CEO Health Education & Training Institute

Stephen Andrew LCSW, LADC, CCS, CGPDate of Activity: 9-17-17

Name Commercial

Interests

Relevant

Financial

Relationships:

What Was

Received

Relevant

Financial

Relationships:

For What Role

No Relevant

Financial

Relationships

with Any

Commercial

Interests

X

Glossary of TermsCommercial Interest - The ACCME defines a “commercial interest” as any proprietary entity producing health care goods or services, with the exemption of non-profit or government organizations and non-health care related companies.

Financial relationships -Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

Relevant financial relationships - ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME defines “’relevant’ financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.

Conflict of Interest - Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

Motivational Interviewing &12 steps

Stephen R. Andrew, LCSW, LADC, CCS, CGP

Health Education & Training Institute

207-773-3275

heti@gwi.net

www.hetimaine.org

BiographyStephen R. Andrew, LCSW, LADC, CCS, CGP

“story teller”, trainer, therapist, author...

Chief Energizing Officer of Health Education & Training Institute (HETI) and member of MINT (Motivational Interviewing Network of Trainers) since 2003. MIA-STEP trainer for ATTC New England since 2007.. Trained MI internationally in 12 countries.. He has

been a substance abuse counselor in a public school system, and the Executive Director of an adolescent prevention/treatment agency. He is the co-founder of the Men’s Resource Center of

Southern Maine. Stephen maintains a compassion-focused private practice in Portland and facilitates men’s, co-ed and

caregivers groups. He is the co-author of the book:

“Game Plan: A man’s guide to achieving emotional fitness”

with 2 friends, Alan Lyme & David Powell.

Stephen lives with his sweet wife, Hilary, and is the proud father

of twentyyear-old Sebastian, lives in Portland, Maine USA.

Before we start…do, tell, show…

♥ House keeping

♥ Breaks

♥ Cell phones

♥ “Parking Lot” Bike Rack..

Skill

Demonstration

Skill

Practice

Feedback

Concept/Skill description

Guidelines for the Training

Ask lots of questions.. make this relevant to your work..

Be mindful – of each other, “Be kind” ...

Attitudes:

“What the Heck !!” Jump into the experience..

Make Mistakes, “OOPS!”

Confidentiality, make the training your experience. Real play instead of Role play

Please resist the “fixing” impulse…

“Compassionate righting reflex”

7

Working Definition of Motivational Interviewing

Motivational Interviewing is a

collaborative, goal-oriented style of

communication with particular attention to

the language of change. It is designed to

strengthen personal motivation for and

commitment to a specific goal by eliciting and exploring the person’s own reasons for

change within an atmosphere of

acceptance and compassion.

Stephen Rollnick and William R. Miller, Sheffield, UK Oct 20118

The nature of the

conversation is critical in

facilitating the 12 steps

What we say - how we say it–and watch how it lands..

largely determines what the client/patient says and what happens next…

What we say matters!

10

Motivational Interviewing Spirit is the practice of..

• when we say something that nourishes

the soul and uplifts the well-being

before us, when compassion lands on

another, discord (resistance), status

quo/sustain talk can not hold itself with “negative self talk”...

Definition of ListeningPresence, Interest & Curiosity

▪ Focusing all of one’s purpose, attention, and energy on understanding what the person’smessage means to the them..

▪ Focus: What is the person is saying? (simple reflection)

▪ Focus: what does the person MEAN?(complex reflection)

Presence ...LISTEN well...

Undivided Attention

Listen with your “soft” eyes,

warm ears and open heart

Acceptance

“Wicked lot” of Delight

Silence...

Deep Interest in...

Friendly & congruent body language

Optimistic

Heard & Believed

Empathic Reflection .... “YOU ...”

no QUESTIONS... ???

Dash of Curiosity ???

Empowerment...

Choice and Autonomy...

Wisdom lies within..

Imagination..

“TELL ME MORE ABOUT ...?”

Motivational Interviewing: Spirit

Collaboration –come alongside

Evocation – Elicit vs Impart

Autonomy – ability to chose

Compassion- Empathy

More then just..Listening-Guiding

“…you are responsible for the intervention not the outcome”

What motivated you?

Speaker: Who has been a

Change Agent ...

( relative, supervisor, teacher, coach,

counselor, clergy person ect.)

“major positive influence ”What were their characteristics/values?

•What did they do? Worker: OQ...R...R...

Four Foundational Processes

Planning…Expose to 12 steps

Evoking …

Ask.. Offer…Ask…

Focusing ….

Listen for spiritual concepts…

Engaging….

Build a therapeutic alliance …OARS

Engaging

• How comfortable is this person talking with me?• How supportive and helpful am I being?• Do I understand this person’s perspective and concerns?• How comfortable do I feel in this conversation?• Does this feel like a collaborative partnership?

Engaging

Time to practice

Skills/Strategies OARSO: open-ended questions...

A: affirm, notice their strength/courage… listen for values/dreams...

R: reflection, empathic, simple & complex, more reflections than questions...

S: summarize (the transitions & end of the session) OARS

Engaging

Focusing

Focusing• What intentions for change does this person really have?• Do I have different hopes for change for this person?• Are we working together with a common purpose?• Does it feel like we’re moving in the same direction?• Do I have a clear sense of where we’re going?

Do I understand ther understanding their concept spirituality?

• Does this feel more like dancing or wrestling?

POWER & CONTROL

(SOVEREIGNTY)

To love and be loved

BELONGING

Capable

Engaging

Focusing

Evoking

Evoking• What are this person’s own reasons for change?• Is the reluctance more about confidence or importance?• What Change Talk am I hearing?• Am I steering too far or too fast in a particular direction?• Is my Righting Reflex making me the one arguing for change?

Use Accurate Empathic Reflection

• One of the most important skills...

• Respond with concise, clear, assertive

statement--acknowledging the person...

• Choose a strength and/or value if possible.

It is a process of:

Hearing what the speaker said

Making a guess at what s/he meant

State it back to them...

Practice Forming Reflections• Speaker:

“One thing about myself that I'd like to change is…?”

• Listeners: You..

• Empathic complex reflection response is

an assertive, concise, clear statement--

inflection turns down or stays flat at the

end. adding significant meaning …

• Speaker:

– Can elaborate with a few more words, phrases or brief sentences adding concepts of 12 Steps. 30

Complex Empathic Reflections..♥ List discord around the 12 steps

(resistance) and/or sustain talk statements

you hear from your clients, patient,

consumers..

amplify,

double-sided,

continuing paragraph,

affective...

Engaging

Focusing

Evoking

Planning

Planning• What would be a reasonable next step toward conceptsof the 12 steps?• Am I evoking rather than prescribing a plan?• Am I asking permission to give information or adviceabout the 12 steps?• Does this feel like a collaborative partnership?• Am I maintaining a sense of quiet curiosity about what kind of support will work best for this person?

Summarizing: collection of utterances

Special form of reflection.

Use at transitions in conversation.

You choose what to include & emphasize think of slogans….

Include client’s; concern about change,

optimism about change, change talk (dreams) and ambivalence about change.

Lets client know you are deeply listening.

Accentuate “change talk”

Rules of a ‘competent’conversation

• Your most common response to what the person says should be a reflection. (reflect two times for each question you ask).

• When you reflect, use complex reflections more often.(stating that which has not been said – tap into their dreams, they feel understood).

• When you do ask questions, ask open questions. (3 out 4)

• Avoid unsolicited advise, direction, , & feedback.

• Dance...

TRAPS TO AVOIDQuestion-Answer Trap...

Trap of Taking Sides...

Expert Trap (I know, you don’t).

Labeling Trap...

Premature Focus Trap...

Blaming Trap...

“All judgment is a form of

Violence”

Thank you!One thing you liked...

One thing you learned...

One thing you relearned...

One thing you are willing to try...

Motivational Interviewing

Books..

1991, 2002, 2013

Motivational Interviewing

3rd edition

Miller & Rollnick

2008

Motivational Interviewing in

Health Care

Rollnick, Miller & Butler

BibliographyMotivational Interviewing in Healthcare: William R. Miller, Stephen Rollnick,

Christopher C. Butler, The Guilford Press. New York, New York. 2008.

Motivational Interviewing: Helping People Change, Third Edition. William R. Miller, Stephen Rollnick. The Guilford Press. New York, New York. 2012.

The Power of Empathy. Arthur Ciaramicoli, Ph.D., Kathleen Ketcham. Dutton Book Company. New York, New York. 2000.

Motivational Interviewing in Groups: Christopher Wagner, Karen Ingersoll, The Guilford Press. New York, NY. 2013.

Game Plan: A Man’s Guide to Achieving Emotional Fitness. Lyme Allan., Powell, David., Andrew Stephen.,Central Recovery Press, Las Vegas NV. 2012.

Rosengren, David (2009). Building Motivational Interviewing Skills: A Practitioner Workbook, New York, NY: Guilford Press.

Motivationalinterviewing.org Website of Motivational Interviewing Network of Trainers (MINT)

Hetimaine.org Website of Health Education and Training Institute (HETI) HETI is located in beautiful Portland, Maine and is run by Stephen Andrew, an incredibly effective and enjoyable trainer and a sweet, four-person MITI Coding Lab..

Spirit Wind CD/Tapes Series. Stephen R. Andrew LCSW LADC CCS CGP

www.hetimaine.org