior

ACTION Have quit behavior Avoiding triggers Asking others for support

MAINTENANCE No use of the behavior in a long time Accepting myself Helping others who are still using or displaying

the behavior (mentor, etc.)

WHAT IS MOTIVATIONAL INTERVIEWING? Motivational Interviewing is a Client centered,

directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

HOW DOES IT WORK? MI works be activating patients’(client, employee,

self) own motivation for change and adherence to treatment. (pge. 5)

MYTHS ABOUT EMPLOYEES When an employee/client seems unmotivated to

change or to take the sound advice of the practitioner/supervisor, it is often assumed that there is something the matter with the employee/client and that there is not much one can do about it.

No person is completely unmotivated. Resistance is actually a sign for the

practitioner/supervisor to try something different.

Pge 5/supervisor

WHY MI? MI works by activating client/employees’ OWN

motivation for change and adherence to treatment/direction.

Reduces resistance

AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL ! AMBIVALANCE IS NORMAL !

THERE IS SOMETHING ABOUT THE WAY WE INTERACT… What is our mind set/biases? What assumptions have we already made? SPIRIT of Motivational Interviewing

ATTENTION VIDEO

SUPERVISING EXPERIENCES Think about a supervisor or leader in an agency

you worked who was instrumental in your life… What did they do? What characteristics did they have?

THE SPIRIT OF MI Collaboration- Involves a partnership and

honors the persons’ expertise and perspectives. The counselor/supervisor provides an atmosphere that is conducive rather than coercive to change.

EVOCATION The resources and motivation for change are

presumed to reside within the person. Intrinsic motivation for change is enhanced by drawing on the person’s own perceptions, goals, and values.

AUTONOMY The supervisor/counselor affirms the person’s

right and capacity for self-direction and facilitates informed choice.

MI – 3: PACE Partnership Acceptance Compassion Evocation

PRINCIPLES OF MI Express Empathy Develop Discrepancy Roll with Resistance Support Self- Efficacy

EXPRESS EMPATHY Acceptance facilitates change. Skillful reflective listening is fundamental. Ambivalence is normal.

DEVELOP DISCREPANCY The clients rather than the counselor should

present the arguments for change. Change is motivated by a perceived discrepancy

between present behavior and important personal goals or values.

ROLL WITH RESISTANCE Avoid arguing for change. Resistance is not directly opposed. New perspectives are invited but not imposed. The client is a primary resource for finding

answers and solutions. Resistance is a signal to respond differently.

SUPPORT SELF EFFICACY A person’s belief in the possibility of change is an

important motivator. The client, not the counselor, is responsible for

choosing and carrying out change. The counselor’s own belief in the person’s ability

to change becomes a self-fulfilling prophecy.

OARS Open Ended Questions Affirmations Reflections Summary

FOUR GUIDING PRINCIPLES RULE

R: RESIST THE RIGHTING REFLEX

We entered this field to make a difference and to help others.

Therefore, we try to convince, threaten, repeat ourselves, and sometimes even beg…but,

It is a natural tendency for someone to resist persuasion.

U: UNDERSTAND YOUR EMPLOYEES MOTIVATIONS

What are your employees motivations to change….I mean really change?

What suggestions do they have on how to make changes?

L: LISTEN TO YOUR EMPLOYEE Listen with Empathic interest in making sure

you truly understand. There is much more to listening than just waiting

long enough for person to finish their response to your question.

E: EMPOWER YOUR EMPLOYEE Helping employees explore how they can make a

difference in their own work life. People who come up with their own solutions are

more likely to follow through.

FROM THE 17TH CENTURY TO THE 21ST CENTURY “People are generally better persuaded by the

reasons which they have themselves discovered than by those which have come in to the mind of others.”

Blaise Pascal- 17th century French Polymath wrote in his Pensees.

COMMUNICATION STYLES

Guide

Follow Direct

FOLLOWING Listening predominates. You follow the person’s

lead. You are communicating “I won’t change you or push you.”

Synonyms for “following”: Go along with, Allow, Understand, Permit

DIRECTING Supervisor takes Charge, at least for the

moment. It implies an uneven relationship with regard to knowledge, expertise, authority or power.

Synonyms for “directing”: Lead, rule, determine, tell, prescribe, authorize

*GUIDING A guide or tutor, who is a resource to help

someone with self directed learning. You are communicating, ”I can help you to solve this for yourself.”

Synonyms for “guide”: enlighten, encourage, support, motivate, look after, elicit

WHICH STYLE DO YOU USE MOST? Following? Directing? Guiding? Mix and Match: We use all three styles

everyday in our life depending on the circumstance. A “mismatch” can cause problems.

ASKING: This is how you gather information.

Closed Open

You get information from both However, Open questions often elicit more useful

information than closed. Open questions set up better situation for a

relationship. Question answer trap

USEFUL OPEN QUESTIONS “What’s worrying you most today about your

work?” “What concerns you most about these results?” “ What exactly happens when you get that

reaction/response?” “Tell me more about…”

CHANGE TALK Self Motivating Speech. Employee begins to

explore or discuss what they “want”, “can”or ”will” do in order to change the identified behavior.

STATEMENTS OF PREFERENCE FOR CHANGE.

“I want to…” “I would like to…” “I wish…”

ABILITY: STATEMENTS ABOUT CAPABILITY.

“I could…” “I can…” “I might be able to…”

REASONS: SPECIFIC ARGUMENTS FOR CHANGE.

“I would probably feel better if…” “I need to have more energy to play with my

kids.”

NEED: STATEMENTS ABOUT FEELING OBLIGATED TO CHANGE. “I ought to…” “I have to…” “I really should…”

COMMITMENT: STATEMENTS ABOUT THE LIKELIHOOD OF CHANGE.

“I am going to…” “I will…” “I intend to…”

TAKING STEPS: STATEMENTS ABOUT ACTION TAKEN.

“I actually went out and …” “This week I started…”

LISTENING Open the Door to communication

Attend to the employee more than the paper Silence can be a good teacher. If you are silent you

have a better chance of listening.

REFLECTING You want to reflect what you heard the employee

tell you Example: Practitioner: Tell me about your work habits Employee: Well I get in the office in the morning with a

schedule and list of things to get done, and then crisis comes and I am on the phone trying to fix it and then I am way off schedule within an hour and I don’t get anything done.

Supervisor: You have a plan each day but other things get in the way of you following it.

Patient: Sometimes. If I don’t immediately listen to my voice mails I can get a little more done.

Practitioner: Answering your phone a little bit later in the morning helps you complete some of your tasks.

INFORMING Most commonly used tool in health

care/supervising communication.

Things can and do go wrong with the informing process. You may give what seems to be perfectly clear instructions, yet the employee doesn’t do it. (pge. 87)

SOME IDEAS TO HAVE YOUR INFORMATION HEARD Slow Down and progress can be quicker Pay attention to the person, what are their needs Consider the Broader priorities Provide positive messages: good news and not so

good news Consider the amount of information you are

giving Deliver information with Care

(compassion/empathy)

INFORMING WITHIN MI Ask Permission Offer Choices Talk about What Others Do

DIRECTING WITH CARE In the busy world of many things to get done,

little time and people who are struggling. Simply, follow the Spirit of Directing them with

Care.

WHAT NEXT?....HOW DO I SUPPORT MI IN THE OFFICE? Model- Model- Model Lunch and Learns Offer readings Practice

QUESTIONS?

CONTACT INFORMATION: Jeanie McCarville Kerber jamccarville1@dmacc.edu 515-783-2779

REFERENCES

Rollnick. S, Miller W., Butler, C. Motivational

Interviewing in Health Care; Helping Patients Change Behavior (2008)

Velasquez, Maurer, Crouch, DiClemente , 2001.