Motivational Interviewing Toolbox Presented by Iowa Vocational Rehabilitation

Motivational Interviewing Toolbox Presented by: Iowa Vocational Rehabilitation Services Jami Schwickerath, MS, Lisa Worden, MS, Justin Clark, MSW, and Patty Galván Ramos, MS

Motivational Interviewing “Motivational Interviewing is a collaborative, person-centered form of guiding to elicit and strengthen motivation for change. ” (Miller, 2009) The goal is to help someone move toward their own vision/goal for change and make a commitment to a plan of action. ① Introductions and Brief History of Vocational Rehabilitation ② Change (Ice Breaker) ③ Scenarios ④ What is in the toolbox?

History • During and after World War I injured soldiers were not able to go to their old jobs. Therefore, the Soldiers Rehabilitation Act of 1918 introduced a new concept in disability support - not just money to live on, but training for the injured veterans as preparation for new jobs matching their "new" abilities. • In 1920 Congress expanded the veteran's program to include anyone with a physical disability, not just veterans. This was the beginning of the Public Vocational Rehabilitation Program, or VR. • The new program was great and has evolved to not only include both visible and invisible disabilities. Produced by the Rehabilitation Continuing Education Program, Region 7, University of Missouri 2004 www. rcep 7. org

Iowa Vocational Rehabilitation Services Mission To work for and with individuals who have disabilities to achieve their employment, independence and economic goals.

Spirit of MI • Partnership: It is an active collaboration between two experts (yourself and the job candidate). A partnership is crucial when change is the goal because we cannot accomplish the goal on our own. • Acceptance: Acceptance is promoting the job candidate’s autonomy. • Compassion: It promoting the job candidate’s welfare and to give priority to their needs. • Evocation: The idea that the job candidate has the knowledge, insight, and motivation inside themselves to make changes.

OARS Review • O: Open-ended questions • A: Affirmations • R: Reflections • S: Summarize

Stages of Change

Stages of Change Introduction • Prochaska and Di. Clemente introduced the “Stages of Change” model in 1983 to aid in developing effective interventions to promote healthy behavior change. • This theory has its roots in the substance abuse field, but it was discovered the stages of change can apply to a variety of behavior modifications. • Consequently, this theory is used across disciplines that range from health care to the field of counseling and therapy.

Stages of Change • Pre-contemplation – Not considering change and not interested in alternative action/ behaviors. • Validate lack of readiness and encourage evaluation of current situation/behavior. • Ex: You are an adult and you will be the one to decide if and when you are ready to lose weight.

Stages of Change • Contemplation – Ambivalent about change. “Sitting on the fence”. Not considering change in the near future. • Continue to validate lack of readiness. Encourage the exploration of the pros/cons of behavior change. • Ex: I’m hearing that you are thinking about losing weight, but you’re not ready to take action right now.

Stages of Change • Preparation – Experience with change and are “testing the waters”. Planning to act soon, within the next month. • Identify and assist with problem solving obstacles to changing. Help identify supports in the individual’s life. • Ex: It’s great that you feel good about your weight loss decision; you are doing something important to increase your health.

Stages of Change • Action – Individual has been practicing new behavior for 3 -6 months. • Bolster confidence/self-efficacy for dealing with obstacles. Continue to focus on personal and social supports. • Ex: What obstacles have been easy to overcome and what obstacles have been most challenging?

Stages of Change • Maintenance – Continued commitment to new behavior for longer than 6 months. • Reinforce internal rewards, discuss coping with relapses and continue to confirm personal and social supports. • Ex: What helps you in being so successful in maintaining this change?

Stages of Change • Relapse – Resumes old behavior patterns. • Evaluate triggers that contribute to old behavior patterns. Reassess motivation and barriers and emphasize past successes. Plan stronger coping skills. • Ex: Has there been a time since your last relapse that you felt like relapsing, but didn’t? If there was, what kept that from happening?

Summary of Stages of Change

Ambivalence toward Change • We may consider Ambivalence as a natural and predictable precursor to change. • In order to facilitate change an MI practitioner will explore ambivalence to reveal the client’s internal motivation for the desired change. • Ballroom Dancing vs Wrestling – Do not oppose energy, gently redirect it in a productive way.

Sustain Talk vs Discord Sustain Talk: Discord: • Recognizable as client speech that favors the status quo over moving toward change. • Interpersonal behavior reflecting dissonance in the working relationship. • “I don’t need to find a job, I’m perfectly happy being unemployed. ” • Behaviors may include arguing, interrupting, discounting or ignoring.

Managing Ambivalence Simple Reflections help define the resistance and buy time to plan your next intervention. Client: “I am going to collect disability benefits until my dying day. ” Practitioner: “At this point you are going to collect disability benefits for as long as possible. ”

Managing Ambivalence Amplified Reflections press the sustain talk, testing the client’s commitment to the previous statement Client: “I am going to collect disability benefits until my dying day. ” Practitioner: “You don’t see any purpose in working. ”

Managing Ambivalence Double Sided Reflections compare the status quo to other statements that the client has made. Client: “I’m going to collect disability benefits until my dying day. ” Practitioner: “For now you expect to collect benefits as long as possible AND on the other hand you recognize that you may change your mind. ”

Scenario 1 • A thirty-five year old parent says: “My Maria is a good girl. She’s never been in trouble, but I worry about her. Lately she wants to stay out later and sometimes I don’t know where she is. She just had her ears pierced without asking me! And some of the friends she brings home—well, I’ve told her again and again to stay away from that kind. They’re no good for her, but she won’t listen. ”

Scenario 1 • O: Open-ended questions • A: Affirmations • R: Reflections • S: Summarize

Scenario 2 Client says that he is interested in working in a funeral home, cooking at a restaurant, office and clerical work, factory and welding. He has jumped from job to job and has difficulty really knowing what he wants to do. -What stage is he and how might we assist?

Scenario 2 • He is in Contemplation. He is considering jobs but not committed to any and unsure about his future. • Questions we might ask: • He has not researched which he really wants to do. • Why might you like to do that _____ job? • What do you like about ____ job? • What training or transferable skills do you have for these jobs?

MIRACLE QUESTION • The Miracle Question is to get the individual to think long-term and develop goals. • It is a 5 year idealistic dream in which all barriers and troubles are set aside. • One might ask: in 5 years, what job do you see yourself doing? Describe the work environment, job duties, work attire, physical location. • This process will allow the person to tell you the interests and expectations they have for work which could lead to current jobs to explore.

Scenario 3 Travis is a 19 year old high school graduate: “My parents told me that I had to come today so you can help me find work. They say that they will kick me out of the house if I don’t stop playing video games and get a real job! It isn’t fair, they don’t understand that most of my friends aren’t being forced to work. I don’t have any clue what type of job I would like. ”

Scenario 3 Analysis: Sample Responses: • Travis is pre-contemplative regarding employment. • “It sounds like video games are important to you, I wonder what else you find important? ” • He feels pressured by his parents and does not recognize value in beginning a job search. • “Your parents are worrying needlessly. What do you think they are seeing that makes them worry this way? ”

Toolbox • Rulers: Importance, confidence, readiness, and commitment • Identifying Values/Motivation • Pros/Cons About Change • Decisional Balance

RULER • IMPORTANCE RULER How important is it to you to change [specify behavior]?

RULER Confidence Ruler

DECISIONAL BALANCE • Defined as a list of pros and cons to determine if to change. • Often can help someone who is experiencing ambivalence. • Good visual tool to see which way one might be leaning

DECISIONAL BALANCE

MI Resources Online • www. motivationalinterviewing. org • www. integration. samhsa. gov • www. stephenrollnick. com

Questions? Thank you! http: //www. ivrs. iowa. gov