Rolling with Resistance Using a Motivational Interviewing Approach

Rolling with Resistance : Using a Motivational Interviewing Approach Presented by Danette Heckathorn, M. S. , L. P. C. 2/24/2021 1

Motivational Interviewing l A Humanistic approach to counseling developed by Miller and Rollnick (1991, 2002). l Motivational interviewing (MI) is not a theory. It is a tool to be used in conjunction with other theories. 2/24/2021 2

Agenda l Motivation l What this training will do for you l Stages of Change Model l Major goals of motivational interviewing l How to address negative behavior l Rolling with Resistance l Practice 2/24/2021 3

Motivation l. What motivates? l. Is motivation enough? 2/24/2021 4

What will this training do for you? l You will learn ways to use motivational interviewing as a tool to roll with client resistance. l This training will give you a taste of MI and introduce you to some resources, but it cannot substitute for a 4 -Day comprehensive MI training. 2/24/2021 5

Cycle of Change Precontemplation Maintenance Action 2/24/2021 Contemplation Preparation 6

Stages of Change (Prochaska et. al. , 1994) l Precontemplation – either unaware of problems related to negative health behavior or lack the desire to change their negative behavior, and they do not report any intention to change their negative habit within the next 6 months. 2/24/2021 7

Contemplation l Individuals recognize that some aspect of their negative behavior is a problem, and they plan to take action in the next 6 months. They are often seen as ambivalent because the perceived costs and benefits of the negative behavior are equivalent (Rollnick et. al. , 1991). 2/24/2021 8

Preparation l Commitment to change has been made and they plan to take action in the near future. Action l Begin to actively change behaviors and environmental conditions to overcome problem. Maintenance l Changes have become a regular part of the individual’s lifestyle. 2/24/2021 9

Why Determine Stage of Change? l Identifying a clients stage of change will help you determine the best approach to take with them. l Change is the responsibility of the client but the caregiver is responsible for enhancing motivation to change. 2/24/2021 10

Ways to Determine Their Stage of Change l I noticed (behavior) is this something that is creating a problem for you or something you would like to change? l People differ in how ready they are to change their (behavior) habits. What about you? 2/24/2021 11

Precontemplative Client l “I don’t have any problems with (behavior)” l They may come across defensive • • Reluctant Resigned Rationalizing Rebellious l No intention to change 2/24/2021 12

Comtemplative Client l “I have been thinking about changing (behavior)” • They have identified the behavior may be problematic • More troubled about the behavior • Ambivalent but may be weighing pros and cons • Decisional balance exercise useful 2/24/2021 13

Preparation Stage and Client l “How can I change (behavior)? ” • • More committed Ready to start Sharing plans for change Change becomes a priority 2/24/2021 14

Action Stage and Client l “Here I go” • They decide on a change strategy and try it out • Actively modify behavior including thoughts, feelings, and the environment • Treatment and/or self-help • Persistence and completion or drop-out 2/24/2021 15

Maintenance Stage and Client l “I think this will work and I am going to continue” • Trying to keep the ball rolling • Preventing relapse – learning new coping skills • Watching out for triggers • Acknowledging self for changes made and taking credit • Moving toward more balance 2/24/2021 16

Practice Identifying Stage of Change l Quick Exercise l We will come back to the stages of change after discussing motivational interviewing 2/24/2021 17

Motivational Interviewing l Defined as “. . . a client-centered directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” (Miller & Rollnick, 2002, p. 25) l Let’s break it down 2/24/2021 18

Four Main Principles of MI l Express empathy l Develop discrepancy l Roll with resistance l Support self-efficacy 2/24/2021 19

Strategies Used in MI l Eliciting Change Talk – motivational statements from the client l OARS Method • • Open-Ended Questions Affirming the client Reflective listening Summarizing 2/24/2021 20

Change Talk l Client identifies that behavior might be problematic l Client expresses concern about a behavior l Client expresses a desire to change the behavior 2/24/2021 21

Reflective Listening l What is it? l How do you do it? l Levels of reflective listening l Optimal reflective listening l Let’s Practice… 2/24/2021 22

Affirming the Client l The idea here is to enhance self-efficacy l Self-efficacy is our belief in our own ability to achieve a goal or accomplish a task l Strengthen the relationship l Enhance self-esteem 2/24/2021 23

Summarizing l A technique to be used throughout the meeting • Strategically repeat a client’s self-motivational statements l Include reluctance/resistance l Reflect optimism for change 2/24/2021 24

Knowing When a Client is Ready to Change l What do you expect to hear when a client is ready to change? l What do you not expect to hear? l What will the client look like? l What other indications might the client make? 2/24/2021 25

How to Elicit Change Talk l Open-ended questions (handout) l Ruler (handout) l Pros/Cons exercise l Looking forward l Looking back l Goals and values

Change Planning l What changes? l Why change? l Goals – SMART l Steps to take? l First steps – concrete l Help l I will know it is working if l Potential obstacles 2/24/2021 27

Resistance to Change l 4 Categories • Arguing • Interrupting • Denying • Ignoring 2/24/2021 28

NO NO’s for Dealing with Resistance l Arguing, disagreeing and challenging l Judging, criticizing, blaming l Warning of negative consequences l Seeking to persuade with logic l Analyzing l Confronting with authority l Sarcasm 2/24/2021 29

How to Respond to Resistance l Simple reflection l Amplified reflection l Double-sided reflection l Agreement with a twist l Shifting focus l Reframing l Rolling with resistance 2/24/2021 30

Simple Reflection l Stating what you here the client saying l It is sometimes helpful for the client just to hear their own words 2/24/2021 31

Amplified Reflection Reflect with modification l Client: I just don’t think that I have a problem with gambling. l Caregiver: There is no cause for concern for you. l Client: I don’t know how changing my eating habits could help me. l Caregiver: You feel your eating habits are perfectly reasonable. 2/24/2021 32

Double-Sided Reflections l Reflect back the statement but also use the other side of the client’s ambivalence • Client: I can’t quit eating sweets. I look forward to having a nice desert each day. • Caregiver: It sounds like you are going to miss eating deserts, but you also don’t want to take diabetic medication. What do you think would be the best way to resolve this situation? 2/24/2021 33

Agreement with a Twist and Shifting Focus Add a slant or twist to the meaning when you reflect back to the client Defuse resistance by shifting focus l Client: I can’t imagine quitting drinking. All of my friends drink! l Caregiver: It sounds like you’ll really miss the social interaction. And at the same time, it might provide an opportunity to expand your social network like you were wanting. l Client: I can’t imagine quitting drinking. All of my friends drink! l Caregiver: It’s hard to imagine giving up a lifestyle that you’re accustomed to. I’m wondering, what can you imagine? 2/24/2021 34

Reframing l Placing something in a more positive light – (what are the benefits? ) • Client – It is really going to be hard for me to quit eating sweets. • Caregiver: While it will be hard to quit eating sweets, you are determined to do it because it will allow you to control your diabetes without taking medication. 2/24/2021 35

Rolling with Resistance l This is where you just want to validate what the client is telling you by letting them know you have heard their problem and understand their ambivalence l It can be one of the most difficult techniques 2/24/2021 36

MI – The BASICS 1) Don’t ignore the behavior – even if you simply say “Hey, (name) I noticed (behavior). 2) Try to determine where they are with regards to stage of change. 3) Let’s Practice… 2/24/2021 37

Summary l The Basics of MI l Can be used to address any negative behavior 2/24/2021 38

Feedback and/or Questions dheckat@uark. edu or (479) 601 -2164 Thank you.