Motivational Interviewing in Corrections 0 FADAA/FCCMH Annual Conference August, 2014 Jim Elder MS, LCDP, CADC

Motivational Interviewing in Corrections

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FADAA/FCCMH Annual ConferenceFADAA/FCCMH Annual ConferenceAugust, 2014August, 2014

Jim Elder MS, LCDP, CADCJim Elder MS, LCDP, CADC

Training Goals and Objectives

•Conceptualize Change through the eyes of our own experience; thereby better appreciating the correctional clients’ experience with changes in their own lives.

•Explore the Spirit and Basic Skills of MI.

•Describe the stages of change and corresponding motivational strategies that are helpful during each stage.

•Practice skills that may enhance treatment engagement, motivation and treatment retention of the correctional client.

•Examine potential challenges with MI application in corrections.

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Where Are You On The Tree?

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Definitions of MI

• A collaboration, person-centered form of guiding to elicit and strengthen motivation for change.

• A collaborative conversation to strengthen a person’s own motivation for and commitment to change.

• A person-centered counseling method for addressing the common problem of ambivalence about change.

What Is Motivational Interviewing?

“…a directive intervention focused on resolving ambivalence in the direction

of change.”

• “… not a series of techniques … but a way of being with clients.”

Motivational Interviewing. Miller and Rollnick, 1991

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Motivational Interviewing

• Based on Stages of Change.

• Assumes motivation is fluid and can be influenced.

• Motivation influenced in the context of a relationship.

• Principal tasks - to work with ambivalence and resistance.

• Goal - to influence change in the direction of health.

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Spirit of MI

• Openness to a more collaborative vs. prescriptive approach

• Honors client autonomy and self-direction – we activate motivation

• Involves invoking vs. installing – done “with” someone, not “to” them

• Willingness to suspend authoritarian role and explore client capacity rather than incapacity – we are not the “experts”

• Requires capacity for genuine interest in client experience and perspectives

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Motivational Interviewing: A Way of Being

“If you treat an individual as he is, he will stay as he is, but if you treat him as if he were what he ought to be and what he could be, he will become what he ought to be and could be.” - Johann Wolfgang Von Goethe

“Any change, even a change for the better, is always accompanied by drawbacks and discomforts.”

- - Arnold Bennet

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All Change Is Self Change

“People tend to only listen to one person — themselves. And, as a result, they’re only influenced by one person … again — themselves. So, as frustrating as this may be for a parent who would like to sternly say, “You have to stop!” and to have that be enough, the real trick to motivating someone is to get them to convince themselves to make a change for their own good reasons.But how do you do this?

1.1.STOPSTOP trying to motivate your child by telling her about your feelings, thoughts or reasons for change, such as, “You’re worrying me to death!” “I think you HAVE to go to rehab right from the hospital,” or “The best reason for you to stop drinking is for your health.”

2.2.STARTSTART asking your child questions that are specially designed to evoke her own good reasons for change.”

Source: Michael V. Pantalon, PhD INSTANT INFLUENCE www.michaelpantalon.com.

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Success and the Correctional Client

Change…

• A process and not a single event.• Is not easy.• Ambivalence is a normal part of the

change process. • People move in and out of the

change process.• Does not happen quickly or easily.• We all resist it.

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What about your change…?

Think about the last big change you made in your own behavior…•How long did it take before you considered that it could be a problem for you?•Before you decided to make a change?•To develop a plan?•Before you actually tried to make the change?•How long before you succeeded completely?•Did you ever go back, and go through the change process again?

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Stages of Change (Prochaska and DiClemente, 1982)

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MAINTENANCE RELAPSE

ACTION PRECONTEMPLATION

PREPARATION CONTEMPLATION

ENTER

PERMANENT EXIT

TEMPORARY EXIT

The Stage of ChangeThe Stage of Change Motivational StrategiesMotivational Strategies

Precontemplation: •Not considering change and do not intend to change behaviors in the foreseeable future. •In some cases may even be actively hostile and defiant to change.•May be unaware that substance abuse or criminogenic (crime-producing) problems exists, or that they should make changes.•Do not recognize that their substance use is a problem, even when society and many of their family members and friends do. •Ambivalent, unwilling or even too discouraged to change their behavior.

Engagement:•Raise awareness and perception of risks associated with current behavior and impact on family, quality of life and freedom.•Focus on developing therapeutic alliance with consumers.•Provide useful outreach and practical assistance to help them face immediate challenges such as housing, employment, transportation, health or financial problems.•Complete a comprehensive risk-needs assessment.

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Precontemplation


Contemplation: •As people become aware that criminality/substance use is a potential problem they begin to consider their behavior and the possibility of changing.•Initial recognition that behavior may be a problem they are responsible for.•They may perceive that there is cause for concern and begin to explore reasons to change.•However, they may be ambivalent and simultaneously have reasons to change and not change.

Persuasion:•Educate clients about the interplay between substance abuse, mental illness criminogenic factors and legal problems.•Foster and evoke reasons and risks of not changing.•Instill hope and help people to see that change is possible/attainable and that you believe in their capacity for change.•Help people think about the role of criminality/substance use in their lives while remaining absent of judgment.•Active listening, asking exploratory questions about experiences and goals.

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Contemplation


Preparation: •When individuals perceive that the advantages of change and the adverse consequences of continued risky/illegal behaviors outweigh the positive features of these behaviors, the decisional balance tips in favor of change. •When this occurs, the emerging commitment to change is strengthened.

Persuasion Continues:•Create ideas for a potential, yet realistic plan.•Build upon Family and Peer Support and other natural support systems (e.g. church, self-help groups) •Help consumers think about the following:Goals settingSubstance use and impact on mental health symptoms and;Whether substance use or symptoms deter achieving life goals.

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Preparation


Action: •Individuals in this stage have chosen a strategy for change and are pursuing it.•They are actively changing their habits and environment while making significant life changes. •They may be faced with especially difficult psychosocial challenges such as relationship issues, which may be perceived as barriers to change, but are willing to develop contingency plans.

Active Treatment:•Encourage clients and families to take “right size” take steps toward change.Medication treatmentSelf-help groups•Explore “how is it working?”•Provide them with additional skills and supports. For example, consumers may need different kinds of skills:Assertiveness skills—to avoid substancesSocial skills—to socialize without substancesStress management skills—to manage emotions without substances.

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Action


Maintenance: •During this stage, individuals make efforts to sustain gains achieved during the action stage. For example, they may work to avoid high-risk situations.•They learn how to identify and guard against dangerous situations that may prompt them to engage in risky behaviors (triggers).

Relapse Prevention:•Explore new peer relationships and new social networks.•Work on a better relationship with children/family.•Expand recovery to other life areas.•Develop relapse prevention plan.•Contingency planning.

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Maintenance

Someone Special Exercise

• I’d like you to think about someone in your life who had a positive influence on you, who helped you become a better person.

• This person still could be in your life or could be someone from your past, but this person should mean a lot to you.

• The person could be a teacher, a coach, a parent, friend, spouse, or someone else.

• Take a minute and visualize this person in your mind.• Now, I would like you to think about this person’s traits or

characteristics.• What was or is it about that person that made him or her so

influential in your life?

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O.A.R.S. The Basic Skills of Motivational

Interviewing

OOpen ended questions

AAffirmations

RReflective listening

SSummaries

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Basic Skills of MI

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OOpen ended questions• “How can I help you while your on probation?”

• “Would you tell me about ___?”

• “How would you like things to be different?”

• “What are the positive things and what are the less good things about ___?”

• “What will you lose if you give up ___?”

• “What have you tried before?”

• “What do you want to do next?”

Basic Skills of MI

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AAffirmations• Statements of recognition of client strengths.

• Build confidence in ability to change.• Must be congruent and genuine.

Basic Skills of MI

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RReflective listening“Reflective listening is the key to this kind of work.

The best motivational advice we can giveis to listen carefully to your clients.

They will tell you what has worked andwhat hasn’t. What moved them forward andshifted them backward. Whenever you are

in doubt about what to do, listen.”

- Miller & Rollnick, 1991

Levels of Reflection

1. SIMPLE 1. SIMPLE Repeating, rephrasing; staying close to the content, maintaining neutrality.2. AMPLIFIED2. AMPLIFIEDParaphrasing, double-sided reflection; testing the meaning/what’s going on below the surface, reflects client statement in exaggerated form, but without sarcasm.3. FEELINGS3. FEELINGSEmphasizing the emotional aspect of communication; deepest form.

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Types of Reflective Listening

1. REPEATING OR REPHRASING 1. REPEATING OR REPHRASING Listener repeats or substitutes synonyms or phrases; stays close to what the speaker has said.

2. PARAPHRASING2. PARAPHRASINGListener makes a major restatement in which the speaker’s meaning is inferred.

3. REFLECTION OF FEELING3. REFLECTION OF FEELINGListener emphasizes emotional aspects of communication through feeling statements- this is the deepest form of listening.

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Reflection: Responding To Resistance With Nonresistance

Simple reflectionSimple reflection•Client: I don’t plan to quit drinking anytime soon.•Clinician: You don’t see abstinence in your near future.

Amplified reflectionAmplified reflection•Client: I don’t know why my parents are worried about this. I don’t drink any more than any of my friends.•Clinician: So your family is worrying needlessly.

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Reflection: Responding To Resistance With Nonresistance

Double-sided reflectionDouble-sided reflection•Client: Maybe I should give up drinking completely, but I’m not going to do that!•Clinician: You can see that there are some real problems here, but quitting altogether clearly is not what you want to do.

Reflection of FeelingReflection of Feeling•Examples…?

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Basic Skills of MI

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SSummarizing“Let me see if I understand thus far …”

•Special form of reflective listening.•Ensures clear communication.•Use at transitions in conversation.•Be concise.•Reflect ambivalence .•Accentuate “change talk.”

G.R.A.C.E. Five Principles of Motivational

Interviewing

GGenerate a Gap

RRoll with Resistance

AAvoid Argumentation

CCan Do

EExpress Empathy

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Principles of Motivational Interviewing

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GGenerate a Gap

• Develop a discrepancy between individual’s current behaviors and his/her stated values and interests.

• Let client present arguments for change.

• Acknowledge both the positives and negatives of behavioral change.


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RRoll with resistance

• Seek to clarify, understand.• Invite consideration of new

perspectives.• Reinforce person’s role as a problem-

solver.


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AAvoid argumentation

• Keep on your client’s side.• Arguing for change often promotes

resistance, thus causing the client to defend the behavior you want them to change.


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CCan do

• Increase individual’s perception of self as a capable person.

• Affirm positive statements and behaviors.

• Offer options, instill hope.• Encourage consideration of role

models, past successes.


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EExpress empathy

• Create a “free and friendly space” to explore difficult issues.

• Use reflective listening.• An accepting attitude facilitates

change, pressure to change thwarts it (paradox).

Rapport Breakers

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• Arguing for change• Assuming the expert role• Criticizing, shaming or blaming• Labeling• Being in a hurry• Claiming pre-eminence• Not being “present”

- Miller & Rollnick, 1991

Other MI Techniques

• Brief Situational Confidence Questionnaire– Measure of efficacy for resisting drinking or

drug use in various situations.[See BSCQ handout]

• Readiness/Confidence Ruler– Simple method for determining clients’

readiness and confidence to change by asking them where they are on a scale of 1-10.

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Not Ready/Confident Unsure Ready/Confident

Is It MI Yet?

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Documents

Motivational Interviewing in Corrections 0 FADAA/FCCMH Annual Conference August, 2014 Jim Elder MS, LCDP, CADC