rolling with resistance : using a motivational interviewing approach presented by danette...
TRANSCRIPT
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
MotivationWhat this training will do for youStages of Change ModelMajor goals of motivational interviewingHow to address negative behaviorRolling with ResistancePractice
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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.
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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PreparationCommitment to change has been made and
they plan to take action in the near future.
ActionBegin to actively change behaviors and
environmental conditions to overcome problem.
MaintenanceChanges have become a regular part of the
individual’s lifestyle.
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?
Precontemplative Client
“I don’t 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)
Let’s break it down
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Four Main Principles of MI
Express empathyDevelop discrepancyRoll with resistanceSupport 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 listeningOptimal reflective listening
Let’s Practice…
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Affirming the Client
The idea here is to enhance self-efficacySelf-efficacy is our belief in our own ability to
achieve a goal or accomplish a taskStrengthen the relationshipEnhance self-esteem
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Summarizing
A technique to be used throughout the meeting• Strategically repeat a client’s self-motivational
statements
Include reluctance/resistanceReflect 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 exerciseLooking forwardLooking backGoals and values
Change Planning
What changes?Why change?Goals – SMARTSteps to take?First steps – concreteHelpI will know it is working ifPotential obstacles
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Resistance to Change
4 Categories
• Arguing
• Interrupting
• Denying
• Ignoring
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NO NO’s for Dealing with Resistance
Arguing, disagreeing and challenging
Judging, criticizing, blamingWarning of negative
consequencesSeeking to persuade with logicAnalyzingConfronting with authoritySarcasm
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How to Respond to Resistance
Simple reflectionAmplified reflectionDouble-sided reflectionAgreement with a twistShifting focusReframingRolling with resistance
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Simple Reflection
Stating what you here the client sayingIt is sometimes helpful for the client just
to hear their own words
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Amplified Reflection
Reflect with modificationClient: I just don’t think that I have a
problem with gambling.Caregiver: There is no cause for
concern for you.
Client: I don’t 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 client’s ambivalence• Client: I can’t 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 don’t 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
Add a slant or twist to the meaning when you reflect back to the client
Client: I can’t imagine quitting drinking. All of my friends drink!
Caregiver: It sounds like you’ll really miss the social interaction. And at the same time, it might provide an opportunity to expand your social network like you were wanting.
Defuse resistance by shifting focus
Client: I can’t imagine quitting drinking. All of my friends drink!
Caregiver: It’s hard to imagine giving up a lifestyle that you’re accustomed to. I’m wondering, what can you imagine?
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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) Don’t 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) Let’s Practice…
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Summary
The Basics of MI Can be used to address any negative
behavior
