A BRIEF OVERVIEW:MOTIVATIONAL INTERVIEWINGDEANNA COOPER, LCSW

UM, SCHOOL OF SOCIAL WORK APRIL, 2019

IBH TRAINING SERIES: SUDS TOOLKIT CONFERENCE

Motivational Interviewing

From Information based on the work of :Bill Miller, PhD and Steven Rollnick, PhD

And their Third Edition of MOTIVATIONAL INTERVIEWING (2013)

Research and Consultation Collaborations withUNM CASAA

And trainings presented byRaymond Anderson, PhD, LPCC, LADAC

Lifelink Institute, Santa Fe, NM

Goals of Overview

Introduce Current Evidence Based Practice s with SUD’s

Understand the History of MI as it relates to and supports EB Approaches

Current research on efficacy of MI as a tool to support behavior change

HISTORY

Developed in the 1980’s- Bill Miller1983: Arranging the conversation so the client makes the argument for change

First Edition in 1991,Bill Miller and Stephen Rollnick

Paralleled with other research in the field: Transtheoretical Theory ( Stages of Change ) DiClemente and Prochaska

Project Match- readiness to change, self efficacy, psych severity (co-occurring) Meta Analysis of What Works, focused on Alcohol Hester and Miller

WHAT WORKS?

Brief Interventions

Motivational Enhancement

Community Reinforcement Approach

M.A.T.

Self Directed Manuals

Behavioral Self Control Training

Cognitive Therapy

Marital/Relationship Therapy

Hester, Miller (2003)

PHARMACOLOGICAL- M.A.T.

BEHAVIORAL THERAPIES: BRIEF INTERVENTIONS

CONTINGENCY MANAGEMENT

COGNITIVE BEHAVIORAL – 3rd Wave

MOTIVATIONAL INTERVIEWING

COUPLES and FAMILY Treatment

HARM REDUCTION ApproachesSAMHSA EBP Registry, UW EBP (2013)

2003 ALCOHOLCURRENT SUD’s EBP

WHAT WORKS?

http://lib.adai.washington.edu/ebpsearch.htm

UNIVERSITY OF WASHINGTON: EBP SUBSTANCE ABUSE

EBP Substance Abuse was developed as a joint project of the University of the Washington Alcohol & Drug Abuse Institute and the Northwest Frontier Addiction Technology Transfer Center, with funding from the Washington State Division of Alcohol and Substance Abuse. 2013

MOTIVATIONAL INTERVIEWING

“Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change”

Miller and Rollnick, 2013

AMBIVALENCE… is to be expected

The Transtheoretical Model (Prochaska & DiClemente, 1983

AMBIVALENCE

AMBIVALENCEIs normal

Is to be Expected

With Confrontation, we WRESTLE with it…..

With MI, we DANCE with it,

RESISTANCE TO CHANGE

Resistance and "denial" are seen not as client traits, but as feedbackregarding therapist behavior. Client resistance is often a signal thatthe counselor is assuming greater readiness to change than is thecase, and it is a cue that the therapist needs to modify motivationalstrategies.

Stephen Rollnick & William R. Miller, Ph.D. (1995)

BASIC SKILLS: OARS

OPEN Requires more than one word answer

AFFIRMING Genuinely positive, Right Direction

REFLECTING What you hear them say

SUMMARIZING Shows you were listening, gives chance to correct

Miller, Rollnick, 1991

And those DARN CATS…. Preparatory and Mobilizing Change Talk

Miller, Rollnick, 2013

Third Edition: The Spirit of MI

The spirit of MI is based on three key elements:

1) collaboration between the therapist and the client

2) evoking or drawing out the client's ideas about change

3) emphasizing the autonomy of the client.

Accurate Empathy- Practitioner style matters

Miller and Rollnick, 2014

SPIRIT and SKILL: ENGAGEMENT

The Spirit of MI acknowledges the regard for the client.

Personalized – client is the expert

Compassionate- Change is hard

Strengths- giving credit for forward movement, past success

Partnership, Accompaniment

Evocation- Client identifies areas they want to work on

Accurate Empathy- Practitioner style matters

What does the evidence say?

Treatment works!!

Treatment outcomes are not predicted by setting/level of care (e.g., outpatient, residential, etc.).*

Counseling approaches have similar outcomes, but… Counselor/Alliance does make a

difference.**

3rd Edition: Four PROCESSES

PLANNING

EVOKING

FOCUSING

ENGAGING

SKILLS: Ask for Permission

In MI we do not give unsolicited advice.If we have suggestions, we ask for permission to share

REVISIT AMBIVALENCE: CHANGE and SUSTAIN TALK

Exercise to argue for and against change.

Giving client permission to look at change and sustain, and consider the positives and negatives of both

Eventual growth of MI skills allow evoking this in conversation and are measurable in speech patterns

Glynn, L. H., & Moyers, T. B. (2010)

WHERE ARE WE NOW?

Delivering the technical within the context of the relational

Delivering CBT in MI consistent way matters… predictor of change

Third Wave CBT- DBT, ACT, Mindfulness-Based CBT

MI used consistently with Behavioral Interventions, not separate from, or sprinkled on

Multi-Disciplinary- use with EBP within discipline, acknowledge when switching out for data, discord

WHERE ARE WE NOW?

SBIRT- EBP, Interprofessional

Healthcare Patient “Education”

Criminal Justice- Probation and Detention officers, Judges

Schools

Child Welfare

MI Is Lifelong Practice and Learning

Proficiency in MI is parallel to the concept of Cultural Competency:

Trainings do not create MI practitioners

The HUMILITY of fumbling about: reflecting on missed opportunities and willingness to engage in lifelong learning

Ongoing skill building through coaching, taping and learning community

REFERENCES

Columbia U Social Work, Motivational Interviewing: A Dialogue with the Practice's Co-founder William R. Miller, 2017https://www.youtube.com/watch?v=DSHh6V9yNzgRetrieved, March, 2019Glynn, H and Moyer. 2010..Chasing Change Talk: The clinician's role in evoking client language about change. Journal of Substance Abuse Treatment 39, 65

Hennesy, S. (2018) Subst Abuse Treat Prev Policy. 2018; 13: 26.Suspension of the National Registry of Evidence-Based Programs and Practices: the importance of adhering to the evidence. Subst Abuse Treat Prev Policy. 2018; 13: 26.

Hester, R.K. & Miller, Wm. (Eds.). (2003) Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.), 2003, Allyn & BaconMiller, W. MINT website, MINT Plenary https://vimeo.com/316279712 , 2018. Retrieved 3/2019Miller and S. Rollnick. Motivational Interviewing: Helping People Change (3rd edition) New York, Guilford Press, 2013

REFERENCES cont.

Hester, R.K. & Miller, Wm. (Eds.). (2003) Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.), 2003, Allyn & Bacon

UW, ATTAC .EBP Substance Abuse. University of Washington Alcohol & Drug Abuse Institute and the Northwest Frontier Addiction Technology Transfer Center, 2013, http://lib.adai.washington.edu/ebpsearch.htm, retrieved 4/16/19

Velasquez, M The Social Work Podcast, Motivational Interviewing: 3rd Edition,Interview with Mary Velasquez, Social Work Podcast, 2013http://socialworkpodcast.blogspot.com/2013/09/MI3.html