Motivational Interviewing [MI] for Educatorsdhss.alaska.gov/akshwi/Documents/2017Presentations/MIforEducators.pdfMotivational Interviewing [MI] For Educators School Health & Wellness

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Motivational Interviewing [MI] For Educators

School Health & Wellness Institute

Pre-Conference Workshop @ BP Energy Center Anchorage, Alaska October 30th 2017

Dr. Michael Fulop www.michaelfulopmitraining.com

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http://www.michaelfulopmitraining.com

People don’t care how much you know until they know how much you care.

- John Hanley

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School Health & Wellness

Institute MI Workshop Learning Objectives

Provide a conceptual overview of MI Find out what you already know of MI Explore how MI skills can help with students Provide MI skill building opportunities Real or Role Play to enhance learning Observe MI deployment in school settings Discuss* MI at your school questions Determine your interest level to learn MI


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Workshop Structure for Day Handouts + Slides Bathroom & Stretch Breaks “Card Me” – Things you don’t like Misspellings, grammar issues Conceptual Sloppiness Write it - hand it to me, Write notes in “Pearl Bucket” or “Light Bulb” List Phrases, Ideas, Metaphors you might want to recall



A word about training model In MI training – many layers, one upon the other! Complicated maps, from different viewpoints. Most MI training is via modeling – Observing others, workshop leaders, videos

Exploring skills, trying on new skills Learning MI is gradual, requires lots of practice Involves some unlearning, & some mental shifts Early on when learning MI; Confusion is normal I often wear 2 hats

Modeling Skills Answering Questions Directly

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou


Intros – Grab a large sheet of paper WRITE IN VERY LARGE LETTERS Name, Profession Locate a personal strength from page 4 Why interested in learning about MI? If you’re an animal, which one would you be?

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Directions Partner Up – Now Each of you explore/discover your partner 2-3 minutes

Partners will introduce each to all of You will listen, and tell us about them Share an impression or observation about

your partner they didn’t say in words.


What do you know about MI?


Your Reasons to Learn MI


So, What is MI?


Some Things MI is Not 10 things MI is not [Miller & Rollnick]

MI – Not a way to trick people into doing what they don’t want to do

MI is with a student, not to a student

MI is not a stand-alone therapy adds to effectiveness of treatments 1- 4 sessions Can be quite brief in encounters


Some Things MI is Not [Cont] MI is simple in some ways, but not easy Not easy to integrate complex skills Like learning a complex skill; Choral singing Playing an instrument in band

MI is not a Panacea It’s a specific way to address the need to

make a behavioral change with an ambivalent person

Those ready for change don’t need MI


What MI is not…


What MI is… After 35 years of MI research, it’s a treatment approach that is: Evidence-based [>250 RCTs] Can be brief [1-4 session], Specifiable, Grounded in a testable theory, With an identifiable method of action, Verifiable if deployed competently Generalizable to many problems Complimentary w other treatments, Learnable by a broad range of providers


Or Playing an Instrument


Definition of MI from MI-3 MI is a collaborative, goal-oriented communication style with focused attention on the language of change. designed to strengthen studental motivation for and commitment to a goal by exploring the student’s own reasons for change within an atmosphere of acceptance & compassion.


MI Spirit Collaborative Honors student’s expertise & perspective People are undisputed experts on themselves Evocative Resources lie within the student Enhancing of intrinsic motivation [SDT] Assumes student is right, w/capacity for change Promotes Student Autonomy Compassionate Beneficent


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The Spirit of MI

A Partnership – Not done by an expert to a passive recipient People are undisputed experts on their life! Decisions should be honored & understood!

MI Conversations seek to create a positive and non-coercive interstudental atmosphere that fosters change


Spirit Exercise

Spirit Video Favorite Teacher


Four Fundamental MI Processes


Engaging

Focusing

Evoking

Planning

The 4 Processes are sort of Linear

Engaging is necessary and comes first Focusing [identifying change goal] is 2nd

But a prerequisite to Evoking Planning is logically a later step


Engage Focus Evoke Plan

But Recursive…


In conversations about change

Most people who want to make a change are ambivalent about it

Seeing both reasons to change & reasons not to change.

Wanting change and not wanting change all at the same time


Ambivalence is normal We believe

ambivalence is a normal step on the road to change

And it is a progression from an earlier state of perceiving no reason to change at all.

Ambivalence can only be resolved by a student!lves, is what they believe” michaelfulopmitraining.com

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Consider what happens when An ambivalent student thinking about a

change meets a counselor or teacher Arguments both for & against change

already within the ambivalent student Often a counselor/teacher’s natural reflex

is to take up a “good side” of an issue and explain, or urge a change as vital

This assumes a student lacks something, such as motivation, knowledge, or common sense!


Avoiding Trouble



Ambivalence under pressure…

Leads to Resistance [Sustain Talk] + Discord The Righting Reflex Elicits push back Predictive of worse student outcomes

We try to avoid this in MI


So, ready to buy into MI?


A Taste of MI Get into groups of 2

Each of you select 1 Role Listener Speaker

And wait for instructions


YOU WILL HAVE 3 MINUTES


Debrief – A Taste of MI

Speakers? - What was this like for you? What did you notice?

Listeners - What was this like for you? What did you notice?

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Write in your “Pearl” Bucket

Time to write your thoughts, questions, pearls of wisdom, concepts you’d like to remember!

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10 Meter Board


Motivating Discrepancies

For discrepancies to be motivating, people need reasonable confidence they can do something to remove or reduce it.

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Misery and Change

It’s a peculiar idea that people will change if you can just make them feel bad enough.

If misery cured misbehavior there would be far less of it.

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3 reasons why discrepancy does not produce instant change

1st, a discrepancy may seem so large that it’s daunting. 2nd, if a discrepancy is too small, it may not appear

important enough to prompt action. 3rd, a discrepancy can evoke such unpleasant experiences

that a student simply avoids thinking about it as a defense

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Change Talk

One major goal of any MI conversation is to

Find & Enhance Change Talk Soften Impact of Sustain Talk

Change Talk is any student speech favoring movement in the direction of a positive change

Change talk is often linked to a particular behavior change goal


Change Talk = DARN CATs

Preparatory Change Talk - D.A.R.N. Examples DESIRE to change (want, like to, wish.,)

I want to get better grades I wish I could remember to take all my books home

ABILITY to change (can, could . . ) I was able to work out those tough math problems I can quit smoking, I’ve done it before…

REASONS to change (if . . then) If I did my homework, I could get better grades… If I wasn’t so distracted, I would not be so bored in class

NEED to change (need, have to, got to . .) I need to stop skipping, cause I want to play basketball. I need more study time, to get to college


Change Talk & Commitment Language: WHY SO IMPORTANT?

The more change talk people use, the more likely they are to initiate change. Magill M, Apodaca TR, Barnett NP, Monti PM: The route to change: within-session predictors of change plan completion in a motivational interview. J Subst Abuse Treat 38:299-305, 2010 ) The frequency and strength of commitment language predicts the success of change. (Amrhein PC,

Miller WR, Yahne CE, Palmer M, Fulcher, L: Client commitment language during motivational interviewing predicts drug use outcomes. J Con Clin Psychol 71: 862-878, 2003)

It’s a powerful way for students to tell us and themselves what they want to change and how they plan do it.

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Commitment Talk Reflects resolution of ambivalence

COMMITMENT [intention, decision, promise]

ACTIVATION [willing, ready, preparing]

TAKING STEPS [already begun to enact changes]


Is preparatory language enough? Important answers to some questions HAND OUT


Imagine you are in court…

The bailiff asks an important question

Do you swear to tell the truth, the whole truth and nothing but the truth?


Imagine a different scene & different question -- Do you ____, take this

woman/man ___ to have and to hold from this day forward, for better or worse, for richer or poorer, in sickness and in health, to love and to cherish for all the days of your life, forsaking all others…?


Sustain Talk and Resistance

Reframed, resistance is Sustain Talk about a behavior I really don’t want to stop smoking I have to take pills to make it through the day

Discord is about you and your relationship You can’t make me quit You don’t understand how hard it is for me Discord is about you, the provider

Discord & Sustain Talk are highly responsive to provider style


Student “Resistance” is Sustain Talk or Discord You’ll see it in a student’s behavior

“Yes-Butting”

Help Rejecting Complainer

The Righting Reflex – evoking reactance

Where does “resistance” reside? In MI we believe it resides in interactions It takes two to create resistance and discord

It’s a signal of dissonance

Predicts no change, or the status quo.


Being Directional Not telling student what to do Choosing to attend to different elements Usually multiple elements in a statement Focus will determine path


OARS


OARS are foundational skills – Simple, but not easy Open Questions Affirmations Reflective Listening Summaries Offering Information

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Core Interviewing Skills OARS

As with all aspects of MI mindset and heart-set, there is an experiential component of affirming for the clinician, whose main task is to find what is right rather than what is wrong with the student.

With kids we called this “catch ‘em being good.”


OARS

Open Ended questions Strength based questions


Asking Open Questions

Questions help develop understanding of a student’s situation, and allow you to:

Follow a decision tree Clarify the situation Complete forms

Closed questions can be: Efficient way to gather specific information May create or reinforce the expert-trap


OARS

Affirmations


Affirmations

Finding authentic aspects of a student’s life that the resonates with the student’s values perceived assets.

Not cheerleading, or “atta boys” Affirmations are not the same as praise.

To praise is to raise a roadblock to communication


Affirmation is not praise Affirmations comment on some thing that is a

strength about your student. The student is your guide. How does she respond to what you said? When you see a facial reaction, you might reflect or

ask about it.


OARS

Reflections [Reflective Listening]


Reflections are Engaging

Because questioning is a less demanding skill for a provider than empathic listening, it’s easy to fall into a question-answer trap, asking a series of questions instead of following reflecting the student’s statements [within the engagement process].


Reflections are harder than questions

Reflective listening can be hard work at first, and it is more difficult than asking questions.

The good news is that, like most skills, it gets easier with practice.


Reflections Reflections are a way to do hypothesis

testing without questions And are a way to attune to the student A reflection not only mirrors what a student is

saying, it is choosing where you think that student might be headed.

This is the Heart of MI


There is no penalty for guessing wrong when you make a reflection

And is it NOT NECESSARY to tack words on

to preface a reflection, such as “What I hear you saying is that you…” “It sounds like what I heard is…”

Of course it’s what you heard!


2 levels of reflection Simple - content stays close

Repeating Rephrasing

Complex – Are guesses at unexpressed thoughts, feelings, and anticipates what is coming - Often in metaphors Paraphrasing Meaning or Intent [even if unsaid]

Reflecting Feeling michaelfulopmitraining.com

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Simple Reflections

Simple reflections add little or nothing to what the student said. Think tip of iceberg

A simple reflection is limited to what shows above the water, the content that has actually been expressed.


Complex Reflections tend to move a conversation forward

Complex reflections makes a guess about what lies beneath the surface.

This is always a judgment, & if your guess is too far off you see it in your student’s response.

It’s important, not to jump too far in guessing what a student means or engagement can be lost.


Checking your guesses

Reflective listening is a way of checking your guess rather than assuming that you already understand.

Skillful reflection is called “continuing the paragraph.”


When you offer a reflection, you’ll get immediate feedback about it’s accuracy

Like on an archery practice range, there is no penalty for missing because when you guess wrong, your adjust

With a reflection, your student simply tells you more about what she meant.


With Reflections - Shorter is Better

Length of reflection As a general rule, a reflection should not be

longer than the statement it follows. Direction in Reflection Even within 5 or 10 minutes of conversation, a

student offers quite a variety of material.


Writing Reflections as a Group “Do you mean practice?...”

Step 1 – What does he/she mean? List a few possibilities at your table – Decide your table’s best Step 2 Write your reflection [not question] to point

at what you he/she means Step 3 Compare notes, determine the best one

from your table


Direction in Reflection

Consciously or not, you decide what to reflect and what to ignore, what to emphasize or de-emphasize, and what words to use in capturing meaning.


Understated & Over-Stated Reflections

Under-stated reflections are useful to slightly decrease the intensity of what was offered.

When understating the intensity of an expressed emotion, your student will tend to think or feel you might not have heard them. Understated are useful to focus on an effort – with a student correcting you in a direction of change

Over-stating reflections are a way to strategically exaggerate what was heard

The student will tend to minimize your overstatement, backing off from their original statement.


Examples If your 16 year old student says “I’ve never felt so humiliated – the principal just called me out in front of everyone!” Think of Understated Reflection Which direction will the student go? Think of an Overstated Reflection Which direction will the student go?


Examples If your 32 year old female student says “I really hate it when my says my butt look good, and

tells me he’d like to date me. ” Think of an Understated Reflection

How might your student react? Think of an Overstated [amplified] Reflection

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Double Sided Reflections On the one hand you want to…On the other hand

you don’t want to.

You’ve said some reasons why you’re so attached to smoking, and some important reasons to stop.

You hate to do homework, and yet your thinking that you want to get into a good college.


OARS

Summaries


Summaries are forms of reflections

Summaries are essentially long reflections pulling together aspects of what your student told you.

It’s your clinical judgment about what to emphasize out of all your student offered.

It’s your decision about the direction to move with your summary.


Summaries

Types of Summaries Collecting

Short, continue flow (change talk) Linking

Adds recent material to prior info (ambivalence) Transitional

Announces a shift in focus


Importance & Confidence

2 dimensions in MI

Importance Confidence


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Advice Giving in MI “Most teachers and counselors have a much stronger need to give advice compared to a student’s desire to get advice.” – Stephen Rollnick


E-P-E Sandwich Elicit What have you heard about ___ ? What’s most important for you to know about ___?

oREFLECT, AFFIRM THEIR KNOWLEDGEoASK PERMISSION TO PROVIDE INFORMATION

Provide Information“From my reading of the literature…“Here’s what some others that succeeded tried…”

Giving Advice “ “Some of what I say may be different from what you heard…” “Giveopportunity for them to disagree

Elicit What do you make of this info? How does that compare with what you thought/heard?


E-P-E This approach is consistent with an SDT

motivational model and therefore promotes student autonomy during each step of the “dance” of giving information.

What do you think?

Michael Fulop MI Training 83

Humble & Curious

These two words, humble & curious best represent the MI spirit.


People don’t care how much you know until they know how much you care.

- John Hanley


Contact Information Michael J. Fulop, Psy.D. 503-539-4932 www.michaelfulopmitraining.com [email protected] www.forsterfulop.com


mailto:[email protected]

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