MOTIVATIONAL INTERVIEWING in CLINICAL SUPERVISION Ann D Carden

MOTIVATIONAL INTERVIEWING in CLINICAL SUPERVISION Ann D. Carden, Ph. D. Carden. Ann@aol. com © Ann D. Carden, Ph. D. - 2006 1

Motivational Interviewing: Preparing People for Change (second edition) William R. Miller & Stephen Rollnick 2002 Guilford Press www. guilford. com ……………. www. motivationalinterview. org © Ann D. Carden, Ph. D. - 2006 2

Three Kinds of Change Developmental Coerced Intentional © Ann D. Carden, Ph. D. - 2006 3

Motivational Interviewing is … Focused on § § § Intentional change and non-change processes Their natural course Ways to empower a person to choose to engage in an intentional change process © Ann D. Carden, Ph. D. - 2006 4

Motivational Interviewing Ø an integrative philosophy Ø a way of being with a person Ø a method of communication -------------… that creates and guides strategies and techniques © Ann D. Carden, Ph. D. - 2006 5

Clinical Supervision A form of mentoring in which one person draws on her personal power (knowledge, skills, experience, influence) to assist another person to: § recognize his personal power and potential apply it in his clinical work continually improve and refine that power § For the benefit of the consumer § § © Ann D. Carden, Ph. D. - 2006 6

“It is in the shelter of each other that the people live. ” Irish Proverb © Ann D. Carden, Ph. D. - 2006 7

Self-Reflection Describe a negative supervisory relationship you have experienced at some point your career. What characteristics/ behaviors of that particular supervisor were most harmful to you in your personal/ professional growth? © Ann D. Carden, Ph. D. - 2006 8

Self-Reflection Describe a positive supervisory relationship you have experienced at some point your career. What characteristics/ behaviors of that particular supervisor were most helpful to you in your personal/ professional growth? © Ann D. Carden, Ph. D. - 2006 9

Self-Reflection List what you believe to be the most important attributes of an effective supervisor. Rate yourself as a supervisor on each attribute on a scale of 1(not there yet) to 10 (absolutely there). © Ann D. Carden, Ph. D. - 2006 10

You’re on the right track when… You employ a full range of supervisory methods Case review and analysis Skill rehearsal and role play Co-facilitation Direct observation Indirect observation Skill assessment and structured feedback © Ann D. Carden, Ph. D. - 2006 11

You’re on the right track when… Your supervisee is actively involved in setting the agenda and reviewing his/her clinical material Your supervisee is evaluating his/her work and making the arguments for any needed changes There is less resistance behavior and more problem-solving behavior in your interactions Your supervisee is actively seeking your feedback © Ann D. Carden, Ph. D. - 2006 12

Motivational Interviewing “Spirit” § Autonomy vs. Authority § Collaboration vs. Confrontation § Evocation vs. Education § § and Exploration and Explanation (a COMPETENCE vs. a DEFICIT view of persons) © Ann D. Carden, Ph. D. - 2006 13

Reflective Listening The “heart” of the MI approach Simple but not easy Non-verbal as well as verbal Affirms & validates the client/supervisee Allows for the revelation of information that might otherwise be overlooked Encourages ownership and creative priority setting and problem solving by the client/supervisee © Ann D. Carden, Ph. D. - 2006 14

MI Guidelines for Feedback of Fact § Elicit person’s readiness, interest, current understanding § Provide information in a non-judgmental, non-interpretive manner § Elicit person’s interpretation of information provided © Ann D. Carden, Ph. D. - 2006 15

Six Supervisor Guidelines 1. Adhere to the MI Guiding Principles 2. Avoid Traps / Roadblocks to progress 3. Teach / model the Philosophical Foundations of MI 4. Maintain a clinical focus 5. Adapt to the Supervisee’s context 6. Assist supervisees to become proficient in MI clinical skills © Ann D. Carden, Ph. D. - 2006 16

Six Supervisor Guidelines 1. Adhere to the MI Guiding Principles 2. Avoid Traps / Roadblocks to progress 3. Teach / model the Philosophical Foundations of MI 4. Maintain a clinical focus 5. Adapt to the Supervisee’s context 6. Assist supervisees to become proficient in MI clinical skills © Ann D. Carden, Ph. D. - 2006 17

Research suggests that … The Four MI Guiding Principles create consonance/harmony in therapeutic / supervisory relationship and support the client’s / supervisee’s progression toward motivation to change and grow. © Ann D. Carden, Ph. D. - 2006 18

Guiding Principle #1 Express Empathy Ø Radical acceptance of the other person Ø Skillful and respectful reflective listening Ø Curious attitude and sincere interest in the other person’s perspective © Ann D. Carden, Ph. D. - 2006 19

Guiding Principle #2 Develop Discrepancy Ø Ø Ø Explore her professional values and goals Heighten awareness of consequences of his present approach with clients Amplify any gaps between her professional values and goals and her present actions © Ann D. Carden, Ph. D. - 2006 20

Guiding Principle #3 Roll with Resistance Ø Go with your supervisee’s energy Ø Shift focus as needed Ø Avoid judgment © Ann D. Carden, Ph. D. - 2006 21

Guiding Principle #4 Support Self-efficacy Ø Believe in the possibility / carry the hope Ø Honor his organismic wisdom Ø Affirm any progress toward her goal © Ann D. Carden, Ph. D. - 2006 22

Six Supervisor Guidelines 1. Adhere to the MI Guiding Principles 2. Avoid Traps / Roadblocks to progress 3. Teach / model the Philosophical Foundations of MI 4. Maintain a clinical focus 5. Adapt to the Supervisee’s context 6. Assist supervisees to become proficient in MI clinical skills © Ann D. Carden, Ph. D. - 2006 23

Research suggests that … Six MI Traps/Roadblocks create dissonance in therapeutic / supervisory relationship, block the client’s / supervisee’s progress and may even cause regression away from motivation to change and grow. (Even within the same session) © Ann D. Carden, Ph. D. - 2006 24

Common Trap #1 q Closed Question trap … - blocks exploration - distances © Ann D. Carden, Ph. D. - 2006 25

Common Trap #2 q Arguing for change trap … - evokes opposition - creates an unsafe environment - encourages shame © Ann D. Carden, Ph. D. - 2006 26

Common Trap #3 q Expert trap … - invites dependency - discourages creative problemsolving - deflates self-confidence © Ann D. Carden, Ph. D. - 2006 27

Common Trap #4 q Labeling trap … - depersonalizes - demoralizes - disempowers © Ann D. Carden, Ph. D. - 2006 28

Common Trap #5 q Premature focus trap … - inhibits exploration - prevents “unpacking” of meaning - weakens the relationship © Ann D. Carden, Ph. D. - 2006 29

Common Trap #6 q Blaming trap … - damages self-esteem - evokes defensiveness © Ann D. Carden, Ph. D. - 2006 30

Six Supervisor Guidelines 1. Adhere to the MI Guiding Principles 2. Avoid Traps / Roadblocks to progress 3. Teach / model the Philosophical Foundations of MI 4. Maintain a clinical focus 5. Adapt to the Supervisee’s context 6. Assist supervisees to become proficient in MI clinical skills © Ann D. Carden, Ph. D. - 2006 31

Motivational Interviewing is … related to: o Client-Centered Therapy o Self-Regulation Theory o Trans-Theoretical Stages of Change Model o Self-Perception Theory © Ann D. Carden, Ph. D. - 2006 32

Client-Centered Therapy Model © Ann D. Carden, Ph. D. - 2006 33

“Non-specific Factors” n Empathy n Unconditional Positive Regard n Genuineness © Ann D. Carden, Ph. D. - 2006 34