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

Guiding Principle #1 Express Empathy © Ann D. Carden, Ph. D. - 2006 2

Self-Regulation Theory © Ann D. Carden, Ph. D. - 2006 3

Intentional change is grounded in awareness of one’s core values and life goals and the gap between those values and goals and one’s present behaviors © Ann D. Carden, Ph. D. - 2006 4

“They say you can lead a horse to water, but you cant’ make him drink…but I say, you can salt the oats. ” Madeline Hunter © Ann D. Carden, Ph. D. - 2006 5

Guiding Principle #2 Develop Discrepancy © Ann D. Carden, Ph. D. - 2006 6

Trans-theoretical Stages of Change Model © Ann D. Carden, Ph. D. - 2006 7

Stages of Change n Precontemplation n Contemplation n Preparation n Action n Maintenance n Termination © Ann D. Carden, Ph. D. - 2006 8

• Resources – internal & external • Risks – internal & external • Readiness ------> intervention © Ann D. Carden, Ph. D. - 2006 9

Guiding Principle #3 Roll with Resistance © Ann D. Carden, Ph. D. - 2006 10

Self-Perception Theory © Ann D. Carden, Ph. D. - 2006 11

Concern Problem Recognition Cog nitiv e ctive Affe REASONS NEED DESIRE Intention COMMITMENT Behavioral Confidence ABILITY © Ann D. Carden, Ph. D. - 2006 12

The Flow of Change Talk MI Desire Ability Reasons Need Commitment Change © Ann D. Carden, Ph. D. - 2006 13

Guiding Principle #4 Support Self-efficacy © Ann D. Carden, Ph. D. - 2006 14

Intentional Change is a process, not an event! © Ann D. Carden, Ph. D. - 2006 15

Intentional change is more likely to occur when goals are Ø Ø Ø Small Important to the goal-setter Specific/Concrete/Measurable Present-focused Realistic/Practical A presence rather than an absence © Ann D. Carden, Ph. D. - 2006 16

Three Phases in the Intentional Change Process © Ann D. Carden, Ph. D. - 2006 17

Common Barriers to Self. Enhancing Intentional Change n n n n n Cluelessness Minimization Projection of responsibility Immediate gratification Fear of failure Skills deficits Information gaps Fear of the unknown Lack of social / material supports Competing stressors © Ann D. Carden, Ph. D. - 2006 18

“Given a choice between changing and proving that it is not necessary, most people get busy with the proof. ” © Ann D. Carden, Ph. D. - 2006 John Galbraith 19

It’s not so much that we’re afraid of change or so in love with the old ways, but it’s that place in between that we fear … It’s like being between trapezes … It’s Linus when his blanket is in the drier. There’s nothing to hold on to. Marilyn Ferguson © Ann D. Carden, Ph. D. - 2006 20

Ambivalence “People often get stuck, not because they fail to appreciate the down side of their situation, but because they feel at least two ways about it. ” Miller & Rollnick © Ann D. Carden, Ph. D. - 2006 21

Ambivalence approach-approach-avoidance-avoidance double approach avoidance © Ann D. Carden, Ph. D. - 2006 22

Motivation When the balance tips away from resistance and toward commitment Never completely free of ambivalence and resistance Requires on-going “buy in” at the level of thinking feelings actions © Ann D. Carden, Ph. D. - 2006 23

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 24

Ongoing assessment of client’s: § § © Ann D. Carden, Ph. D. - 2006 stages resources risks readiness 25

Ongoing assessment of supervisee’s: § § alliance with client MI consistent interventions goals for client beliefs about outcomes © Ann D. Carden, Ph. D. - 2006 26

Supervisory Responsibility “Above all do no harm” © Ann D. Carden, Ph. D. - 2006 27

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 28

Cultural Diversity n n n n n Age Socio-economic status Gender / sexual orientation Ethnicity / race Geographic location Religion Educational level and type Life roles Disability / diagnosis © Ann D. Carden, Ph. D. - 2006 29

Cultural effects …. n n n n n Values Perspective Meanings Relationships Independence Current focus / life task Time orientation / pacing Communication and learning style Client-counselor alliance © Ann D. Carden, Ph. D. - 2006 30

Client-Related Stressors of Direct Service Providers n n n n Client resistance / supervisee’s unrealistic expectations of client change Boundary issues/ethical dilemmas Client suicide/attempts Client anger/hostility Premature termination Client violence toward others Client death © Ann D. Carden, Ph. D. - 2006 31

Job-Related Stressors of Direct Service Providers n n n n Isolation / insufficient supports Productivity pressures / time crunches Paperwork, paperwork Organizational politics Low pay Self-doubt Perfectionism / compulsive responsibility Limited training opportunities © Ann D. Carden, Ph. D. - 2006 32

Moving Toward Melt-down/Freeze-up n n n n Increased absenteeism Over-reacting Physical complaints Chronic exhaustion Low self-confidence Depression / Anxiety Procrastination Boundary violations Cynical attitude about job / clients Social withdrawal Hostility Us-them mentality Disorganized thinking / behavior © Ann D. Carden, Ph. D. - 2006 33

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 34

Consolidate Counter Elicit/Explore Principles Opening MI Spirit Strategies Traps Change Talk Sustain Talk MI Core Skills © Ann D. Carden, Ph. D. - 2006 Commitment 35