5/2/2017

1

USING

MOTIVATIONAL

INTERVIEWING METHODS

IN COUNSELING GROUPS

Steve Gallon, Ph.D.

Janis Crawford, MA LPC ACS

1

LET’S GET TO KNOW

EACH OTHER…

2

INTRODUCE YOURSELF

I’m…

At work I am…

For me, leading groups is…

What attracted me to this

workshop was…

3

5/2/2017

2

HOW MIGHT MI

METHODS ENHANCE

GROUP EFFECTIVENESS?

4

WORKSHOP OBJECTIVES

Clarify MI process

Explore interconnect between MI

process and group development

Identify activities that integrate MI

methods into group counseling

5

AGENDA

DAY 1

Relationship between MI process and how groups develop

Facilitating engagement

DAY 2

Establishing a focus on change

Evoking motivation & building confidence

Change planning

6

5/2/2017

3

Methods:

Brief instruction, structured

learning activities,

demonstrations, skill practice

Materials:

Workbook, evaluations

Sources:

Miller & Rollnick (2013):

Motivational Interviewing

Wagner & Ingersoll (2013):

Motivational Interviewing in

Groups7

ME

TH

OD

S A

ND

SO

UR

CE

S

HOUSEKEEPING

Schedule: 8:30–4:30 each day

CE Credits: 14

Breaks and lunch

Refreshments

Restrooms

Cell phones

Others

8

GUIDELINES

Be on time

Share comments & questions

Take risks

Stay open to new ideas

Decide what to use

Take care of personal needs

9

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4

HALLMARK

CHARACTERISTICS

OF MI

Make notes

on page 2

10

Acceptance and

compassion

Collaborative partnership

Establishing a focus/goal

Exploring reasons to change

Strengthening motivation

and commitment

11

KE

Y E

LE

ME

NT

S O

F M

I

RESEARCH ON MOTIVATION

• Assume ambivalence

• Motivation is interactive and interpersonal

• Motivation is influenced by counselor style and

expectations

• Internal motivation is more likely to produce

change that lasts

• Client talk about change predicts action12

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13Increased Discord

TELLclient

HOW to change

ARGUE for the

benefits of change

try to CONVINCEclient she

has a problem

WARN of

result of

not

changing

14

SP

IRIT

OF

MI

Partnership

Acceptance

Compassion

Evocation

p. 3

DANCING vs

WRESTLING

SPIRIT of MI

15

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6

WHAT MAKES MI

DIFFERENT?

Counselor RESISTS

fixing

Emphasizes AMBIVALENCE

as NORMAL

Reframes resistance

as DISCORD

Evokes talk about

the FUTURE

Acceptance & Support can

yield CHANGE

16

How have your professional

thoughts, feelings, and/or

behaviors been modified

since first being trained in or

introduced to Motivational

Interviewing?

DISCUSSION

17

18

SUMMARY

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19

The MI Process of

Change

Engage

Focus

Evoke Motivation

Plan

Act

p. 4

20

Strength of Relationships

(Engage)

Clarity of Group Purpose

(Focus)

Structure and Relevance

(Evoke)

Interdependence(Plan & Act)

Group Effectiveness

Owning Change Process

Build OARS Skills

Increase Confidence & Autonomy

Facilitate Decision Making

Change Planning

Reinforce Action

BENEFITS OF USING MI

PRINCIPLES

21

p. 5

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LEADERSHIP PRINCIPLES

Normalize AMBIVALENCE

MOTIVATIONImportance + Confidence + Willingness

Combine EMPATHY & DIRECTION

Embrace the SPIRIT of MI

1

2

3

422

Leadership Behavior

Be IN THE

PRESENT

POSITIVE AND

HOPEFUL Focus

Explore the

FUTURE

23

p.6

“Overall,

MI groups

focus more on

making positive

changes than on

resolving

problems.”

Chris Wagner (2016)

24

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ACTIVITY

1. Small groups of 3-5

2. 15 minutes

3. Discuss the question assigned to you

4. Have a spokesperson to share how you answered the question

5. Facilitate a brief discussion with the whole group

25

p. 6

SU

MM

AR

Y1. Key elements of MI

2. What makes MI different

3. Uses of MI in group

4. Leadership principles and

behavior

5. How MI fits you, your agency,

and your groups

26

ProcessEngaging Focusing Evoking Planning

SkillsOpen

QuestionsAffirmations Reflections Summaries

Advice with Permission

SpiritPartnership Acceptance Compassion Evocation

THE LANGUAGE OF MI

27

p. 7

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28

CORE MI SKILLS

Skill Impact

Open questions exploration

Affirmingnote strengths,

appreciations

Reflecting convey intent, meaning

Summarizingessence, linkage,

transition

What…

…do you think…?

…was that like…?

…might cause you…?

…would happen if…?

How…

…does that make you…?

…might you like to…?

…could you…?

…would you like…?

…can you get past…?

OPEN QUESTIONS

29

Increase change talk

Reduce sustain talk

AFFIRMATIONS

J Subst Abuse Treat. 2016 Feb 30

p. 8

5/2/2017

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Something you appreciate

Acknowledging effort

Noticing a valueSomething

positive

AFFIRMING

31

RE

FL

EC

TIN

G•Close paraphrase

•Keeps flow going Simple

•Describes both sides of client’s ambivalence

Double-sided

•A guess about deeper unsaid meaning/emotion

Complex

What you

think the

person

means

32

•What’s been said

Synthesis

•Connecting inputs

Linking

•Shifting the focus

Transitions

33

SU

MM

AR

IES

3 Types

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34

CLIENT TALK ABOUT CHANGE

• OA&R increase change talk

• Giving information and closed questions reduce change talk

• Affirmations reduce sustain talk

• By using OARS counselors improve potential for change

“What core MI skills do you

prefer? Which come easily

and which take a bit more

work to feel proficient?”

DISCUSSION

35

MI PROCESS GOALS

• Strengthen relationships1. Engaging

• Clarify purpose, resolve conflicts, & increase skills2. Focusing

• Elicit motivation for change3. Evoking

• Commit to action steps4. Planning36

p. 9

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Planning

Evoking

Focusing

Engaging

PARALLEL PROCESSES

Performing

Norming

Storming

Forming

Group Development MI Process

37

In small groups,

1. Discuss:

What do the questions in your assigned process suggest about a facilitator’s responsibilities at that stage in the group’s development?

2. Make a list of responsibilities to share with the other groups.

3. Present and discuss briefly

38

ACTIVITY

pp. 9-10

Process 1

ENGAGING

Get acquainted

Build trust & respect

Understand values & goals

Offer hope

39

p. 11

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You… or Your…

Intonation goes down

Types:

1. Simple restatement

2. Double-sided

3. Complex

Underlying meaning or emotion

Validate unstated client thought/feeling

Encourage deeper disclosure

REFLECTIONS

40

pp. 11-12

SKILL PRACTICE

In pairs,

a. Speaker shares a hobby or something

about which he/she is passionate.

b. Listener encourages using only

reflections – no questions.

c. After several minutes summarize and

reverse roles.

41

DEBRIEF

What do you think about using more

reflections than questions?

How did reflections help move the

conversation forward?

How did the use of reflections impact

the storyteller?

42

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Evoke energy

Bridge change targets

Link participant comments

MI METHODS IN GROUP

43p. 13

ENGAGEModel

Dyads

OARS E-O-E

Exercises

Reframe

ENGAGING GROUP MEMBERS

44

1. Share appreciation for the group’s

participation

2. Today’s task: Share methods we currently

use to engage group members and build

cohesiveness

3. Facilitator engages members by using:

Open question to start

Reflections to expand the conversation

Linking members to each other

Noting themes

PRACTICE

45

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Getting members engaged

Orientation

Decontaminate Referral

Shift focus to the future

Proactive Goals

Structured Activities

46

p. 14

47

“If the client is raising

the problems and you’re

providing the answers,

you’re in the wrong

chair.”

Miller & Rollnick

(2013), p.273

CLOSURE ACTIVITY

1. What have you liked or appreciated

about the workshop today?

2. What wishes do you have for

tomorrow’s session?

3. Share an affirmation with at least

one other group member.

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Day 2USING MI METHODS IN

COUNSELING GROUPS

49

Re

vie

wONE WALK-AWAY

MESSAGE FROM

YESTERDAY THAT WAS

IMPORTANT TO YOU

50

p. 15

Getting familiar with methods for:

1. Building relationships

2. Focusing participation

3. Evoking motivation for change

4. Change planning

TODAY’S AGENDA

51

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MI PROCESSES

Engage

Focus

EvokePlan

Integrate

ACTION

52

GROUP PROCESSES

• Strengthening relationships1. Engaging

• Clarifying purpose2. Focusing

• Eliciting personal motivation for improving life situation3. Evoking

• Committing to specific action steps4. Planning

53

Members of MI groups increase:

Sense of autonomy

Readiness to change

Awareness of ambivalence

Willingness to try new behaviors

Attendance

Participation

Completion rate

54

EVIDENCEp. 15

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Process 2

FOCUSING

Clarify purpose and direction

Explore opportunities

for change

Deeper collaborative interaction

55

When facilitating:

• Take a client-centered perspective

• Focus on the positives

• Bring the group into the moment

• Acknowledge suffering without

eliciting grievances

SHARPENING FOCUS ACTIVITIES

Wagner & Ingersoll, 2013, chapter 1056

SHARPENING FOCUS ACTIVITIES

1. Lifestyles and habits

2. A typical day

3. Exploring values

4. Introducing ambivalence

5. Circle of ambivalence

6. The good and not-so-good

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ACTIVITY INSTRUCTIONS

58

1. Trainer will demonstrate.

2. 4 small groups; each assigned a different

“sharpening focus” activity.

3. Each group will review the strategy in the

workbook and decide how to describe the

activity to the larger group.

4. Each of the 4 activities is then presented

and discussed.

PRESENTATION TIPS

59

1. Introduce the title and purpose

2. Clarify important concepts or terms

3. Identify appropriate stage (s) of group

development for which it may be used

4. Estimate the approximate time needed

5. Instructions for facilitating the activity

6. Options for modifying the activity, if any

LIFESTYLES AND HABITS

1. Define ‘lifestyle’ – How we spend our time

2. Ask members about their lifestyle habits

3. Summarize patterns you hear

4. You can ask, “How does_________ fit in?”

5. Facilitate sharing both positive and negative

aspects of _______.

6. Ask, “How have your habits impacted your

health, your relationships, other aspects?”

7. “What habits would you like to develop?”60

Strategy 1

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A TYPICAL DAY

1. Consider developing a worksheet that divides

a typical day into sections

2. Ask group members to share how a typical

day unfolds

3. Focus on feelings & behavior

4. Leader reflects themes, invites others to

reflect and summarize

5. Ask, “How does _________fit into your daily

pattern?”61

Strategy 2

EXPLORING VALUES

1. Introduce values as personal guides

2. Ask members to share what is important to

them – Frame those as “values”

3. Ask one person to describe how a value has

served as an important guide

4. Encourage others to share

5. “What about conflicts in values & behavior?”

6. “How could values guide your future?”

7. “Whose story really spoke to you?”62

Strategy 3

INTRODUCING AMBIVALENCE

1. Define ambivalence

2. Describe ambivalence as normal

3. Note you are not trying to force change

4. Goal is to be more aware of our choices and what keeps us stuck

5. Invite members to share issues about which they feel ambivalent

6. Be sure to acknowledge both sides of ambivalence

63

Strategy 4

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CIRCLE OF AMBIVALENCE

1. Divide a circle – ‘want to’ vs ‘don’t want to’ and

share some personal examples of ambivalence

2. “What are some examples of ambivalence in

your own lives?”

3. “What helped you make a decision or make a

change when you felt ambivalent?”

4. “What situations are you facing now that give

rise to ambivalence?”

5. Reflect and summarize what you hear64

Strategy 5

The Good and Not-So-Good

1. When ambivalent it is helpful to

see the ‘big picture’

2. Think of something you have

thought about changing

3. Jot down some of the good

things about not changing and

some of the not-so-good things

about not changing

4. Members invited to share.

5. Facilitator uses reflections and

summaries to reduce defenses

& consider alternatives

FO

CU

SIN

G O

N

CH

AN

GE

Skill

Practice

Strategy 6

65

Member

focus is

the key

CHANGE TALK

66

p. 22

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LISTEN FOR…

Self-expressed language

…that is an argument for change

67

Desire

Ability

Reason

Need

PR

EP

AR

AT

OR

Y

CH

AN

GE

TA

LK

D

A

R

N68

Commitment

Activation

Taking steps

MO

BIL

IZIN

G

CH

AN

GE

TA

LK

C

A

T

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1. 2 teams line up in front of the posters

2. First person in line has the swatter

3. Trainer reads a statement and whichever

team swats the correct type of change

talk first gets a point and opportunity for

bonus response statement

4. Bonus response: team huddles for 1 min

and decides on reflection for extra point

ACTIVITY

70

• How…? What…?Evocative questions

• Tell me about…Elaboration

request

• The worst…? The best…?Using extremes

• How were you able to…?Looking back

• What does success look like?Looking forward

HOW TO ELICIT CHANGE TALK

71

USING RULERS

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USING RULERS

Follow-up to evoke change talk

“Why a 6 and not a 3?” What’s

pushing client toward change

“What would it take to move from a 6 to

an 8?” Possible next steps in change

process

73

1. Place numbers 1-10 on floor

2. Participants asked to position themselves on

the continuum with regard to IMPORTANCE

of the change each is considering

3. Discuss in large group, asking participants

What makes you a __ and not a__ (lower)?

What would have to happen to move you from

a __ to a __ (higher)?

4. Use OARS to highlight change talk and

encourage more sharing

ACTIVITY

74

CHANGE TALK SHIFTS THE

FOCUS TOWARD THE

FUTURE

Members often feel more

hopeful, optimistic,

supported

75

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BUILDING MOMENTUM

Using guided imagery to

evoke motivation

76

p. 24

Process 3

EVOKING Building Momentum

Listen for discrepancies

Focus on positivesTilt toward the

future

Resolve ambivalence

Respond to Change Talk

77

7. Ready-Willing-Able

8. Re-examining Expectations

9. Exploring Importance and

Confidence

10.Change Success Stories

MOMENTUM BUILDING

STRATEGIES

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4 groups

One strategy assigned to each group

Groups will have time to review their

assigned activity plan a description

Each group presents their activity and

invites discussion with the larger

group

ACTIVITY

79

READY-WILLING-ABLE

1. Introduce the concept

2. Inquire about meaning of each word

3. Regarding a change in alcohol/drug use, ask members to rate themselves on 1-10 scale for each of the 3 words

4. Invite members to share their ratings and what they mean

5. Encourage the sharing of both high and low motivation examples

6. Leader reflects what was heard

80

Strategy 7

RE-EXAMINING EXPECTATIONS

1. Ask members to consider their past dreams

and hopes for their lives.

2. After some sharing ask, “How are those

dreams different from how your life is

today?”

3. A bit later ask, “What would it be like to let

go of some of your old wishes and modify

them to better fit for today?”

81

Strategy 8

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IMPORTANCE AND CONFIDENCE

1. Ask members to think of 1 specific change

they would like to make

2. Draw a line on flipchart or whiteboard:

0………………………5………………………10 no importance medium high importance

4. Ask members to share their importance

rating

5. Ask why the number and not zero?

6. Ask members to make a confidence rating

7. Again, why the number and not zero?82

Strategy 9

CHANGE SUCCESS STORIES

1. Ask members to think of 2-3 things they

have accomplished in their life

2. Reflect and summarize

3. Ask, “How could you apply what you learned

to your current situation?”

4. If need be, remind the group that everyone

has had successes in their life

5. Note themes

83

Strategy 10

Process 4

PLANNING Moving to

Action

Build confidence

Share outcome

Commit to act

What

Where

When

How

84

p. 29

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MO

VIN

G IN

TO

AC

TIO

N

GOAL: Build hope and

confidence

ASSUMPTION:

Members are considering

a different future and

willing to experiment

MI STRATEGIES:

11. Hypothetical change

12. Strengthening

commitment85

Hypothetical Change

1. Start by summarizing what

you have heard that indicates

readiness to change

2. Invite members to develop a

hypothetical change plan:

a. Change to be made

b. Reasons for the change

c. Steps to take, and

d. Ways others can help

3. Divide into groups of 3 to

discuss their plans

ST

RA

TE

GY

11

86

Strengthening Commitment to Change

1. Suggest members make a commitment to the group:

a. What specifically is planned,

b. When they will start, and

c. A commitment to it.

2. Share an example

3. Ask who is ready to commit

4. Ask the committed to write out a statement of commitment

5. In pairs, commitment statements are reviewed and modified before sharing

ST

RA

TE

GY

12

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Wo

rksh

op

Re

vie

w

• Key elements of MI

• Importance of MI Spirit

• Core skills: O-A-R-S

• Leadership principles

• MI processes that parallel

group development

• 6 strategies to enhance focus

• 4 strategies for evoking

motivation

• 2 strategies for action

planning

88

CHANGE PLANNING

1. Review the My Change Plan Draft on page 32 in the Workbook.

2. Plan 1 change you intend to integrate into your life or your group counseling practice

3. Review your plan with a partner

4. Sharing in the large group

89

WRAPPING UP

You are invited to share

affirmations with whomever

you wish

Share any final comments

about your experience at the

workshop

90