INTRODUCE YOURSELF Im At work I am For me, leading groups is What - PDF document

5/2/2017 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 1

5/2/2017 HOW MIGHT M MI METHODS E ENHANCE GROUP EFFECTIVENESS? 4 WORKSHOP OP OBJECTI JECTIVE VES  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 2

5/2/2017 Methods: SOURCES METHODS AND Brief instruction, structured learning activities, demonstrations, skill practice Materials: Workbook, evaluations Sources:  Miller & Rollnick (2013): Motivational Interviewing  Wagner & Ingersoll (2013): Motivational Interviewing in Groups 7 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 3

5/2/2017 HALLMARK CHARACTERISTICS OF MI Make notes on page 2 10 KEY ELEMENTS OF MI  Acceptance and compassion  Collaborative partnership  Establishing a focus/goal  Exploring reasons to change  Strengthening motivation and commitment 11 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 action 12 4

5/2/2017 WARN of result of not try to changing CONVINCE ARGUE for client she the has a benefits of problem change TELL client HOW to change Increased Discord 13 SPIRIT OF MI Partnership Compassion Acceptance Evocation p. 3 14 SPIRI PIRIT of MI DANCING vs WRESTLING 15 5

5/2/2017 Counselor RESISTS fixing Emphasizes Acceptance & AMBIVALENCE Support can as NORMAL yield CHANGE WHAT MAKES S MI NT ? DIFFERENT Reframes Evokes resistance talk about as the DISCORD FUTURE 16 DISCUSSION How have your professional thoughts, feelings, and/or behaviors been modified since first being trained in or introduced to Motivational Interviewing? 17 SUMMARY 18 6

5/2/2017 Engage Focus The MI Evoke Process of Motivation Change Plan Act p. 4 19 Strength of Clarity of Group Relationships Purpose (Engage) (Focus) Group Effectiveness Interdependence Structure and (Plan & Act) Relevance (Evoke) 20 BENEFITS OF USING MI PRINCIPLES p. 5 Owning Change Facilitate Process Decision Making Build OARS Skills Change Planning Increase Confidence Reinforce Action & Autonomy 21 7

5/2/2017 LEADERSHIP PRINCIPLES 1 Normalize AMBIVALENCE MOTIVATION 2 Importance + Confidence + Willingness 3 Combine EMPATHY & DIRECTION 4 Embrace the SPIRIT of MI 22 POSITIVE AND HOPEFUL Focus Be Explore IN THE the PRESENT FUTURE Leadership Behavior p.6 23 “Overall , MI groups focus more on making positive changes than on resolving problems.” Chris Wagner (2016) 24 8

5/2/2017 ACTIVITY p. 6 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 SUMMARY 1. 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 THE LANGUAGE OF MI p. 7 Spirit Partnership Acceptance Compassion Evocation Skills Open Advice with Affirmations Reflections Summaries Questions Permission Process Engaging Focusing Evoking Planning 27 9

5/2/2017 CORE MI SKILLS Skill Impac act O pen questions exploration note strengths, A ffirming appreciations R eflecting convey intent, meaning essence, linkage, S ummarizing transition 28 OPEN QUESTIONS …do you think…? …was that like…? What… …might cause you…? …would happen if…? …does that make you…? …might you like to…? …could you…? How… …would you like…? …can you get past…? 29 AFFIRMATIONS p. 8 Increase change talk Reduce sustain talk J Subst Abuse Treat. 2016 Feb 30 10

5/2/2017 Something you Acknowledging appreciate effort AFFIRMING Something Noticing a value positive 31 REFLECTING • Close paraphrase Simple • Keeps flow going • Describes both Double- sides of client’s sided ambivalence What you • A guess about think the Complex deeper unsaid person meaning/emotion means 32 •What’s been Synthesis SUMMARIES said • Connecting Linking inputs 3 • Shifting the Transitions Types focus 33 11

5/2/2017 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 34 DISCUSSION “What core MI skills do you prefer? Which come easily and which take a bit more work to feel proficient?” 35 MI PROCESS GOALS p. 9 1. Engaging • Strengthen relationships • Clarify purpose, resolve 2. Focusing conflicts, & increase skills 3. Evoking • Elicit motivation for change 4. Planning • Commit to action steps 36 12

5/2/2017 PARALLEL PROCESSES Group p Dev evelo lopm pment MI Proces ess Forming Engaging Focusing Storming Evoking Norming Planning Performing 37 ACTIVITY In small groups, pp. 9-10 1. Discuss: What do the questions in your What assigned process suggest about a 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 Get acquainted Build Offer Process 1 trust & hope ENGAGING respect Understand values & goals p. 11 39 13

5/2/2017 REFLECTIONS  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 pp. 11-12 40 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 14

5/2/2017 MI METHODS IN GROUP Bridge Link Evoke change participant energy targets comments p. 13 43 ENGAGING GROUP MEMBERS OARS E-O-E Dyads Exercises ENGAGE Model Reframe 44 PRACTICE 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 45 15

5/2/2017 Orientation Decontaminate Structured Getting Referral Activities members engaged Shift focus Proactive Goals to the future p. 14 46 “ If the client is raising the problems and you’re providing the answers, you’re in the wrong chair .” Miller & Rollnick (2013), p.273 47 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. 48 16

5/2/2017 USING MI METHODS IN Day 2 COUNSELING GROUPS 49 Review ONE WALK-AWAY MESSAGE FROM YESTERDAY THAT WAS IMPORTANT TO YOU p. 15 50 TODAY’S AGENDA Getting familiar with methods for: 1. Building relationships 2. Focusing participation 3. Evoking motivation for change 4. Change planning 51 17

5/2/2017 MI PROCESSES Engage Integrate ACTION Focus Evoke Plan 52 GROUP PROCESSES 1. Engaging • Strengthening relationships 2. Focusing • Clarifying purpose • Eliciting personal motivation 3. Evoking for improving life situation • Committing to specific action 4. Planning steps 53 EVIDENCE p. 15 Members of MI groups increase:  Sense of autonomy  Readiness to change  Awareness of ambivalence  Willingness to try new behaviors  Attendance  Participation  Completion rate 54 18

5/2/2017 Clarify purpose and direction Process 2 FOCUSING Deeper Explore collaborative opportunities interaction for change 55 SHARPENING FOCUS ACTIVITIES When facilitating: • Take a client-centered perspective • Focus on the positives • Bring the group into the moment • Acknowledge suffering without eliciting grievances Wagner & & In Ingersoll, 2013, chapt apter 10 56 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 57 19