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MOTIVATIONAL INTERVIEWING Conference on Poverty September 18 th. Brad Lundahl, PhD University of Utah Compass Counseling & Consulting College of Social Work Licensed Psychologist Brad.Lundahl@socwk.utah.edu www.cccslc.com (801) 635 – 4141. Why M.I.?.

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MOTIVATIONAL INTERVIEWING Conference on Poverty September 18 th


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    1. MOTIVATIONAL INTERVIEWINGConference on PovertySeptember 18th Brad Lundahl, PhD University of Utah Compass Counseling & Consulting College of Social Work Licensed Psychologist Brad.Lundahl@socwk.utah.eduwww.cccslc.com (801) 635 – 4141 Brad Lundahl, PhD 801 581 4570

    2. Why M.I.? • Evidence supports its effectiveness • Effect sizes range from small to moderate range; research suggests about a 10 – 15 % advantage from incorporating M.I. • (see end slides for supporting evidence) • Rather easy to incorporate into practice

    3. Consumers and Behavior Change • What behaviors do you hope your clients will change? • Why do you hope they will change such behaviors?

    4. What are the “ingredients” involved in behavioral change? Brad Lundahl, PhD 801 581 4570

    5. Ingredients to Behavioral Change • True or False? Knowledge = Change Brad Lundahl, PhD 801 581 4570

    6. Ingredients to Behavioral Change • Getting closer to reality Knowledge x Motivation = Change Brad Lundahl, PhD 801 581 4570

    7. Ingredients to Behavioral Change Knowledge x Motivation ____________________ = Change Resistance *Inverse relationship btwn Resistance & Change Brad Lundahl, PhD 801 581 4570

    8. Ingredients to Change Knowledge x Motivation ____________________ = Change Resistance M.I. M.I. Brad Lundahl, PhD 801 581 4570

    9. Many Ingredients to Change Support Change Resist Change Fear, insecurity Ignorance “Stubborn” Denial of problem Comfort with status quo Lack of resources Low motivation Etc • Knowledge • Skill • Confidence • Motivation • Vision, plan • Resources • Ownership • Etc Brad Lundahl, PhD 801 581 4570

    10. Essence of M.I. WHY before HOW M.I. Strategies and plans Brad Lundahl, PhD 801 581 4570

    11. Two desired outcomes from conversations about change • Clients’ become more motivated to change • Clients’ resistance is prevented, neutralized, or at least not increased

    12. Increasing Client Motivation

    13. Nature of Motivation • Motivation varies across • People • Situation • Time • Because motivation is dynamic, we can influence it even though clients are ultimately 100% responsible for their own change Brad Lundahl, PhD 801 581 4570

    14. Change Talk What it is: Client speech that favors making a change … Forward momentum language. How it works: Promotes internalization of belief When I hear myself talk, I realize I am the author of the message and believe it (D. Bem) Brad Lundahl, PhD 801 581 4570

    15. 3 Things We Do with Change Talk Recognize it - See it Evoke it - Mine it Reinforce it - Get greedy Brad Lundahl, PhD 801 581 4570

    16. Example: Client Statement Client says: Money is tight. I know I should save a little, but there are always things that come up. You say: Brad Lundahl, PhD 801 581 4570

    17. Example: Client Statement Client says: Money is tight. I know I should save a little, but there are always things that come up. You say: Brad Lundahl, PhD 801 581 4570

    18. Change Talk and Sustain Talk • The green language suggests that client is thinking about making a change … something that is desirable from a financial planning perspective • The red language reflects the difficulty of making changes; suggests ambivalence or complexity

    19. Change is complex

    20. Client says I’ve stuck with a budget before, for almost a year. It did help. But then I my rent changed and I had to move and I went through all of my savings. It feels hopeless at times. You say: Brad Lundahl, PhD 801 581 4570

    21. Client says I’ve stuck with a budget before, for almost a year. It did help. But then I my rent changed and I had to move and I went through all of my savings. It feels hopeless at times. You say: Brad Lundahl, PhD 801 581 4570

    22. Change talk: Types DESIRE ABILITY REASON NEED COMMITTED TAKING STEPS PROBLEM RECOGNITION Brad Lundahl, PhD 801 581 4570

    23. DESIRE (emotion promoting change) I’m sick of the stress that comes from debt I want to buy my own place ABILITY (confidence) If I put my mind to it, I can do it I have been assertive before REASON (If-Then) If I can keep to a budget, I’ll feel more peaceful. Brad Lundahl, PhD 801 581 4570

    24. NEED (time imperative) I need to get a job! COMMITTED (declare future action) I will cook meals and not eat out this week TAKING STEPS (past tense verb) I opened a savings account last week PROBLEM RECOGNITION I do not keep a budget; I need to. Brad Lundahl, PhD 801 581 4570

    25. Examples of Change Talk You Hear • Desire • Ability • Reason/Need • Problem-Recognition • Taking Steps • Commitment Brad Lundahl, PhD 801 581 4570

    26. Respond to Change Talk: GET GREEDY Encourage clients to expand on change talk Justify it Provide examples or proof Understand the implications Why? The more clients hear themselves say something, they internalize it – or believe it. Brad Lundahl, PhD 801 581 4570

    27. Practice • With a neighbor, practice evoking change talk • Counselor ask these questions, listen to responses, and follow-up on cha

    28. Strategies for MINING Change Talk: Open-ended, evocative questions Exploring the Decisional Balance Querying Extremes Exploring Goals and Values Brad Lundahl, PhD 801 581 4570

    29. Mining Change Talk:Evocative Open-Ended Questions Advantages of change If you were to change, what would be better? How would your kids benefit if you saved more? What do you hope will be different by changing? Disadvantages of status quo What problems arise from not maintaining a budget? For your, what problems come from eating out? How has ___ behavior affected you and your family?

    30. Mining Change Talk:Evocative Open-Ended Questions Optimism that you can change Tell me about a time you were successful in changing. What are your strengths that can help you change? Intention to change (next step) What is next for you? What plans do you have for making a change? If you were to change, what is the first thing you would do?

    31. Mining Change Talk: Decisional Balance Brad Lundahl, PhD 801 581 4570

    32. Mining Change Talk:Exploring Extremes EXTREMES What was the best thing about …. What was the worst thing about …… Brad Lundahl, PhD 801 581 4570

    33. Mining Change Talk:Highlighting Goals & Values Ask client about their goals, values, and priorities What goals are you working on? What do you want for yourself in 6 months? What matters most to you? What is most important to you? What do you value most in life? What do you value about your family? Brad Lundahl, PhD 801 581 4570

    34. Ingredients to Change Knowledge x Motivation ____________________ = Change Resistance Brad Lundahl, PhD 801 581 4570

    35. Client says I’ve stuck with a budget before, for almost a year. It did help. But then I my rent changed and I had to move and I went through all of my savings. It feels hopeless at times. You say: Brad Lundahl, PhD 801 581 4570

    36. Responding to “Resistance” (sustain talk) • Compassion … • Not having $$ is overwhelming • http://nbcnews.to/14HBvv7 • Avoid getting into a tug of war … • Empathize with the red AND strive to get back to Change Talk

    37. Understanding Resistance • What kinds of resistance do you see? • How does resistance influence the client? • How does resistance influence you? • What does resistance signal? Brad Lundahl, PhD 801 581 4570

    38. Resistance • How to reduce it • STOP - DROP - ROLL • Stop • arguing, defending, explaining, persuading • Drop • Your agenda (temporarily) to UNDERSTAND client’s perspective • Roll • Roll with resistance (Effective responses to be discussed) (Rolls Royce Listening) Brad Lundahl 801.581.4570

    39. Best strategy for lowering resistance??? PREVENT IT!

    40. Prevent resistance through Partnering • Use lots of “we” language • Can we discuss a few ideas about why it is important to change ________ • Let’s review your goals for our meeting today. • Can we partner on some ideas on how to make this plan work for you?

    41. Prevent resistance through Partnering • Treat all patients with deep respect and dignity. • View them as partners • View them as individuals • Cultivate compassion

    42. Prevent resistance through Partnering • Ask lots of permission questions • Can I give you a few ideas? • May I provide an alternative idea? • Can we switch directions or a moment?

    43. Prevent resistance through Partnering • Emphasize personal choice and DO NOT own responsibility for clients’ change • It really is up to you • You get to decide if you are going to change • This is your call • I hope you decide to make this change; what are your intentions?

    44. Prevent resistance through Partnering Develop a Menu to guide consultation How about we discuss our goals for our meeting. I would like to focus on: 1. Your response to the medication … 2. How you did with taking the medication 3. And what is important to you. Which would you like to discuss first? Brad Lundahl, PhD

    45. WHY LAND toHOW LAND Brad Lundahl, PhD

    46. Transition to Change Plan What: Concrete, explicit bid to discuss change plan When: After you have heard and reinforced considerable change talk …. The “WHY” or “IF” question is settled How: Permission Questions Menu of options Brad Lundahl, PhD

    47. Giving Advice If advice giving worked (our moms tried!) we would not need: Legal system: judges, attorneys Fines Most mental health workers’ jobs This training Brad Lundahl 801.581.4570

    48. Advice on Advice Giving More likely to work Welcomed by client or permission obtained Client is ready Client is told that he/she has freedom to choose Advice giver is seen as an ally or partner in change Less likely to work Forced upon client Few options given Client is not ready Brad Lundahl 801.581.4570

    49. When, in MI, do you give information and advice? With permission Brad Lundahl 801.581.4570

    50. Giving Advice: The MI Way ELICIT What do you already know about ______(court system, anger management classes, etc) ? PROVIDE with Permission Can I discuss how you might be successful in making this change? Can I provide you with some information on this issue? ELICIT What do you think about the information I gave you? What questions do you have? Brad Lundahl 801.581.4570