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Motivational Interviewing with Latino Populations. Presenter : James (Diego) Rogers, PsyD, CPRP VP of Clinical Services Community Research Foundation San Diego, CA MINT Member 2004. What is Motivational Interviewing?.

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Motivational Interviewing with Latino Populations

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Motivational Interviewingwith Latino Populations

Presenter:

James (Diego) Rogers, PsyD, CPRP

VP of Clinical Services

Community Research Foundation

San Diego, CA

MINT Member 2004


What is Motivational Interviewing?

  • A person-centered directive method for enhancing internal motivation for change by exploring and resolving ambivalence.

    (Miller & Rollnick, 1991; 2002)


What is Motivational Interviewing?

  • A way of being with a person, not just a set of techniques for doing counseling.

    (Miller & Rollnick, 1991; 2002)


Broader than Behavior Change

  • Decision- to make a choice

    • Forgiveness, leaving or staying

  • Attitude- to become a different person

    • To be more compassionate, assertive etc.

  • Resolution- acceptance

    • Complicated grief

    • Finding peace regarding a decision

    • Tolerance for anxiety, uncertainty etc.


MI Spirit

  • Autonomy (Person-centered)

  • Collaboration

  • Compassion

  • Evocation (Guiding/eliciting style)


Normal Human Reactions to the Righting Reflex (Teach/Direct)

InvalidatedResistWithdraw

Not respectedArguingDisengaged

Not understoodDiscountingDisliking

Not heardDefensiveInattentive

AngryOppositionalPassive

AshamedDenyingAvoid/leave

UncomfortableDelayingNot return

Unable to changeJustifying


Normal Human Responses to a Listen/Evoke/Empathic Style

AffirmedAcceptApproach

UnderstoodOpenTalk more

AcceptedUndefensiveLiking

RespectedInterestedEngaged

HeardCooperativeActivated

Comfortable/safeListeningCome back

Empowered

Hopeful/Able to change


“Change Talk”

The goal of MI is for the provider to guide the client to discuss/argue for his/her own reasons for change in a compassionate way that respects the client’s autonomy.


4 Principles of MI(2nd Edition)

  • Express Empathy

  • Develop Discrepancy

  • Roll with Resistance

  • Support Self-efficacy/Elicit Change Talk

    (Miller & Rollnick, 1991; 2002)


Express Empathy(Use your OARS)

  • Open-ended questions

  • Affirmations

  • Reflections

  • Summaries


Develop Discrepancy

  • Empathize with the ambivalence

  • Explore gains/losses of all options

  • Imagine extreme outcomes

  • Look forward & backward

  • Amplify ambivalence with reflections & affirmations

  • Values sorting


What is Resistance?

  • Therapy Interfering Behaviors

  • Interpersonal (It takes two to resist)

  • A signal of dissonance (empathic failure)

  • Predictive of (non)change


What is Sustain Talk?

  • Desire for status quo

  • Inability to change

  • Reasons for sustaining status quo

  • Need for status quo

  • Commitment to status quo


Sustain Talk and Resistance

  • Sustain Talkis about the target behavior

    • I really don’t want to stop smoking

    • I have to have my pills to make it through the day

  • Resistanceis about your relationship

    • You can’t make me quit

    • You don’t understand how hard it is for me

  • Both are highly responsive to counselor style


How to Roll w/ Resistance(Sustain Talk)

  • Simple/Double-sided Reflections

  • Shifting Focus

  • Agreement with a Twist

  • Emphasizing Personal Choice

  • Reframing


Change Talk & Sustain Talk

Opposite sides of the same coin


Preparatory Change Talk

  • DESIRE to change (want, like, wish . . )

  • ABILITY to change (can, could . . )

  • REASONS to change (if . . then)

  • NEED to change (need, have to, got to . .)


Mobilizing Change TalkReflects resolution of ambivalence

  • COMMITMENT (intention, decision, promise)

  • ACTIVATION (willing, ready, preparing)

  • TAKING STEPS


Responding to Change Talk(All EARS)

  • Elaboration- Asking for elaboration, more detail, in what ways, an example, etc.

  • Affirming- commenting positively on the person’s statement

  • Reflecting- continuing the paragraph, etc.

  • Summarizing- collecting bouquets of change talk


Culturally Competent Adaptations

  • Balancing act between maintaining fidelity to an evidence-based practice…

  • While adapting and tailoring the practice to increase engagement, receptivity, efficacy, and value to the recipent(s) (Cultural Responsiveness).

    • Linguistic Translations

    • Incorporating Social Contexts

    • Incorporating Cultural Values


Linguistic Translations

  • Motivational Interviewing (MI) = La Entrevista Motivacional (EM)

  • MI Spirit = Espíritu de EM

  • OARS = PARS


Incorporating Social Contexts

  • Immigration/migration experiences/status (including political/historical contexts)

  • Contexts of Migration (Falicov, 1998)

  • Receptivity of the host community/dominant culture

  • Language barriers

  • Experiences of Group Antagonism

  • Acculturation process/Level of Acculturation

  • Ethnic Identity

  • Socio-economic Status


Social Context

  • A Cultural Adaptation of MI to Address Heavy Drinking Among Hispanics (Lee, Lopez, Colby, Caetano, Borrelli, & Rohsenow, 2011).

    • Social Context of Immigration (OARS)

    • Changing Family Dynamics (immigration & drinking)

    • Social Support (familismo y amistades/compadres_

    • Alcohol Health Literacy (E-P-E)


Incorporating Latino Cultural Variables

Assess for value adherence (using OARS/PARS):

  • Familismo (family orientation)

  • Personalismo (relationships with people not agencies)

  • Respeto (mutual respect and deference)

  • Confianza (trust and intimacy in the relationship)

  • Controlarse (self-containment or control)

  • Agüantarse/Luchar (ability to withstand stress & difficult times)

  • Poner de su parte (doing one’s part)

  • Religión


Latino Cultural Variables

  • Engaging Latinos Through the Integration of Cultural Values and MI Principles (Añez, Silva, Paris Jr., Bedregal, 2008).

  • Mental Health treatments were four times more effective when culturally modified for a specific group and when attentive to cultural context and values (Griner and Smith, 2006).


General Research Findings on MI and Latinos

  • Still generally limited in number of studies, sample sizes, and populations.

  • Studies that do exist show that adopting the MI Spirit and incorporating social contexts and cultural values yielded favorable results in the therapeutic relationship:

    • Personalismo

    • Respeto

    • Confianza (buena gente, simpatico)


General Research Findings on MI and Latinos

  • Studies also show that incorporating social contexts and cultural values with the MI principles/techniques yielded favorable results (High Engagement & Client Satisfaction):

    • Clients enjoyed talking about their cultural values and striving for change toward those values (OARS).

    • Clients enjoyed talking about the change plan goals and action plans (Agenda Setting and Change Talk).

    • Clients enjoyed have an ability to demonstrate “poniendo de mi parte” (Change Talk)

    • Clients enjoyed having their opinion “respected” even when given advice (E-P-E)


Motivational Interviewing Web Site

www.motivationalinterview.org


Thanks for your

participation!!


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