presented by dee-dee stout, ma, cadc-ii ; member of mint; advisor/trainer, icce for lake county...

Presented by Dee-Dee Stout, MA, CADC-II; Member of MINT; Advisor/Trainer,

ICCEFor Lake County Health Services

Lakeport, CA July 2010

Motivational Interviewing - Part 2

Quick Review – MI Part 1Ask-Tell-AskAgenda Setting4 Basic PrinciplesTraps to AvoidOARS, esp. Reflections

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TalkLookDo

Day’s Format

Share with another HOW you know these things are important to you?

(20)

Value Cards Sort

Agenda Setting

Walk Away Skill #2

Agenda SettingAgenda Setting

Write out the topics in which the client is asking for your help

Then ask, in a time frame you set (30 minutes, etc), what 1 or 2 items the client would most like to discuss in that time, or ask which are most important, or say “or is something else more important to talk about right now?”

Note: You may also add 1 thing that you need to discuss but talk about that last & only after you ask permission


Read examples or do live?

Demonstration

Reflection Exercise

The Penny Game

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Building a Rapport BankIn dyads: 1 Speaker and 1 Listener

Speaker begins by talking about something real though not too tender.

Each time the Listener reflects appropriately, the Speaker moves 1 penny or more from their pile to the Listener’s “bank.” How many is up to the Speaker.

The goal is to get as many of the Speaker’s pennies in front of you.

Return to debrief in big group

Good, Better, Bull’s Eye!

Scenarios

Good, Better, Bull’s Eye!In your group, find the scenario on the table and

read aloudUsing the scenario as a guide, decide what simple

reflection you might use with this client that simply shows you’re listening (good)

Think about possible responses to this reflection and consider more “back-story” to form the next reflection, perhaps one more complex (better)

Finally, decide on the most complex reflection you all think accurately shows what you’ve heard in both content & emotion from the client so far, & what you’re NOT hearing this client say with words

What have we discussed so far?

Summary

Change Talk, Commitment Language,

and More

MI - Phase 2: Strengthening the Commitment for Change


Review: Recognizing Readiness

AcceptanceLess resistanceLess problem-talkChange Talk

Questions about change

EnvisioningExperimenting/

taking steps


DARN-CAT: The New LanguageDesire (I want to change)Ability (I can change)Reasons (It’s important to change)Need (I should change)=Commitment (intention, decision,

readiness)Activation (ready, prepared, willing)Taking Steps (action)

Pulling for Change Talk

Walk Away Skill #4

Getting to Change Talk - 1 Ask evocative questions Ask clients to elaborate Use Rollnick’s Rulers Explore the Decisional Balance

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Getting to Change Talk - 2 Query the extremes Look back Look forward Explore clients’ goals & values


Desire – Preference for changeI want to…I would like to…I wish I could …


Ability - ConfidenceI could…I can…I might be able to …


Reasons – Specific arguments for changeI would probably feel better if I …I need to have more energy to play with my

kids.


Need – Feeling obligated to changeI ought to…I have to …I really should …


Commitment – Likeliness of changeI am going to…I will…I intend to …


How can we hear the difference? And what does it matter anyway?

Change Talk v Commitment Language

Commitment Language Demo5 Volunteers:

I want to…I could…I need to…I ought to because I have good reason…I do or I will…

OathsWhat do you think?

Which would you want to hear?


ActivationI’m ready to take this on!I’m prepared to make this change this timeI’m willing to do anything I need to in order

to make this work


Taking Steps – Action taken!You might be surprised to hear this but I

actually went out and …This week I started …That meeting was pretty good last night


Another way to Assess & to pull for Change Talk

Walk Away Skill #3: Scaling


Scaling (DARN-C & more)ConcernProblem RecognitionDesire/ImportanceAbility/Confidence/OptimismReasons, Need & /ReadinessCommitment/ Intention to Change

ConcernWhat is there about your behavior that you

or others might see as a reason for concern?

What worries you about your behavior? What do you think could happen if you

continue?How do you feel about your behavior?How much does you behavior concern you?What do you think might happen if you

don’t change your behavior?


Problem RecognitionWhat things make you think that this might be a

problem?What difficulties have you had in relation to your

use (or other behavior)?How have you or others been harmed by this

behavior?How has your behavior been a problem for you?How has your behavior kept you from your

goals?How has your behavior stopped you from doing

what you want to do?


Exploring ImportanceWhat would have to happen for this to

become much more important for you to change?

What would have to happen before you seriously considered changing?

Why have you given yourself such a high score on importance?

What would need to happen for your score to move up from (-) to (-)?

Based on “Health Behavior Change”

by Rollnick, Mason, & Butler, 1999; Churchill Livingstone.


Enhancing Confidence - 1Traps

It’s OK, I’ll take care of things! (plumber)There, there you’ll be fine (patronize)You’re right; things are horrible (pessimist)

Enhance confidence before you give advice


Enhancing Confidence -2Getting & Strengthening Confidence Talk

Ask open questions; use complex reflectionsThe Confidence RulerLook at past successesTalk up clients’ strengths & supportBrainstorm!Give info & advice (w/permission only)Reframe


Enhancing Confidence -3Getting & Strengthening Confidence Talk

Radical change?Hypothetical change

Suppose you were going to ___. How might you do that?

Who do you know who’s made this change? How did they do it?

- The Miracle Question



ConfidenceIf you decided to change right now, how

confident are you that you could be successful?On a scale of 1 to 10, with 1 being “no way”

and 10 being “absolutely no problem”, how confident are you that you could be successful in making this change?

What would it take for you to move to a 4? How would you know if you were at a 7? What indicators would tell you your confidence was down to a 2?

Which of these behaviors are you most confident that you could change if you wanted to?

Exploring ConfidenceWhat have you learned from the way things

turned out the last time you tried to make this change?

If you were to decide to change, what might your options be? Are there any ways you know of that have worked for other people?

What are some of the practical things you would need to do to achieve this goal? Do any of them sound achievable?

What can you think of that would help you feel more confident?


Exploring ConfidenceWhat would make you more confident

about making these changes?Why have you given yourself such a high

score on confidence?How would you move up higher so that

your score goes from – to -?How can I help you succeed?What did you find helpful in any previous

attempts to change?


OptimismWhat encourages you to see that you are

ready to make a change? What helps you to see that you could make a change if you wanted to?

What do you think would work for you if you decide to make a change?



Before Giving Advice…Elicit the client’s own ideas & knowledgeConsider the importance of what you will

offer (remember the DARN-CAT Bouquet!)Obtain the client’s permissionHave several options (the Menu)

Intention to Change - 1How come you think you need to change?

Why now?If things were to work out as you want,

what would that look like?What would be different if you were to

change?What makes you think you should not

change your behavior?


Intention to Change - 2What are you thinking about your behavior

at this point?What would be the advantages to making a

change? Or not?I can see that you’re feeling stuck right

now. What will have to change to get “unstuck?”

What would have to happen for you to be ready to make a change? What would that look like?



Recap: Possible Key QuestionsWhat do you think you will do?What does this mean about your ___?It must be uncomfortable for you now,

seeing all this. What’s the next step?What do you think has to change?What could you do? What are your options?How would you like things to turn out for

you now, ideally?What concerns you about changing your

use of ____?


Recap: Possible Key QuestionsIt sounds like things can’t stay the way

they are now. What are you going to do?

Of all the things we’ve discussed here, which do you think are the most important reasons to make a change? How are you going to do it?

What’s going to happen now?Where do we go from here?


Negotiating a Change PlanSetting goals

How would you like for things to be different?What do you want to change?If you were completely successful in

accomplishing your goal, what would be different?

Let’s take things one step at a time. So, what do you think is the first step?


Step 2: Considering the OptionsOffer a menu of options

Try “warm turkey” approachNegotiate a period of trial abstinence: “sobriety

sampling”Gradually taper off to abstinencePeriod of trial moderation

Offering advice on what type of treatment typically works for whom

The client (& you) may not choose the right treatment approach the first time


Step 2: Considering Change Options“The truth is that there is no one approach that

is best for everyone. What works for some is unacceptable or ineffective for others. What’s encouraging is that there are quite a few different ways that have been shown to be promising. The question now is which ones would be best for you. We can talk about the options if you want, and I would certainly try to help you find the right approach the first time. But if you try one way and it doesn’t seem to be working, don’t get discouraged. It might only mean that it isn’t the right approach for you. Would you like to hear about some of the possibilities?”


Step 2: Considering Change OptionsClearly discuss each optionInclude what the client can expect from

each option and the likely outcomesAnswer any questions clients may have

regarding each optionAsk the client what outcome they might

expect from each option or what they may expect if they decide to do nothing (which is another option.)


Step 3: Arriving at a PlanArriving at a plan

Evaluate alternative courses of actionStay with the client! Summarize the plan based on the client’s goals,

needs, intentions, and beliefsSo, how do we know if this plan could work? Try

asking: How would your life be different if you followed this idea

and quit altogether? You have said that you would like to cut down, so let’s

talk about that for a while. How do you think this would work?

OK, so that’s your goal. Great! I wonder what obstacles you think might keep you from being successful?

What else do you think might go wrong with this plan?


Step 4: Eliciting Commitment - EndgameMake it public!Arrive at a clear planObtain the client’s verbal decision to follow

the planReinforce the client’s decisionInitiate immediate steps for implementing

the plan

“Maria”(15)

Using MI: The Change Plan Interview

This will bring it all together for us – LIVE!

5-Chair Exercise

LETTING GO“If you let go a little you’ll have a little peace; if you let go a lot you’ll have a lot of peace; and if

you let go completely, you’ll have complete peace.”

---Author Unknown

“The ideal change plan is one to which you as consultants have contributed

nothing.”

---Allan Zuckoff, PhD; MINT member

---Bill Miller, 2000

“MI is a way of being with people and that way must be of love. It is love and profound

respect that are the music in motivational interviewing, without which the words are

empty.”

Thanks to all of you, John D. & The Crew!!

Dee-Dee Stoutwww.responsiblerecovery.org

[email protected] or

[email protected]

DONE – WOOHOO!

presented by dee-dee stout, ma, cadc-ii ; member of mint; advisor/trainer, icce for lake county...

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