Motivational Interviewing

1. Motivational Interviewing Presentation by Lorell Thoms – BA, BSW MRC Instructor / Program facilitator

2. Today’s Talk • This session will define motivation, change, and ambivalence in accordance with Motivational Interviewing; provide an overview of the Transtheoretical Model – ‘the Stages of Change’; describe the key principles underlying the MI approach; and conclude examination of MI in corrections will conclude the presentation. I hope you will leave with a with a sense of hope and confidence to help others ‘Tip the scale’ towards change and to address even the most resistant offender.

3. How do you feel about the attending the ACEA conference? Motivational Interviewing (MI) would say that your initial motivation does not predict the outcome and long-term motivation for learning at the conference.

4. What is Motivational Interviewing • Motivational Interviewing, developed by Miller and Rollnick (1991), is a way to help people recognize and do something about their present or potential problems. It is especially useful with people who are either reluctant to change or ambivalent about changing. It is intended to help resolve ambivalence and get a person moving along the path to change. The strategies of MI are persuasive and supportive rather than coercive or argumentative. The goal is to encourage internal change rather than impose external change onto clients.

5. Spirit of MI When the tires begin to slide off the road to the right, there is a natural tendency to turn the steering wheel to the left, because that is where you want to go. Doing so, however, simply decreases control and increases skidding toward the right. Wrong as it feels in the beginning, you must turn in the direction of the skid; turn the wheel to right when the vehicle is skidding to the right. This provides traction that allows you to redirect momentum back onto the road. This ‘righting principle’ is the essence of MI – moving with people to help them find traction for change. The spirit of MI gives autonomy and asks for collaboration. When done effectively, it leaves people with feelings of hope and confidence.

6. Definitions of Motivation • Motivation – state of readiness or eagerness for change. • Motivation is the set of reasons that determines one to engage in a particular behavior. According to various theories, motivation may be rooted in the basic need to minimize physical pain and maximize pleasure.

7. Motivation • Assumptions about the nature of motivation: Motivation is a key to change • Motivation is multidimensional • Motivation is dynamic & fluctuating • Motivation is influenced by social interactions • Motivation can be modified

8. Definitions of Change • Change is to make different; to transform; to continue on one’s journey from one station.

9. Ambivalence • AMBIVALENCE – COEXISTING BUT CONFLICTING FEELINGS ABOUT SOMETHING. • It is an important part of the process of change and resolving ambivalence is the purpose of MI. Ambivalence makes change possible – it is the precursor to positive behavior change.

10. Stages of Change Precontemplation Maintenance

11. Stages of ChangeProchaska and Diclemente, 1994 • PRECONTEMPLATION • CONTEMPLATION • DETERMINATION • ACTION • MAINTENANCE • RELAPSE • People move from being unaware or unwilling to do anything about their situation, to considering the possibility of change, to preparing to make the change, and finally taking action, and then sustaining change over time.

12. Principles of MI • Express empathy • Develop discrepancy • Avoid argumentation • Roll with resistance • Support Self-efficacy

13. Engaging Motivation • Video scenario • MANDY – An addictions counselor talks with Mandy about her struggle to give up smoking. Mandy is keen to give up but has tried unsuccessfully and in the scenario the counselor aims to re-build her self-efficacy after relapse. • 13 minutes in duration

14. MI in Corrections • MI aligns with evidence based practice and enhances intrinsic motivation. Evidence Based – NIAAA MI performed significantly better than other approaches in 3 out of 4 published research studies MI outperformed traditional advice-giving approaches 80% of the time. In 64% of MI single sessions (<15 minutes), effects were long lasting. Good Correctional Interventions address offenders’: RISK NEEDS RESPONSIVITY MI helps address needs and responsivity.

15. MI and corrections • It can help an officer “get back into the game” of behavior change • Offers tools for handling resistance and for stopping difficult situation from worsening. • MI lets offenders do the talking. • Helps prepare for change by leading offender to ask the questions. • MI elicits “change talk”. • Allows officers to enforce rules and deliver sanctions without having to leave a motivational style.

16. Signs of Readiness for Change • Decreased resistance • less arguing & interrupting. • Decreased questions about the problem • Information has been gathered & solution is new focus • Resolve – a resolution is reached • More peaceful, calm or settled. • Self-motivational statements • Statements of concern, openness to change, & optimism. • Increased questions about change • Asking the ‘HOW’ of change • Envisioning • Futuristic talk – talks about advantages of change • Experimenting • Trying new approaches & forms of communication

17. Final remarks . . . • Thank you – if this presentation has got you thinking about motivation and change, please pick-up a copy of Miller and Rollnick’s Motivational Interviewing: Preparing people to Change Addictive Behavior – 1st or 2nd editions. It is a great read. • Enjoy the rest of the conference!