+Motivational Interviewing

An Evidence-Based Tool for Drug Court

Joe Lunievicz, BA, RYTDirector Training Institute, NDRI, Inc.

Executive Director, NDRI-USA, Inc.

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Agenda

• What is it?• Evidence Base• Techniques Used• Practice

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Exercise in Pairs

Write down on paper:•What are three things you value in life?

•What is one five-year goal you have?

Discuss with your partner

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What Motivates your participants to move towards graduation?

What are their goals?

What do they value?

How does present behavior get in the way?

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Participants?

+Motivational InterviewingA directive, client-centered

counseling style for eliciting

behavior change by helping clients

to explore and resolve

ambivalence. It is a style of

helping that uses a set of specific

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+Motivational Interviewing (Cont.)

Motivation- or presumed lack of it- is not viewed as a personality problem or character trait, but as a state of readiness for change that can be influenced by a helping relationship.

Rollnick & Miller, 1995

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+After 30 years of Research … Bill Miller & Steve Rollnick - Stockholm, June 2010 Presentation

200+ randomized clinical trials – Evidence Base

10 multisite clinical trails – Evidence Base

1000+ publications

Dozens of books and videotapes – MI 2 in 2002

Several coding systems for quality assurance

MIA-STEP to support MI supervisors

Research on MI Training

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+Evidence Base with…

100,000 + individuals

Alcohol, crime, drugs, family/relationships, social functioning, trauma/injuries, treatment/recovery

Age 18-25, 26-55, 55+

Male, female

Caucasian, Asian, Black or African American, Hispanic or Latino

Outpatient, school, community settings

Urban, suburban

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Motivational Interviewing

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Motivational Interviewing

Is a brief intervention

Developed to work with “unmotivated drinkers”

Based on work by Rollnick and Miller 1991

Useful for clients who are reluctant to change (ambivalence - contemplators)

Draws on client-centered therapy, cognitive therapy & change therapy

Is non-confrontational

Uses specific strategies/skills

+MI Basic Principles

Expressing Empathy

Developing Discrepancy

Rolling with Resistance

Supporting Self-Efficacy

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MI helps the client…

Enhance intrinsic motivational change

Recognize the need to do something about the potential problem

Resolve ambivalence

Decide to change

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Motivational Interviewing

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The Counselor…

Does not assume an authoritarian position

Avoids conveying the message “I have the answers”

Treats the client as an adult capable of making responsible decisions

Treats the client as the “expert” on his or her own experience

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Motivational Interviewing

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The Counselor Does Not…

Argue with client

Impose a diagnostic label on client

Tell client what they “must” do

Seek to “break down” denial by direct confrontation

Imply clients’ powerlessness

+Why use MI in Drug Court?

Better EngagementMore Information

Better Assessments

More Relevant Recommendations

More Successful Outcomes

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+MI Intervention vs. MI techniques

Full intervention

Or

Individual techniques that make up the intervention

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Motivational Interviewing

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Example: Motivational Enhancement Therapy - NIDA

Alcoholics, outpatient tx

7-8 hour assessment

4 sessions 1&2, structured feedback, future plans & motivation

for change 3&4, reinforce progress, encourage reassessment &

provide objective assessment of progress Significant other involved in session 1 & or 2 Breath alcohol readings 90 day timeframe

+MINT blog post – “Old”

Are you a smoker? Well, sort of, yes.

How much do you smoke each day? A pack or two.

The way you’re coughing, I have to tell you, it’s going to get worse if you continue. Yes, I know but you see it helps with the stress. If you knew what I go

through with the truck and long hauls. It’s enough just to get through the day.

But if you carry on like this you might lose even more time at work. Yeah. I’m cutting back, you see.

Well we’ve got some good aids to quitting if you are interested? Yes, thanks, sure. I’ll give it some thought.

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+MINT blog post – “New”

Would you mind if we talked about your smoking? Well, ok.

How do you really feel about it? I’m trying to cut back, but I can’t say its easy with my job. You know its stressful driving a truck.

Its not easy for you, yet you’d like to smoke less. Oh, if I could, definitely. I know it’s not good for my lungs or this cough for a start.

You can feel the effect for yourself and its not pleasant That’s right. But its such a stress reliever its hard to let go.

It’s difficult to imagine being without smoking. Yes, that’s exactly right. You got me.

I don’t want to give you a lecture or hassle you about this, but I’m wondering what would be helpful for you? I just don’t know.

Tell me. Deep down. How important is this for you right now? I feel sick and I’m tired and this smoking wears me down.

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+Paraphrasing/Reflection

Pairs

Can’t respond until you have paraphrased accurately.

Argue your point.

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+MI Strategies

OARS Open Ended

Questions

Affirming

Reflection

Summarizing

Balance sheet

Stages of change

Using the importance Ruler

Exploring goals and values

Elicit Change Talk

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+Questioning SkillsEffective vs. Ineffective Questions

Ineffective Too many questions Accusatory questions: Why? Multiple questions Explanatory questions Closed questions

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+ Questioning SkillsEffective vs. Ineffective Questions

EffectiveHave specific objectives in mindState background for questionUse language of the clientCheck out whether client is understandingAsk openly: Who, What, When, Where & How

Use open-ended questionsParaphrase; Reflect; Summarize

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+Open Ended Questions

Who, what, where, when

Tell me about…

How did you…

Redirect: Now tell me about…

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+Open-ended Examples:

What worries you about your current situation?

Tell me about difficulties have you had with your drug use?

What do you think will happen if you don’t change?

How has your anger interfered with your life?

What would your life be like 5 years from now?

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+Affirm (but don’t flatter)Strengths based technique

Verbally supports or validates a participant’s thoughts, emotions, or actions

Demonstrates: Appreciation, Understanding, Support

When you see a strength, notice it

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+Affirmation Example:

1. Participant arrives on time for his case management appointment.

“You’re punctual. That will be a big help in this program.”

2. Participant: “I don’t want to do anything more than I need to. I just want to finish the program and get on with my life.”

“Determination is a good characteristic to have in treatment. It will help to keep you focused.”

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+Reflective Listening

Rationale Conveys willingness to try to understand

Serves as a perception check

Clarifies feelings Leads to more exploration

Demonstrates empathy

Common Errors Not listening

closely Limited feeling

vocabulary Monotone vocal

qualities Premature focus

on problem solving

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+Reflection

Expressing Empathy:“So, what I hear you saying is…”Reflecting Conflict:“On the one hand…but on the other hand…”“So what you’re saying is…but you are not able to…”Rolling with resistance:“You don’t have to do anything you don’t want to.”

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+Summarizing

The set-up statementLet me see if I understand correctly…

Reflection, Reflection, Reflection

Open ended QuestionWhat did I miss?What other concerns do you have?

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+Practice: Speaker

• Something about yourself that you• Want to change• Need to change• Should change• Have been thinking

about changing• … but you haven’t

changed yet.

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Practice: Listener• Listen carefully

• Ask these 4 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 for you to do

it?• On a scale from 0 to 10, how important

would you say that it is for you to make this change?

• Why are you a (?) and not a zero?

• Give a short summary/reflection of the speaker’s motivations for change.

• Ask: “So what do you think you’ll do?” and just listen with interest.

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+Resources:

NREPP SMAHSA’s National Registry of Evidence-based programs and practices

MI – Bill Miller email wrmiller@unm.edu

MI – http://www.motivationalinterviewing.org

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