integrated behavioral health interventions for substance use core
integrated behavioral health interventions for substance use core components of motivational interviewing WEEK 3
core MI components relational technical • partnership • empathy • cultivating change talk • softening sustain talk
DANCR Steps D – Desire A – Ability N – Needs C – Commitment R – Reasons Steps mobilizing change talk
core components of MI • O-open-ended questions • A-affirmations • R-reflections • S-summaries
open vs. closed questions = those that can be answered “yes, ” “no, ” or in a few words – Ex: How much do you drink each night? – Ex: What is your drug of choice? – Ex: How old are you? open questions = those that pull for a longer answer – Ex: Tell me about your evening routine. – Ex: What is your family like? – Ex: Tell me about your drinking.
the impact of closed-ended questions • • leave the person waiting for the next question feel more like an interrogation don’t expand the conversation if you don’t ask the right question, you might miss something
affirmations • praising or affirming the person • support autonomy & empathy • build therapeutic relationship examples: – “You’ve been working really hard to cut back. ” – “I realize it was challenging to get here; I respect that you are dedicated to following through on your obligations. ” – “You feel like you have a ways to go, but you’ve come a long way thus far. ”
simple reflections - defined • responding to resistance with non-resistance • acknowledge and validate • • emphasize change talk encourage more change talk - person opens up enhance collaboration, trust, and rapport clarifies points of confusion
simple reflections (cont’d) Patient says: “My wife says she’s going to leave me if I don’t quit drinking. ” DBH says: “If you don’t make some changes you may lose your family. ”
complex reflections
complex reflections Patient says: “I’ve been smoking for a long time. ” DBH says: “It’s become a part of who you are now, but you don’t want it to be. ”
complex reflections Patient says: “I guess I’ve thought about whether or not my drinking is hurting my efforts to get control of my diabetes. ” DBH says: “You’re starting to think this could be the missing link. ”
double-sided reflections • to explore ambivalence • “So on the one hand you. . . but on the other you want…” • work off of previously supplied information • end on the change talk
double-sided reflections Patient says: “I know I need to quit smoking for my health, but it’s so hard to stop. ” DBH says: “So on the one hand you are worried about withdrawal from nicotine, but on the other hand you don’t want to die from smoking. ”
ruined reflections • meant to be a reflection, however, inflection at end sounds like question • example: “You’re seeing that your drinking is having some real consequences now, right? ”
empathy Putting yourself in the patient’s “shoes” through reflective listening.
summaries & key questions • summarize key points (snippets of change talk) from the conversation (this is akin to a long reflection) • use the summary to direct the session toward the change goal or transition • end with a key question (open) that evokes change talk and moves the person into a planning phase example: “So you started out just kind of drinking in the evenings to relax, after a stressful day at work. As your work stress started to increase you found yourself drinking a little more than you’d planned each night. Now you have some mornings where you’re a little hungover in the mornings and your co-workers are starting to take notice. I’m curious…what are some other ways you’ve managed work stress in the past? ”
providing information how to provide information in an MI-consistent fashion: • Elicit: ask permission to provide the information – e. g. : “There’s something I’ve seen that seems to work for some of my patients. Is that something you’d like to hear about? ” • Provide: provide the information • Elicit: elicit their response to the information – e. g. : “Is that something you think might work for you? (or) How does that fit for you? (or) What do you make of that? ”
4 strategies for decreasing sustain talk 1) ask about extreme situations: - “What if this problem continued on the current trajectory? What would things look like a few years from now? ” 2) inquire about the past - “How have you been successful making changes in the past? Can you think of something challenging you’ve overcome in the past? ” 3) ask about the future - “If you quit drinking, what do you think your life would look like 3 years from now? ” 4) bring their values into the conversation
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