Applying Motivational Interviewing to Job Corps Students and

Applying Motivational Interviewing to Job Corps Students and

Applying Motivational Interviewing to Job Corps Students and in GROUPS Presenter: Ian Schere, PhD, MINT www.IanSchere.com Objectives

To learn the fundamental spirit and principles that governs the practice of MI. To conceptualize motivation and resistance from a motivational interviewing perspective. To review the format of MI group interventions to address substance abuse and co-occuring disorders What is Motivation?

Probability of behavior change or movement toward or against a goal. Can be Internal, External, or Both Traditional Assumptions of Motivation and Change Only the client has control over motivation Person must hit Rock Bottom No motivation = No treatment

(Ping-Pong for individuals with COD) Change is linear and static (on-off switch) Double Standard of Efficacy What is Motivation? What ROLE do we play? In impacting our clients MOTIVATION towards their desired goals?

(If any.) Taste of MI Four opened ended questions Why would you want to make this change? How might you go about it, in order to succeed? What are the three best reasons to do it? On a scale from 0-10, how important would you say it is for you to make this change? Follow up: And why are you a ____ and not a zero

So what do you think youll do? and just listen Taste of (non) MI Directive style Explain why the person should make the change Give at least three specific benefits that

would result from making the change Tell the person how they could make the change Emphasize how important it is to make the change Persuade the person to do it If you meet resistance, repeat the above (this is NOT motivational interviewing) The Righting Reflex Sometimes our interns efforts to

HELP their clients HINDERS them instead. Actions requires preparation Resist the Righting Reflex Normal Human Reactions to the Righting Reflex (Teach/Direct) Invalidated Not respected Not understood

Not heard Angry Ashamed Uncomfortable Unable to change Resist Arguing Discounting Defensive

Oppositional Denying Delaying Justifying Withdraw Disengaged Disliking Inattentive Passive Avoid/leave

Not return Normal Human Responses to a Listen/Evoke/Empathic Style Affirmed Understood Accepted Respected Heard Comfortable/safe

Empowered Hopeful/Able to change Accept Open Undefensive Interested Cooperative Listening

Approach Talk more Liking Engaged Activated Come back Righting Reflex Which students would prefer to work with? Theyre the same students!

What is Motivational Interviewing? A person-centered directive method for enhancing internal motivation for change by exploring and resolving ambivalence. (Miller & Rollnick, 1991; 2002)

Effectiveness of MI Addictions Medication Adherence Diet & Exercise Co-Occurring Disorders Various Self-Management challenges Various age groups, demographics, cultures

Basic Skills for MI How do we begin? Rowboat metaphor Using our OARS created by Ian Schere Ph.D.

OARS Basic Skills for resisting the righting reflex and expressing empathy and understanding of our clients. Using our OARS Open-ended questions Affirmations Reflections Summaries

Our clients feel understoodWhats next? Developing discrepancy Elicit change talk Developing Discrepancy Understanding Motivation Do people fail to make important changes in their lives because the lack motivation, or have too much? (role of values)

What is Ambivalence? The existence of mutually opposing emotions or thoughts about a person, object, or idea. (or simply) Feeling two ways about something. All of our VALUES dont AGREE Develop Discrepancy How does AMBIVALENCE

Relate to MOTIVATION? Develop Discrepancy Positives things about keeping things the way they are Positives things about making the change

problem Negative things about keeping things the way they are Negative things about making the change Develop Discrepancy Introduce and/or empathize with

ambivalence. Discuss pros and cons. Stay with the ambivalence (double sided reflections). This allows the person to free up his/her own internal resources. Whats next? Our clients feel connected to both their reasons for wanting change, and the obstacles.whats next?

Roll with resistance Elicit change talk Tip the scale Resistance Conventional View MI View Person is not motivated.

A signal that the provider is being perceived as not getting it. What do you like or find rewarding about working with the students at Job Corps?

What is motivational interviewing? Motivational interviewing is a collaborative, goal-oriented method of communication with particular attention to the language of change. It is designed to strengthen an individuals motivation for and movement toward a specific goal by eliciting and exploring the persons own

arguments for change. What is motivational interviewing? People tend to believe the things they say! How would the conversation differ if I asked what you dislike or find tedious or limiting about working with Job Corps students?

Change Talk What is Change Talk? Change Talk vs. Sustain Talk Change Talk Advantages of Change Disadvantages of status quo Intention to change

Optimism about change Sustain Talk Disadvantages of Change Advantages of status quo Intention not to change Pessimism about

change Develop Discrepancy Positives things about keeping things the way they are sustain talk problem Positives things about making the change

change talk Negative things about keeping things the way they are change talk Negative things about making the change sustain talk Change Talk

Research shows that when people express change talk, they are significantly more likely to act on is sooner. Eliciting clients to verbalize reasons and rationales for change, increases internal motivation for that change, which results in change behaviors. Responding to Change

Talk: All EARS E: Elaborating: Asking for elaboration, more detail, in what ways, an example, etc. A: Affirming commenting positively on the persons statement R: Reflecting, continuing the paragraph, etc. S: Summarizing collecting bouquets of change talk

Wheres the Change Talk? See if you can find the Change Talk in these client statements created by Ian Schere Ph.D. Wheres the Change Talk? I really dont want to stop using,

but I know that I should. Ive tried before and its really hard. Would you reflect: 1. You really dont want to stop using 2. You feel like you should and have tried before 3. Its really hard created by Ian Schere Ph.D. Wheres the Change Talk? I know the hard stuff is not good

for me. Usually its just beer and wine coolers. 1. You usually drink beer and wine 2. You know the hard stuff is not good for you 3. Its hard for you to stay away from drinking created by Ian Schere Ph.D. Wheres the Change Talk? Sharing needles every once in a while

is no big deal. Everybody does it. 1. Youre not the only person who shares needles 2. Its pretty common to share needles these days 3. Sounds like you try to limit the amount of times you share needles, just every once in a while created by Ian Schere Ph.D. Wheres the Change Talk?

Theres so much drama here at Job Corps! I cant wait to finish my trade and get out of here! 1. The drama here on center is really bothering you. 2. You want to get out of here. 3. Its important for you to complete your trade and move on to the next chapter of your life. created by Ian Schere Ph.D.

Change Talk The more frequently they talk about it? Good The more definitively they talk about it? Better The more EMPATHIC and UNDERSTOOD they perceive the person they are talking about it to? Best MI Spirit The Spirit of MI

Collaboration (vs. Confrontation) Evocation (drawing out, rather than imposing ideas) Autonomy (vs. Authority) Compassion (vs. Self-interest) created by Ian Schere Ph.D. Motivational Interviewing in GROUPS Maintaining the MI spirit

Work collaboratively Remember that individuals are the REAL experts of themselves All the wisdom is in the room! Group focus on empathizing and understanding each others struggle rather than fixing or solving each others problems Motivational Interviewing in GROUPS

Group can be arranged on either shared change goals Ex. Substance abuse group, chronic care management group, smoking cessation group Or mixed groups where individuals are focusing on unique, personal change goals Motivational Interviewing in

GROUPS Unlike traditional psycho-educational groups where students are learning and practice new skills.. MI groups focus on the students values, opinions, and personal arguments for making desired changes As well as exploring their strengths are resources for accomplishing their goal Motivational Interviewing in

GROUPS Resource: Website www.groupmiforteens.org Free MI training videos Freetalk group MI curriculum Motivational Interviewing in GROUPS FREETALK- developed by Elizabeth J. DAmico Ph.D. 6 session group MI intervention for atrisk youth with a 1st time alcohol or drug

offense. For those interested in utilizing an MI approach, this program fits nicely into the TEAP group requirements for Job Corps. In Summary Remember the RULE R- Resist the Righting Reflex U- Understand you clients motivation

L- Listen to you clients E- Empower your clients Motivational Interviewing Web Site www.motivationalinterview.org

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