Motivational Interviewing for Victim AdvocatesMotivational Interviewing for Victim Advocates Kate...

MotivationalInterviewingforVictimAdvocatesKateWatson,M.A.,Ed.M.,Dr.PH(c)

WatsonWellnessPromotionwww.watsonwellnesspro.com

Kate@WatsonWellnessPro.com

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MIisusedinmanyfields,asanapproachtocommunicatingwithpeopleaboutchange:

• Healthcare• SocialWork• Psychology• CaseManagement• Education(teachingandadvising)

• HumanResourcesandManagement

• CareerCounseling• FinancialCounseling• VictimAdvocacy• Corrections• Probation• Policework

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A Note About My Language• Provider: general term to describe the person delivering the

motivational interviewing intervention• Client: general term to describe the person receiving the

motivational interviewing intervention

WhatisMotivationalInterviewing?

MI is a kind of conversation about behavior change

•Think about a change that you would like to make…• Exercising More?• Quitting smoking?• Saving money?• Managing anger?• Managing stress?• Eating more healthy foods?• Taking better care of yourself? • Pursuing a career or education goal?

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MIinVictimAdvocacyWork:DefiningtheTargetBehavior

1. Making the decision to engage in services or treatment2. Seeking steps toward safety in the future (defined by survivor)3. Learning to understand and accept one’s symptom’s trauma4. Deciding whether or not to report a perpetrator5. Participating in the investigation or criminal justice process

Knowing, of course, that as well-trained victim advocates you already know not to tell survivors what they SHOULD do, can we agree that there are moments when you often WANT to?

MI is a good set of skills in that moment.

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CommonAssumptionsabouttheChangeProcess

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UnderstandingtheDynamicHelpingRelationships

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"Argueforonesideandtheambivalentpersonislikelytotakeupanddefendtheopposite."

(MillerandRollnick,2013,p7).

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Key Concept: Change the environment of the interaction, not the person.

-----------If you create the space, the person is likely to change in

a way that makes most sense for him/her. You are responsible for the quality of the intervention, not the

outcome.

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ExamplesofAmbivalenceTargetBehavioris:increasingexercise

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ExamplesofAmbivalenceTargetBehavioris:

ENGAGEMENTWITHSERVICES

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ExampleofAmbivalenceTARGETBEHAVIOR:

SeekingSafetyfromanAbusivePartner

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ExamplesofAmbivalenceTargetBehavioris:Understandingand

AcceptingTraumaSymptoms

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Meta-AnalysesofMI

• Meta-analysis from Rubak, 2005 concluded that MI outperforms “advice giving” in 80% of studies

• A single session of MI has been shown to have an impact• Brief sessions, 15 minutes, can be effective

• Meta-analysis by Van Buskirk and Wetherall (2013) found that • 9 of 12 studies found MI more effective than other interventions

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RevisitingourDefinitionofMI

• Our Original definition of MI: • A particular conversation about behavior change

• Updated: • A conversation about behavior change, in which the

provider creates an environment that gives the opportunity for a client to explore his or her own reasons and strategies for change in a non-threatening and non-judgmental manner.

So how do we achieve that?

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Wheretheseoverlap,you’relikelytofindmorechangetalk

Whereyoufindmorechangetalk,you’relikelytoseemorelastingchange

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victim/

EvokingandstrengtheningchangetalkusingOARS

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OpenQuestionstoElicitChangeTalk

• D DESIRE “What makes this something that you want?”• A ABILITY “How would you go about doing this?”• R REASON “What reasons do you have to do this?”• N NEED “In what ways might you need to do this?”• C COMMITMENT “How committed are you to this change?”• A ACTIVATION “What are you willing to start doing now?”• Ts TAKING STEPS “What steps have you already taken?”

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SKILL:Elicit-Provide-Elicit(EPE)

• ELICIT• “Whatideasdoyouhaveabouthowyoumightmakethischange?”

• “WoulditbeokaywithyouifIsharedsomeideasthatIhadthatmighthelpyou?”

• PROVIDE• “Somepeoplefindthat_____”• “Researchshows_____”

• ELICIT• “Whatisyourreactiontothat?”• “Howdoyouthinkyoumightusethatinformation?”

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EvokingandstrengtheningchangetalkusingOARS

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AffirmationstoEnhanceSelf-Efficacy

An affirmation is a statement that identifies a strength in your victim/survivor.

What is the difference between affirmation and praise?

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Affirmationsvs.Praise

• Praise is a statement of approval, which is a form of positive judgment.• Praise can be paternalistic and creates a power dynamic that may not

be conducive to engagement:• “Good job!”• “I’m proud of you!”• “That’s great!”

• Affirmations recognize an undeniable strength through evidence.• “You stayed focused when obstacles arose.”• “Once you put your mind to something, you go for it.”• “You’re the kind of person who is loyal to others.”

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EvokingandstrengtheningchangetalkusingOARS

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TypesofReflections

•Simple Reflection• Restating what the victim/survivor said

• Complex Reflection• Adds meaning to what the victim/survivor has said• Think of this as repeating what the person said

PLUS what they haven’t said YET. • Moves the conversation forward.

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Examples of Reflections:

Survivor says, “I’m only here because my friend thinks I going through something tough.”

SIMPLEREFLECTION

• Youfeelmisunderstood.• Youdisagreewithyourfriend.

COMPLEXREFLECTION

• Yourfriendthinksyoushouldbehere.

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MoreReflections

• “Ihaveagoodsenseofhumor”• Youknowhowtolaughatyourself.• Yoursenseofhumorhashelpedyou.

• “ItakeonmorethanIshould”• Youfeelalotofresponsibility.• You’dpreferanewwayofdoingthings.

• “Idon’tknowwhattodo.”• You’veexhaustedallofyouroptions.• You’refeelinglost.

• “Ican’tdoanythingright.”• You’redisappointed.

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AReflectiondoesnothavetobeanagreement

• “Ijustfeellikeaterriblemother.”“Youfeellikeyoudon’tmeetyourownexpectations.

• “It’snotmyfaultthatIgotintrouble.Everyoneisouttogetme.”“Youfeeltargeted.”

• “Therapyistotallypointless.Shrinksarejustafteryourmoney.”“You’reskeptical.”

• “Tryingtogetajobatthispointiscompletelyhopeless.Noonewilleverhireme.I’mworthless.”

“Youhaveahardtimeseeingyourownvalue.”

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EvokingandstrengtheningchangetalkusingOARS

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GeneralTipsforSummaries

• Highlight the change talk that you heard:• “You told me this is something that you want.”• “You told me that you have some strengths that make it likely that you

will be successful.”• “You’ve committed to start _____.”

• Ask an open-ended question at the end:• “What have a missed?”• “What else would you like to tell me that we haven’t covered?”• “Tell me how well I’ve understood our meeting.”

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MIisagoodfitforworkthatisalreadytrauma-informed

Inmanyways,MItakesgoodtrauma-informedpracticeandpackagesitintosomethingmeasurableandoperationalized.• Evocativeopen-endedquestionsputtheclientintheteachingrole,whichcanbeempowering

• Affirmations buildupontheclient’sstrengthsinawaythatisempowering(especiallyoverpraise,whichmaintainsthepowerwiththeprovider)

• Complexreflectionslendanemotionalvocabularytothosewhomayhavedifficultyconnecttofeelings

• EPE respectsboundaries• Compassion prioritizestheclient’sowngoals,values,andneeds.• Acceptance remindsustoresisttheurgetofixaperson.Attemptstofixareinherentlyshamingbecausetheysuggestthepersonisbroken.Changetheenvironmentoftheconversation,nottheperson.

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ATasteofMI

• Gettingstarted:Whatisthechangethatyouareconsidering?• Evocation:

• Whatgoodreasonsdoyouhavetomakethischange?• Whatstrengthsdoyouhavethatwouldhelpyoumakethischange?

• Partnership:• Whatthoughtsdoyouhaveabouthowyoumightgoaboutthis?• WoulditbeokaywithyouifIsharedanideathatmightworkforyou?(ifyourclientsays“yes”,thenoffersomeadviceorinformation).

• Howdoyouthinkyoumightusemyadvice?• Acceptance:

• [Makeastatementthatshowsyouareunderstandingyourclient]“Itsoundslikeyouare_____”

• Itisultimatelyuptoyouwhetheryoumakethischangeornot.Whatdoyouthinkyou’lldo?

• Compassion:• Regardlessofwhatothersmayexpectofyou,whatdoyouseeasthebestpossibleoutcomeforyou?

HowwillyoumaintainyourMIskillsthatyoulearnedtoday?

•Additional training• www.motivationalinterviewing.org

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